658 - Chemotherapy Order Review: The Role of the Liaison Nurse

Abstract

Topic Significance & Study Purpose/Background/Rationale: The number of patients transplanted by the Pediatric Hematopoietic Stem Cell Transplant Program at Boston Children's Hospital increased by 65% in fiscal year 2016 as compared to fiscal year 2008. The increase in the number of admissions corresponds with an increase in number of chemotherapy orders. Often orders requiring modification, missing lab values and incomplete consents or treatment plans are discovered by bedside nurses during the order review process. The role of a Liaison Nurse was introduced in the spring of 2016. This nurse reviews chemotherapy orders, consents, treatment plans and pertinent lab results in advance of Hematopoietic Progenitor Cell Transplant (HPCT) admission. Methods, Intervention, & Analysis: The Liaison Nurse reviews chemotherapy orders, treatment plans, consents and lab values prior to admission. Prior to implementing the Liaison Nurse role, bedside nursing staff completed an audit to capture the number of orders requiring clarification of consent or clarification of treatment plan and/or modifications to ordered chemotherapy or supportive care. Post implementation, the Liaison Nurse collected data on the same metrics. Findings & Interpretation: Audit results between December 2015 and March 2016, prior to introduction of the Liaison Nurse, demonstrated 27%-67% of sampled chemotherapy orders needed consent, treatment plan or order modification before final verification could occur. The most recent quarter, (July 1, 2017-September 30, 2017), demonstrated 10 of 21, (48%), of patients admitted required clarification of consent, treatment plan or modifications to ordered chemotherapy or supportive care. These clarifications and modifications were requested by the Liaison Nurse prior to the bedside nurse review of the orders. Discussion & Implications: Previously collected quarterly data post implementation of the Liaison nurse role in the review process demonstrated that between 19-60% of the total orders written required consent, treatment plan or order modifications. While the number of required interventions remains consistent with data collected prior to the implementation of the Liaison Nurse role, fewer of these interventions are requested by the bedside nurse during at 0-6% of requests. Though the time it took to review orders was not measured, the time it takes a bedside nurse to review chemotherapy orders is reduced if the review process does not need to be interrupted for modification requests or clarification. Interceptions have also inspired programmatic process improvements and template revisions.