Developing a standardized protocol for the prescription of oral chemotherapy.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 120-120
Author(s):  
Nirav Niranjan Shah ◽  
Donna L. Capozzi ◽  
Erica Casella ◽  
Suzanne McGettigan ◽  
Tara C. Gangadhar ◽  
...  
Keyword(s):  
Informed Consent ◽  
Policy Change ◽  
Nurse Practitioners ◽  
Oral Chemotherapy ◽  
Route Of Administration ◽  
University Of Pennsylvania ◽  
Cancer Center ◽  
Safety Standards ◽  
Time Period ◽  
The University

120 Background: Over the last 10 years there has been a dramatic increase in the use of oral chemotherapy in the treatment of cancer. However, despite the route of administration, oral chemotherapies carry many of the same risks as intravenous agents and may have greater risks of drug-drug interactions due to variability in absorption and metabolism. Due to these risks, ASCO included oral chemotherapy as part of their updated chemotherapy safety standards in 2013. With this in mind, we sought to examine and improve the reliability and safety of the oral chemotherapy prescription process at the Abramson Cancer Center (ACC) of the University of Pennsylvania. Methods: A multi-disciplinary quality improvement team consisting of oncologists, nurse practitioners, and pharmacists was formed to analyze the current state of our oral chemotherapy practice. We identified an absence of signed informed consent and lack of pharmacist prescription review as areas for improvement. To address these deficiencies, we electronically routed our oral chemotherapy orders to an oncology specific pharmacist for review and implemented a policy change requiring that oral chemotherapy have signed informed consent. These changes were applied to the melanoma group of the ACC. Results: Over a 3 month time period, 33 orders for oral chemotherapy were placed for 18 individual patients. Signed informed consent was obtained in 9 of 18 patients (50%). Of the 33 orders, all were reviewed by ACC pharmacists, and as a result, 11 interventions were made by these providers (33%). Types of interventions included dose adjustment (9%), modification of an interacting drug (27%), and additional monitoring specific to the oral agent (64%). Conclusions: Despite its route of administration, oral chemotherapy should be prescribed and reviewed with the same oversight as intravenous chemotherapy. At our institution, involvement of an oncology specific pharmacist in the review of oral chemotherapy led to meaningful interventions in about 1/3 of orders, and with a policy change, signed informed consent was performed in 1/2 of patients. Given these findings, and the clinical implications of this pilot, we plan to continue to study and disseminate this intervention throughout our cancer center.

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.

scholarly journals Improving the Safety of Oral Chemotherapy at an Academic Medical Center

2016 ◽  
Vol 12 (1) ◽  
pp. e71-e76 ◽  
Author(s):  
Nirav N. Shah ◽  
Erica Casella ◽  
Donna Capozzi ◽  
Suzanne McGettigan ◽  
Tara C. Gangadhar ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Medical Center ◽  
Academic Medical Center ◽  
Lean Six Sigma ◽  
Oral Chemotherapy ◽  
University Of Pennsylvania ◽  
Cancer Center ◽  
Improvement Project ◽  
Academic Medical ◽  
The University

Purpose: Over the last decade, the use of oral chemotherapy (OC) for the treatment of cancer has dramatically increased. Despite their route of administration, OCs pose many of the same risks as intravenous agents. In this quality improvement project, we sought to examine our current process for the prescription of OC at the Abramson Cancer Center of the University of Pennsylvania and to improve on its safety. Methods: A multidisciplinary team that included oncologists, advanced-practice providers, and pharmacists was formed to analyze the current state of our OC practice. Using Lean Six Sigma quality improvement tools, we identified a lack of pharmacist review of the OC prescription as an area for improvement. To address these deficiencies, we used our electronic medical system to route OC orders placed by treating providers to an oncology-specific outpatient pharmacist at the Abramson Cancer Center for review. Results: Over 7 months, 63 orders for OC were placed for 45 individual patients. Of the 63 orders, all were reviewed by pharmacists, and, as a result, 22 interventions were made (35%). Types of interventions included dosage adjustment (one of 22), identification of an interacting drug (nine of 22), and recommendations for additional drug monitoring (12 of 22). Conclusion: OC poses many of the same risks as intravenous chemotherapy and should be prescribed and reviewed with the same oversight. At our institution, involvement of an oncology-trained pharmacist in the review of OC led to meaningful interventions in one third of the orders.

