Quality Resources and Improvement Activities

Quality Resources to Support Evidence-based Practice (EBP) and Quality Improvement

Nursing plays a critical role to identify and eliminate waste while actively improving systems and care delivery, all resulting in improved patient experiences and outcomes. ONS offers resources to inform healthcare professionals about quality reporting with an emphasis on improvement.

Evidence-based practice is a problem-solving approach to clinical practice that integrates the conscientious use of best research evidence in combination with clinician expertise as well as patient preferences and values to make decisions for care that will promote the optimal outcome.

Quality improvement (QI) is a method of improving clinical processes through the use of quality tools and methods with the goals of the activity depending on the practice gap identified in the performance data.

  • LEAN Healthcare – QI tools that help identify sources of waste in a clinical process and replace those non-value adding activities with those value adding practices that improve outputs and clinical outcomes.
  • Six Sigma – QI tool that aims to reduce impractical variation in processes and clinical practice between clinicians. Variation increases costs and often indicates lack of EBP utilization on the part of clinicians.
  • Model for Improvement – QI tools that utilize testing of ideas and hypothesis about what we might change to achieve EBP and improved outcomes using small tests of change often called PDSA cycles.

Data-Driven Quality Improvement refers to the use of scientifically tested quality metric to measure nursing sensitive and patient centered key performance metric to identify gaps in practice and variations between clinician and practice sites. These data are needed to determine greatest opportunities for improvement in practice to prioritize improvement activities.

ONS maintains a portfolio of scientifically tested quality measures. These measures are both process focused and outcome focused. Both process and outcome measures are important for use in a well-designed clinical quality program in oncology care.

ONS Custom Quality Measures

  • Goal Setting and Attainment for Cancer Survivors
  • Fatigue Improvement
  • Exercise Recommendation to Adult Cancer Survivors
  • PCR Test with MR2 or great result (BCR-ABL1 < 1% [IS]) for patients receiving TKI for at least 6 months for Chronic Myelogenous Leukemia
  • Patient Reported Health-Related Quality of Life during Treatment for Advanced Cancer
  • Assessment and Management of Immune-Related Adverse Events during Cancer Treatment with Checkpoint Inhibitors
  • Assessment and Intervention for Psychosocial Distress in Adults Receiving Cancer Treatment
  • Assessment and Intervention for Sleep-Wake Disturbance During Cancer Treatment
  • Education on Neutropenia Precautions
  • Post-Treatment Education


ONS EBP and EBQI Resource Matrix


ONS Practice Resource

Quality Metric/Tools/Resources

Cancer-Related Fatigue

ONS Fatigue PEP Resources


Quality Metric:

1. Assessment for Fatigue – process measure

2. Recommendation for Exercise in Adult Cancer Survivors – process measure

3. Fatigue Improvement – outcome measure


Health-related Quality of Life


Quality Metric:

Health-related Quality of Life (HRQoL) in Advanced Cancer – outcome measure

Immune Mediated Adverse Events

ONS Immunotherapy-induced Diarrhea PEP Resources


Quality Metric:

Immune-mediated Adverse events – intermediate clinical outcome measure


ONS Radiodermatitis PEP Resources


Skin Toxicity

ONS Skin Reactions PEP Resources



ONS Lymphedema PEP Resources


Hot Flashes

ONS Hot Flashes PEP Resources



ONS Constipation PEP Resources


Sleep-Wake Disturbance

ONS Sleep-Wake Disturbance PEP Resources

Quality Metric:

Assessment and Intervention for Sleep-Wake Disturbance during Cancer Treatment – process metric

Prevention of Infection: General

ONS Prevention of Infection – General PEP Resources

Quality Metric: Education on Neutropenia Precautions – process measure

Anxiety and Depression

ONS Anxiety PEP Resources

ONS Depression PEP Resources

Quality Metric: Assessment and Intervention for Psychosocial Distress in Adults Receiving Cancer Treatment – process measure


Why Use ONS Quality Measures?
The ONS eCQMs address care priorities important to people with cancer during and after treatment. The measures address care delivered by the entire health care team, especially providing data to support the value of nursing contributions in delivering quality care.

The ONS eCQMs have been tested for feasibility, reliability and validity; you can use them with confidence and compare your performance to peers within your care setting and across the country.

Contact ONS staff at Research@ons.org to learn more.