改善口服抗癌药物 (OAM) 坚持/毒性评估文档:质量改善倡议
Lisa M Holle1,2, Andrea Moran2, Margaret Savage2
1Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, USA.
概括
一项质量改善计划加强了口服抗癌药物 (OAM) 监测,显著增加了遵守和毒性文档. 这导致了较少的与患者有关的电话,提高了护理效率和患者安全.
科学领域:
- 在瘤学瘤学.
- 药理学 药理学是指药理学的学科.
- 提高质量 提高质量
背景情况:
- 在开始7-14天内,对口服抗癌药物 (OAM) 坚持和毒性的最佳监测至关重要.
- 现有的OAM计划往往表现出低于最佳的坚持和毒性监测,对患者的安全构成风险.
- 为了解决这些监测缺陷,采用了正式的质量改进 (QI) 方法.
研究的目的:
- 为了改善成年患者遵守和毒性监测的过程,他们开设了新的OAM.
- 为了减少与非最佳OAM管理相关的患者风险.
- 加强与OAM遵守和毒性相关的关键任务的文档.
主要方法:
- 包括患有固体瘤或血液恶性瘤的成年患者,以及新处方的OAM.
- 在基线和每月在计划-做-研究-行动 (PDSA) 周期期间从电子病历 (EMR) 收集数据.
- 一个跨专业团队确定了OAM遵守/毒性文档的九个关键过程措施,并使用统计过程控制图表来分析结果.
主要成果:
- 总体结果指标 (完成关键任务的百分比) 从基线时的50%显著改善到QI干预后的67% (p < 0.001).
- 具体的过程措施,包括知情同意,患者教育文件,OAM开始日期文件和预约安排,显示出显著的改善.
- 余额测量表明,与OAM相关的电话信息显著减少 (41.7%与33%相比;p < 0.001),这表明患者管理得到改善,提供者负担减少.
结论:
- 在第一个周期的第10天之前,QI计划成功地提高了OAM遵守和毒性监测任务的完成率.
- 文档和监控流程的改进导致了与OAM相关的电话消息的显著减少.
- 观察到的改善持续了长达六个月,证明了口服抗癌药物管理中实施的变革的长期有效性.
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