PPRNet Tips for Nurses

The PPRNet A-TRIP Basics:

• Read practice reports and use them to guide your quality improvement efforts and monitor your progress.  Select areas of weak performance and formulate a realistic plan for improvement.
• Become aware of treatment guidelines and goals.  Take an active role in patient education, and explain goals to patients. Be involved in screening and monitoring of patients.  For example, know blood pressure, A1C, and cholesterol goals for diabetic patients.  Alert provider and patient if patient not at goal.
• Activate your patients.  Provide copies of lab reports to patients, use letter templates to generate letters reporting lab results to patients.  Provide A-TRIP Patient Education handout to patient to explain guidelines and health care goals.
• Take an active role in quality improvement efforts. Come up with new ideas to improve quality.
• Obtain self-management education; establish contact with local resources, take courses to provide patients with more resources and educate patients about chronic diseases, health care goals.

Please send your tips to the PPRNet ListServ and we will update this list accordingly.

Specific Tips from successful PPRNet-TRIP Practices:

• See patients independently for nurse visits (i.e. BP check, coumadin clinic).  Look at repeat blood pressure checks, follow patterns, and determine if MD visit or intervention is needed.
• Obtain blood pressures as patients come in for A1Cs to reach goal of BP every 3 months for diabetic patients.
• Implement standing order for DM, cholesterol screening for all patients to facilitate easier screening. Determine if patients are due for screening and draw labs accordingly. Patients can then schedule an appointment with provider to review results. 
• Allow patients to come at regular times for cholesterol testing, then refer to MD if necessary.
• Flag charts of patients with certain conditions such as DM, review labs and determine which labs are needed prior to patient being seen by provider. Pull in data for templates in advance. Check to see whether labs are up to date (e.g. DM-look for retinal eye exam, foot check, A1C, lipids, etc); make a note for provider regarding unmet needs.
• Use a “Float Nurse” system for free walk in BP checks and allergy shots.
• Conduct chronic disease education, i.e. follow-up for diabetes, anticoagulation, hyperlipidemia, etc. You can go through patient’s glucose log, educate patient etc. and then obtain plan for f/u care with MD.
• Establish Chronic Disease clinics certain half days per week, such as DM, diabetes foot care, lipids, anticoagulation. A nurse or NP may run these, where nurse provides direct patient care while MD is available for consultation. Visits may also be classified as nursing visits, doctor visits, or nurse/doctor visits.  Nurse/doctor visits can encompass more in-depth chronic disease state management with regular changes in therapy.
• Group visits/classes can also be established for patients with chronic diseases such as DM.
• Check for commonly co-occurring conditions (HTN, DM, hyperlipidemia), look for important care items (i.e. if a BP is elevated) and alert provider.
• Insert Pb/Dx codes into templates, on problem list, or on T line of visit note. Adding diagnoses will heighten awareness and prompt subsequent treatment. Insert major problems into record during office visits.
• Ask patients about any medications prescribed by other physicians. Keep medication lists updated.  Point out patients with unmet needs, e.g. not on medications, etc.

Please send your tips to the PPRNet ListServ and we will update this list accordingly.

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