Improving the safe delivery of systemic treatment by assessing concordance with labeling guidelines.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 257-257
Author(s):  
Kathy Vu ◽  
Vicky Simanovski ◽  
Leonard Kaizer ◽  
Esther Green ◽  
Sherrie Hertz ◽  
...  
Keyword(s):  
Cancer Care ◽  
Individual Component ◽  
Systemic Treatment ◽  
Intravenous Chemotherapy ◽  
Safe Delivery ◽  
Culture Of Safety ◽  
Measurement Strategy ◽  
Improvement Strategies

257 Background: Improper labeling of medication may lead to errors. In 2009, Cancer Care Ontario published Key Components of Chemotherapy Labeling, with recommendations for the necessary components and formatting of intravenous chemotherapy labels. A jurisdiction-wide evaluation for concordance occurred in 2011. Results were shared, improvement efforts were supported through a provincial quality network, and a re-evaluation was conducted in the fall of 2013. Methods: Three defined chemotherapy labels were evaluated at baseline and after improvement strategies were implemented at each of Ontario’s 77 hospitals providing systemic treatment. Labels were reviewed centrally and awarded points for concordance for each of 15 guideline-specified criteria. Results: The provincial average overall score for concordance increased from 59% to 80% (p<0.001). Improvement was seen for 12 of the 15 criteria evaluated and for 64 of the 77 facilities. The greatest increase in overall score by a facility was 53.4%. The greatest overall improvement in score for an individual component was 67% (TALLman lettering). The scores of 2 components were unchanged, as 100% concordance was achieved on both the baseline and re-evaluation. Conclusions: Improvement in concordance to chemotherapy labeling guidelines was observed following the implementation of a measurement strategy and improvement plans. This approach is one component of a larger strategy to promote a culture of safety in chemotherapy delivery in Ontario. [Table: see text]

scholarly journals Toward a Common Goal: Improving Safety of Oral Chemotherapy Prescribing Practices at a Jurisdictional Level

2020 ◽  
Vol 16 (9) ◽  
pp. e1036-e1044
Author(s):  
Marla Campbell ◽  
Kathy Vu ◽  
Aliya Pardhan ◽  
Daniela Gallo-Hershberg ◽  
Rosemary Ku ◽  
...  
Keyword(s):  
Cancer Care ◽  
Systemic Treatment ◽  
Implementation Strategies ◽  
Oral Chemotherapy ◽  
Prescribing Practices ◽  
Culture Of Safety ◽  
Quality Cancer Care ◽  
Treatment Facilities ◽  
Chart Audits ◽  
Physician Order Entry

PURPOSE: Extending the safety agenda from parenteral to oral chemotherapy was identified as a provincial improvement priority in the 2014-2019 Cancer Care Ontario (CCO) Systemic Treatment Provincial Plan. Elimination of handwritten prescriptions for oral chemotherapy was one of the specific goals and led to a provincial quality improvement (QI) initiative involving systemic treatment facilities across 14 regional cancer programs. METHODS: The initiative was centrally organized by CCO but locally implemented by the regional partners. CCO provided templates and tools, such as preprinted orders (PPOs), project charters, and an evaluation plan, and facilitated cross-jurisdictional knowledge sharing and exchange. Regions had flexibility in determining their local implementation strategies and were responsible for conducting chart audits to evaluate implementation success. Each participating hospital completed 3 audits—at baseline, immediately after implementation (audit 1), and 1 year later (audit 2)—using either a clinic-based or an outpatient pharmacy–based assessment. RESULTS: Thirty-five facilities providing systemic treatment participated. At baseline, the provincial average for the use of computerized physician order entry (CPOE) or PPOs for prescribing oral chemotherapy was 71%. After implementation of the QI initiative, the provincial average for the use of CPOE or PPO increased to 91% at audit 1 and 95% at audit 2. CONCLUSION: Although not all facilities met the goal of 100% CPOE or PPO compliance, the QI initiative led to improvement in safe prescribing practices for oral chemotherapy. A coordinated QI approach between a central decision maker and local partners can be an effective strategy to encourage high-quality cancer care and promote a culture of safety across a jurisdiction.

