Publication Date
Spring 2026
Degree Type
Doctoral Project
Degree Name
Doctor of Nursing Practice (DNP)
Department
Nursing
First Advisor
Robin L. Whitney
Keywords
Graft-versus-host disease (GvHD), Flowsheet, Stem cell transplant
Abstract
Graft-versus-host disease (GvHD) is a common and serious complication following allogeneic hematopoietic stem cell transplantation (HSCT). Accurate documentation of GvHD severity and management is essential for clinical decision-making, interdisciplinary communication, and regulatory reporting to organizations such as the Foundation for the Accreditation of Cellular Therapy (FACT) and the Center for International Blood and Marrow Transplant Research (CIBMTR). Despite the availability of structured documentation tools within the electronic health record (EHR), their utilization is often inconsistent. The purpose of this quality improvement project was to evaluate whether a targeted provider-focused intervention could improve completion rates of a standardized GvHD documentation flowsheet in adult outpatient allogeneic transplant encounters. A pre-post design was implemented in an outpatient transplant clinic at a comprehensive cancer center. Data were obtained from Epic SlicerDicer queries of outpatient encounters before and after the intervention. The intervention included provider education, workflow integration strategies, and a GvHD documentation tip sheet. A total of 128 outpatient encounters were analyzed, comprising 64 pre-intervention and 64 post-intervention. GvHD flowsheet utilization increased from 23.4% pre-intervention to 45.3% post-intervention. Chi-square analysis demonstrated a statistically significant association between intervention period and flowsheet use (χ²(1, N = 128) = 6.79, p = .009). Improving documentation reliability strengthens quality monitoring, regulatory compliance, and continuity of care in transplant programs.
Recommended Citation
Shearon, Emily, "Improving Graft-versus-Host Disease Documentation through Provider Education on an Epic-Based GvHD Documentation Flowsheet" (2026). Doctoral Projects. 222.
DOI: https://doi.org/10.31979/etd.wfu2-u7c4
https://scholarworks.sjsu.edu/etd_doctoral/222
