Chemotherapy safety initiative.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 226-226
Author(s):  
Maria Tomaro ◽  
Paula Silverman ◽  
Wendy Rowehl Miano ◽  
Amy Wakeling ◽  
Kathleen Gonzalez
Keyword(s):  
Medication Errors ◽  
Gap Analysis ◽  
Safety Margin ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Institute Of Medicine ◽  
University Hospitals ◽  
Minor Variation ◽  
Order Sets ◽  
Order Set

226 Background: The 2006 Institute of Medicine report "Preventing Medication Errors," stated that “medication errors harm at least 1.5 million patients every year…” Chemotherapy (CT) has a narrow therapeutic index and safety margin which can and does lead to fatal errors. University Hospitals Seidman Cancer Center (UHSCC), an National Cancer Institute (NCI) designated Comprehensive Cancer Center, dispensed 10,500 CT doses in 2012 and has taken an active approach to enhance CT safety. Methods: In the last quarter of 2012, a nurse coordinator (NC) for chemotherapy orders and a Chemotherapy Safety Governance Committee (CSGC) was conceptualized. The NC’s role would be to incorporate CT safety best practices into order set development. The charter for the CSGC includes 1) to establish cancer CT standards and operating procedures across the adult and pediatric oncology population; 2) to develop and oversee cancer CT order set infrastructure applicable to our hybrid electronic/paper current state; and 3) to lead performance improvement initiatives related to CT safety. Leading organizations involved in oncology practice and medication safety standard-setting (ASCO, Oncology Nursing Society, Institute For Safe Medication Practices, National Comprehensive Cancer Network, Journal of Cancer Research) were reviewed for recommendations for standards for CT order sets. Results: Thirty standards for a CT order template were identified by the NC. A comprehensive gap analysis was completed to compare the current inpatient and ambulatory CT order sets to these standards. Results of the gap analysis were brought to the CSGC, a multi-disciplinary group of cancer and quality clinicians and leaders over 6 meetings. Consensus was achieved on the application of these standards to CT order sets. Our new orders will adopt 100% of all identified standards for CT orders. Conclusions: The gap analysis led to the development of a CT order set template that maximizes safety by applying best-practice standards. This template is designed to be applicable to electronic and paper-based order sets and with minor variation, appropriate to all disease-based order sets. This template is currently being utilized to revise 330 electronic and 398 paper CT order sets at UHSCC. [Table: see text]

Elective chemotherapy admission pilot and work-flow improvements to reduce excess days.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 101-101
Author(s):  
Wendy Rowehl Miano ◽  
Paula Silverman ◽  
Frank Colella ◽  
Bernadette McQuigg ◽  
Heather Hines ◽  
...  
Keyword(s):  
Intervention Group ◽  
Work Flow ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Order Entry ◽  
University Hospitals ◽  
Late Evening ◽  
Time Parameters ◽  
Flow Changes ◽  
And Control

101 Background: The Inpatient (Inpt) Oncology Service at University Hospitals Seidman Cancer Center, a large urban academic NCI Comprehensive Cancer Center was charged with identifying opportunities to link patient (pt) quality improvement and decreased length of stay (LOS) in pts admitted for elective chemotherapy (EC). Historically, EC admissions were delayed due to pt variables, inpt bed availability, and chemotherapy order entry errors. Often chemotherapy was not initiated until late evening on day of admission, resulting in increased LOS. Safety concerns associated with late starts included fewer pharmacy resources, lower nurse/pt ratio, and no onsite APRN. Methods: A 2-month pilot was conducted, using an intervention group (IG) and control (C) group representing usual care (UC). The IG group was a subset with oropharyngeal pts and C group, all other EC admissions. Pre-registration and bed placement processes were reviewed. Workflow changes for IG included chemotherapy order set entered in electronic medical record 48 hours before admission, labs drawn day before admission, and weekly huddle including admitting, inpt and outpatient (Outpt) teams to review upcoming week’s admissions. IG pts were pre-scheduled for am admission. Inpt oncology services incorporated admissions into morning workflow. Census was taken above cap to accommodate IG patients. Time parameters were tracked from point of pt arrival in Admitting to initiation of EC. Results: There were 32 pts in the 2-month pilot study; 14 in the IG and 9 in UC. Mean admit time was 0900 (range 0730-1030) for IG and 1200 noon (range 1000-1600) for UC. Initiation of EC before 1500 occurred in 93% of IG compared to 11% of UC pts. This resulted in an average decreased LOS for IG of 1.1 day compared to UC. Pt and family comments included appreciation of predictable admit time and LOS. Conclusions: Because of the 8-week pilot success, these EC workflow changes have been implemented across Oncology services. Weekly huddles and coordination of clinical services across inpt and outpt settings continue to show advantage of proactive planning and troubleshooting before the day of EC admission. More importantly, EC pt safety and experience has improved with these work-flow changes.

Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. Sweeney CJ, Chen YH, Carducci M, Liu G, Jarrard DF, Eisenberger M, Wong YN, Hahn N, Kohli M, Cooney MM, Dreicer R, Vogelzang NJ, Picus J, Shevrin D, Hussain M, Garcia JA, DiPaola RS. Department of Medicine; Department of Biostatistics and Computational Biology; Dana-Farber Cancer Institute, Boston; Harvard Medical School, Boston; Johns Hopkins University, Baltimore; University of Wisconsin Carbone Cancer Center; School of Medicine and Public Health; Madison; Fox Chase Cancer Center, Temple University Health System, Philadelphia; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis; Mayo Clinic, Rochester, MN; University Hospitals Case Medical Center, Seidman Cancer Center; Cleveland Clinic Taussig Cancer Institute; Both in Cleveland; University of Virginia Cancer Center, Charlottesville; Comprehensive Cancer Centers of Nevada, Las Vegas; Siteman Cancer Center, Washington University School of Medicine, St. Louis; NorthShore University Health System, Evanston, IL; University of Michigan Comprehensive Cancer Center, Ann Arbor; Rutgers Cancer Institute of New Jersey, New Brunswick.N Engl J Med. 2015 Aug 20;373(8):737-46. [Epub 2015 Aug 5]. doi: 10.1056/NEJMoa1503747.

2017 ◽  
Vol 35 (3) ◽  
pp. 123 ◽  
Author(s):  
Eggener Scott
Keyword(s):  
Health System ◽  
Medical Center ◽  
Cleveland Clinic ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
University Hospitals ◽  
University Of Wisconsin ◽  
School Of Medicine ◽  
Johns Hopkins University ◽  
Ann Arbor

Medication safety in cancer clinical trials: An analysis of medication error reports at a comprehensive cancer center

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6547-6547 ◽  
Author(s):  
M. P. Kane ◽  
K. Fessele ◽  
J. Gordilis-Perez ◽  
S. Schwartz ◽  
S. Lisi ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Medication Errors ◽  
Education And Training ◽  
Standards Of Care ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Healthcare Team ◽  
Improvement Project ◽  
And Training

6547 Background: Although medication errors comprise 10–25% of all medical errors, little is known concerning the occurrence or types of medication errors occurring while treating patients on a clinical trial. Therefore, we retrospectively reviewed the medication errors reported in patients enrolled on clinical trials at our center. Methods: As part of a multidisciplinary continuous quality improvement project, from January 2003 through December 2006, we collected voluntary reports of medication errors in adult and pediatric patients on clinical trials involving both oral and intravenous chemotherapy. All reports were classified prospectively regarding clinical trial involvement, severity category (A to I) per the National Coordination Council on Medical Error Reporting and Prevention, type, cause, and where in the medication use process the error occurred. Results: There were 163 reports involving patients treated on clinical trials. The most common errors were those corrected prior to reaching the patient in 68% of events (Category A&B), while 31% reached the patient but did not result in harm (Category C&D), with 1% resulting in temporary patient harm (Category E&F). The most common type of errors were prescribing (66%), improper dose (42%), and omission errors (9%). Not following an institutional procedure or the protocol was the primary cause for these errors (39%), followed by the written order (30%), and poor communication involving both the healthcare team and the patient (26%). The processes where the errors initiated were in prescribing 47%, administration 10%, dispensing 6%, and monitoring 5%. Conclusion: Medication errors do occur in clinical trials, however the majority of these are corrected prior to reaching the patient or do not result in harm. Not following an institutional procedure or the protocol was the most common cause of error. This is most likely due to the protocol procedures differing from existing standards of care. Protocol-specific education through the Centralized Education and Training Service, a shared resource within our cancer center, addresses this issue enhancing the quality and safety of clinical trials through the education and training of healthcare professionals. No significant financial relationships to disclose.

