Health Information Technology (HIT) and Chemotherapy Management

Health Information Technology (HIT) and Chemotherapy Management Diane Abisaleh, RN, BSN, MSN Department of Nursing, Thomas Jefferson University Hospital, Philadelphia, PA

INTRODUCTION SOLUTIONS STANDARDIZED TERMINOLOGIES CLOSED LOOP MEDICATION

I Cancer is the 2nd most I Chemotherapy order entry system with standardized I Flow of information from one electronic system to another ADMINISTRATION common cause of death, regimens and documentation templates accounting for 26% of all I Help EHR to create maps I Bar code technology is I Alerts and decision support within the Electronic emerging as a solution to deaths I Provide a crosswalk between systems for interoperability Health Record (EHR) support the closed loop I Chemotherapy errors I Provide outcome analysis medication administration can potentially lead to I Bar-coding all through all the chemotherapy management processes and the “Five Rights”: significant harm or death – Increase patient safety I 1 out of every 50 I Inter-professional approaches to documentation CLINICAL DECISION SUPPORT (CDS) – Eliminate error chemotherapy orders, results in serious death – Improving communication between I Encompasses a variety of tools and interventions pharmacy and nursing I Lack of HIT support for workflow increases error – Improve medication documentation PROCESS I Computerized alerts regarding dose limits, allergies, checking drug-drug interactions I Coordination between BENEFITS OF HIT FACTS professionals and I Reminders synchronization between each I Reduce risk of error by 50% post EHR oncology Electronic SystemsToday Fail to Support Chemotherapy I Clinical guidelines I step within the chemotherapy implementation Management workflow process is essential I Order sets per specialty I Reduce chemotherapy order preparation time by ten minutes – 20% of medication errors reported in 2003 were made with computerized I Patient data reports and systems dashboards I Improve patient safety –The Institute of Safe Medication Practices (ISMP) identified numerous problems with electronic systems HIT & EHR I Documentation templates I Reduce errors related to dosing – ISMP developed recommendations for chemotherapy management REQUIREMENTS I Diagnostic support I Improve health outcomes I Integrated Automated Electronic Systems With Decision I Clinical workflow tool I Produce a flowchart for clinicians to track all dates of Support are Needed I Principles and Guidelines chemotherapy regimen in details for EHR I Monitor the patient’s progress – Accuracy ORGANIZATIONS & RECOMMENDATIONS EVIDENCE-BASED PRACTICE I Optimize the care by timely communicating of markedly – Standardization abnormal laboratory tests The American Society of Clinical Oncology (ASCO) – Automation Evidence-based practice is a I I I Facilitate access to better quality healthcare & Oncology Nursing Society (ONS) – Decision Support multi-step, dynamic process that – Efficiency – Produce chemotherapy safety standards, intended to reduce the risk for errors incorporates best external data – Reliability and best clinical judgment IMPLICATIONS I The Institute of Safe Medication Practices (ISMP) – Usability – Recommend standardized order & pharmacy recalculation of all dosing I Use of EHR data for quality I Nursing Research: Oncology nurse's feedback and including maximum doses reporting is essential to meet involvement must be encouraged and translated into action Meaningful Use I The Institute of Healthcare Improvement (IHI) WORKFLOW by conducting their own research in the future – Recommend establishing dose limits for chemotherapy agents I Integration of evidence-based I Education: Oncology nurses perceive patient education and guidelines within the EHR is safety as a core element of their professional role and are required receptive to advancing their expertise in this area STRATEGIES FOR ERROR DETECTION & PREVENTION DATABASE WAREHOUSE REFERENCES: I Education Bates, D. (2005).Medication safety in the ambulatory chemotherapy setting. Cancer, 104(11), 2477–2483. – Chemotherapy Management Oncology EHRs will be able Bonnary,P.,Despont-Gros,C,Grauser,D,Casey,P.,Despond,M.,Pugin,D.,Rivara-Mangeat,C.,Koch,M.,Iten,A.,& Lovis, I C.(2008).A risk Analysis Method to evaluate the impact of a computerized provider order entry system on patient – Culture Change – Reporting Errors is Acceptable to replicate information in a safety. Journal of the American Medical Informatics Association. 15 (4)453–460. flowsheet to track where DuBeshter, B.,Walsh,C., Altobelli, K., Loughner, J., & Cynthia.A.(2006).Experience with Computerized Chemotherapy I Dedicate chemotherapy teams Order Entry. Journal of Oncology Practice. 2(2), 49–52 patients are in their Ghandi,T.,Bartel,S.,Shulman,L.,Verrier,D.,Burdick,E.,Cleary,A.,Rothschild,J.,Leape,L.,Giannangelo,K. & I Provider order entry has been shown to reduce the serious chemotherapy regimen Berkowitz.L.(2005).SNOMED CT Helps Drive EHR Success. Journal of AHIMA. 76 (4), 66–67. medication error rate by 55 percent KLAS (2004).Medication Administration 2004: Medication administration Application Performance. Electronic I Point of care documentation Healthcare. 3 (4), 107–110. Nice company (n.d.).White Paper: From Prescription to Administration: A Complete Environment for Chemotherapy I Nursing Medication Administration Check is Essential can feed a data warehouse so Management. CATO software. Austria. Retrieved Dec 1, 2010, from http:// www.nicecomputing.ch. performance measurement Schulmeister, L. (2006). Preventing Chemotherapy Errors. The Oncologist.11:463–468. can be assessed Shulman.LN, Lokay.K, &Hoverman.R. (2009).The Oncology Electronic Health Record System for Chemotherapy Ordering, Preparation, and Administration: Principles and Practice. American Society of Clinical Oncology. 659–664. Stanely, J. (2006).Oncology Nursing Society: Evidence-Based Practice. Journal of Oncology Practice. 2 (3)142.