A quality improvement project to increase compliance with indicated prechemotherapy pneumococcal vaccination.

218 Background: Severe pneumonia is associated with high morbidity and mortality in cancer patients. The most common pathogen is S. pneumoniae, responsible for 2/3 of pneumonia-related deaths. Current guidelines recommend routine use of 13-valent (Prevnar 13) and 23-valent (PPSV23) pneumococcal vaccine for immunocompromised patients (cancer patients). Of the 110 patients younger than 65 years old who started chemotherapy in our clinic from July 2013 to June 2014, only seven patients received the pneumonia vaccine through our clinic. We conducted a quality improvement (QI) project to improve compliance of pneumonia vaccination in patients who will start on chemotherapy in our outpatient clinic. Methods: We reviewed the current guidelines for pneumonia vaccinations in cancer patients with our physicians and encouraged them to prescribe the pneumonia vaccination to their patients prior to therapy. In addition to educating the primary provider, we took a multidisciplinary approach and recruited our clinic nurse practitioner who meets all patients for chemotherapy teaching to prescribe the vaccine to patients less than 65. Results: Of the 90 patients (median age 60, 20-86) who started chemotherapy during the study period, 58 were less than 65 years old of which three patients were already vaccinated prior to their diagnosis. Twenty five (45.5%) patients were vaccinated through our QI project. We have improved our compliance with pneumonia vaccination guidelines by 39%. Conclusions: We have improved compliance of pneumonia vaccination in cancer patients starting chemotherapy in our clinic through a QI project. We found that screening and intervention are best accomplished by a single person who is able to see all patients. This practice is now being conducted as standard of care in our clinic.

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Implementing a Multidisciplinary Approach to Enhance Compliance With Guideline-Recommended Prechemotherapy Pneumococcal Vaccination in a Military-Based Medical Oncology Practice

Journal of Oncology Practice ◽

10.1200/jop.2016.015602 ◽

2017 ◽

Vol 13 (11) ◽

pp. e966-e971 ◽

Cited By ~ 1

Author(s):

Wilfred Delacruz ◽

Sandra Terrazzino ◽

Michael Osswald ◽

Casey Payne ◽

Brian Haney

Keyword(s):

Pneumococcal Vaccination ◽

Standard Of Care ◽

Baseline Period ◽

Community Acquired Pneumonia ◽

Vaccination Rates ◽

Patients With Cancer ◽

Single Person ◽

Increased Risk ◽

Oncology Practice ◽

Current Guidelines

Purpose: Patients with cancer are at increased risk for invasive pneumococcal disease, including community-acquired pneumonia. Current Advisory Committee on Immunization Practices and National Cancer Comprehensive Network guidelines recommend pneumococcal vaccination for immunocompromised patients, including patients with cancer. Methods: We conducted a quality improvement (QI) project to enhance compliance with pneumococcal vaccination in patients before their chemotherapy. Baseline pneumococcal vaccination rates were gathered from July 2013 to June 2014. We reviewed the current guidelines for pneumococcal vaccinations in patients with cancer with physicians and encouraged them to prescribe the pneumococcal vaccination to patients before therapy. We also recruited our clinic nurse practitioner, who meets all patients for chemotherapy teaching, to prescribe the vaccine to patients younger than 65 years of age. Results: During the baseline period, of the 110 patients younger than 65 years who received chemotherapy, seven (6.4%) received the pneumococcal vaccine. Of the 90 patients (median age, 60 years; range, 20 to 86 years) who received chemotherapy during the study period, 58 were younger than 65 years, of whom three patients were already vaccinated before their diagnosis. Twenty-five (45.5%) patients were vaccinated through our QI project. We have improved our compliance with pneumococcal vaccination by 39% ( P < .001). Conclusion: We have improved compliance with pneumococcal vaccination in patients with cancer receiving chemotherapy in our clinic through a QI project. We found that screening is best accomplished by a single person who is able to screen all patients. This practice is now a standard of care in our clinic.

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149 Virtual Care: A Quality Improvement Project on the Experience of Paediatricians during the COVID-19 Pandemic

Paediatrics & Child Health ◽

10.1093/pch/pxab061.117 ◽

2021 ◽

Vol 26 (Supplement_1) ◽

pp. e102-e104

Author(s):

Emma McCrady ◽

Julie Strychowsky ◽

Jessica Woolfson

Keyword(s):

