• Introduce standardized forms and flowcharts to create a routine for documenting a patient's clinical status (stable or unstable) in the medical record.
• Use stamps or stickers in progress notes that include ARV management criteria and stable/unstable status assessment to facilitate documentation at every encounter.
• Routinely communicate the expectation to all providers that they will consistently document the rationale for ARV management decisions at all times.
• Modify forms for medical history and physicals by including checkboxes (to the extent possible) to improve documentation about ARV management.
• Encourage patients to record their issues related to ARV management (e.g., adherence, ARV meds, side effects, etc.) prior to a clinical appointment.
• Develop a progress note that prompts providers at each visit to address and review CD4 count, viral load, and treatment plans.
• Include a case management section in the medical record to record case management interventions related to ARV management.
• Reorganize medical records to better coordinate information about ARV management, such as lab values, ARV medications, adherence assessment information, case management notes, etc.
• Accelerate return of laboratory and other results into the medical record by working with lab representatives and clinic staff; engage them in a QI project.
• Create or modify existing flow sheets:
  • Develop standardized forms covering the following areas:
    • CD4 and viral load monitoring with trends; provide a visual display of data over time
    • Triggers for action when a patient’s viral load is more than 1,000 cells/mm³
    • Automatically indicate whether the viral load changes in logs
    • Include specific ARV management parameters to provide decision support
  • Utilize medication flow sheet with documentation about adherence

Promoting Adherence to HIV Antiretroviral Therapy