scholarly journals A tool to improve the performance of multidisciplinary teams in cancer care

2019 ◽  
Vol 8 (2) ◽  
pp. e000435 ◽  
Author(s):  
Lynleigh Evans ◽  
Brendan Donovan ◽  
Yiren Liu ◽  
Tim Shaw ◽  
Paul Harnett
Keyword(s):  
Performance Improvement ◽  
Team Performance ◽  
Cancer Care ◽  
Assessment Tool ◽  
Multidisciplinary Teams ◽  
Self Assessment ◽  
Team Members ◽  
Innovative Methodology ◽  
Improvement Strategies ◽  
The Matrix

IntroductionWhile multidisciplinary teams (MDTs) are well established in many healthcare institutions, both how they function and their role in decision-making vary widely. This study adopted an innovative methodology to assess multidisciplinary team performance and engage teams in performance improvement strategies.MethodsThe study comprised a survey to evaluate MDT members’ perceptions of their team’s performance before the implementation of the programme and annually thereafter, and a maturity matrix designed as a self-assessment tool. Each MDT used the matrix to collectively assess its performance and identify areas for improvement.ResultsIn the first cycle, 180 member surveys from 19 MDTs were completed. This provided insights into team members’ perceptions of performance. 12 of these teams continued with the study and all 12 completed the matrix. Most teams rated themselves at level one or two (low) on a scale of five for most items.ConclusionsThe MDT survey and maturity matrix have the potential to be useful for cancer care teams to identify their strengths and weaknesses and monitor performance over time and also for management to review its performance against standard criteria and to identify priority areas for improvement and further support.

Enabling quality improvement in systemic cancer treatment through a collaborative approach.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 88-88
Author(s):  
Vicky Simanovski ◽  
Sherrie Hertz ◽  
Esther Green ◽  
Elaine Meertens ◽  
Leonard Kaizer ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Health Care Providers ◽  
Large Scale ◽  
Systemic Treatment ◽  
Lessons Learned ◽  
Average Score ◽  
Quality And Safety ◽  
Care Providers ◽  
Safe Delivery ◽  
Regional Engagement

88 Background: The Regional Systemic Treatment Program at Cancer Care Ontario (CCO) aims to ensure the highest quality of systemic treatment is available to Ontarians, as close to home as possible. CCO initiated a provincial collaborative with the aim of improving the safe delivery of parenteral chemotherapy from orders through preparation, to administration, for patients, and providers. Methods: From April 2011 to March 2012, interdisciplinary hospital teams across Ontario followed multiple Plan, Do, Study, Act cycles to perform QI projects focusing on safe delivery of systemic treatment. Over this period, three in-person sessions educating participants on improvement methodology were held. Monthly teleconferences and an electronic discussion forum encouraged a culture of knowledge sharing and collaboration. Results: 113 participants from 26 teams participated in a total of 81 improvement initiatives. 96% of participants surveyed indicated that the collaborative provided a valuable opportunity to network with peers, share ideas, and discuss lessons learned. During the collaborative, teams reported their progress on a scale of 1-5. At May 2011, teams averaged a self-assessment score of 1, indicating no progress had been made. By February 2012, this increased to an average score of 4, indicating significant progress and achievement of at least one improvement objective/goal. CCO has leveraged the foundations built by the collaborative to develop a Regional Quality and Safety Network. This network provides a regular forum for health care providers and administrators to share knowledge and collaborate on strategies for improving quality and safety in the delivery of systemic treatment. Conclusions: The collaborative demonstrated that the use of a formal quality improvement model is a successful mechanism for regional engagement; that provides the foundation necessary for building a provincial network with common goals and understanding regarding quality improvement. By educating participants, supporting local efforts and enabling knowledge transfer and exchange, the collaborative showed that shared ideas and even small changes can lead to large-scale improvements for patients and providers.

