Implementation of pre-chemotherapy checklist of R-CHOP for lymphoma patientsimproves chemotherapy starting time

By Bik Yu KAN, FHKAN, MN

Purpose

The objective of this project was to improve chemotherapy starting time with the implementation of a pre-chemotherapy checklist of R-CHOP for lymphoma patients.

Background

Hematological oncology cases are complex. Oncology nurses providing treatment to patients in the ambulatory chemotherapy center face a broad range of responsibilities and frustrations. These factors may result in human errors during treatment at the ambulatory chemotherapy center. An audit of records from January to April 2016 revealed that 5% of patients had missing information and incomplete work-up on the first day of chemotherapy. This resulted in a delay in chemotherapy starting time. Other problems which may result from this setback include decreased bed utilization rates, increase in chemotherapy treatment cancellation, and increase in patient dissatisfaction and staff frustration.

Methods

The pre-chemotherapy checklist was created in accordance to standard protocol guidelines for treating lymphoma patients. The implementation was started in May 2016. Baseline data was reviewed in an audit of the four months prior to implementation. Six months of data were analyzed after the checklist implementation.

Results

From May 2016 to November 2016, 15 cycles of chemotherapy were monitored and completed. There was no missing information nor incomplete work-up found. Resources were fully utilized and treatment process was completed smoothly. Chemotherapy treatments were started on time. Patients did not have any complaints during treatment. Staff did not encounter any problems during patient treatment.

Implications/Conclusion

With checklist implementation, chemotherapy administration is more efficient. Overall, the checklist is easy for the nurses to follow. Consideration may be given to adoption of the checklist to other patient groups. When procedures are complicated, it is difficult to avoid human errors. However, if an intervention as simple as a checklist is developed, it can make the complicated treatment procedures easier to follow.