Integrating EMR Systems Across Departments Improves Care in Brachytherapy Suite

Integrating radiation oncology electronic medical records (EMR) system with other departments’ records systems streamlined and standardized charting, allowing safer, easier handoffs, according to researchers from the University of California, San Diego Health Center. Their findings were presented in a poster session at the 48th Annual Oncology Nursing Society (ONS) Congress.

“Charting now aligns with procedural suite charting standards across the institution,” reported lead study author Zachary Peterson, RN, OCN, of UC San Diego Health Cancer Services, and coauthors. “Order sets allow for more RN autonomy and safer administration of medications.” 

“This provides improved continuity of care for our patients; it also allows us to chart per UCSD Health organizational OR standards,” Peterson noted.

The UC San Diego Moore Cancer Center’s brachytherapy suite “handles the most complex cases in the San Diego region,” Peterson reported. “Brachytherapy is a multidisciplinary treatment, frequently given in conjunction with external beam radiation, chemotherapy, or surgery.”

The brachytherapy suite had previously used its own electronic records system, ARIA, for charting, but it was not readily accessed from other departments.

“The multidisciplinary team was unable to see the whole picture of a patient’s treatment” as a result, Peterson noted, the situation “created potential for miscommunication” about a patient’s care.

The Radiation Oncology Brachytherapy Team, which consists of a nurse, physician, physicists, and nurse manager, worked with their health system’s pharmacy and EPIC electronic patient records system team to create a new brachytherapy-specific charting tool, notes templates, and order sets, allowing radiation oncologists and physicists who chart in ARIA to share those records with other departments, which use EPIC; to develop templates for simple and complex brachytherapy plans, and pharmacy order set options; and to adopt electronic vitals flow sheets from other departments to brachytherapy, making them consistent across departments and eliminating a need for “superfluous” narrative notes, Peterson reported.

Count sheets can now be scanned into EPIC and paper brachytherapy order sets have been replaced with electronic order sets signed by physicians prior to patient appointments. The EPIC team also worked with the billing department to use billing codes that more accurately reflect patient treatment during brachytherapy. The team worked with the operating suite team to incorporate their charting standards into the brachytherapy suite’s EMR procedures.

The transition work identified a need for simple appointment summaries for other healthcare providers to reference between departments after handoffs, and an absence of department policies and procedures for brachytherapy involving patient sedation, Peterson noted. The team worked with the anesthesia department to make brachytherapy sedation charting consistent with general anesthesia standards.

“The After Visit Summary is more comprehensive,” Peterson noted. “It now includes future appointments amongst all UCSD disciplines.”

The team also transitioned from paper sedation records and Instrument Logs to a completely electronic sedation record, he added.

“We seized this opportunity as a chance to improve the quality, safety, and efficiency of the care we are giving our patients,” Peterson concluded.

Reference

Peterson Z, Gotfredson K, Smith P, et al. Radiation oncology – improving radiation oncology nursing care through EMR implementation. Poster presentation at: 48th Annual ONS Congress; April 26-30, 2023; San Antonio, Texas.