Implementation of Chemotherapy Order and Administration Checklists Ensures Adherence to National Chemotherapy Guidelines

Krivoy, M., Elledge, C., Downey, C. Methodist Hospital, San Antonio, TX

Background: In 2011, the  American Society of Clinical Oncology (ASCO) and the Oncology Nursing Society (ONS) expanded the scope of their 2009 guidelines to address chemotherapy administration safety in the inpatient setting (Jacobson, J., Polovich, M., et al., 2012).  The guidelines encompass physician, pharmacy and nursing practices surrounding chemotherapy ordering, processing and delivery. A review of our current processes elucidated opportunity for improvement.

Objectives:

1. To develop and implement processes promoting multidisciplinary congruency with the ASCO/ONS guidelines across our BMT, Hematology and Oncology Inpatient and Ambulatory Care units.
2. To safeguard administration of chemotherapy.

Interventions: Our initial step involved updating our chemotherapy administration policy for pharmacy and nursing to include recommendations from ONS/ASCO. The policy underwent multiple revisions by nursing, pharmacy and the medical staff prior to approval in July, 2013. Once approved, we developed a checklist for both pharmacy and nursing use to help ensure all required elements were addressed in the order sets prior to processing a chemotherapy order. A separate checklist was created for RN use before and after chemotherapy administration.  Finally, we revised the chemotherapy order template for physicians to use in the absence of a pre-printed order set. RN staff, oncology pharmacists and the oncologists were in-serviced on the new policy, order sets and checklists. Beginning in September, 2013, audits were performed on all returned checklists.

Evaluation: In the first months following implementation of the policy, compliance with completion of the checklists was less than 50%. RN champions agreed to audit 100% of the chemotherapy doses ordered and administered. Pharmacy and Nursing compared their orders for the month to ensure there were no missing checklists. Compliance data was shared with the staff on the Oncology/ Blood Cancer/ BMT Units and individual performance deficits were addressed. Audits of all orders and checklists were continued until greater than 90% compliance was reached . Audits are now done quarterly to monitor continued compliance.