1. Serious Illness Conversations (SIC) in the Community: A Quality Improvement Project to Increase SIC Documentation in the Community Oncology Setting (QI420).
- Author
-
McGuire, Hilary and Lally, Kate
- Subjects
- *
ONCOLOGY nursing , *ADVANCE directives (Medical care) , *ONCOLOGY , *DOCUMENTATION , *PATIENT-centered care , *NURSES - Abstract
1. Distinguish unique challenges of engaging in and documenting Serious Illness Conversations (SICs) in the community oncology setting 2. Design a systemic approach to increasing documentation of SICs in the community oncology setting 3. Implement opportunities to engage in and document SICs into already established workflows in the community oncology setting Serious Illness Conversations (SICs) are essential to providing patient-centered care driven by patient goals and values. Clinicians need to be able to quickly find documentation of these conversations so they can be used to guide decision making. The Epic Advanced Care Planning (ACP) module centralizes these conversations to allow providers to track changes in goals and preferences over time. Our large integrated healthcare system has agreed to prioritize use of the ACP module; however, at our community oncology clinic, few patients have documentation in the ACP module. We will increase the number of SICs documented in the ACP module by 20% and increase the number of clinicians and RNs using the ACP module by 100% in 4 months. This will necessitate documentation from oncology clinicians and RNs other than our Supportive Oncology Collaborative. Surveys of clinic and infusion nurses (N = 20, 76% response rate) and MD/NP providers (N = 10, 50% response rate) indicated weekly engagement in SICs. Chart review indicated SICs were occasionally occurring and documented in places other than the ACP module. 80% of MD/NP providers identified an education gap regarding the ACP module as greatest challenge. Individual and group education and individual MD/NP provider support in documentation were provided. Computer-side tip cards were also provided. Average weekly SICs documented in the ACP module did not significantly increase. The number of unique clinicians and RNs using the ACP module increased by 100%. Solicited feedback indicated providers were open to education but not to changing their practice. There is substantial interest in increasing documentation of SICs, but community oncology clinics may have unique challenges around changing workflows. We will use a multidisciplinary approach and next focus on standardization of SIC documentation in existing clinic workflows (eg, using RNs during chemo teaching) in future Plan-Do-Study-Act cycles while also supporting community clinicians during this cultural shift to prioritizing ACP. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF