Implementation of an Electronic Form for Hematopoietic Stem Cell Transplant Infusions Improves Documentation Compliance

Background: Historically, Hematopoietic Stem Cell (HSC) Infusion was documented on a standard paper form available from a document library throughout the institution. Once complete, the form remained in the patient's chart until discharge at which time the chart was scanned into the EMR.  This limited the availability and portability of the information.  Completion of this form was the responsibility of the clinician infusing the HSC product.  Additionally, HSC infusions are conducted in a variety of units throughout MSKCC. These areas have been divided into 5 major groups.    

The Bone Marrow Transplant Quality Assessment Committee (BMT QAC) conducted a compliance audit of infusion documentation.  The timeframe used for the audit was October 2010 through March 2011, which included a total of 194 transplants.  A random selection of 50 transplants (10 from each major group) during this 6 month period was reviewed; resulting in a total of 60 forms (10 of which were double cord transplants requiring 2 forms).  Seven key elements of the form were identified based on regulatory and institutional requirements and audited for completeness. The results of the audit indicated that documentation compliance was 77%.   

Intervention: To improve documentation compliance of HSC Infusions, we developed an electronic infusion form.  The building and testing of the form lasted approximately one year.  Simultaneously, we modified our vital sign monitoring parameters for better standardization between different cell types.  During this time period, infusion Standard Operating Procedure (SOP) was revised to incorporate use of the electronic document and standardized vital sign parameters.  The design of the electronic form required all fields to be complete prior to final electronic signature and acceptance of the form.  Additionally, Infusion vitals entered into the electronic flowsheet by the RN were imported into the note by the documenting clinician.  Subsequent to distribution of the SOP and training of Stem Cell Transplant service (Physicians, Nurse Practitioners, Registered Nurses and Cell Processing Technicians) the form went live in March 2012.  Three weeks post roll out to all areas, the paper form was removed from the document library; however the form will be available during system downtime.

Outcome: A follow up audit was conducted to measure compliance post implementation of electronic documentation.  The timeframe for the audit was April 2012 through July 2012, a total of 209 transplants.  Similar to the pre-implementation audit, a random selection of 50 transplants from the 5 major groups during this 4 month period were reviewed for a total of 60 forms.  The same 7 key elements of the form were audited for completeness. The results of the post implementation audit indicated that compliance of documentation improved from 77% to 92%, an improvement of 15%.