25 Mar The next step in the process is to begin identifying the challenges and impediments to implementing a quality improvement plan.

Some of the proposed action steps for implementing improved practice is to use the PDSA model as framework for implementation.  First, I would start by assembling a team of stakeholders such as front desk clerk, patient care technicians, nurses, doctors, clinic and unit manager. I would develop a run chart that will display the performance of the clinic over the past year based on the HEDIS measure for chlamydia screening sexually active patients 15-24 years old annually.  This will give a baseline of the screening rates during the pre-intervention period.  Using the 5 whys tool and collaborating with the family planning manager and unit manager, we have identified a few reasons for the low screening rates such as providers lack of awareness regarding screening guidelines, chlamydia screening data is not consistently entered in the EHR  using the Family Planning/STI tab, several missed opportunities to screen individuals who do not come to the clinic for routine preventative care, there was no screening protocol in place for walk in patients, patients’ fear of stigmatization if they request testing or get a positive diagnosis. During the do phase, I want to implement the intervention starting in the point of care room. This room is where patients walking into the clinic for blood draw, pregnancy tests, HPV vaccine or contraceptive will first come for services.  I have identified the POCT room as the location to implement the change on a small scale and mitigate the numerous missed opportunities to screen for chlamydia.

Some of the potential challenges I anticipate with implementation is getting the staff to be enthused about the change which will require more frequent screening of patients and documentation using the tab in the EHR.  Providers may be reluctant if they find the intervention to be more time consuming for the staff, and it changes the current workflow. Patients' perception of their risk for STI and the stigma associated with testing for chlamydia may also be a challenge to implementation.  Having enough supplies on hand to accommodate the increase in testing.

Some of the resources needed are staff training on the importance of increasing chlamydia screening in our patients, the risks of untreated chlamydial infection, how inadequate documentation in EHR impacts our funding and the services we are able to provide to our patients. Staff will also need to be trained on using normalizing language that avoids asking the patient if she wants to be tested but instead recommend screening.  It may cost the company additional fees to improve EPIC best practice alerts that will remind providers to document the screening in the EHR. Also, patient educational material written pamphlet and videos in the waiting are that will enlighten patients about the prevalence of chlamydia, the dangers of untreated chlamydia and the need to be tested. This may come at a cost to the department as well.  Also, more urine cups and specimen collection kits will be needed for testing so the PAR level will need to be increased.