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Quality performance improvement with the implementation of standard chemotherapy order forms
Lena Dumasia1, Ellen Harris, Anibal Drelichman
1Division of Hematology-Oncology, Providence Cancer Institute, Providence Hospital and Medical Centers, Southfield, MI.
Insights
Standardizing chemotherapy order forms significantly improved order completeness. Electronic forms further enhanced accuracy, establishing them as a best practice for oncology.
Area of Science:
- Oncology
- Health Informatics
- Patient Safety
Background:
- Chemotherapy orders were historically handwritten on blank sheets, leading to frequent omissions.
- Incomplete orders necessitated pharmacist intervention, increasing potential for errors.
- Standardization was implemented to enhance chemotherapy order accuracy and patient safety.
Purpose of the Study:
- To assess the impact of standardized chemotherapy order forms on order completeness.
- To compare the effectiveness of handwritten versus electronic standardized forms.
- To evaluate the adoption of electronic forms as a best practice in oncology.
Main Methods:
- Implemented a written standardized chemotherapy order form including essential variables (diagnosis, BSA, dose, etc.).
- Transitioned to an electronic chemotherapy order form with similar standardized variables.
- Analyzed order completeness rates before and after the implementation of each form.
Main Results:
- Average order completeness increased from 45% with unstandardized forms to 81% with written standardized forms.
- Further improvement to 93% average completeness was observed after implementing electronic forms.
- A 36% improvement in order completeness was achieved with the introduction of standardized forms.
Conclusions:
- Standardization of chemotherapy order forms substantially improves order completeness.
- Electronic forms provide a greater improvement in completeness compared to handwritten forms.
- Electronic standardization of chemotherapy forms is recommended as a national best-practice model.
Purpose:
Before October 2000, physicians in our institution handwrote chemotherapy orders on blank order sheets. There was no standard to which the physician could include variables that were crucial to the completeness of a chemotherapy order. For this reason, chemotherapy orders were frequently incomplete and had to be adjusted by the pharmacist after discussing the missing variables with the ordering physician. As a part of our goal to minimize errors, standard chemotherapy forms were initiated at our institution in October 2000.
Methods:
The first standard form implemented was a written order form that constituted a standard of the ideal variables necessary to accurately complete chemotherapy orders. These variables were the diagnosis, regimen, height, weight, body surface area (BSA), route, frequency, duration and chemotherapy dose and calculation based upon BSA. The next updated form was an electronic version similar to the original, and was implemented in April 2002.
Results:
From February 1999 to March 2000, using the traditional unstandardized blank order sheets, the average order completeness was 45%. After the standard written forms were introduced, from October 2000 to March 2002, the average chemotherapy order completeness was 81%, an improvement of 36%. Completeness improved to an average of 93% from April 2002 to December 2003, after the implementation of the electronic chemotherapy form.
Conclusion:
Chemotherapy order completeness improves considerably through the standardization of chemotherapy order forms. The electronic forms show an additional improvement over handwritten forms. Electronic standardization of chemotherapy forms should be adopted as a best-practice model in hematology-oncology practices throughout the country.
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