Document Type


Publication Date


Date of Final Presentation


Committee Chair

Cara Gallegos, PhD, RN

Committee Member

Kelly Connor, PhD, RN

Coordinator/ Chair of DNP Program

Pamela Gehrke, EdD, RN

Abstract/ Executive Summary

Background: Within the United States, chronic disease in children has doubled over the last 20 years. Many diseases defined as chronic (attention deficit, epilepsy, and diabetes) require daily medication regimens for optimal management. To be covered by insurance, many of these medications require prior authorization (PA) from the patients’ pharmacy benefits policy. Delays in processing and receiving PA orders can lead to worsening disease and inadequate disease management.

In 2014, a pediatric academic medical center in the Midwest found that processing medications from prescription order to PA approval took nurses an average of over 90 hours. In August 2020, the organization implemented an electronic prior authorization (ePA) system that interfaced with the organization’s electronic health record (EHR). The primary goals of this implementation were to reduce medication PA turnaround times and to increase employee engagement with the ePA system.

The goals of this quality improvement (QI) project are to optimize the existing ePA system with the medication PA process to reduce average medication PA turnaround times and to increase the approval rates for medication PAs by five percent.

Project Design: Three interventions support the outputs of this QI project.

  1. Increase the availability of the ePA system by changing the patient and pharmacy benefits insurance matching interface logic.
  2. Reduce the number of medications falsely requiring PA by removing them from the ePA system.
  3. Increase PA processing efficiency by improving the workflow for attaching documents required for PA approval.

To accomplish and measure these interventions, data reports and surveys were developed to establish baselines and to measure ePA turnaround times, PA approval rates, and user satisfaction both pre- and post-intervention. User satisfaction was measured utilizing a secure online survey emailed to ambulatory division nurses.

Results: The median medication ePA turnaround pre- and post-interventions was unchanged at 36 hours. The ePA approval percentage dropped from 55.7% in June 2021 to 46.9% in August 2021. The primary QI project outcomes of reducing turnaround time and increasing the approval rate by 5% were not met. A user involvement survey was sent to 194 nurses with a response rate of 29% pre intervention and 8% post intervention. Overall user satisfaction was measured using a net promotor score which registered scores of –70 pre- and –82 post-intervention, revealing overall dissatisfaction with the ePA system. The use of an alternative ePA system outside the organization’s EHR was discovered after the QI project data was reviewed and showed that roughly 45% of ePAs were completed using this alternative system during the QI project timeframe.

Recommendations: User involvement surveys measure user engagement with electronic systems and measuring user satisfaction is beneficial to providing direction for interventions as well as predicting future utilization of healthcare informatics projects.

Conclusion: Though most of the goals for this QI project outcome were not met, use of the alternative ePA system confirmed the Technology Acceptance Model that users prefer the electronic system that they perceive as being the most useful. Nurses using ePA will use the system that best addresses their own user experiences regarding content, accuracy, format, timeliness, ease of use, and overall satisfaction.

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Nursing Commons