Evaluation of fosaprepitant-associated hypersensitivity reactions at a National Cancer Center

2020 ◽  
Vol 26 (6) ◽  
pp. 1369-1373 ◽  
Author(s):  
Catherine Michelle Laird ◽  
Ashley E Glode ◽  
Kerry Schwarz ◽  
Elaine T Lam ◽  
Cindy L O'Bryant
Keyword(s):  
Small Sample Size ◽  
Medication Administration ◽  
Small Sample ◽  
Patient Specific ◽  
Cancer Center ◽  
Hypersensitivity Reactions ◽  
University Of Colorado ◽  
Time Period ◽  
Systemic Hypersensitivity ◽  
The University

Introduction At our institution, an increased incidence of hypersensitivity reactions was reported following standardization of fosaprepitant as the preferred agent for the prophylaxis of chemotherapy induced nausea and vomiting (CINV) caused by highly emetogenic therapies. The purpose of this evaluation was to assess the incidence of systemic hypersensitivity reactions (HSRs) to fosaprepitant infusions compared to available literature. Methods This evaluation is a retrospective review of electronic health records of adult patients who received their first dose of fosaprepitant for CINV prophylaxis beginning January 1, 2017 through June 30, 2017 at the University of Colorado Cancer Center outpatient infusion center. Subjects were identified using medication administration reports. Individual chart reviews were performed for all patients who received fosaprepitant during the specified timeframe and had a reaction reported on the same date. Results A total of 868 patients received fosaprepitant in the outpatient infusion center during the study time period. Four patients (0.461%) had a systemic HSR attributed to fosaprepitant. Two of the reactions were reported as HSRs in the adverse reaction reporting system and two were found in provider notes during chart review. Due to the small sample size, risk factors for HSRs to fosaprepitant were not able to be determined. Conclusion The incidence of HSRs to fosaprepitant at our institution was found to be consistent with the <1% incidence currently noted in literature. Based on these findings, opportunities have been identified for education on fosaprepitant-associated HSRs, proper documentation and patient-specific precautions.

scholarly journals Financial impact of oral chemotherapy wastage on society and the patient

2018 ◽  
Vol 25 (4) ◽  
pp. 824-830 ◽  
Author(s):  
Varun Monga ◽  
Chenise Meyer ◽  
Brandon Vakiner ◽  
Gerald Clamon
Keyword(s):  
Cancer Progression ◽  
Financial Burden ◽  
Wholesale Price ◽  
Oral Chemotherapy ◽  
Financial Impact ◽  
Insurance Companies ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Time Period ◽  
Oral Agents

Background Targeted oral agents are now increasingly being utilized in cancer treatment, but are expensive. Changing the dose of these medications due to toxicity or discontinuation secondary to disease progression or death causes waste from unused medication. Limiting waste is an important goal, as waste has a substantial financial impact on patients and insurance companies. Methods Patients started on oral targeted agents' sunitinib, everolimus, axitinib, or vemurafenib between January 2012 and February 2015 who obtained their medications at Holden Comprehensive Cancer Center specialty pharmacy were included in the analysis. We acquired dispensing data retrospectively for each of the agents and reviewed patient charts. Wasted tablets/capsules were calculated from their last fill to the dates of stoppage or dose adjustment. The amount associated with the wastage was calculated using the average wholesale price. Repository drug usage data during the same time period was obtained. Results Eighty-eight patients had their prescriptions filled at Holden Comprehensive Cancer Center during the study time period. Waste occurred in 41% of all patients with primary reasons attributed to cancer progression in 25 patients, death in five patients, toxicity in five patients and increase in dosage of targeted therapy in two patients. A total of 1179 tablets or capsules were wasted from all causes, priced at a total of $248,595.69. Conclusion Oral chemotherapy medications are associated with wastage, which is a significant financial burden to society. Progression of disease emerged as the single most important factor accounting for wastage. Novel ideas are needed to prevent wastage, thereby reducing healthcare costs.

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.

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