Improving the assessment and documentation of constipation at UF Health Cancer Center through mandatory prompts.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 263-263
Author(s):  
Brian Hemendra Ramnaraign ◽  
Bilal Farooqi ◽  
Priya Kadambi Gopalan ◽  
Merry Jennifer Markham
Keyword(s):  
Hospital Admissions ◽  
Medical Oncology ◽  
The Other ◽  
Cancer Center ◽  
Intervention Period ◽  
Opioid Use ◽  
Academic Hospital ◽  
Post Intervention ◽  
Chart Abstraction ◽  
Oncology Practice

263 Background: Opioids are commonly prescribed to patients for management of pain and the most common and persistent side effect from opioid use is constipation. Opioid-induced constipation (OIC) affects 52% of patients with advanced cancer and 87% of terminally ill patients. In the Spring 2017 Quality Oncology Practice Initiative (QOPI) chart abstraction round, UF Health Cancer Center’s Medical Oncology clinic notes documented the assessment of constipation in only 45.45% of charts. This is below the academic hospital aggregate documentation rate of 55.61%. Methods: Our objective was to improve the rate of documentation of assessment of constipation in the Thoracic Oncology Clinic at UF Health Cancer Center by 33% to a goal rate of at least 60% by 3 months. We used a Plan-Do-Study-Act model in order to design our project. We worked with the EPIC developers to include a mandatory prompt at the end of the assessment/plan section of the clinic template notes for the Thoracic Oncology practice. Our prompt was “Constipation was addressed and @HE@ {DOES/DOES NOT} have symptoms” where the author chooses from a drop down list to select whether the patient “does” or "does not” have symptoms. We planned to assess a total of 60 random charts in the 3 month post intervention period. Results: At the end of our study, a total of 48 out of 60 charts (80%) documented constipation thus surpassing our goal of 60%. Of the 12 charts assessed that did not address constipation, 11 did not use our revised templates and were notes that were “copied forwarded” from previous encounters. Conclusions: Given that our intervention was a success, we plan to expand these revised templates to the other medical oncology subspecialties in order to better document assessment of constipation for all cancer patients. While our mandatory prompt was shown to lead to increased documentation of constipation, further studies to show whether or not this leads to decreased complaints of abdominal pain, decreased incidences of bowel obstructions, and/or decreased hospital admissions, would be interesting to pursue.

Hospitalization rates related to coordinated home healthcare services with a community oncology practice.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 273-273
Author(s):  
John F. Sandbach ◽  
John Bachelor ◽  
Kimberly Larson ◽  
Denize Jordan ◽  
Janet Mullins ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Medical Oncology ◽  
Health Agency ◽  
Healthcare Services ◽  
Home Healthcare ◽  
Oncology Patients ◽  
Cancer Centers ◽  
Avoidable Hospitalizations ◽  
Hospitalization Rates ◽  
Oncology Practice

273 Background: Unplanned hospital admissions or hospital re-admissions in cancer patients after discharge cost in excess of 16 billion dollars. Oncology patients are a very high risk of hospitalization despite the involvement of a home healthcare agency. The 30-day medical oncology re-hospitalization rates are reported to be 21.6%. Unplanned hospitalization rates in selected oncology patients over a 12 month period have been reported to be as high as 58%. Methods: A large home health agency and a community based medical oncology practice created a delivery model referred to as the Advanced Community Care Model (ACCM). We are reporting our initial 14 month experience. The initial pilot involved three of the medical group’s six cancer centers. The ACCM created standing intervention orders regarding hydration, nausea/vomiting, central line management, antiemetic and diarrhea and a continuum of monthly management meetings with the agency and the practice. Navigation services by a designated RN were provided. Enhanced interventions with either telephone communication or home visits took place when deemed appropriate. Results: ACCM impacted 60-day hospitalization rates fell a baseline at 6 months into the program from 43% to 22% by the end of the 18 month pilot. Avoidable hospitalizations and re-hospitalizations related to N/V, pain, SOB and infection were less than 10%. The initial program has involved 310 unique patients. Conclusions: The reduction in the 60 day hospitalization rates and the low hospitalization and re-hospitalization rates related to pain control, infection, SOB and infection were below published national averages. The results were felt to be encouraging and the ACCM will be expanded to involve all 7 cancer centers in the practice.

