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Impact of Quality on Improving Chemotherapy Ordering Process

Jill Norann Bryant-Bova

Quality improvement methodology provides the necessary processes to help reduce medication errors. A project was initiated to improve the chemotherapy ordering process by using the quality improvement methodology of Plan, Do Study, Act. The Plan phase was to determine the problem and develop an aim statement. The aim was to improve the chemotherapy ordering process by decreasing deviations when completing the order form. Tools utilized throughout the project were a fishbone diagram to provide the causes and effects of the deviations; a process map to describe the flow of the order form with nursing and pharmacy, and after baseline data collection of types of deviation, a pareto chart provided a percentage display of the various types of deviations with the order form. The Do phase involved the implementation of interventions to improve knowledge of the process to complete the chemotherapy order forms. The Study phase required the collection and analysis of data. The Act phase incorporated the process throughout the organization with a follow-up status to assess for sustainment. After a six-month follow-up, this project reflected a 51% decrease in the number of order forms with deviations, surpassing the goal. The one-year follow-up reflected a slight increase in the number of reviews with a deviation in the chemotherapy ordering process. Even with the slight increase, education to physicians and staff continue. The overall goal was to decrease the number of deviations on the chemotherapy order form and to promote improvement in safe, efficient, and quality care of our patients.