Poster Presentation Clinical Oncology Society of Australia 2014 Annual Scientific Meeting

Filling the gaps: Implementation and evaluation of the Haematology/Oncology Plan of Care Documentation in a Chemotherapy Day Unit   (#247)

Lisa Brady 1 , Linda Marshall 2 , Tracey Tobias 1 , Jill Beattie 3
  1. Southern Melbourne Integrated Cancer Service, Melbourne, VIC, Australia
  2. Monash Health, Bentleigh, VIC, Australia
  3. Monash University School of Nursing and Midwifery, Melbourne, VIC, Australia

Previously, there was no systematic, streamlined multidisciplinary Haematology/Oncology plan of care documentation for Chemotherapy Day Unit (CDU) patients treated in a Victorian metropolitan health service. A consultative process was used to develop and implement the new Haematology/Oncology plan of care to improve clinician access to accurate and timely, assessment and documentation of treatment requirements and care delivered. The project used an action research approach, to monitor the changes and impact on clinicians as they occurred over 4 months. Following the pilot, focus groups were conducted to identify barriers and enablers related to implementation and its impact on clinicians and patients.  A pre/post documentation audit was conducted to assess improvement and gaps. Analysis included descriptive statistics of audit data and thematic analysis of focus group data. While results indicated a notable improvement, areas related to patient safety such as documentation of treatment intent, priority of when to start treatment, frequency of medical review, written evidence of patient consent, falls risk assessment, chemotherapy administration procedures and post treatment final checks were still not being completed in all cases. Duplication included documentation of nosocomial infection and nursing discharge notes.  Key barriers to implementation included: initial overwhelm; lack of support from consultants; the need to scan medical records with increased workload and duplication, and documentation format and flow issues. Enablers included: good leadership, informed staff, familiarity with the documentation process following initial overwhelm and addressing issues as they arose through PDSA cycles. The introduction of the plan of care supported a more timely assessment process, a more comprehensive multidisciplinary approach and consistency across assessments, and improved patient safety with the addition of side effect cues. These findings suggest that the implementation of the Haematology/Oncology plan of care indicated advancements in health service quality improvement, increased patient safety, improved timeliness and reduction in costs.