Impact of language on distress screening in cancer patients at an NCI-Designated Comprehensive Cancer Center.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18070-e18070
Author(s):  
Veronica Jones ◽  
Karen L. Clark ◽  
Susanne Warner ◽  
Jenny Rodriguez ◽  
Joanne E. Mortimer ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Treatment Options ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Institute Of Medicine ◽  
Distress Screening ◽  
Chi Square ◽  
Spanish Speaking ◽  
Significant Difference ◽  
Poor Outcomes

e18070 Background: Psychological distress has been linked to poor outcomes among cancer patients. In 2007, the Institute of Medicine reported that distress is often unrecognized. While much is known about distress screening in English speaking populations, little is known about the provision of screening in Spanish. Methods: From 2009-2016, over 9000 solid tumor and lymphoma patients treated at an NCI CCC were prospectively administered a validated biopsychosocial distress questionnaire in their preferred language. The data was retrospectively stratified by language and Chi-square and ANOVA tests were performed to detect differences. Results: Spanish-speaking patients had the highest levels of reported distress in every category when compared to any other group. Of the 629 patients that reported Spanish as their preferred language, 400 (63.6%) took the questionnaire in Spanish (SS) with the rest taking it in English (SE). There was no difference in reported gender, marital status, education level or income between the two groups. The SS patients were younger (mean age 56 vs 60.5, P = 0.00) and reported significantly higher distress than the SE patients in every biopsychosocial domain except functional. The greatest difference was seen in “understanding treatment options” (40.1% SS vs 19% SE, p = 0.00) with a significant difference seen also in “fear of medical procedures” (38.2% SS vs 29.9% SE, p = 0.037), “finances” (66.5% SS vs 55.4% SE, p = 0.01), “finding community resources” (34.8% SS vs 26% SE, p = 0.03), “managing emotions” (40.3% SS vs 31.5% SE, p = 0.032), “needing help to coordinate care” (41% SS vs 23.4% SE, p = 0.00) and “transportation” (35.2% SS vs 21.9% SE, p = 0.001). The distress of the SE patients was more similar to that seen in the English-English patients, but was still significantly higher. Conclusions: These provocative data demonstrate distress levels are stratified by preferred language among cancer patients. Spanish speaking patients had the highest levels of reported distress but this difference was more pronounced when they were administered the questionnaire in Spanish. More studies are needed to determine culturally effective ways to identify distress in Spanish speaking populations.

Improving the cancer chemotherapy use process.

1996 ◽  
Vol 14 (12) ◽  
pp. 3148-3155 ◽  
Author(s):  
D S Fischer ◽  
S Alfano ◽  
M T Knobf ◽  
C Donovan ◽  
N Beaulieu
Keyword(s):  
Cancer Chemotherapy ◽  
Gynecologic Oncology ◽  
University Hospital ◽  
Cancer Center ◽  
University Hospitals ◽  
Cancer Centers ◽  
Order Sets ◽  
American Society ◽  
Effective Use ◽  
Attending Physicians

