How to integrate vital interdisciplinary information in a non-closed-loop system?

Abstract

314 Background: History of hypersensitivity reactions (HSR) must be readily accessible to ensure patient safety while receiving chemotherapy. While documentation of HSR is a routine process, gaps are found in maintaining vital information amongst various stand-alone systems (SAS). Centralized documentation (CD) by frontline nursing staff in the Electronic Patient Record is key to reduce risk. Pharmacists refer to CD for HSR information when processing chemotherapy. We developed and evaluated a technology-based workaround approach as a possible solution to a non-closed-loop system. Methods: An e-clinical point of care documentation tool was designed and built for nursing data collection of HSR details within the Electronic Patient Record. Vital parameters necessary for “complete” HSR documentation were outlined in a cue card, including time of reaction, reaction drug, volume and rate of infusion, management, vital signs and objective symptoms, re-challenge or discontinuation, and patient outcome. This cue card standardizes e-documentation. Pre- and post-system rollout survey was used to gauge effectiveness of CD by nursing and pharmacists. Results: Over a 6-month period, there were 173 HSRs in 11,754 patient visits (1.5%), with variability in collection of vital documentation in relation to roll out of the e-tool. In the pre-CD rollout phase (May 25 to September 12, 2011) 108 HSRs were identified that were documented in multiple locations including an electronic prescribing SAS (86%) and the chemotherapy nursing paper record (77%). In the post-CD phase (April 23 to June 23, 2012) 65 HSRs were identified, 46% of which were documented in CD, 72% in the electronic prescribing SAS, and 85% in paper record. Six of 7 pharmacists (85%) and 7 of 10 nurses (70%) who were surveyed indicated that the new CD documentation process was “effective” or “significantly effective”. Conclusions: As non-fully integrated systems exist in current environments, technology workarounds should be used to “close the loop”. E-Clinical documentation is an upcoming centralized technology solution, which we have used with promising initial adoption results. Formal e-documentation tools can lead to more detailed documentation than current processes.