Assessing the use of low value oncology care following the release of Choosing Wisely guidelines.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18861-e18861
Author(s):  
Alexander Gunn ◽  
Melissa Sarver ◽  
Samantha J Kaplan ◽  
Yousuf Zafar ◽  
Rachel Adams Greenup
Keyword(s):  
Cancer Screening ◽  
Guideline Adherence ◽  
Cancer Care ◽  
Systemic Treatment ◽  
The United States ◽  
Choosing Wisely ◽  
Surveillance Imaging ◽  
Patient Reported ◽  
Oncology Care ◽  
The Impact

e18861 Background: Low -value care contributes to the high costs of cancer treatment. Almost a decade has passed since the American Society of Clinical Oncology (ASCO) Choosing Wisely campaign identified costly diagnostic testing, radiographic imaging, and therapies that are routinely utilized in cancer care despite lacking evidence of benefit. We sought to evaluate the impact of ASCO Choosing Wisely guidelines and to identify barriers to and facilitators of guideline adherence. Methods: A systematic review of published literature from 2012-2021 was performed in accordance with PRISMA guidelines on the trend in use of low value oncology care. All ten of ASCO Choosing Wisely Guidelines were selected for inclusion; these included recommendations focused on cancer screening, staging and surveillance imaging, and systemic treatment and support. The following databases were searched for original research based in the United States: PubMed, CINAHL, Embase, Web of Science, Scopus, and ASCO Meeting abstracts. Eligible studies were examined for information on design, population, and study outcomes, which included guideline adherence and facilitators and barriers to implementation. All citations were independently dual-screened in a blinded fashion by authors (AG, MS). Results: 35 independent studies were identified from 3,590 unique citations and included n = 1,130,216 patients. Data sources captured large claims database analyses (13 studies, n = 1,069,289), institutional studies (14 studies, n = 53,358), patient-reported surveys (2 studies, n = 915), and interventional studies (6 studies, n = 6654). Adherence to ASCO Choosing Wisely guidelines ranged from 13% to 100% overall. Use of low value oncology care varied depending on the area of recommendation, such as cancer screening (44% to 77%), staging and surveillance imaging (30% to 100%), and systemic treatment and support (13% to 100%). Adherence was facilitated by: (a) physician awareness of and education around the recommendations; (b) patient engagement; (c) embedded EHR best practice alerts; (d) guideline alignment with insurance payer requirements; and (e) integrated healthcare systems. Barriers to guideline incorporation included perceived patient anxiety and concerns about patient satisfaction; illness-specific practices; and time needed for patient-provider conversations regarding low value care. Conclusions: Adherence to the ASCO Choosing Wisely guidelines is variable across the cancer care continuum. Health system and policy-level interventions are needed to further reduce the overuse of low value care in oncology.

Key components of intravenous chemotherapy labeling: A systematic review and practice guideline

2010 ◽  
Vol 17 (4) ◽  
pp. 409-424 ◽  
Author(s):  
Maureen Trudeau ◽  
Esther Green ◽  
Roxanne Cosby ◽  
Flay Charbonneau ◽  
Tony Easty ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
English Language ◽  
Data Extraction ◽  
Sources Of Information ◽  
Inclusion Criteria ◽  
Intravenous Chemotherapy ◽  
Safe Delivery ◽  
Environmental Scan ◽  
Relevant Evidence ◽  
Study Characteristics

