title: Improving adherence to the Epic Beacon ambulatory workflow.
abstract: Computerized physician order entry has been shown to significantly improve chemotherapy safety by reducing the number of prescribing errors. Epic's Beacon Oncology Information System of computerized physician order entry and electronic medication administration was implemented in Henry Ford Health System's ambulatory oncology infusion centers on 9 November 2013. Since that time, compliance to the infusion workflow had not been assessed. The objective of this study was to optimize the current workflow and improve the compliance to this workflow in the ambulatory oncology setting. This study was a retrospective, quasi-experimental study which analyzed the composite workflow compliance rate of patient encounters from 9 to 23 November 2014. Based on this analysis, an intervention was identified and implemented in February 2015 to improve workflow compliance. The primary endpoint was to compare the composite compliance rate to the Beacon workflow before and after a pharmacy-initiated intervention. The intervention, which was education of infusion center staff, was initiated by ambulatory-based, oncology pharmacists and implemented by a multi-disciplinary team of pharmacists and nurses. The composite compliance rate was then reassessed for patient encounters from 2 to 13 March 2015 in order to analyze the effects of the determined intervention on compliance. The initial analysis in November 2014 revealed a composite compliance rate of 38%, and data analysis after the intervention revealed a statistically significant increase in the composite compliance rate to 83% ( p < 0.001). This study supports a pharmacist-initiated educational intervention can improve compliance to an ambulatory, oncology infusion workflow.
authors.affiliation: Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Chackunkal
authors.affiliation: Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Vishnuprabha
authors.initials: V
authors.lastname: Dhanapal Vogel
authors.affiliation: Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Meredith
authors.initials: M
authors.lastname: Grycki
authors.affiliation: Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Diana
authors.initials: D
authors.lastname: Kostoff
mesh_terms: D005260:Female; D006282:Health Personnel / Q000193:education*; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D016134:Organizational Policy; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D010607:Pharmacy Service, Hospital; D012189:Retrospective Studies; D057188:Workflow
keywords: Epic Beacon; infusion center; workflow compliance