Care Algorithms for Retail Clinicians

July 26th 2016
Jeannette Y Wick, RPh, MBA, FASCP

Algorithms are effective ways to follow and communicate instructions in both health care and cooking. These strategies—used by clinicians the same way cooks use recipes—are step-by-step instructions that walk you through the evidence-based way to solve a problem or perform a task.

Algorithms are effective ways to follow and communicate instructions in both health care and cooking. These strategies—used by clinicians the same way cooks use recipes—are step-by-step instructions that walk you through the evidence-based way to solve a problem or perform a task.

Although not everything we do can or should be reduced to an algorithm, clinical challenges that should be addressed with standard approaches may have better outcomes when clinicians have algorithms to follow.

Multistep processes are common in retail health, and algorithms create a structure for care that lists the interventions that almost every patient should receive with no real reflection or discussion. The experts who create algorithms often use checklists if the approach is straightforward, but employ more comprehensive flowcharts as approaches become more complicated.

Algorithms ensure that you don’t overlook a step. Many love macaroni and cheese and make it using a boxed mix or from scratch. Even if you’ve made macaroni and cheese a hundred times, following a recipe ensures that you boil water for the macaroni before starting the cheese sauce.

The same is true when working in a retail health. You may have assessed patients who have diabetes 100 times (eg, taking vitals, reviewing glycemic control, checking adherence, determining their level of understanding, and looking for complications,), but a number of tasks will compete for your attention during the patient’s visit. This is especially true if the patient is in pain, has comorbidities, is coping poorly with an acute illness, or is just generally a poor communicator.

An algorithm will remind you to take the opportunity to educate, conduct motivational interviews, and ask specific questions. Following step-by-step instructions can minimize errors.

In health care, the most common algorithms employed in retail health are most likely for diabetes and asthma. For example, many retail clinicians like to refer to the the American Association of Clinical Endocrinologists/American College of Endocrinology’s Comprehensive Diabetes Management Algorithm.

Algorithms vary in complexity from simple to more visual and colorful. Consider making your own algorithms or modifying existing documents when you see certain conditions frequently (eg, lactose intolerance) or seasonally (eg, swimmer’s ear).

Additionally, your organization may have specific requirements (Did you check that diabetic patient’s immunization record? Offer smoking cessation help?) or paperwork requirements. You can incorporate these into your algorithms.

However, all algorithms need to be easy and short. Bear in mind the following concerns about algorithms:

· Algorithms should never replace sound clinical judgment.

· Often, algorithms address large populations, rather than specific populations, so retail clinicians may want or need to modify established algorithms. If clinicians see a large number of patients from a specific cultural group, knowing their related health habits and incorporating nuances into your algorithm will improve the care you deliver.

Various health care systems have additional requirements (eg, clinical, screening, paperwork). Incorporate these requirements into your algorithm.

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