Objective. To determine the necessary components and formatting of an intravenous chemotherapy label to maximize safe delivery and minimize errors. Date sources. The MEDLINE and EMBASE databases (up to April 2009) were searched for relevant evidence. Reference lists from retained studies were then searched for additional trials. An environmental scan was also conducted to locate other published and unpublished sources of information. Study selection. Relevant articles were selected and reviewed by one methodologist. Articles were selected for inclusion if they were published English language reports of Phases II or III randomized controlled trials, other comparative studies, single-arm studies, practice guidelines, or systematic reviews with or without meta-analyses, which related to the study question. MEDLINE and EMBASE searches yielded 685 potential studies of which 17 met the inclusion criteria. The environmental scan located one guideline. Three additional relevant studies were identified during the external review process. In total, 21 documents met the inclusion criteria. Data extraction. Data were extracted by one methodologist. Quality of systematic reviews was assessed using the AMSTAR tool. All other studies were evaluated based on study characteristics applicable to the particular study design. Data synthesis. The evidence collected and the consensus of expert opinion of Cancer Care Ontario’s Chemotherapy Labeling Panel form the basis of a series of recommendations for the generation of intravenous chemotherapy labels including formatting, required information, and order of information. These guidelines inform the efficient, effective, and safe administration of intravenous chemotherapy. Illustrative examples are provided.

Patients as partners in managing cancer treatment-related toxicity.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 215-215
Author(s):  
Erin Redwood ◽  
Kathy Vu ◽  
Meaghan Wright ◽  
Colleen Fox ◽  
Noor Ahmad ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Cancer Care ◽  
Systemic Treatment ◽  
Safety Issues ◽  
Cancer Services ◽  
Medical Oncologists ◽  
The Government ◽  
Treatment Safety ◽  
Oncology Providers ◽  
First Time

215 Background: Cancer Care Ontario is the government agency responsible for improving cancer services across Ontario’s 14 regions. To promote advances in best practices related to systemic treatment, Cancer Care Ontario hosts annual Systemic Treatment Safety Symposia, which serve as a platform to discuss quality and safety issues and results of quality improvement (QI) initiatives in alignment with the Systemic Treatment Provincial Plan. For the first time, the 2015 Symposium brought together patients and providers to discuss gaps and opportunities for improvement in relation to toxicity management (TM) during chemotherapy. The main goal of the event was to define improvement priorities. Methods: The Symposium presents a valuable engagement opportunity with regional stakeholders including medical oncologists, nurses, pharmacists, administrators and patient and family advisors. An interactive agenda was designed to elicit direction from these stakeholders. At the event attendees identified and prioritized improvement opportunities using a simulated investment scenario, where marked bills were given to participants to finance the solutions they felt would best address the challenges posed by current TM. The mock money was counted and analyzed based on the role of the ‘investors’ and the prioritized theme. Results: The Symposium had 92 attendees including 17 patients and caregivers. Themes that emerged are presented in the Table below. Endorsement varied depending on stakeholder group. For example, Access was the top improvement priority for patients, whereas Communication was highest for providers. Conclusions: A one day engagement event that brings together patients and providers can be successful in identifying priority areas for quality improvement. Based on the outcomes of the prioritization exercise, improving access to oncology providers for TM 24/7 was identified as a focus area for provincial and regional QI initiatives. [Table: see text]

scholarly journals 2013 Updated American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards Including Standards for the Safe Administration and Management of Oral Chemotherapy

2013 ◽  
Vol 9 (2S) ◽  
pp. 5s-13s ◽  
Author(s):  
Michael N. Neuss ◽  
Martha Polovich ◽  
Kristen McNiff ◽  
Peg Esper ◽  
Terry R. Gilmore ◽  
...  
Keyword(s):  
Clinical Oncology ◽  
Oral Chemotherapy ◽  
Parenteral Administration ◽  
Oncology Nursing ◽  
Intravenous Chemotherapy ◽  
Good Practices ◽  
Safe Delivery ◽  
Safety Standards ◽  
Chemotherapy Administration ◽  
American Society

Chemotherapy providers have generally developed and implemented good practices around the safe delivery of intravenous chemotherapy. Nonetheless, practices applying for QOPI certification usually modify or expand one or more processes to meet standards for safe parenteral administration.

