Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Proposed Topic (Second preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Authors (including presenting author) :
Wong CC(1), Ng HMI (1), Lam YLA (1), Chan SYA(1), Luk MY(1), Yuen KK(1)
Affiliation :
(1) Department of Clinical Oncology, Queen Mary Hospital
Introduction :
Radiotherapy plays a crucial role in the comprehensive care provided to cancer patients by clinical oncologists. As the overall survival of cancer patients improves, an increasing number of individuals may undergo multiple courses of radiotherapy throughout their cancer journey. Having an easy access to the complete history of previous irradiation is vital for providing optimal care to our patients and ensuring effective communication across medical teams. However, the current system of radiotherapy planning and record is separated from Clinical Management system (CMS), which is used by oncologists and other healthcare providers in their day-to-day practice within Hospital Authority, making it challenging to retrieve treatment records easily. Therefore, it is important to address the current situation in order to improve the accessibility of treatment records.
Objectives :
To enhance the quality and accuracy of documentation of radiotherapy prescription on CMS at QMH.
Methodology :
This project focuses on complete documentation of radiotherapy prescription on CMS for patients receiving radiotherapy in QMH. A complete documentation should include four essential pieces of information: (1) treatment site, (2) method of delivery, (3) dose per fraction or total dose and (4) total number of fractions. Performance on documentation of radiotherapy prescription were reviewed in three audit periods, namely August 2023, November 2023, and January 2024. 100 randomly selected patients were reviewed in each audit period. Following the first audit period, a template for documentation was introduced on CMS and it became mandatory for all patients starting from January 2024. Furthermore, radiation therapists were assigned the responsibility of verifying the availability of prescription documentation on CMS prior to treatment initiation, effective from January 2024.
Result & Outcome :
The overall full documentation rate of radiotherapy prescription witnessed significant improvement over the audit periods. It was improved to 91% in the third audit period, from 33% and 75% in the first audit period and second audit period respectively. Improvements were noticed across different radiotherapy techniques. The full documentation rates were increased to 96.7% from 34.8% for RT treatment using 2D techniques, to 89.7% from 30.6% for 3D and IMRT techniques, and to 83.3% from 60% for SBRT and SRS techniques.
During the last audit period, the template on CMS was utilized for 85 out of 100 patients (85%). It was observed that complete documentation was available for all patients who used the template. Among the remaining 15 patients (15%) whose records were not documented with the template, complete documentation was available on 6 patients (40%), while more than half of the patients (60%) had one or more missing elements in their record. These results highlight the effectiveness of using a template in facilitating comprehensive radiotherapy prescription documentation.
According to the audit result, the implementation of the template on CMS has demonstrated its effectiveness in improving complete documentation for radiotherapy prescription. This standardized approach not only enhances patient safety but also improves the overall efficiency of doctors and healthcare workers. The positive outcomes observed from this implementation are expected to bring benefits to our practice.
