PO37 Presentation Time: 4:45 PM: Standardizing an Inpatient Order Set for Patients Undergoing Inpatient Brachytherapy for Gynecologic Oncology Patients

Abstract

<h3>Purpose</h3> Brachytherapy, also known as internal radiation therapy, is often use for treatment of cervical, uterine and vaginal cancers using intracavitary (e.g. tandem and ring), interstitial (e.g. Syed), or hybrid (e.g. intracavitary applicators with interstitial needles) applicators. Currently, there is little consensus or formal society guidance on management of patients receiving brachytherapy in an inpatient setting. We performed a pre- and post-implementation study of an order set created as a qualitive improvement initiative to standardize admission orders for all patients admitted to the gynecologic oncology service for brachytherapy. <h3>Materials Methods</h3> We reviewed electronic medical records of all patients at a single urban, academic institution who received brachytherapy associated with an overnight stay 6 months prior to and after implementation of the order set, (pre-order set period: 8/2020-1/2021, post-order set period: 2/2021-7/2021). The order set had pre-selected orders to facilitate ease and uniformity with admission orders. Compliance of order set use was assessed in the following categories: ancillary and nursing orders (head of bed elevation, speech and swallow evaluation), medications (pain, anti-diarrheal), laboratory examination, and venous thromboembolism prophylaxis. This project was undertaken as a Quality Improvement Initiative and as such was not formally reviewed by Institutional Review Board. <h3>Results</h3> Thirty patients received brachytherapy associated with an overnight stay for a gynecologic malignancy during the evaluation period with 18 (60%) patients in the pre-order set period and 12 (40%) in the post-order set period. Mean age of the patients was 56 years. Patients demographics were 53% (n=16) white, 37% (n=11) black, and 6% (n=2) identified as other race. Cancer diagnoses were 67% (n=20) cervical, 20% (n=6) vaginal, 10% (n=3) uterine - cuff recurrence, and 3% (n=1) vulvar. Orders for head of bed elevation no higher than 15 degrees increased from 89% (n=16) in the pre-order set period to 100% (n=12) in the post-order set period. Speech and swallow evaluation by speech language pathologists increased from 39% (n=11) in the pre-order set period to 75% (n=9). In the post-order set period, 97% of patients had baseline admission labs ordered, 97% of patients had all recommended medications ordered and 100% of patients had an order for venous thromboembolism prophylaxis. 29% (n=5) of patients in the pre-order set group had a safety event, while 8% (n=1) in the post-order set group had a safety event. <h3>Conclusions</h3> While there are no current society-level recommendations for management of brachytherapy patients associated with an overnight stay, utilization of an order set enhances compliance to core elements of quality overnight admission. Further investigation is needed to see if such order sets improve patient safety, satisfaction, and efficiency over a longer study period.