PURPOSE Reports of the tragic consequences of erroneous cancer chemotherapy overdoses at a prominent cancer center and a university hospital prompted a review of our institution's practices and those of 123 other hospitals to ascertain for each the current in-house process to prevent chemotherapy errors. METHODS A multidisciplinary committee of oncologists, nurses, and pharmacists reviewed the chemotherapy use process and identified opportunities for improvement. A 1-page facsimile survey was answered by 150 of 215 members of the American Society of Clinical Oncology (ASCO) who received it. RESULTS We further restricted the writing of cytotoxic chemotherapy orders to physicians who were board-certified or -eligible in hematology or medical, pediatric, and gynecologic oncology and their approved fellows. Dispensation of drugs is limited to oncology-certified pharmacists, and administration to chemotherapy-certified nurses. Standard orders are used either on special oncology forms or designated order sets in the computer. Procedures to regulate the ordering of antineoplastic drugs for nonmalignant indications by nononcology specialists are outlined. A process to prevent chemotherapy errors is in place in 95% of hospitals. Dedicated medical oncology units are ubiquitous, and most cancer centers and university hospitals have dedicated gynecologic and pediatric oncology units. Chemotherapy orders are generally written by oncology fellows and countersigned by an attending oncologist in cancer centers and university hospitals, whereas private oncology attending physicians write them in most community hospitals. Drugs are administered by oncology-certified nurses in most institutions. CONCLUSIONS These recommendations should improve the safety and effective use of chemotherapy and reduce the error rate to as close to zero as human fallibility will allow.

The financial implications of a conversion from enoxaparin to dalteparin as the LMWH of choice at a comprehensive cancer center

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17566-e17566
Author(s):  
S. G. Patterson ◽  
P. Johnson ◽  
B. Bradbury ◽  
J. Tata ◽  
R. Quilitz ◽  
...  
Keyword(s):  
Low Molecular Weight Heparin ◽  
Cost Savings ◽  
Fiscal Year ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Low Molecular Weight ◽  
Significant Cost ◽  
Order Sets ◽  
The One ◽  
Full Class

e17566 Background: To assess the financial implications of a conversion from enoxaparin to dalteparin as the low molecular weight heparin (LMWH) of choice at a large, comprehensive cancer center. Methods: A full class review of LMWH's was conducted in September of 2007 resulting in dalteparin replacing enoxaparin as the LMWH of choice. The Pharmacy and Therapeutics Committee approved automatic substitution with notification of the prescribing physician. The one exception to the policy was conversion if the patient was on enoxaparin at home, the policy would allow for continuation of therapy. Once the policy was approved, laminated dosing conversion cards and pre-printed order sets were developed. Multiple in-services were held prior to the official conversion date of October 15, 2007, to address any issues and to facilitate the conversion. Cost comparisons were made within individual settings adjusting for utilization levels. Results: In the fiscal year prior to the conversion from enoxaparin to dalteparin the cancer center purchased nearly $360,000 of enoxaparin for the inpatient and infusion center settings. In the year following the LMWH change, the total projected cost for LMWHs is $244,000, resulting in a 32% cost savings of $115,000. Conclusions: The change from enoxaparin to dalteparin resulted in significant cost savings for the cancer center. Additional studies are underway to examine the clinical outcomes of the LMWH change. No significant financial relationships to disclose.

Multidisciplinary optimization of oral chemotherapy delivery at the UW Carbone Cancer Center.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 58-58
Author(s):  
Daniel Mulkerin ◽  
Mary Mably ◽  
Jason Bergsbaken ◽  
Kari Schuhmacher ◽  
Chris Nemergut ◽  
...  
Keyword(s):  
Gap Analysis ◽  
Oral Chemotherapy ◽  
Multidisciplinary Optimization ◽  
Cancer Center ◽  
Safety Standards ◽  
Institutional Practice ◽  
Caregiver Education ◽  
Chemotherapy Administration ◽  
Partial Compliance ◽  
Order Sets

