| Sumario: | Significance & Background: Safe chemotherapy ad-ministration requires rigorous adherence to double-check processes to reduce risk of medication errors and harm. The ASCO/ONS Chemotherapy Administration Safety Standards specifically mandate independent verification by two licensed clinicians at several steps throughout the chemotherapy preparation and administration process. Our electronic health record (EHR) includes a "Pre Chemo Checklist," which is required to be completed prior to each administration and co-signed by the second registered nurse. It was discovered compliance averaged only 37% across three inpatient oncology units. This gap represented a significant patient safety risk and an opportunity to improve adherence to best practice and institutional policies. Purpose: The purpose of this project was to improve compliance with documentation of the Pre Chemotherapy Checklist in the EHR. Our intended outcomes were to increase checklist documentation rates, enhance staff accountability, and reduce the risk of medication errors. Interventions: Prior to initiating audits, the leadership team facilitated in-person educational sessions targeting registered nurses. Electronic communications containing expectations and resources were disseminated. Beginning in June 2025, an audit and feedback process was implemented. Each month, ten chemotherapy charts per unit were reviewed for checklist completion. Patient charts were selected from a report generated in the EHR that displayed all patients who were billed for chemotherapy during their inpatient stay. Individual nurses with documentation fallouts received direct email feedback, with unit leadership copied to promote accountability. Unit-wide summary emails were distributed monthly to share compliance rates and highlight opportunities for improvement. Awards were sent out to nurses for adherence to processes. The intervention emphasized transparency, reinforcement of expectations, and real-time correction opportunities. Results: Baseline compliance across the three units averaged 37%. After three months of implementing the audit and feedback process, compliance improved to an average of 80%. Early trends suggest sustained improvement with monthly reinforcement. Continued auditing will determine whether this approach supports long-term adherence. Discussion: This project demonstrates that audit and feedback can significantly improve compliance with two RN pre-chemotherapy safety checks and documentation in a busy oncology setting. Increasing compliance strengthens adherence to best practices, enhances patient safety, and reduces risk of chemotherapy errors. Lessons learned include the importance of timely individual feedback, involvement of unit leadership, and sharing unit-level results to promote team accountability. Next steps include sustaining monthly audits and expansion of this process to other high-risk medications.
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