A chart review of the ordering and documentation of urine toxicology screens in a cancer center: Do they influence patient management?

Urine toxicology screens (UTSs) may be useful in the diagnosis or monitorin g of patients with established or suspected substance abuse. In the medical ly ill, including those with cancer, the test may help clinicians manage th erapy with controlled prescription drugs. To describe the current use of UT Ss in a cancer center, the medical records of 111 patients who underwent UT S were reviewed. These 111 patients were randomly selected from a group of 215 patients who underwent screening between January 1, 1990 and December 3 1, 1994 (a period during which over 80,000 admissions occurred). Fifty-six of the 111 patients had evidence of one or more illicit drugs, a prescripti on medication that had not been ordered, or alcohol; 50 patients had negati ve screens. The likelihood of a positive UTS was higher if the patient had human immunodeficiency virus (HIV) infection (100% versus 46.6%) or was und ergoing treatment for chronic nonmalignant pain (100% versus 43.9%). Docume ntation of the UTS in the medical record was infrequent: 37.8% of the chart s listed no reason for obtaining the test and the ordering physician could not be identified in 29% of the records. Eighty-nine percent of the records did not contain a subsequent mention of the result of the UTS, The result was more likely to lead to a documented outcome when it was positive rather than negative (14.3% versus 0%). These results suggest that UTSs are used infrequently in the tertiary care oncology center. The documentation surrou nding the ordering and subsequent use of the test in patient management is unsystematic. The appropriate use and documentation of UTSs, like substance abuse issues in general, should be a focus of staff education and quality improvement efforts. (C) U.S. Cancer Pain Relief Committee, 2000.