Measuring chemotherapy safety in a community oncology practice: Results of a three-year prospective study

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6019-6019
Author(s):  
J. O. Jacobson ◽  
M. K. Krzyzanowska ◽  
J. H. Schwartz ◽  
B. Maloney ◽  
A. Lavino ◽  
...  
Keyword(s):  
Prospective Study ◽  
Hospital Admissions ◽  
Medical Center ◽  
Low Risk ◽  
Administrative Databases ◽  
Cancer Center ◽  
Severe Toxicity ◽  
Community Based ◽  
Chemotherapy Administration ◽  
Oncology Practice

6019 Background: Chemotherapy administration is associated with a risk for severe toxicity and mortality. Limited data are available to assess these risks outside of clinical trials or administrative databases. We sought to determine the risk of chemotherapy administration in a community-based oncology practice, to identify potential risk factors, and to look for trends over time. Methods: The North Shore Medical Center Cancer Center (NSCC) is a community-based cancer facility in Peabody, MA. In 1/03, we began a prospective study to identify and categorize all adult patients admitted to hospital with severe chemotherapy toxicity and to compare them to all chemotherapy recipients. Consecutive cases admitted to hospital from NSCC were reviewed in a monthly multidisciplinary peer review meeting. Admissions deemed to be treatment-related were entered into a toxicity database. Results: Between 1/1/03 and 11/30/05, 2206 courses of chemotherapy were administered to 1574 patients resulting in 12,380 treatment-months of therapy. 162 patients required 174 hospital admissions, for an annualized risk of treatment-related hospitalization (TRH) of 16.6% and a mean length of stay of 7.0 days. Mean age of cases was similar for those admitted for toxicity compared to all chemotherapy patients (65.3 versus 64.6 yrs.). GI toxicity and infection (principally fever and neutropenia) accounted for 77% of TRH. Between 2003 and 2005, the risk of a TRH declined for colorectal cancer cases while it increased for breast cancer and lung cancer cases. There were 14 treatment-related deaths (TRD) for an annualized risk of 1.1%. TRD’s were infectious in 9, GI in 4 and cardiac in 1. Median age was 67, similar to the entire cohort. TRD occurred early (median 28 days from the inception of chemotherapy, range 1–120 days). Significant comorbidity was identifiable in 12 of 14 cases. 10 of 14 cases were being treated palliatively. Conclusions: These prospectively collected data confirm that chemotherapy administration in a community-based practice can be associated with a low risk of severe toxicity and a very low risk of mortality. TRH and TRD could become standard measures of quality care for cancer facilities. No significant financial relationships to disclose.

Assessing and acting on distress in oncology patients.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 89-89
Author(s):  
Jessica A. Zerillo ◽  
Myrna Rita Nahas ◽  
Hester Hill Schnipper ◽  
Laurie Rosenblatt ◽  
Holly Dowling ◽  
...  
Keyword(s):  
Action Plan ◽  
Electronic Record ◽  
Well Being ◽  
Distress Thermometer ◽  
Post Intervention ◽  
Academic Medical ◽  
Distress Score ◽  
Chart Abstraction ◽  
American Society ◽  
Oncology Practice

89 Background: The American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) set a benchmark that 75% of cancer patients have emotional well-being assessed by the second visit. However, clinicians poorly assess and document emotional well-being. Methods: Our aim was to increase the documented assessment of emotional well-being in an academic medical center's Hematology/Oncology clinic to 75% or greater through a pre/post intervention study design. In fall 2012, clinicians collected baseline QOPI data from the first two visits of a sample of patients with newly diagnosed breast, non-small cell lung and colorectal cancers. Oncology social work and psychiatry implemented the NCCN Distress Thermometer in May 2013. At every provider visit, patients' distress scores were transcribed into a structured field in the electronic record. In spring 2014, clinicians collected post-intervention data. Results: All data used was collected through the routine QOPI chart abstraction process. 142 charts in fall 2012, and 55 charts in spring 2014 met criteria for pre/post assessment, respectively. There was a significant improvement in the assessment of distress (78.2% vs. 64.1%, p=0.01) and in the identification of distress presence (46.5% vs. 27.5%, p=0.01). However, there was better documentation for a plan of action for distress before the intervention (80% vs. 55%, p=0.02). Conclusions: The NCCN Distress Thermometer improved assessment and identification of distress. However, an action plan specifically addressing distress was significantly worse after implementation of the tool. Possible explanations include lack of documentation even if an action was implemented, lack of specificity of the tool to identify the source of the patient's distress so that a therapeutic plan could be targeted, or a failure of the clinician to appreciate the distress score as a valid measure. Further data are needed in order to understand the barriers for clinician documentation of action on patient distress. [Table: see text]

scholarly journals Know When to Test: Optimizing Diagnostic Practices for Clostridium difficile Infection (CDI) Among Patients at a Tertiary-Care Cancer Center