Quality Improvement ◽

Online Survey ◽

Local Level ◽

Standard Of Care ◽

Subject Area ◽

Future Research ◽

Improvement Project ◽

Diagnostic Uncertainty ◽

Virtual Care ◽

Practice Efficiency

Abstract Primary Subject area Practice/Office Management Background Prior to the COVID-19 pandemic, in-person visits were the standard of care for paediatricians at our centre. With the pandemic onset, virtual care (VC) was adopted at an unprecedented scale and pace. Studies have reported positive patient VC experience; however, few have explored physician experience. This quality improvement (QI) initiative sought to qualify the VC experience of local paediatricians during the pandemic, with the intention of implementing VC clinical practice changes at the department level. Objectives To determine key factors that have supported and challenged the adoption of, and that will support integration of, VC in the future. Design/Methods The Donabedian model for healthcare QI was used to evaluate VC experience through an online survey with a focus on structure, process, and outcome measures. All physicians affiliated with the Department of Paediatrics (generalists and subspecialists in medicine and surgery) were invited to participate via email. Three reminder emails were sent at 2-week intervals. Descriptive statistics were reported. Results The response rate was 32.3% (63 of 195 physicians). The majority of respondents were subspecialists (84.1%), and at academic centres (87.5%) (Table 1). Pre-pandemic, only 30.1% used VC and saw <10% of patients virtually. During March-May 2020, 93.8% transitioned to VC, with > 50% seeing over 75% of patients virtually. By summer 2020, VC use declined, but remained higher than pre-pandemic (53.6% seeing < 25% of patients). OTN and telephone were platforms most used (32.8% and 28.6%, respectively). Most conducted visits from their work location (55.2%) versus home (44.8%). VC experience was considered positive by most physicians (73.6%), and only 18.8% found VC difficult to use despite technical difficulties reported by 41.5% (Figure 1). Physicians with ≤ 5 years in practice were most likely to find VC convenient (93.8%). Challenges with VC included lack of physical exam, diagnostic uncertainty, lower patient volumes, and poor patient VC etiquette. Regardless of practice location, specialty, years in practice, and prior experience, 96% would continue VC to 25% of patients, ideally for patients who live far away (26.4%) and for follow-ups of patients with established diagnoses (21.4%). Conclusion A rapid transition to VC during the COVID-19 pandemic was associated with challenges but also positive experiences. Willingness to continue VC was high. VC experience could be improved with greater patient education and focus on select patient populations. Future research is needed to improve practice efficiency and to inform regulatory guidelines for VC at a local level.

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Nutritional screening and assessment of paediatric cancer patients: A quality improvement project (baseline results)

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2020.04.003 ◽

2020 ◽

Vol 38 ◽

pp. 242-252

Author(s):

Dominique Glatt ◽

Caoimhe Hughes ◽

Orlaith McCarthy ◽

Fiona O'Shea ◽

Mark F.H. Brougham ◽

...

Keyword(s):

Quality Improvement ◽

Cancer Patients ◽

Quality Improvement Project ◽

Paediatric Cancer ◽

Nutritional Screening ◽

Improvement Project

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Protecting patients from infection: Improving topical prophylaxis compliance on surgical wards

Journal of Infection Prevention ◽

10.1177/1757177419885011 ◽

2019 ◽

Vol 21 (2) ◽

pp. 47-51

Author(s):

Holly Slyne ◽

Natalie Clews ◽

Sid Beech ◽

Elizabeth Smilie

Keyword(s):

Quality Improvement ◽

Infection Prevention ◽

Communication Strategies ◽

District General Hospital ◽

Site Infection ◽

Improvement Project ◽

Medication Prescription ◽

Improvement Plan ◽

Number Of Patients ◽

Improve Compliance

Background: At a medium-sized district general hospital in the heart of England, it was identified that compliance to the administration of topical prophylaxis on three general surgery wards had reduced to 23%, following implementation of an electronic medication prescription record. Therefore, a quality improvement project was commenced to improve this compliance to protect patients from meticillin-resistant Staphylococcus aureus (MRSA) colonisation and associated bacteraemia. Aim: To improve compliance of topical prophylaxis administration on three surgical wards to protect patients from infection. Method: Quality improvement plan – do – study – act (PDSA) cycles evaluated the effectiveness of four different strategies from baseline data which was 23% compliant in December 2016. These included teaching and communication strategies, prompts in medical notes, discontinuation of Mupirocin 2% nasal ointment as part of the topical prophylaxis regime and discontinuation of the topical wash lotion from requiring a prescription. Results: The compliance of prophylaxis administration increased consistently throughout from 23% in December 2016 to 92% in March 2018. Consequently, the number of patients that developed a MRSA colonisation on the three wards reduced by 54%, from 13 in the 12 months before the study to six in the 12 months after the study. Discussion: This study led to a change in the Trust MRSA Policy to better protect patients from infection, particularly surgical site infection and MRSA bacteraemia. It suggests that quality improvement methodology has a place in infection prevention practice.

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Ward round template: enhancing patient safety on ward rounds

BMJ Open Quality ◽

10.1136/bmjoq-2017-000170 ◽

2018 ◽

Vol 7 (2) ◽

pp. e000170 ◽

Cited By ~ 3

Author(s):

Niall Gilliland ◽

Natalie Catherwood ◽

Shaouyn Chen ◽

Peter Browne ◽

Jacob Wilson ◽

...

