NCCN Chemotherapy Order Templates: Enhancing patient safety through standardization

Abstract

e17537 Background: NCCN Chemotherapy Order Templates (COT), which delineate antineoplastics and associated supportive care agents, monitoring and safety parameters, and instructions for self-administered agents, were launched in 2008 to complement the NCCN Clinical Practice Guidelines in Oncology and NCCN Drugs and Biologics Compendium for nine cancers. Through COT, NCCN sought to enhance patient safety by reducing medication errors, anticipating and managing adverse events, and standardizing care. NCCN developed and distributed a survey to evaluate the reception, use, and impact of COT on oncology practice. Methods: The survey included multiple-choice questions with filtering logic. Questions included 5-point Likert scale. The survey was emailed on December 18, 2008 to a convenience sample of 10,183 registered users of NCCN.org who had clicked at least once to the COT; 110 (1%) survey emails were undeliverable. 734 (7%) responded by 1/5/09 and 588 (6%) completed the survey (80% completion rate). 28 (&lt;1%) recipients opted out of participating. Results: 476 (64%) respondents were providers, including MDs (47%), mid-level (8%) and nurses (10%); 11% were pharmacists. Of the 734 respondents, 465 (63%) had used COT. Among the 465 users, the median number COT accessed was 2 (range 0 - 9) with physicians accessing more than other providers (p = 0.002). Breast cancer COT were accessed most (68%). COT were used as a reference (52%) and for setting up chemotherapy orders (42%). 292 users (63%) agreed that COT impacted patient safety; with MDs more likely to agree (p = 0.001) compared to other providers. Of these, 89% responded that COT made chemotherapy ordering safer. 271 users (58%) agreed that using NCCN COT in practice impacted the ordering of supportive care agents. Among providers, MDs were more likely to agree (p = 0.002). Of those who agreed, 86% responded that COT made it more likely that appropriate supportive care orders were included. Conclusions: Adding NCCN Chemotherapy Order Templates to the core NCCN content was done to make the NCCN Clinical Practice Guidelines in Oncology more accessible to providers. Survey results indicate that COT users feel that template use improves the safety of chemotherapy and supportive care agents. Throughout 2009, NCCN will continue to develop COT to cover most cancers. [Table: see text] </jats:p