Use of Nursing Documentation to Capture Quality Metrics in an Outpatient Chemotherapy Infusion Center

Purpose:
The tracking and trending of quality metrics were dependent upon manual chart abstracts or paper tracking methods. Data collection was cumbersome and results were felt to be dependent upon data sources. Discussion of trends with staff confirmed concerns about data.

Significance:
Method of tracking did not always reflect results of process improvement activities or consistent reporting to trend metrics over time, resulting in periodic prevalence studies. Results from data collection often were not timely and incomplete.

Strategy and Implementation:
A bar-coded medication administration system was implemented in an outpatient chemotherapy infusion center. This allowed an opportunity to generate reports from the nursing documentation. Two indicators, adverse infusion reactions and infiltrations/extravasations, were tracked prior to the implementation of the bar coded administration system. The stakeholders expressed interest in having an automatic report generated weekly to capture these two events with the hopes of improved tracking and trending. Builders expanded one data field in system to capture if infusions were stopped due to reaction or infiltration/extravasation. After system had been implemented, a weekly report was generated to reflect all infusions that were documented as stopped instead of completed. Nurse manager and quality consultant reviewed reports and trended the two indicators.

Evaluation:
Report has assisted with the identification of chemotherapy infusions stopped due to a reaction or infiltration/extravasation. Report has also increased in the trending of severity of both events. Timeliness of report allows opportunity to go back to staff for more information or clarification.

Implications for Practice:
This improved tracking of these two indicators has lead to better data and information which impacts staffing, staffing needs and improved communication with all stakeholders. It also has provided data to determine effectiveness of improvement activities surrounding these two indicators.