Safety culture interventions in cancer care: A systematic review.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 247-247
Author(s):  
Dan Le ◽  
Charles Henry Lim ◽  
Rouhi Fazelzad ◽  
Monika K. Krzyzanowska
Keyword(s):  
Systematic Review ◽  
Patient Safety ◽  
Safety Culture ◽  
Cancer Care ◽  
Healthcare Research ◽  
Risk Of Bias ◽  
Provider Education ◽  
Medical Subject Headings ◽  
Culture Of Safety ◽  
Improvement Programs

247 Background: Creation of a culture of safety in healthcare organizations is fundamentally important to patient safety. However, there is limited guidance on how to effectively promote a culture of safety in healthcare settings including in oncology. We performed a systematic review to identify interventions or strategies to promote safety culture in cancer care. Methods: Medical Subject Headings and text words for “safety culture” and “cancer care” were combined to conduct structured searches in MEDLINE, EMBASE, CDSR, CINAHL, Cochrane CENTRAL, Epub Ahead of Print & In-Process, PsycINFO, Scopus, and Web of Science databases, for peer-reviewed articles published between 1999 and 2017. Articles were included if they described an intervention or strategy to promote safety culture in an oncology setting, and quantitative outcomes were reported. Study quality was assessed using the ROBINS-I risk of bias tool. Results: We screened 21,572 studies, of which 46 underwent full-text review, and 19 met the inclusion criteria. Studies described interventions in radiation oncology (15 articles), medical oncology (3), and general oncology (1) settings in either North America (15) or Europe (4). The most common experimental designs were interrupted time series (10) or before-and-after comparisons (6), and were of either moderate (89%) or severe (11%) risk of bias. Interventions varied but could be broadly categorized as incident learning systems (8), quality improvement programs (7), provider education programs (2), a provider scheduling system (1), and a patient safety champion intervention (1). While 89% of studies reported improvement in safety culture, there was substantial heterogeneity in evaluated outcomes. Most assessed provider outcomes such as number of reported adverse events (11) or Agency for Healthcare Research and Quality Safety Culture survey results (7). Conclusions: Despite a growing evidence base to identify interventions to promote safety culture in cancer care, definitive recommendations were difficult to make due to heterogeneity in study designs and outcomes. Given the importance of safety culture in cancer care, additional high-quality studies and standardization of outcome measures are needed.

Developing a culture of safety in systemic cancer treatment at the system level.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 230-230
Author(s):  
Sherrie Hertz ◽  
Leonard Kaizer ◽  
Monika K. Krzyzanowska ◽  
Vicky Simanovski ◽  
Kathy Vu
Keyword(s):  
Cancer Treatment ◽  
Performance Management ◽  
Health Care Providers ◽  
Systemic Treatment ◽  
Quality Measurement ◽  
System Level ◽  
Evidence Based ◽  
Care Providers ◽  
Culture Of Safety ◽  
Four Levels

230 Background: Chemotherapy ordering, preparation and delivery involve multiple providers and complex systems where high impact errors may occur. Cancer Care Ontario, a provincial agency responsible for continually improving cancer services in Ontario, Canada employs a comprehensive systematic approach to build a culture of safety for systemic treatment. Methods: A comprehensive strategy is applied at 77 systemic treatment hospitals in the Province. A multi-pronged approach is used that includes: 1) system planning, organization and funding, 2) engagement of health care providers working at the regional and local levels, 3) guidelines implementation and, 4) quality measurement. Results: Institutions are organized into regional networks, according to four levels of service complexity based on quality standards, planning, funding, coordination and health human resources. A customized, system-wide incident reporting system is available. Quality improvement is undertaken in several ways. Regional clinical and administrative leaders foster engagement with local providers and work is facilitated by a provincial multidisciplinary community of practice, an annual Safety Symposium, and local improvement projects with funding support. In this way, collaborative sharing and learning occurs across the Province. Comprehensive evidence-based guidelines have been produced addressing safe labeling, administration, handling and the use of computerized prescriber order entry systems. Routine performance management together with guideline concordance measurement, public reporting, planning for improvement and re-evaluation strategies, has produced system improvements. Conclusions: A comprehensive, evidence-based and systematically applied approach to providing systemic cancer treatment can produce a culture of safety that is coordinated and standardized across multiple providers and provider sites.

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