Quality Performance Improvement With the Implementation of Standard Chemotherapy Order Forms

Abstract

Purpose Before October 2000, physicians in our institution handwrote chemotherapy orders on blank order sheets. There was no standard to which the physician could include variables that were crucial to the completeness of a chemotherapy order. For this reason, chemotherapy orders were frequently incomplete and had to be adjusted by the pharmacist after discussing the missing variables with the ordering physician. As a part of our goal to minimize errors, standard chemotherapy forms were initiated at our institution in October 2000. Methods The first standard form implemented was a written order form that constituted a standard of the ideal variables necessary to accurately complete chemotherapy orders. These variables were the diagnosis, regimen, height, weight, body surface area (BSA), route, frequency, duration and chemotherapy dose and calculation based upon BSA. The next updated form was an electronic version similar to the original, and was implemented in April 2002. Results From February 1999 to March 2000, using the traditional unstandardized blank order sheets, the average order completeness was 45%. After the standard written forms were introduced, from October 2000 to March 2002, the average chemotherapy order completeness was 81%, an improvement of 36%. Completeness improved to an average of 93% from April 2002 to December 2003, after the implementation of the electronic chemotherapy form. Conclusion Chemotherapy order completeness improves considerably through the standardization of chemotherapy order forms. The electronic forms show an additional improvement over handwritten forms. Electronic standardization of chemotherapy forms should be adopted as a best-practice model in hematology-oncology practices throughout the country.