IMPLEMENTATION OF A STANDARDIZED ANTINEOPLASTIC TELEHEALTH EDUCATION WORKFLOW - QUALITY IMPROVEMENT INITIATIVE

ABSTRACT

ASCO-ONS 2016 guidelines specify the necessity of patient antineoplastic education with documentation prior to antineoplastic administration. Advanced Practice Providers (APPs) are key to delivery of effective pre-antineoplastic education. The Covid-19 pandemic has impacted the APPs shared visit model approach to provide pre-antineoplastic education due to staffing shortages and patient access barriers. Use of telehealth, and adoption of the individual visit APPs practice model, are alternative strategies for APPs to continue delivery of guideline-based antineoplastic education despite these limitations. The purpose of this project was to 1) evaluate the implementation of a standardized antineoplastic telehealth education workflow that went into effect 6/2020;2) record the number of completed Nurse Practitioner (NP) anti-neoplastic telehealth visits according to the individual visit APPs practice model;3) and evaluate documentation adherence to ASCO-ONS 2016 guidelines for these visits. We used the Plan-Do-Study-Act (PDSA) methodology to develop a standardized workflow for antineoplastic education telehealth visits in an academic breast oncology clinic from 4/2020- 5/2020. The workflow consists of a standardized note template in the electronic health record (EHR) and standardized patient education handouts. New telehealth pre-antineoplastic education encounters were identified in the EHR from 6/2020- 8/2022. NP documentation in the EHR was evaluated retrospectively, adherence to ASCO-ONS guidelines was evaluated (yes/no) for pre-antineoplastic telehealth video visits (VVs) and phone visits (PVs), according to the ASCO-ONS guideline criteria. The goal was 80% for each metric. From 4/2020-5/2020, during the PDSA cycles, 6 anti-neoplastic education telehealth visits were conducted by NPs and 2 (33.3%) had guideline adherent documentation. Root cause analysis revealed documentation nonadherence was due to NP unfamiliarity of the new EHR system and lack of knowledge of anti-neoplastic education documentation standards. From 6/2020- 8/2022, after implementation of the workflow, 266 NP antineoplastic education visits were completed, 204 (76.7%) were VVs, and 62 (23.3%) were PVs. Overall, 241 (90.6%) of total visits, 201 (98.5%) and 40 (64.5%) of VVs and PVs, respectively, met guideline-based documentation standards. After implementation of the standardized workflow, approximately 10 NP antineoplastic telehealth visits per-month were completed. Over 90% of visits had guideline adherent, however, documentation standards were only met in about a third of PVs. The APP individual visit model was a successful strategy to provide pre-antineoplastic education. Further PDSA cycles are needed to improve documentation quality for telehealth PVs.