Background/Aim: In response to significant quality incidents in New South Wales with off-protocol prescribing of carboplatin and in South Australia with underdosing of cytarabine, a survey of health services providing chemotherapy in Victoria was undertaken. It was identified that retrospective auditing of chemotherapy prescribing was reported by only 27% of health services. To address this gap, a project was launched to develop a Chemotherapy Audit Toolkit, which would include an overarching quality framework and an audit tool to enable health services to govern and monitor chemotherapy prescribing.
Method: Extensive consultation was held with the healthcare sector to understand current auditing practices and the distribution of Electronic Prescribing Systems. The first phase focused on providing an audit tool for the four electronic systems currently in use in public hospitals in Victoria: CHARM, ARIA, Epic and Cerner Oncology, with a pilot completed at CHARM sites.
Results: The audit tool has currently been tested with hospitals using CHARM, three in Victoria, one in Queensland and a national private provider. The tool has identified prescribing that deviates from protocol, enabling review by internal quality processes. Feedback from these test sites has found that the audit tool is relatively easy to use, has a small time burden for health professionals and is able to be integrated with existing oncology department structures. Avenues for use with Epic, ARIA and Cerner are currently being explored and tested. The next phase is focusing on developing an audit method that will provide maximal impact for paper based systems.
Conclusion: Pilot testing has demonstrated that the Chemotherapy Audit Toolkit can facilitate chemotherapy prescribing audits with pilot sites being able to identify deviations from protocol. The toolkit will be further tested and developed to provide a best practice quality framework and a supporting audit tool to support health services.