58 Background: Use of oral chemotherapy is expanding and offers advantages but introduces unique safety challenges. ASCO and ONS addressed these issues with inclusion of oral chemotherapy in published chemotherapy administration safety standards. Methods: The updated ASCO/ONS standards offered a framework for the University of Wisconsin Carbone Cancer Center to evaluate and improve our practice with the goal of full compliance with these standards. Gap analysis revealed noncompliance with five and partial compliance with eleven standards. We divided areas for improvement into three foci: patient education, workflow, and information technology. Multidisciplinary groups addressed each area generating twenty-five recommendations. Important changes included: defining chemotherapy, standardization of patient and caregiver education, mandated use of standardized electronic order sets incorporating safety checks, and standardizing dose modification documentation. The revised electronic process allows for prospective order review of all oral chemotherapy by pharmacists and supports automated processes for assessing adherence and toxicities utilizing a library of scripted drug specific materials. Results: Prior to implementation of new processes we estimated that only 39% of our oral chemotherapy was delivered with potential demonstrable compliance with ASCO/ONS standards. Audit of oral chemotherapy orders from February to July 2015 now shows compliance with use of electronic chemotherapy plans in 244/251 (97.5%) of cases. Prospective pharmacist order review resulted in one or more interventions in 24% of these cases.Identification of patients to receive adherence and toxicity monitoring calls is 100%. Conclusions: Closure of significant gaps between institutional practice and published standards was accomplished for our oral chemotherapy practice. Key elements of success included: multidisciplinary approach, defining chemotherapy, leveraging our electronic health record with mandated use of standardized order sets, and standardization of clinical and educational processes. We are disseminating this approach across our regional network and we believe our tools are broadly applicable.

A pilot study about methods to reduce prescription errors in a chemotherapy day unit – Aspects to consider in pharmacist verification process

2021 ◽  
pp. 107815522110665
Author(s):  
Asta Kähkönen ◽  
Sanna Eestilä ◽  
Kirsi Kvarnström ◽  
Riikka Nevala
Keyword(s):  
Medication Errors ◽  
Clinical Pharmacist ◽  
University Hospital ◽  
Medical Documentation ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Prescribing Errors ◽  
Common Error ◽  
Training Requirements ◽  
Clinically Significant

Introduction Prescribing errors can happen unintentionally during the prescribing process, or when choosing a treatment therapy. Prescribing errors have the highest prevalence amongst common error types related to chemotherapy medication in outpatient settings. According to the Joint Commission International (JCI), prescriptions should be reviewed for appropriateness by someone else than the prescriber or practitioner to prevent medication errors. Aim The study was aimed to map out the existing type and amount of occurring deviations in prescribing and to clarify the current chemotherapy prescribing practices at the Comprehensive Cancer Center at Helsinki University Hospital. Similar research has not been published in Finland before. Methods and patients The researcher selected patients randomly from the daily outpatient attendance list following a predetermined numerical order. Data was collected by conducting a medication verification review in line with the JCI guidance by a clinical pharmacist the day before the patient's clinic appointment using the available medical documentation. A clinical pharmacist evaluated findings from prescriptions and contacted an oncologist if the findings were considered clinically significant. Results A clinical pharmacist verified prescriptions from 101 patients for appropriateness and found discrepancies in four percent of the prescriptions ( n = 4/101). The oncologist approved 50 percent of the suggested amendments by the pharmacist as clinically significant ( n = 2/4). The study revealed that patient’s regular home medications were not always correctly recorded into the database, so verification of medicine interactions could not be trusted as completely accurate. It took on average 16 min per patient to perform a medication verification review. The process was slowed down by the lack of detailed enough protocols for this purpose and the current patient care record system not having structural formatting of data entry. Conclusions Verification of prescriptions provides a tool to identify prescribing discrepancies and to prevent unintended medication errors affecting patients. The development of detailed protocols and guidelines, as well as an appropriate training program, would support pharmacists in compiling clinical medication reviews for chemotherapy patients. More research is needed to further develop the operating model in Finland. Information gathered from this study can be used for identifying training requirements.

scholarly journals Multidisciplinary Optimization of Oral Chemotherapy Delivery at the University of Wisconsin Carbone Cancer Center

