| Sumario: | Significance & Background: National guidelines for oral anticancer medications (OAMs) mandate that clinicians provide comprehensive patient education, monitor toxicity, and track adherence. However, the details of how to implement these guidelines are intentionally broad, allowing individual oncology practices to adapt them into their workflows (2016). Therefore, the education and follow-up patients and caregivers receive varies widely by institution (Blinder et al., 2022; Jacobs et al., 2019; Mackler et al., 2019; Watson et al., 2020) or between practice sites within an institution. While the details of intravenous chemotherapy administration are usually standardized by a system-wide policy, OAM initiation, including patient education, monitoring, and follow-up are not included in this policy. The absence of a policy outlining the implementation of national guidelines on OAMs has resulted in inconsistent clinician compliance, which could lead to poor patient adherence and symptom management and, consequently, poorer patient outcomes (Thomas et al., 2019). Purpose: The aim of this quality improvement project was to standardize the process for initiating OAMs to align with American Society of Clinical Oncology (ASCO) and Oncology Nursing Society (ONS) guidelines. Interventions: A review of the literature was completed to find effective interventions for initiating OAMs. Next, an anticipatory checklist and standardized EHR documentation tool were created to guide patient education, documentation, and follow up in the initiation of OAMs. These tools were piloted with the breast cancer patients of one oncologist at this clinic who initiated an OAM during an 8-week implementation period. The anticipatory checklist was used as a teach-back tool to ensure patient understanding of education. Follow-up included calls or MyChart messages at 1-week intervals after initiation to assess adherence and side effects. Results: Implementation of an anticipatory checklist and standardization of the EHR documentation tool improved documentation of ASCO/ONS-mandated topics for 6 of the 7 (85%) of patients initiating an OAM during the QI project period. Comprehensive education using the checklist helped to reduce the patient-initiated phone calls and EHR system messages by 35% as compared to a control sample of 14 patients who initiated OAMs in the 6 months prior to project implementation. Discussion: Anticipatory checklists and EHR documentation tools are effective methods for standardizing the process of initiating OAMs. Standardized tools like these should be incorporated into health system policies for OAMs to ensure quality care and patient safety.
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