A pilot intervention collecting Patient-reported outcomes in two ambulatory clinics led to increase in psychosocial distress screening followed by sustained improvement, indicated by both process and QOPI measures.

PURPOSE: Ineffective handoffs contribute to gaps in patient care and medication errors, which jeopardize patient safety and lead to poor-quality care. The project aims are to develop and implement a standardized handoff process using an electronic medical record (EMR)–based tool to ensure optimal communication of treatment-related information for patients receiving cancer treatment between oncology nurses. METHODS: A multidisciplinary team convened to develop a standard and safe treatment handoff process. The intervention was developed over a series of phases using Plan-Do-Study-Act methodology, including current workflow process mapping; identifying gaps, limitations, and potential causes of ineffective handoffs; and prioritizing these using a Pareto chart. An EMR-based tool incorporating a standardized treatment handoff process was developed. Study outcomes included proportion of handoff-related medication errors, tool utilization, handoff completion, patient waiting time, and nurse satisfaction with tool. All outcomes were evaluated before and after the intervention over a 1-year period. RESULTS: The proportion of medication errors as a result of ineffective handoffs was reduced from 10 of 17 (60%) pre-intervention to 11 of 34 (32%) postintervention ( P = .07). The EMR-based handoff tool was used in 9,274 of 10,910 (85%) patient treatment visits, and the handoff completion rate increased from 32% pre-intervention to 86% postintervention. Patient waiting time showed an average reduction of 2 minutes/patient/month. A majority of nurses reported that the new tool conveyed necessary information (85% of nurses) and was effective in preventing errors (81% of nurses). CONCLUSION: Multidisciplinary stakeholders guided the development and implementation of a standard handoff process and an EMR-based tool to optimize communication between nurses during patient transition. The intervention was associated with a reduction in the proportion of medication errors as the result of ineffective handoffs. In addition, the intervention improved communication between nurses.

166 Background: Barcode scanning of patient wristbands is a critical stop-gap to prevent administration errors. After EPIC go-live and the implementation of barcode scanning, we created 10 EPIC-based metric reports including scanning compliance. Prior to having reports, our clinical leadership relied on variable qualitative feedback on scanning rates. Our AIM was to reach 90% patient barcode scanning compliance by Feb, 2014 and 95% by Aug, 2014 across Smilow Cancer Hospital Care Centers of Yale-New Haven Hospital. Methods: To engage staff, we shared data on the importance of barcode scanning, compliance and related adverse event reports. Staff reported challenges with scanning patients. We engaged pharmacy leadership to rectify barcode mapping errors. Leadership shared the expectation that all patients would be scanned, that there would be spot checks to prevent workarounds, that staff would be accountable for their own performance and that of their peers, remediation plans for areas <90% compliant and use of a dashboard for employee and medication specific reports. Results: Monitoring, feedback, competition, and improved scanning equipment led to compliance increasing form 89% to 99%. Conclusions: Staff input, detailed reports and workflow review were needed for successful barcode scanning implementation. Staff knowledge that compliance was monitored, communicating improvement, and competition were required for incentive to change practice. Leaders encouraged a culture of safety by ensuring staff feedback was addressed and issues were resolved.Interdisciplinary teamwork between nursing, pharmacy, education and products was necessary to improve barcoding capability.EPIC-based metric reports can drive awareness of and improvement in quality metrics to ensure safe patient-care. [Table: see text]

Hospital blood glucose (BG) management is a challenge. We implemented an electronic health record (EHR)-based system at our 1541-bed academic medical center (AMC), alerting when a patient (pt) experiences significant hyperglycemia (hyper; 2 BGs ≥300 mg/dL over 48 hours) or hypoglycemia (hypo; &lt;70 mg/dL). These Excursion Event Alerts (EEAs) fired to the clinician entering orders and provided links to insulin order sets and consult requests. The EEAs were launched on 14 non-ICU wards in mid-2019. We compared BG control during the 3 months prior to launch vs. the most recent 3 months. The control group consisted of 12 non-EEA wards. Our 1° outcome was the Quality Hyperglycemia Score-2 (QHS2), previously developed to assess/compare the overall BG quality on individual wards. QHS2 (scale, 0-100) incorporates 5 elements of BG management, crediting overall control as well as the minimization of significant fluctuations. After the intervention, there was a substantial 13.8% improvement in mean QHS2 (+9.36, p=0.029), comprised of more pt-days in target (+4.3%, p=0.024) and a trend for less pt-days with severe hyper (-2%, p=0.09), with no change in hypoglycemia. In contrast, there was no change in QHS2 on control wards. We conclude that a glycemic alert system was associated with improved BG control at our large AMC, suggesting that a simple EHR-based intervention can favorably impact hospital diabetes management. Disclosure L.B. Bak: None. T.M. Fandel: None. J.E. Bozzo: None. M.L. DeWitt: None. P. Chen: None. R.A. Pando: None. L. Ferro: None. R. Kaplan: None. K.C. Hendrickson: None. S.B. Amport: None. L. Sussman: None. S.E. Inzucchi: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Lexicon Pharmaceuticals, Inc., Novo Nordisk A/S, Sanofi. Consultant; Self; Abbott, Merck & Co., Inc., vTv Therapeutics.