Kaur Varinder, Haider Sajjad, Sasapu Appalanaidu, Mehta Paulette, Arnaoutakis Konstantinos, Makhoul Issam
Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences; Central Arkansas Veterans Healthcare System, Little Rock, AR; and British Columbia Cancer Agency, Vancouver Island Cancer Center, Victoria, British Columbia, Canada.
J Oncol Pract. 2017 Jan;13(1):e91-e97. doi: 10.1200/JOP.2016.013797. Epub 2016 Oct 31.
Using the Quality Oncology Practice Initiative, an affiliate program of ASCO, we outlined opioid-associated constipation (OAC) as a subject in need of quality improvement (QI) in our fellowship program at the University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System. We initiated a fellow-led QI project to advance the quality of patient care and provide a valuable avenue for QI training of young physicians. Fellows organized meetings with all stakeholders, addressed the scope of the problem, and devised strategies for OAC management. Monthly meetings were organized using Plan-Do-Study-Act principles. Mandatory check boxes were inserted into our electronic medical record templates to remind all physicians to identify patients on opioid medications and assess and address OAC. Final chart audit and patient satisfaction surveys were performed 6 months after project initiation. Assessment of OAC improved from 52% at baseline to 92% ( P < .003). This improvement corresponded with high patient satisfaction scores, with 90% of surveyed patients reporting adequate management of their constipation. In this QI initiative, we showed that participation in ASCO's Quality Oncology Practice Initiative helps identify areas in need of QI, and such fellow-led QI projects can serve as models for QI training of young physicians.
利用美国临床肿瘤学会（ASCO）的附属项目“肿瘤学质量实践倡议”，我们将阿片类药物所致便秘（OAC）确定为阿肯色大学医学科学分校和中阿肯色州退伍军人医疗保健系统的住院医师培训项目中需要质量改进（QI）的一个主题。我们启动了一个由住院医师主导的QI项目，以提高患者护理质量，并为年轻医生的QI培训提供一条有价值的途径。住院医师组织了与所有利益相关者的会议，探讨了问题的范围，并制定了OAC管理策略。使用计划-执行-研究-行动原则组织了月度会议。在我们的电子病历模板中插入了必填项，以提醒所有医生识别使用阿片类药物的患者，并评估和处理OAC。在项目启动6个月后进行了最终病历审核和患者满意度调查。OAC评估从基线时的52%提高到了92%（P < .003）。这一改善与高患者满意度得分相对应，90%的受访患者报告其便秘得到了充分管理。在这项QI倡议中，我们表明参与ASCO的肿瘤学质量实践倡议有助于识别需要QI的领域，而且这种由住院医师主导的QI项目可以作为年轻医生QI培训的典范。