2016 ◽  
Vol 12 (10) ◽  
pp. e912-e923 ◽  
Author(s):  
Daniel L. Mulkerin ◽  
Jason J. Bergsbaken ◽  
Jessica A. Fischer ◽  
Mary J. Mulkerin ◽  
Aaron M. Bohler ◽  
...  
Keyword(s):  
Gap Analysis ◽  
Oral Chemotherapy ◽  
Multidisciplinary Optimization ◽  
Cancer Center ◽  
Oncology Nursing ◽  
Safety Standards ◽  
University Of Wisconsin ◽  
Order Sets ◽  
The University ◽  
Electronic Order

Purpose: Use of oral chemotherapy is expanding and offers advantages while posing unique safety challenges. ASCO and the Oncology Nursing Society jointly published safety standards for administering chemotherapy that offer a framework for improving oral chemotherapy practice at the University of Wisconsin Carbone Cancer Center. Methods: With the goal of improving safety, quality, and uniformity within our oral chemotherapy practice, we conducted a gap analysis comparing our practice against ASCO/Oncology Nursing Society guidelines. Areas for improvement were addressed by multidisciplinary workgroups that focused on education, workflows, and information technology. Recommendations and process changes included defining chemotherapy, standardizing patient and caregiver education, mandating the use of comprehensive electronic order sets, and standardizing documentation for dose modification. Revised processes allow pharmacists to review all orders for oral chemotherapy, and they support monitoring adherence and toxicity by using a library of scripted materials. Results: Between August 2015 and January 2016, revised processes were implemented across the University of Wisconsin Carbone Cancer Center clinics. The following are key performance indicators: 92.5% of oral chemotherapy orders (n = 1,216) were initiated within comprehensive electronic order sets (N = 1,315), 89.2% compliance with informed consent was achieved, 14.7% of orders (n = 193) required an average of 4.4 minutes review time by the pharmacist, and 100% compliance with first-cycle monitoring of adherence and toxicity was achieved. Conclusion: We closed significant gaps between institutional practice and published standards for our oral chemotherapy practice and experienced steady improvement and sustainable performance in key metrics. We created an electronic definition of oral chemotherapies that allowed us to leverage our electronic health records. We believe our tools are broadly applicable.

Implementation of a student pharmacist-driven medication history service for ambulatory oncology patients in a large academic medical center

2019 ◽  
Vol 25 (6) ◽  
pp. 1419-1424 ◽  
Author(s):  
Ha Phan ◽  
Macey Williams ◽  
Kelly McElroy ◽  
Bradley Burton ◽  
Denise Fu ◽  
...  
Keyword(s):  
High Risk ◽  
Medication Errors ◽  
Academic Medical Center ◽  
Chemotherapeutic Agents ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Johns Hopkins Hospital ◽  
Medication History ◽  
Oncology Patients ◽  
Ambulatory Oncology

Objective Patients who have an up-to-date and accurate medication list are less susceptible to medication errors and allow care teams to make more informed treatment decisions. Through utilizing student pharmacists to provide medication history services, we anticipate improved patient safety and overall quality of patient care. The purpose of this project was to implement a medication history service for ambulatory oncology patients of the Sidney Kimmel Comprehensive Cancer Center at the Johns Hopkins Hospital. Methods A phased approach was utilized to implement a standardized operating procedure for completing medication histories in ambulatory oncology patients. Data collection included number of total medication discrepancies, percentage of patients with high-risk medications, and high-risk medication classes involved in discrepancies. Additionally, time data were collected, including time spent calling the patient, completing patient work up, and preceptor oversight. Results Students completed medication histories for 60 patients; 83% of patients had at least one discrepancy with 21% of those discrepancies involving a high-risk medication. High-risk medications involved in discrepancies included oral chemotherapeutic agents, anticoagulants, insulin, and opioids. Conclusion The majority of patients seen had at least one medication discrepancy that was identified and corrected through the medication history service. By correcting the discrepancy, the likelihood of medication errors occurring was decreased. Continuous workflow changes are being made to identify the number and type of resources to expand the service to all appropriate ambulatory oncology patients at the Sidney Kimmel Comprehensive Cancer Center.

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