Nurses at Fox Chase Cancer Center successfully implemented an electronic medical record tool to improve compliance documentation for patients taking oral chemotherapy drugs.
An abstract detailing the success of this program, “Implementation of an Oral Chemotherapy Smart Form in an Outpatient Setting,” will be presented as part of the 47th Annual ONS Congress being held April 27 to May 1 in Anaheim, California.
“In recent years we realized that there is an abundance of oral chemotherapy prescriptions being prescribed to our patients that required follow-up,” said Maria Market, BSN, PCCN, of the Ambulatory Clinic at Fox Chase.
After oral chemotherapy is prescribed, it is standard practice to follow-up with patients to make sure they are taking the medication as prescribed, to see if they need refills, or to monitor adverse side effects. However, Fox Chase had not yet implemented a formal process for this follow-up.
As part of the 2020 Quality Oncology Practice Initiative Certification Program, Fox Chase learned that only about one-third of its patients on oral chemotherapy had a documented oral chemotherapy plan, 7% were assessed for adherence, and none had documentation reflecting efforts to address non-adherence—patients not taking their medication.
Market and her colleague Allison Ward, MSN, OCN, CCRN, RN-BC, designed a smart form tool within the electronic medical record to provide a standard form for documenting the treatment plan, education, and monitoring for oral chemotherapy. The form was integrated into nursing, pharmacy, and physician workflows.
“The smart form follows patients from chart to chart,” Market said. “If a patient I spoke with three weeks ago calls and speaks with Allison, she can see everything I wrote in the form. It is beneficial for nurse-to-nurse communication.”
About a year ago, Market and Ward started an eight-week pilot study of the smart form to see if it would increase patient monitoring and compliance. During the study, 223 patients on oral chemotherapy were seen in clinic.
After this period, 45% of patients on oral chemotherapy had the smart form completed and 41% had an oral chemotherapy plan documented. In addition, 87% had an administration schedule compared with 81% prior to implementation.
Strikingly, the number of patients contacted after the start of oral chemotherapy increased from 4% to 35% and documented discussions addressing adherence increased from zero to 78%.
“These are powerful drugs that we are sending home with our patients,” Market said. “By implementing this tool we were able to increase patient safety.”
The team has regular meetings every month to make sure the numbers continue go in the right direction and to evaluate if there are ways the tool can be improved. Based on the results of the pilot study, the smart form tool will be implemented throughout the ambulatory clinic as a standard practice for all patients on oral chemotherapy.