Quality performance improvement with the implementation of standard chemotherapy forms

Abstract

6097 Background: There is always a need for quality improvement. Our oncology division has a quality improvement committee with a focus on reducing pharmaceutical chemotherapy clarifications. We hypothesize that reduced clarifications may in turn lead to decreased medication errors. In the past, chemotherapy orders were handwritten by the physician on blank order sheets. There was no standard to which the physician could accurately complete and include these necessary variables. For this reason, chemotherapy orders were frequently incomplete and had to be adjusted by the pharmacist after discussing the missing variables with the ordering physician. As a part of our goal, standard chemotherapy forms were initiated at our institution in October of 2000. Methods: The first standard form implemented in October of 2000 was a written order form that constituted a standard of the ideal variables necessary to accurately complete chemotherapy orders. These variables were the diagnosis, regimen, height, weight, BSA, route, frequency, duration and chemotherapy dose and calculation based upon BSA. The updated next form was a similar electronic version of the original and was implemented in April, 2002. Those required variables necessary for completeness were electronically made mandatory for submission. Results: With our data from 2/99–3/00, using the traditional unstandardized blank order sheets, the average completeness was around 45%. After the standard written forms were introduced, from 10/00 to 3/02, the average chemotherapy order completeness rose to of 81%; a difference of a 36% improvement. In April of 2002, a standard electronic chemotherapy order form was then implemented. From 4/02- 12/03, the average order completeness rose to 93%. For four consecutive months, the orders were 100% complete. Conclusion: Our quality performance improvement project does demonstrate that chemotherapy order completeness improves considerably through the standardization of chemotherapy forms. The electronic forms do show an additional improvement over handwritten standard forms. This may decrease medication errors, a topic for ongoing research. The standardization of chemotherapy forms should be a model in the practice of oncology. No significant financial relationships to disclose.