ABSTRACT
PURPOSE: Appropriate cancer pain documentation is one of the quality measures in the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI). MedStar Washington Cancer Institute has participated in QOPI since 2008, and documenting a plan of care for moderate to severe pain (which was defined as a pain score of ≥ 4 on a scale of 0 to 10, with 10 being the worst) was identified as an area for improvement. METHODS: We undertook a structured approach to improve documentation of the plan of care for moderate/severe pain with support from ASCO's Quality Training Program. Our team used standard plan-do-study-act (PDSA) methodology to achieve our goal of 90% documentation. We used a statistical process control chart (p chart) to determine whether our process was under control and to monitor the improvement in the documentation of pain management. RESULTS: The baseline rate of a documented plan of care for pain was 70%. In January 2014, we implemented action plans including an electronic health record trigger for a pain score of ≥ 4, education for fellows and midlevel providers, and establishment of a faculty consensus on documenting management of pain unrelated to cancer. After these interventions, the pain documentation rate improved to 90%. CONCLUSION: After one cycle of PDSA, we achieved our goal of a 90% pain documentation rate. To sustain our project, we continued to monitor the pain documentation rate quarterly in 2014 and continue the process of education and orientation to new staff, rotating residents, and fellows.
Subject(s)
Documentation/standards , Neoplasms/drug therapy , Pain/drug therapy , Quality Assurance, Health Care/standards , Cancer Care Facilities/standards , District of Columbia , Hospitals, Community/standards , Hospitals, Teaching/standards , Humans , Pain Management , Patient Care PlanningABSTRACT
OBJECTIVE: To assess the effect that accreditation training in fetal growth surveillance and evidence-based protocols had on stillbirth rates in England and Wales. DESIGN: Analysis of mortality data from Office of National Statistics. SETTING: England and Wales, including three National Health Service (NHS) regions (West Midlands, North East and Yorkshire and the Humber) which between 2008 and 2011 implemented training programmes in customised fetal growth assessment. POPULATION: Live births and stillbirths in England and Wales between 2007 and 2012. MAIN OUTCOME MEASURE: Stillbirth. RESULTS: There was a significant downward trend (p=0.03) in stillbirth rates between 2007 and 2012 in England to 4.81/1000, the lowest rate recorded since adoption of the current stillbirth definition in 1992. This drop was due to downward trends in each of the three English regions with high uptake of accreditation training, and led in turn to the lowest stillbirth rates on record in each of these regions. In contrast, there was no significant change in stillbirth rates in the remaining English regions and Wales, where uptake of training had been low. The three regions responsible for the record drop in national stillbirth rates made up less than a quarter (24.7%) of all births in England. The fall in stillbirth rate was most pronounced in the West Midlands, which had the most intensive training programme, from the preceding average baseline of 5.73/1000 in 2000-2007 to 4.47/1000 in 2012, a 22% drop which is equivalent to 92 fewer deaths a year. Extrapolated to the whole of the UK, this would amount to over 1000 fewer stillbirths each year. CONCLUSIONS: A training and accreditation programme in customised fetal growth assessment with evidence-based protocols was associated with a reduction in stillbirths in high-uptake areas and resulted in a national drop in stillbirth rates to their lowest level in 20 years.
