The Weekly Chart Check: How Much is Necessary?

Abstract

The weekly chart check process at the North East Cancer Centre (NECC) was very long and had many redundant checks. Each unit was responsible for checking their own charts on a weekly basis. Looking back at the incidents and good catches that were reported over the last two years (at NECC), the majority were not caught on the chart check, but rather on the treatment unit, during daily pre-treatment checks. Those that were caught on the chart check were minor documentation errors (eg: forgot to initial a note). This brought up the question of whether the weekly chart check was the right place to catch an error. The radiation therapists at NECC formed a working group to recommend changes to the weekly chart check process. Using LEAN thinking to reduce waste within the system, all of the checks were reviewed using “value added” and risk/severity assessments, to ensure that any checks that were removed do not increase the chances of incidents occurring. A new weekly chart check work flow was created, ensuring that each check was done at the right place and at the right time. With the recommendations, the majority of the chart checks were completed, even during heavier workloads. Using a teamwork approach and optimizing resources, all chart checks are the responsibility of all units. LEAN thinking should be used when developing and assessing all practices. We need to encourage a culture amongst coworkers that the majority of incidents occur are a result of system failure (environment, system design, etc.) and not people. Creating a standard of work with clear roles and responsibilities has positively contributed to the work environment by optimizing quality, patient safety and efficiencies.