Improving Communication on Intent of Chemotherapy Using QOPI Scores and PDSA Cycles

Abstract

Using the standardized ASCO Quality Oncology Practice Initiative (QOPI) guidelines for assessing quality cancer care, we identified communication about intent of chemotherapy as an area needing improvement in our program at the University of Arkansas for Medical Sciences (UAMS) and the Central Arkansas Veterans Healthcare System (CAVHS). We organized training in communications on intent of treatment (palliative vs curative) and added optional checkboxes to our electronic templates for progress notes. Afterwards, we conducted a retrospective review of electronic medical records of initially often randomly selected patient charts. The first 10 patient charts after 1 month of implementation showed intent of treatment in 80 % of charts compared to 74 % at baseline. We then changed checkboxes from mandatory to optional and reviewed 30 randomly selected patient charts. Intent of treatment was documented in 96.7 % of cases compared to 74 % at baseline. We also assessed patient satisfaction through surveys distributed in clinic. Patient satisfaction scores were close to 100 % for receiving clear information, understanding the reason for which they were receiving chemotherapy, and willingness of oncologists to listen carefully, to take time to answer questions, to explain things clearly, and to spend adequate time with them. In this study, we showed that training in communication of intent of chemotherapy and use of checkboxes in progress note templates could improve competency in communication of intent of therapy in cancer patients.

Efficacy and unintended consequences of hard-stop alerts in electronic health record systems: a systematic review

“…The evidentiary table (Table 1) outlines the characteristics of the included studies and their outcomes. Of the 32 included studies, 3 were randomized controlled trials, 8,50,52 3 retrospective cohort studies, 7,18,36 18 pre-post studies, 12,13,15,16,19,20,33,35,37,[39][40][41][42][43][44][45][46][47][48][49] and 5 time series studies. 17,23,32,34,38 Six were conducted before 2010 7,32,39,41,48,49 and 12 within the past 3 years.…”

“…17,23,32,34,38 Six were conducted before 2010 7,32,39,41,48,49 and 12 within the past 3 years. 12,15,16,18,[33][34][35][36]38,46,47,50 The majority (n ¼ 29) were conducted in the United States, with the remaining conducted in Taiwan (n ¼ 1), 13 Korea (n ¼ 1), 48 and Israel (n ¼ 1). 41 Most (n ¼ 26) were conducted in the hospital setting at single-institution, academic medical centers.…”

“…41 Most (n ¼ 26) were conducted in the hospital setting at single-institution, academic medical centers. Two were conducted at a Veterans Affairs hospital 35,43 and 4 in a multipractice primary care setting. 15,41,44,49 Fourteen studies targeted inpatient medicine, 7,8,12,13,16,18,23,32,34,37,40,[45][46][47][48] 4 emergency medicine, 20,38,39,43 5 primary care, 13,41,44,49,51 3 anesthesia, 17,36,52 and 2 pediatrics 23,33 with the remainder targeting diverse specialties.…”

“…Twenty-three of the 32 studies evaluated interruptive alerts 7,8,12,13,[15][16][17][18][19][20]23,32,33,37,[39][40][41]44,45,[47][48][49][50] and 9 evaluated inline alerts. 23,32,[34][35][36]38,42,43,49 Technical specifics for each group are available in Supplementary Appendices C and D, respectively.…”

“…Inline alerts were primarily used to increase documentation in orders (n ¼ 3), 38,42,43 flowsheets (n ¼ 2), 32,36 and notes (n ¼ 4). 23,34,35,49 In all cases, the order could not be signed or flowsheet/note closed until documentation was complete. In no cases was there a mechanism for override other than abandoning the task altogether.…”