Purpose
Ensuring that patients/families are engaged as partners in their health care is an effective way to measure the quality of patient care. Self-reported patient data, such as symptom burden, provides an accurate and effective way to measure patient-reported outcomes. Our team reviewed 20 patient charts, randomly, to assess for documentation of at least 3 or more domains of toxicities of immune checkpoint inhibitors. The baseline comprehensive documentation rate was 50%. Our goal is to improve the documentation rate to 80% for our first process improvement cycle.
Aim Statement
Increase documentation of 3 or more toxicities immune checkpoint inhibitors to a goal rate of 80%.
Methods
A free online patient monitoring checklist tool was printed and provided to patients receiving immune checkpoint inhibitors (on their infusion day) during the check-in process. The patients were instructed to complete the tool prior to the provider clinic visit, while in the waiting area. The completed tool was given to the provider on the day of their visit. Prior to the start of this Plan-Do-Study-Act (PDSA) cycle, all providers were “reminded”/ instructed to ensure documentation of 3 or more toxicities immune checkpoint inhibitors. The cycle lasted for 3 weeks. At the end of the 3 weeks, our team reviewed the charts of those patients.
Results
Documentation rate of 3 or more toxicities increased from 50% to 90%.
Conclusions
When completed patient monitoring tools were provided to the providers during the clinic visit, the providers increased their documentation rate of the toxicities. There is literature supporting improving patient satisfaction using self-reported symptoms monitoring tools. Also, given the burden of documentation and shorter visit times, providers found this to be an easy way to address patient symptoms. While electronic patient-reported outcome (e-PRO) tools are ideal for ongoing symptom monitoring, this is a simple way to address the same in low-resourced communities. For our next cycle, we plan on using patient feedback to improve the documentation form incorporating larger fonts for patients with low vision.