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S397-S398
Author(s):  
Anoshé Aslam ◽  
Janet Eagan ◽  
Janice Kaplan ◽  
Elizabeth Robilotti ◽  
Tracy McMillen ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Tertiary Care ◽  
Diagnostic Testing ◽  
Antibiotic Use ◽  
Cancer Center ◽  
Intervention Period ◽  
Post Intervention ◽  
Testing Algorithm ◽  
Unnecessary Testing

Abstract Background Polymerase chain reaction (PCR) based diagnostic testing for the detection of toxigenic Clostridium difficile infection (CDI) does not distinguish between carriers and patients with true CDI. As a result, CDI is over-diagnosed in hospitalized patients with diarrhea. Unnecessary testing generates false positives and several downstream sequelae. Aim: The aim of this study was to reduce unnecessary testing for CDI through an electronic alert, targeted education, and implementation of evidence-based laboratory testing policy. Methods In order to quickly identify laxative induced diarrhea and avoid CDI testing, an electronic alert was created in the electronic medical record (EMR) system. The alert was built on a logic that identified patients who had received laxatives within 48 hours of a CDI PCR test order. The alert additionally provided the rationale for avoiding testing in patients on laxatives and guidance on appropriate testing for CDI. The following steps were taken simultaneously to complement these efforts: 1) Infection Control conducted hospital-wide education for licensed independent practitioners on a CDI testing algorithm 2) Laboratory based policy was instated to reject all formed stools (Bristol Stool Chart types 1 through 4) for CDI testing. Results In the 6 month pre-intervention period, there were 29 CDI tests per 1000 patient-days. In the post-intervention period, CDI tests decreased to 19 per 1000 patient-days, a 35% decrease (P < 0.0001). The decline in testing has been sustained for 7 months. The following observations were also made: 1) HAI rate reduction of 28%; 2) decrease in oral vancomycin use. Conclusion Decreasing inappropriate testing has several distinct advantages, including reducing excessive and unnecessary antibiotic use, avoiding misclassification of carriers as CDI cases, normalizing healthcare-associated CDI rates, and diminishing healthcare costs associated with preventable tests. Laboratories that use PCR only testing for CDI diagnosis should follow stringent policies to ensure that only patients with high pretest probability are tested. EMR systems are a useful and effective resource to achieve this for patients with laxative induced diarrhea. Disclosures All authors: No reported disclosures.

Implementation of a restrictive opioid prescription protocol after minimally invasive gynecologic oncology surgery

2021 ◽  
pp. ijgc-2021-002968
Author(s):  
Soyoun Rachel Kim ◽  
Stephane Laframboise ◽  
Gregg Nelson ◽  
Stuart A McCluskey ◽  
Lisa Avery ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pain Control ◽  
Gynecologic Oncology ◽  
Cancer Center ◽  
Provider Education ◽  
Opioid Use ◽  
Post Intervention ◽  
Opioid Prescription ◽  
Post Surgery ◽  
The Impact

ObjectivesOpioids are routinely prescribed after minimally invasive gynecologic oncology surgery, with minimal data to inform the ideal dose. The aim of this study was to evaluate the impact of a restrictive opioid prescription protocol on the median morphine milligram equivalents prescribed and pain control in patients undergoing minimally invasive surgery.MethodsA restrictive opioid prescription protocol was implemented from January through December 2020 at a single tertiary cancer center in Ontario, Canada. Consecutive patients undergoing minimally invasive hysterectomy for suspected malignancy were included. Simultaneously, we implemented use of multimodal analgesia, patient and provider education, pre-printed standardized prescriptions, and tracking of opioid prescriptions. Total median morphine milligram equivalents prescribed were compared between pre- and post-intervention cohorts. Patients were surveyed regarding opioid use and pain control at 30 days post-surgery.ResultsA total of 101 women in the post-intervention cohort were compared with 92 consecutive pre-intervention controls. Following protocol implementation, median morphine milligram equivalents prescribed decreased from 50 (range 9–100) to 25 (range 8–75) (p<0.001). In the post-intervention cohort, 75% (76/101) used 10 median morphine milligram equivalents or less and 55 patients (54%) used 0 median morphine milligram equivalent. There was no additional increase in opioid refill requests after implementation of our strategy. Overall, patients reported a median pain score of 3/10 at 30 days post-surgery; the highest pain scores and most of the pain occurred in the first week after surgery.ConclusionsImplementation of a restrictive opioid prescription protocol led to a significant reduction in opioid use after minimally invasive gynecologic oncology surgery, with over 50% of patients requiring no opioids postoperatively.

