1. ASCO’s Quality Training Program
Project Title: Incorporating Distress Screening Tool in an Oncology Office Setting
Presenter’s Name: Caroline Usry, RN, BSN, OCN
Laura Holder, Pharm.D.
Jennifer Lamneck Heaberlin DO, MPH
Institution: University Oncology, Augusta, Georgia
Date: 10/08/2015
Storyboard for Session 2 will be the slides up to and including the Baseline Data slide.
ASCO will be providing other versions of this PPT that provide an example and tips on adding content to your Storyboard and Presentation.

2. Institutional Overview
University Oncology is a hospital based hematology oncology practice
We have two locations: Augusta, Georgia and Aiken, South Carolina
The practice has 6 physicians providers and one physician assistant.
The practice caters to an average of 1200 new patients a year
Include basic demographic information about your practice/ institution. E.g. location, patient volume, practice setting (community, academic), # of oncologists, etc.

3. Problem Statement
Identifying and addressing all of the stressors within the relationship-centered care process of our practice will enhance our ability to better relieve or lessen distress, hopefully improving outcomes. The integration of the ambulatory and hospital based services also offers the ability to impact admissions and hospital length of stay, both impacted by psychosocial issues that can severely compound symptoms related to the primary disease and its treatment. An effective process may, therefore, reduce the overall cost of care while maximizing outcomes and patient outcomes and patient satisfaction.
Describes the concern or opportunity objectively.
Describes the extent of the problem.
Describes the impact of the problem.
Example:
Medication lists are often inaccurate which compromises patient care. It is challenging to fit medication reconciliation into minute multi-issue visits. Providers often rely on EMR medication lists rather than patient history. No clear policy on who “owns” the list and who is “allowed” to modify and no standard process exists across the institution.

4. Team Members Job Function Role Name Team Sponsor Kim Taylor
Chief Operating Officer
Team Leader
Jennifer Lamneck
Physician
Core Team Members
Meg Harmon
Laura Holder
Caroline Usry
Cancer Liaison
Pharmacist
Charge Nurse
Other Team Members
Anu Batra
Alan Faulkner
Chaplain
Advisor
Michael Shlaer
Use information from the project charter.
Project Leaders: You!
Team Members: have “fundamental knowledge” of the process you are addressing (e.g. frontline workers)
Project Sponsors: accountable for your overall effort, provides your team with direction and support, assists you with implementation when appropriate, and ensures that key stakeholders have appropriate involvement.
Be sure to specify the role/discipline and contribution for each member (frontline knowledge, influencer, etc)
Example:
Jane Smith, Floor nurse
Dr. John Doe, Physician
Dr. Mary Last, Chief, Dept of Med

5. Process Map Yes No No Yes >= 5 0-4
Patient arrives at the front desk
Form scanned in patient’s chart
Form
Filled out
Patient is given the new patient packet to be filed out with NCCN distress thermometer
New Patient
Form given to Chaplain
Yes No No
Yes
MD visit
PA visit
RN eval
Lab draw only
Distress score
>= 5
0-4
Form scanned in patient’s chart
Referred to Cancer Liaison
Financial Assistant
Chaplain
Patient Advocate MD

6. Cause & Effect Diagram Patient Material Staff Resources Workflow
Do not want to share
Not a priority at the time of appointment
Language barrier
Illiteracy
Don’t want to be held up
Cultural
Perceived lack of resources
Educationally appropriate for alll
Is it working..the form
Unwilling to ask
Time/efficiency
Don’t know how to
response
Staffing ratios
Another office process
Who should address
Low screening
Not enough time to fill out form
Already under stress of referral
Overwhelmed with forms
Privacy
Stress level is multifacttorial and varies constantly
Lack of training to detect stress
Lack of training to implement program
Lack of standardization in asking questions
When is the right time /
How often
Instructions not
given initially on
why this is I
mportant
Lack of resources
Who should follow up
No outpatient psychiatrist
No outpatient dietician
Lack of referral resources
Resources
Workflow
Environment

7. Diagnostic Data
We have not had consistent process of documenting distress
We have previously documented spiritual and emotional distress using part of the NCCN tool, but comprehensive distress assessment has not been carried out.
We found only 45% of responders marked the distress thermometer.
Links directly to the measurement implied in your primary aim statement
Example:
% of Accurate Lists One Week Post Annual Visit (p-chart)
UCL
Mean
% accurate lists
LCL
Week

8. Common Barriers to Screening
Time versus efficiency among staff
Instructions not clearly given
Lack of referral resources once distress identified
Any observations, tally sheet data, interviews, that helped you understand your process, prioritize opportunities, etc.
Displayed in a Pareto chart, frequency distribution, run chart, etc. Demonstrates how you identified your opportunities for improvement and how you prioritized your specific area of focus that will relate to your aim statement.

9. Aim Statement
By September 30, 2015, incorporate a comprehensive assessment tool and increase the documentation of physical, practical, emotional and spiritual problems for new oncology patients being seen in University Oncology’s office to 75% at the time of their initial visit.
Defines the team’s specific improvement objective – what you are trying to accomplish.
AIM statements should be SMART - specific, measurable, attainable, relevant and time bound.
Example:
By June 30, 2011, increase the accuracy of medication lists one week after physical exams and chronic disease visits to 90% by providing physicians with accurate patient generated medication lists during the targeted visit at XYZ clinic.

