nursing staff to predict workload and schedule staffing and treatments accordingly.
Limitations
Although proud of this project as a creative and effective solution, the oncology department staff recognize that there are some limitations with the process that preclude its use as a permanent tool. The main limitation of this approach to chemotherapy ordering stems from use of the CPRS progress note module to create an order. One important feature of any order is that it can be changed or discontinued. Due to the permanence of progress notes, an addendum must be made to the order to qualify it as discontinued, since a progress note cannot be discontinued. The users within the system are aware of this limitation and are vigilant for new addenda to these notes, but it could open a window for error.
This process is also not consistent with the ideal that all orders be entered by CPOE. In a perfect world, on signing the note at the end of this process, the orders would automatically generate pharmacy orders for the drug items. Unfortunately, that level of automation is not available at this time. Within the current infrastructure, that functionality would be devastating to the flexibility that is of greater importance for this process. It is exactly this problem that has led to the consideration of third-party software solutions.
Conclusion
The chemotherapy ordering process at the Kansas City VAMC is an effective communication tool. Ultimately, a physician’s order for treatment is a one-way communication to pharmacy and nursing staff. This process streamlines the communication and minimizes the need for callbacks and clarifications. It also permits anyone with access to the patient’s CPRS record to be able to review the plan. And it creates a standardized treatment checklist for more consistent care. The ASHP strongly recommends standardizing oncology ordering practices, and checklists are a recognized tool for improving the quality of care. 2 The simplicity of the process and the no-cost maintenance of the technology are added benefits.
A novel solution was needed to improve safety and efficiency of chemotherapy ordering. The pharmacy department was the key in developing such a solution at the Kansas City VAMC. A transparent, standardized process was developed and implemented within a relatively short time frame. Built within existing software/hardware capabilities, the project had an immediate return on investment and avoided the overhead costs associated with implementing third-party ordering systems. In addition the process decreased turnaround time and increased throughput of the ordering process. An added benefit is that if a better tool (third party or otherwise) becomes available, the Kansas City VAMC is ready on a moment’s notice.
Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner , Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications,warnings, and adverse effects—before administering pharmacologic therapy to patients.