Keyword(s):

Patient Safety ◽

Quality Improvement ◽

Antibiotic Stewardship ◽

Ward Round ◽

Early Warning Score ◽

Improvement Project ◽

Inpatient Ward ◽

Improve Compliance ◽

Safety Parameters ◽

Ward Rounds

Introduction and aimsConcerns had been raised at clinical governance regarding the safety of our inpatient ward rounds with particular reference to: documentation of clinical observations and National Early Warning Score (NEWS), compliance with Trust guidance for venous thromboembolism (VTE) risk assessment, antibiotic stewardship, palliative care and treatment escalation plans (TEP). This quality improvement project was conceived to ensure these parameters were considered and documented during the ward round, thereby improving patient care and safety. These parameters were based on Trust patient safety guidance and CQUIN targets.MethodThe quality improvement technique of plan–do–study–act (PDSA) was used in this project. We retrospectively reviewed ward round entries to record baseline measurements, based on the above described parameters, prior to making any changes. Following this, the change applied was the introduction of a ward round template to include the highlighted important baseline parameters. Monthly PDSA cycles are performed, and baseline measurements are re-examined, then relevant changes were made to the ward round template.Summary of resultsDocumentation of baseline measurements was poor prior to introduction of the ward round template; this improved significantly following introduction of a standardised ward round template. Following three cycles, documentation of VTE risk assessments increased from 14% to 92%. Antibiotic stewardship documentation went from 0% to 100%. Use of the TEP form went from 29% to 78%.ConclusionsFollowing introduction of the ward round template, compliance improved significantly in all safety parameters. Important safety measures being discussed on ward rounds will lead to enhanced patient safety and will improve compliance to Trust guidance and comissioning for quality and innovation (CQUIN) targets. Ongoing change implementation will focus on improving compliance with usage of the template on all urology ward rounds.

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A Quality Improvement Project to Provide Early Referral to Palliative Care Clinic for Advanced Oral Cancer Patients (TH341A)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2019.12.081 ◽

2020 ◽

Vol 59 (2) ◽

pp. 429-430

Author(s):

Aanchal Satija ◽

Karl Lorenz ◽

Michelle DeNatale ◽

Jake Mickelsen ◽

Odette Spruijt ◽

...

Keyword(s):

Palliative Care ◽

Quality Improvement ◽

Oral Cancer ◽

Cancer Patients ◽

Quality Improvement Project ◽

Early Referral ◽

Improvement Project ◽

Care Clinic ◽

Oral Cancer Patients

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Barriers to receipt of novel oral oncolytics: A single-institution quality improvement investigation

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155219841424 ◽

2019 ◽

Vol 26 (2) ◽

pp. 279-285

Author(s):

Ann A Wang ◽

Christopher Tapia ◽

Yasin Bhanji ◽

Christopher Campbell ◽

Daniel Larsen ◽

...

Keyword(s):

Quality Improvement ◽

Care Center ◽

Tertiary Care ◽

Standard Of Care ◽

Wait Times ◽

Prescription Data ◽

Electronic Prescription ◽

Improvement Project ◽

Pharmacy Claims ◽

Oral Oncolytics

Introduction Novel oral oncolytic agents have become the standard of care and first-line therapies for many malignancies. However, issues impacting access to these drugs are not well explored. As part of a quality improvement project in a large tertiary academic institution, we aim to identify potential barriers that delay treatment for patients who are prescribed novel oral oncolytics. Methods This was a retrospective review of adults who were newly prescribed a novel oral oncolytic for Food and Drug Administration-approved indications at a single tertiary care center. Patients were identified via electronic prescription data (e-Scribe). Demographics, insurance information, and prescription dates were extracted from the electronic medical record and pharmacy claims data. Statistical analyses were performed to determine whether time-to-receipt was associated with insurance category, pharmacy transfers, cost assistance, and drug prescribed. Results Of the 270 successfully filled prescriptions, the mean time-to-receipt was 7.3 ± 10.3 days (range: 0–109 days). Patients with Medicare experienced longer time-to-receipt (9.1 ± 13.1 days) compared to patients with commercial insurance (4.4 ± 3.3). Uninsured patients experienced the longest time-to-receipt (15.7 ± 7.8 days) overall. Pharmacy transfers and cost assistance programs were also significantly associated with longer time-to-receipt. Ten prescriptions remained unfilled 90 days after the study period and were considered abandoned. Conclusion Insurance has a significant effect on the time-to-receipt of newly prescribed novel oral oncolytics. Pharmacy transfers and applying for cost assistance are also associated with longer wait times for patients. Our retrospective analysis identifies areas of improvement for future interventions to reduce wait times for patients receiving novel oral oncolytics.

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