Date of Degree

Fall 2023

Document Type

DNP Scholarly Project

Academic Department

School of Nursing

Degree Type

Doctoral

Degree Name

Doctor of Nursing Practice

First Advisor

Dr. Debbie Conner

Abstract

Problem: Prior authorizations (PAs) play a pivotal role in ensuring patients’ access to prescription medications. However, this process often leads to delays in patient care and places increased burden on healthcare professionals.

Aim of the Project: The aim of this project was to expedite the processing of medication PAs for adult patients with a target of reducing the processing time to less than 36 hours. This not only facilitates prompt medication initiation for patients but also reduces costs and time expended by the healthcare organization.

Review of the Evidence: A comprehensive review of the literature indicates that suboptimal PA processes can result in patient care delays, elevated healthcare expenses, and added administrative burden. Evidence showed centralizing responsibilities and utilizing electronic prior authorization (ePA) systems simplified and expedited the process.

Project Design: This quality improvement (QI) project design was based on Deming’s Model for Improvement principles used to enhance patient care by standardizing processes. An inter-professional team consisting of nurses, pharmacists, and administrative staff collaborated to develop and implement a new standard workflow. Using Plan-Do-Study-Act (PDSA) cycles, the team identified key drivers of delays, which included manual data entry, fragmented communication, and a lack of standardized workflows. The OhioHealth Change Management Model was used to support the development and execution of the project and to communicate the change effectively.

Intervention: The pilot intervention centralized PA tasks with a dedicated coordinator at the FQHC, utilizing electronic tools to enhance communication among the providers, pharmacies, and payers. The team conducted PDSA cycles to refine workflow standardization, PA transaction routing, and the development of a workforce coverage plan.

Significant Findings/Outcomes: The project yielded substantial results, in line with existing literature. In twelve weeks, 36 PAs were processed using the centralized workflow, reducing average processing time by 79% compared to previous months. While the average time didn’t dip below 36 hours, it improved patient and staff satisfaction, and PA processing costs dropped 78%.

Implications for Nursing: Efficiencies in the medication PA process significantly enhance nursing practice by reducing administrative burden and streamlining patient care, in alignment with the IOM six domains of healthcare quality. Additionally, this QI project supports the Institute for Healthcare Improvement’s Triple Aim by enhancing patient experience as nurses can devote more time to patient care instead of navigating complex, manual authorization processes.

Rights

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