Development of a SmartPhrase in the electronic health record to promote chemotherapy and immunotherapy safety
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2021 prov rn wa; 2021 prov rn poster; washington; prmc; everett
Nursing | Oncology
Background: Chemotherapy-immunotherapies are high risk medications that can include multi-drug and multi-day regimens with narrow therapeutic indexes and high risk for toxicities. Susceptibility for errors exists if adherence to protocol is inconsistent or if pertinent patient specific information is omitted. Prior to the creation of the "SmartPhrase" in the Electronic HealthRecord (EHR) pre-administration safety checks were on paper, not included in the EHR, not standardized among clinicians, and not completed every time. Chart audits revealed a need for consistent, centralized documentation to enhance patient safety while minimizing professional liability. A trans-disciplinary team created a "SmartPhrase" template for streamlining relevant patient specific information and individualizing plans of care. The template created, included the nine components recommended by the Oncology Nursing Society (ONS) guidelines and recommendations for practice in correlation to chemotherapy-immunotherapy pre-administration checks. Purpose & Goal: Improve patient-centered care and transitions in care while standardizing chemotherapy-immunotherapy pre-administration documentation. Collaborate with inpatient and outpatient settings and service lines to have buy in and continuity related to content and location in the EHR. Ensure ONS recommendations for pre-administration checks included a documented dual verification process in the EHR. Methods: A baseline chart audit was conducted to determine if pre-administration safety checks were within the electronic health record. Based on findings a trans-disciplinary team of multiple stakeholders, including clinical informatics and bedside providers developed a "SmartPhrase" to promote rapid access to critical information. Safety checks included "hard stops" in the "SmartPhrase" template. Formalized education for providers included emails, posters, huddle presentations, job aids, and face-to-face classes with return demonstration and validation of comprehension and usage. Post implementation a three-month EHR audit was preformed, and feedback was solicited from end users to identify opportunities for improvement which lead to template revisions. Re-educated was initiated based on template modifications. Six-month audits re-evaluated usage and completion of documentation. Upon completion of the project the "SmartPhrase" was incorporated into new hire orientation. Results: Practitioner utilization of the "SmartPhrase" exceeded the project goal of 95% after implementation. Change from baseline use of "SmartPhase" documentation were noted in the following specific key areas: dual verification (↑100%),diagnosis and protocol (↑69%), drugs (maintained 100% utilization), consent (↑54%), patient education (↑37%), blood return from venous access device (↑29%), dosages (↓6%), initial labs (↓6%), schedule (↑3%). Implications for practice: Nurses need to be actively involved in identifying barriers to care delivery to improve safety by initiating quality improvement projects. A defined location for the "SmartPhrase" in the EHR made for easy access between shifts and future encounters to enhance patient centered care based on clinical status at time of treatment as well as ongoing treatment tolerance. The "SmartPhrase" allowed consistent documentation and dual verification of pre-administration safeguards. Implementing tools within the EHR based on standards and guidelines decreases organizational liability concerns while promoting safety. Completing the "SmartPhase" in advance supports stewardship of resources including nursing expertise/time, delays in treatment (bed/chair availability, admission/appointment time), and medication/supply cost. Many organizations and healthcare systems utilize Epic® EHR systems which offer "SmartPhrases" that can be shared within an individual facility and/or network of healthcare delivery systems. Standardized documentation promotes continuity of patient centered care in the EHR for ease of retrieval across oncology patient's initial, ongoing and follow up treatment
Conference / Event Name
2021 Providence RN Conference
Sarver, Mary Jo; McManus, Monica; Allen, Amy; Johnson, Bethany; Padgett, Dennielle; and Ser, Elizabeth, "Development of a SmartPhrase in the electronic health record to promote chemotherapy and immunotherapy safety" (2021). 2021 Providence Nurse Research Conference. 33.