Creation of a telehealth task force to improve successful use of telehealth to maintain patient access during the COVID-19 pandemic.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 264-264
Author(s):  
Avnish K Bhatia ◽  
Lauren Waldman ◽  
Melissa Hunt ◽  
Amy Leader ◽  
Janene Palidora ◽  
...  
Keyword(s):  
Access To Care ◽  
Digital Media ◽  
Digital Literacy ◽  
Medical Oncology ◽  
Task Force ◽  
Cancer Center ◽  
Patient Portal ◽  
Full Time ◽  
Health Crisis ◽  
Oncology Practice

264 Background: In response to the COVID-19 National Emergency, the Sidney Kimmel Cancer Center (SKCC) medical oncology practice desired to greatly expand telehealth (TH) utilization to decrease patient risk while maintaining access to care. TH utilization requires resources (smart phones, internet) and there are disparities in digital media access in our patient population. A digital literacy survey performed at the SKCC in 2018 noted that 30% of patients used Android phones and > 60% of patients accessed the internet from a PC. Methods: In response to increased TH demand and need for support, the SKCC launched an oncology-dedicated Telehealth Task Force (TTF) to address barriers to TH access. The TTF team consisted of nine full-time individuals with digital and healthcare literacy to assist in telehealth and patient portal troubleshooting. Critical functions of TTF’s targeted patient solutions include; set-up and delivery of smartphones, creating email accounts, performing test visits, creating EHR patient portal accounts, real- time assistance during TH visits with implementation of this intervention beginning on April 3, 2020 with monitoring of patient interactions/touchpoints. Results: The SKCC medical oncology TTF noted increased interactions with patients immediately with a marked increase in the composite of medical oncology appointments completed by TH (51.0% in April 2020 compared to a prior level of 15.7% in March 2020). Additionally, there was a statistically significant increase in the proportion of patients have an active patient portal EHR account during this same period (14.6%; 95% CI, 12.3% to 16.9%; p < 0.0001). Oncology infusion treatment appointments remained relatively consistent over time. Conclusions: The SKCC medical oncology practice experienced an exponential rise in TH utilization during an uncertain public health crisis. Disparity in digital literacy and resources essential for successful TH use were quickly appreciated as potential barriers to access. The creation of a dedicated Telehealth Task Force was critical in maintain access to care for oncology patients given their vulnerability to infection. Further investigation of TH supports to improve TH use are warranted. [Table: see text]

Is it time for quality time? Intensive medical oncology follow-up during treatment for esophageal adenocarcinoma.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 29-29
Author(s):  
Nishi Kothari ◽  
Ravi Shridhar ◽  
Sarah E. Hoffe ◽  
Kenneth L. Meredith ◽  
Jacques Fontaine ◽  
...  
Keyword(s):  
Weight Loss ◽  
Esophageal Adenocarcinoma ◽  
Hospital Admissions ◽  
Medical Oncology ◽  
Locally Advanced ◽  
Concurrent Chemotherapy ◽  
Cancer Center ◽  
Chi Squared ◽  
The Impact

29 Background: Concurrent chemotherapy and radiation for esophageal cancer patients is morbid with many potential complications. The efficacy of intensive patient follow up by medical oncology during concurrent treatment was retrospectively evaluated at our cancer center. We hypothesized that weekly follow up would result in better compliance and less toxicity, leading to better outcomes. Methods: Patients with locally advanced esophageal adenocarcinoma referred to our cancer center for potentially curable neoadjuvant therapy were identified. Age, gender, radiation dose, weight loss, hospital admissions, and outcome were compared between patients who had intensive follow up and patients who did not. Wilcoxon Rank Sum Test and Chi-squared test, both exact tests using Monte Carlo estimation, were used to compare weekly follow-up status with continuous and categorical factors, respectively. Kaplan-Meier curves and Log-Rank tests were used for OS analysis, and a multivariable model was fit using Cox Proportional Hazard models. Results: 169 were patients eligible for analysis, including 154 men and median age of 66 years. 108 patients were seen weekly by medical oncology while on treatment. Groups had balanced baseline characteristics except for age; the weekly follow up patients were older (68 vs. 63 years, p=0.007). There was no difference in hospitalization rate (33% vs. 28%) or weight loss (4 kg vs. 4.7 kg) between groups. In multivariate analysis, advanced age and stage were associated with worsened OS. Weekly follow up did not lead to improved survival at 3 years (42% vs. 50%). Conclusions: This study is retrospective in nature, but to our knowledge it is the first of its kind to investigate the impact of intensive follow up during concurrent chemotherapy and radiation. Though we did not find improved outcome in patients who were seen weekly, a potential confounder is the older age of these patients. In addition, at our institution patients have close weekly follow up with radiation oncologists, dieticians and oncology nurses. While we were not able to substantiate our hypothesis that weekly follow up by medical oncology leads to improved outcomes, our preliminary findings merit further study.

