Five Years Experience with a Customized Electronic Checklist for Radiotherapy Planning Quality Assurance in a Multi-campus Institution

Publication date: Available online 24 December 2017
Source:Practical Radiation Oncology
Author(s): Sean L Berry, Kevin Tierney, Sharif Elguindi, James Mechalakos
IntroductionAn electronic checklist has been designed with the intention of reducing errors while minimizing the user effort in completing the checklist. We analyze the clinical use and evolution of the checklist over the past 5years and review data in an incident learning system (ILS) to investigate whether it has contributed to an improvement in patient safety.Methods and MaterialsThe checklist is written as a standalone HTML application utilizing VBScript. User selection of pertinent demographic details limits the display of checklist items only to those necessary for the particular clinical scenario. Ten common clinical scenarios were used to illustrate the difference between the maximum possible number of checklist items available in the code versus the number displayed to the user at any one time. An ILS database of errors and near misses was reviewed to evaluate whether the checklist influenced the occurrence of reported events.ResultsOver five years, the number of checklist items available in the code nearly doubled, while the number displayed to the user at any one time stayed constant. Events reported in our ILS related to the beam energy used with pacemakers, projection of anatomy on digitally reconstructed radiographs, orthogonality of setup fields, and field extension beyond matchlines, did not recur after the items were added to the checklist. Other events related to bolus documentation and breakpoints continued to be reported.ConclusionOur checklist is adaptable to the introduction of new technologies, transitions between planning systems, and to errors and near misses recorded in the ILS. The electronic format allows us to restrict user display to a small, relevant, subset of possible checklist items, limiting the planner effort needed to review and complete the checklist.SummaryAn electronic safety checklist for radiotherapy treatment planning has been in use at our institution for more than five years. We demonstrate that the electronic format allows the user display to be restricted to a small, relevant, subset of possible checklist items. The electronic checklist can be modified to adapt to the introduction of new technologies, transitions between planning systems, and in response to errors and near misses in the clinic.



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