Improving Chemotherapy Ordering Process [Quality in Action]

Purpose:

Chemotherapy is a high-risk medication and is the second most common cause of fatal medication errors. The ordering process can be unsafe and inefficient, putting patients at risk for medication errors. The aim of this project was to decrease the number of chemotherapy order forms with at least one deviation by 50% within 5 months.

Methods:

A multidisciplinary team identified causes for variance in form completion, deficits in knowledge of ordering processes, and acceptance of incomplete orders by the staff. The Plan, Do, Study, Act improvement methodology evaluated the chemotherapy ordering process and found different types of deviations on order forms. Interventions consisted of educating physicians on entering complete information on orders, instituting same-day laboratory work on the day of the physician's visit, standardizing laboratory parameters, performing audits of the order forms manually, and educating nurses on not accepting orders with deviations.

Results:

All order forms were reviewed, and data were collected on different types of deviations. The following deviations were identified: laboratory test results were not being entered into the order form within 7 days, physicians were not providing their name and pager number, and the days of the chemotherapy cycle were missing from the order forms. Before the intervention, 70.1% of the chemotherapy order forms had at least one deviation. After 5 months of interventions, there was a reduction of 19% in the number of order forms with at least one deviation. Follow-up at 6 months and 1 year showed continuing reductions in the number of chemotherapy orders with at least one deviation.

Conclusion:

Improvement was a result of collaboration between interdisciplinary departments. The original goal was surpassed as a result of educating physicians and staff and standardizing the ordering process. If the number of deviations in chemotherapy order forms is decreased, oncology patients will receive safe, efficient, and quality care.

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