scholarly journals Implementing ERAS: how we achieved success within an anesthesia department

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dan B. Ellis ◽  
Aalok Agarwala ◽  
Elena Cavallo ◽  
Pam Linov ◽  
Michael K. Hidrue ◽  
...  
Keyword(s):  
General Hospital ◽  
Residency Program ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Massachusetts General Hospital ◽  
Educational Interventions ◽  
Nurse Anesthetists ◽  
Intervention Period ◽  
Post Intervention ◽  
Anesthesia Group

Abstract Background The Massachusetts General Hospital is a large, quaternary care institution with 58 operating rooms, 164 anesthesiologists, 76 certified nurse anesthetists (CRNAs), an anesthesiology residency program that admits 25 residents annually, and 35 surgeons who perform laparoscopic, vaginal, and open hysterectomies. In March of 2018, our institution launched an Enhanced Recovery After Surgery (ERAS) pathway for patients undergoing hysterectomy. To implement the anesthesia bundle of this pathway, an intensive 14-month educational endeavor was created and put into effect. There were no subsequent additional educational interventions. Methods We retrospectively reviewed records of 2570 patients who underwent hysterectomy between October 2016 and March 2020 to determine adherence to the anesthesia bundle of the ERAS Hysterectomy pathway. RESULTS: Increased adherence to the four elements of the anesthesia bundle (p < 0.001) was achieved during the intervention period. Compliance with the pathway was sustained in the post-intervention period despite no additional actions. Conclusions Implementing the anesthesia bundle of an ERAS pathway in a large anesthesia group with diverse providers successfully occurred using implementation science-based approach of intense interventions, and these results were maintained after the intervention ceased.

scholarly journals 986. Improvement in Administration of HIV Post-Exposure Prophylaxis in the Emergency Department Following Sexual Assault

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S521-S522
Author(s):  
Jennifer R Silva-Nash ◽  
Stacie Bordelon ◽  
Ryan K Dare ◽  
Sherrie Searcy
Keyword(s):  
Emergency Department ◽  
Sexual Assault ◽  
Hiv Transmission ◽  
Post Exposure Prophylaxis ◽  
Intervention Period ◽  
Post Intervention ◽  
Post Exposure ◽  
Assault Victims ◽  
Exposure Prophylaxis

Abstract Background Nonoccupational post exposure prophylaxis (nPEP) following sexual assault can prevent HIV transmission. A standardized Emergency Department (ED) protocol for evaluation, treatment, and follow up for post assault victims was implemented to improve compliance with CDC nPEP guidelines. Methods A single-center observational study of post sexual assault patients before/after implementation of an ED nPEP protocol was conducted by comparing the appropriateness of prescriptions, labs, and necessary follow up. A standardized order-set based on CDC nPEP guidelines, with involvement of an HIV pharmacist and ID clinic, was implemented during the 2018-2019 academic year. Clinical data from pre-intervention period (07/2016-06/2017) was compared to post-intervention period (07/2018-08/2019) following a 1-year washout period. Results During the study, 147 post-sexual assault patients (59 Pre, 88 Post) were included. One hundred thirty-three (90.4%) were female, 68 (46.6%) were African American and 133 (90.4%) were candidates for nPEP. Median time to presentation following assault was 12.6 hours. nPEP was offered to 40 (67.8%) and 84 (95.5%) patients (P&lt; 0.001) and ultimately prescribed to 29 (49.2%) and 71 (80.7%) patients (P&lt; 0.001) in pre and post periods respectively. Renal function (37.3% vs 88.6%; P&lt; 0.001), pregnancy (39.0% vs 79.6%; P&lt; 0.001), syphilis (3.4% vs 89.8%; P&lt; 0.001), hepatitis B (15.3% vs 95.5%; P&lt; 0.001) and hepatitis C (27.1% vs 94.3%) screening occurred more frequently during the post period. Labratory, nPEP Prescription and Follow up Details for Patients Prescribed nPEP Conclusion The standardization of an nPEP ED protocol for sexual assault victims resulted in increased nPEP administration, appropriateness of prescription, screening for other sexually transmitted infectious and scheduling follow up care. While guideline compliance dramatically improved, further interventions are likely warranted in this vulnerable population. Disclosures Ryan K. Dare, MD, MS, Accelerate Diagnostics, Inc (Research Grant or Support)

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