10. Measures Measure: Percentage of new patients screened for distress
Patient population: New patients
Exclusions (if any):
Calculation methodology:
Numerator : Number of patients with screening tool documented
Denominator (if applicable): Number of new patients
Data source: New Patient Packet
Data collection frequency: weekly
Data quality (any limitations) Incomplete filling out of forms
Describe your outcome, process or balance measures which you will present as your baseline data and change data. If you have more than one measure you will want to create a slide for each measure.
Describe the measure and note whether it is your outcome, process or balance measure. Include the patient population (who is included and any exclusions). Specify the calculation methodology (specify the numerator, denominator if applicable). Describe the data source, data collection frequency, quality of data (any limitations).
Measures should be directly related to your AIM statement. Can also show off your data collection tools that you developed.

11. Baseline Data % of Accurate Lists One Week Post Annual Visit Example:
Should be one of the measures outlined on the measurement slide which is directly related to your aim statement. Annotate chart to identify when intervention/PDSA cycles began, label the x and y axis, and indicate the type of chart used. Note if rules of special cause are present indicating improvement is significant.
Example:
% of Accurate Lists One Week Post Annual Visit
UCL
Mean
% accurate lists
LCL
Intervention Started Week 8
Week

12. Prioritized List of Changes (Priority/Pay-Off Matrix)
Ease of Implementation
High
Low
Easy
Difficult
Impact
Self screening tool provided to patients as a part of the new patient packet which is later scanned into our system
Education of front desk staff about importance of form and making sure it is completed
Change format of the form to 2 pages to help ensure patients fill out both parts of the tool
Tool filled out by MD/RN with questions directly asked to the patient
No standardized tool
Review of distress by providers and Nurses
Filling out the tool at each visit and reviewing with MD/RN
Describe process of idea generation (brainstorming, etc)
Highlight ideas selected for this PDSA cycle 12 12

13. PDSA Plan (Tests of Change)
Date of PDSA cycle
Description of intervention
Results
Action steps
4/18/ /5/2015
Identification of tool
Workflow
NCCN Distress thermometer
Educated MD’s, Nurses, Staff in the practice regarding implementation
5/5/2015 – 7/1/2015
Pilot Implementation of tool
Development of data collection plan
Low screening not meeting goals
Plan to educate the front desk to reinforce the importance of form to the patient
8/1/2015-
9/30/2015
Changed the format of the distress tool
Educated the front desk on administration of the tool and asking patients to fill it out.
Overall percentage of pts filling out the form completely is improved.
Plan to continue distress screening tool and start to find ways to better address stressors in patient’s lives.
Describe your test plan – briefly summarize PDSA cycles or multiple PDSA cycles.
Could include stakeholder analysis or communication plan if relevant.

14. Materials Developed
E.g. patient education materials; visual of tools to test as part of tests of change.
This slide is optional for a team to include. If your team did not develop any materials related to your project (e.g. patient education tools; survey), you may delete this slide.

15. Materials Developed

16. Change Data – P Chart % of Accurate Lists One Week Post Annual Visit
Should be one of the measures outlined on the measurement slide which is directly related to your aim statement. Annotate chart to identify when intervention/PDSA cycles began, label the x and y axis, and indicate the type of chart used. Note if rules of special cause are present indicating improvement is significant.
Example:
% of Accurate Lists One Week Post Annual Visit
UCL
Mean
% accurate lists
LCL
Intervention Started Week 8
Week

17. Conclusions
Our p chart does not show specific cause as we don’t have enough data points since the intervention
We did see a trend toward a change and achieving our aim of having at least 75% of new patients filling out the form completely.  
Conclusions should be directly related to your change data. Describe whether or not you saw improvement or if you met your aim. This is different than lessons learned.

18. Next Steps/Plan for Sustainability
Continue to collect data on if patients are filling out the form completely to evaluate our intervention
Explore resources so we can address the concerns appropriately on the distress screening which was the original plan for project before we realized that patients were not using the form correctly.
Meet with social worker, chaplain and team to develop a plan on how to find better ways to address the stressors that we are identifying in the patients.
Continue with staff education.
Continue to meet on weekly basis
Describe additional tests of change, how intervention will be incorporated into standard work flow, etc.
Example:
Increase and measure reliability of process elements of our intervention
Continue to measure post encounter medication list accuracy to evaluate intervention
Collaborate with IT to develop system fixes (e.g end date for antibiotics)
Explore utility of patient portal for inter-visit medrec

19. Name, credentials, job title
Entity
Project Title
Incorporating Distress Screening Tool in an oncology office setting
TEAM:
Physician : Jennifer Lamneck
Nursing : Caroline Usry
Pharmacy : Laura Holder
Social Work : Meg Harmon
PROJECT SPONSORS:
Kim Taylor
AIM:
BySeptember 1,2015, incorporate a comprehensive assessment tool and increase the documentation of physical, practical, emotional and spiritual problems for new oncology
patients being seen in University Oncology’s office by 75% at the time of their initial visit.
INTERVENTION:
Introduction of the NCC
RESULTS: Should be related to your AIM statement. Be sure to title the graph, identify the SPC chart used, label the x & y axis, include a legend
CONCLUSIONS: Should summarize the data in the results section, state whether or not the AIM was met. Conclusions are different than lessons learned.
NEXT STEPS:
Graph title
Once a team has completed their final presentation for the Quality Training Program, they may wish to display it in their institution or at conferences. The content can be displayed in a poster format, similar to this.
This is a sample template slide for a poster presentation or summary of your work.
Insert graph