AN EVIDENCED-BASED SMART-PHRASE TO IMPROVE DOCUMENTATION OF SUPPORTIVE CARE MEASURES IN PATIENTS WITH IDIOPATHIC PULMONARY FIBROSIS

Abstract

SESSION TITLE: Diagnosis and Treatment of IPF SESSION TYPE: Original Investigations PRESENTED ON: 10/20/2019 2:15 PM - 3:15 PM PURPOSE: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrosing interstitial pneumonia of unknown cause occurring in adults over the age of 50, affecting approximately 5 million people worldwide. Two FDA approved mediations are used to slow progression of the disease process but not all patients can tolerate the medication nor are they curative. The American Thoracic Society (ATS) 2015 guidelines provide recommendations for the treatment of patients with IPF including supportive care measures to compliment medical therapy, such as; symptom management of cough, breathlessness and fatigue. Important supportive care measures include oxygen therapy, pulmonary rehabilitation, gastric acid reflux (GERD) therapy, sleep apnea testing, vaccinations, lung transplant evaluation and pulmonary hypertension assessment METHODS: A retrospective chart review demonstrated the medical providers at the Duke University Health System Interstitial Lung Disease clinic did not consistently document if supportive care measures were discussed when treating patients with IPF. Research demonstrated using a checklist as a visual tool for assessment and documentation can be helpful in improving compliance with the clinical guideline. A checklist was developed that outlines the supportive care measures for the IPF patient. A pretest-posttest design was utilized to assess improved medical provider knowledge of ATS guidelines. Education was provided to the physician group regarding these supportive care measures and then the smart-phrase was implemented in the electronic medical record system to be used for documentation in IPF patient charts. Paired t-tests were used to assess pre-implementation documentation as compared to post-implementation documentation of seven supportive care measures: pulmonary rehabilitation, lung transplant assessment, vaccination, oxygen therapy, gastric acid reflux, sleep apnea therapy, and palliative care. RESULTS: Documentation of oxygen therapy did not change as our providers already documented this with 100% consistency. The rest of the measures improved significantly after implementation of the smart-phrase. Specifically; pulmonary rehab (p<0.0000), vaccination (p<0.000), pulmonary hypertension (p<0.000), GERD therapy (p<0.000), lung transplant assessment (p<0.000), and pulmonary hypertension assessment (p<0.0000). CONCLUSIONS: With the implementation of an evidence-based checklist in the patient electronic medical record, documentation of supportive care measures improved significantly among patients with idiopathic pulmonary fibrosis. CLINICAL IMPLICATIONS: Clinical implication for this project is the need for an evidence-based checklist to ensure evaluation and treatment of supportive care measures are provided to all IPF patients to improve quality of life in this population. DISCLOSURES: Speaker/Speaker's Bureau relationship with BI and Genentech Please note: $1001 - $5000 Added 03/12/2019 by Christine Anderson, source=Web Response, value=Honoraria