The effects of COVID-19 on new oral oncolytic treatments.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 102-102
Author(s):  
Rachel L. Mitchell ◽  
Edward Arrowsmith ◽  
Jack L. Taylor ◽  
Stephen Matthew Schleicher ◽  
Natalie R. Dickson ◽  
...  
Keyword(s):  
Patient Education ◽  
Oral Therapy ◽  
Turnaround Time ◽  
Patient Volume ◽  
Order Entry ◽  
Seamless Care ◽  
Number Of Patients ◽  
Measured Time ◽  
Specialty Pharmacy ◽  
Oral Oncolytics

102 Background: Dependable and timely dispensing and delivery of oral oncolytics to patients with a new indication for therapy is a central part of modern cancer care. The COVID-19 pandemic has presented numerous impediments and challenges to patients receiving oral therapy from many specialty pharmacies in a timely due to remote pharmacy staffing and drug shipment. Tennessee Oncology has an integrated URAC and ACHC accredited Specialty Pharmacy to ensure the seamless care for our patients prescribed oral oncolytics. We investigated the effect of COVID-19 on the number of patients initiating care with an oral oncolytic and the time to fill during the pandemic. Methods: We analyzed the number of overall new patients to the practice and new patients receiving oral oncolytics in two year-to-year comparisons: (1) January-March 2019 vs. January-March 2020 and (2) April-May 2019 vs. April-May 2020. We then compared the average pharmacy turnaround time (defined as the time of entry of a regimen in the electronic medical record that contained an oral oncolytic until the time that prescription was ready for shipment) and the average time from regimen entry until the patient received that medication. Prescriptions received and filled on the day of order entry were recorded as a one-day turnaround time. Results: A year to year increase of 7% in practice new-patient volume was associated with a 13% increase in new oral oncolytic patients from January-March 2020. Year to year April and May comparisons, noted a 33% decrease in new-patient volume to our practice with an associated 10% decrease in new oral oncolytic patients. Time to fill remained consistent in March and April 2020 at 1.84 days vs. 1.78 for 2019. The time from regimen entry to patient shipment receipt was also stable year to year (3.10 vs. 3.06 days). Conclusions: Our in-house Specialty Pharmacy was able to continue delivery of new prescriptions for oral oncolytics during the COVID-19 pandemic. There was a fall in the number of new patient dispensing in April-May 2020 that we attribute to a decrease in cancer diagnoses related to COVID-19 as reflected by a fall in total practice new patients. New patient on-boarding activities including prior authorizations, co-pay assistance, patient education were maintained and the measured time to fill from regimen entry to patient receipt were unchanged.

Providing uninterrupted oral oncolytic therapies during the COVID-19 pandemic.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 226-226
Author(s):  
Edward Arrowsmith ◽  
Rachel L. Mitchell ◽  
Jack L. Taylor ◽  
Stephen Matthew Schleicher ◽  
Natalie R. Dickson ◽  
...  
Keyword(s):  
Insurance Coverage ◽  
Home Delivery ◽  
Pharmacy Staff ◽  
Cost Share ◽  
Grant Support ◽  
Number Of Patients ◽  
Specialty Pharmacy ◽  
Time Periods ◽  
Comparison Table ◽  
Oral Oncolytics

226 Background: Uninterrupted utilization of oral oncolytics is critical to maximizing safety and efficacy of cancer treatment. The COVID-19 pandemic presented numerous challenges to delivering a continuous and safe supply of oral oncolytics to patients with cancer including potential loss of insurance coverage, patient lost income making copays more difficult, remote pharmacy staffing difficulties, and logistical challenges in safely distributing drug to cancer patients. Tennessee Oncology has an in-house Specialty Pharmacy that utilizes home delivery of oral oncolytics while coordinating care with providers during changing patient situations. Methods: We analyzed patients who received an oral oncolytic from our pharmacy in two periods: January-May 2019 and January-May 2020. We compared the aggregate patient copay amounts during these periods, the number of patients who utilized copay assistance or foundational financial support. For insights on continuation we also assessed the medication possession ratios (MPR, the sum of the day’s supply for all fills of a given drug in a particular period divided by the number of days in that period) during these time periods for five of our most commonly dispensed drugs. Results: The aggregate patient copay was similar between the two time periods. A 22% increase in the utilization of copay cards indicated patient’s insurance coverage was sustained. We also observed a 12% increase in the number of patients utilizing foundation support for prescriptions filled. MPRs for five commonly dispensed oral oncolytics were unchanged during COVID-19. Conclusions: Our in-house specialty pharmacy maintained delivery of oral oncolytics during the COVID-19 pandemic. Patient cost share was contained by our pharmacy staff proactively utilizing copay cards for all eligible patients and diligently securing foundational grant support. The pharmacy interventions allowed for affordability, uninterrupted pharmacy operations, and consistent medication supply. This led to continued medication adherence. MPR for the 5 top dispensed medications was consistent in a year-on-year comparison. [Table: see text]

The Use of Computerized Provider Order Entry to Improve the Effectiveness and Efficiency of Coagulation Testing

2011 ◽  
Vol 135 (4) ◽  
pp. 495-498
Author(s):  
Andrew Georgiou ◽  
Stephen Lang ◽  
David Rosenfeld ◽  
Johanna I Westbrook
Keyword(s):  
International Normalized Ratio ◽  
Turnaround Time ◽  
Activated Partial Thromboplastin Time ◽  
Test Results ◽  
Order Entry ◽  
Computerized Provider Order Entry ◽  
Related Information ◽  
Number Of Patients ◽  
Coagulation Testing ◽  
Effectiveness And Efficiency

Abstract Effective pathology services require timely communication of patient-related information between the laboratory and clinicians. The aim of this study was to measure the effect of a computerized provider order entry (CPOE) system on the frequency with which clinicians notify the Hematology Laboratory of details on heparin or warfarin treatments when ordering activated partial thromboplastin time (aPTT) or the prothrombin time (PT) and international normalized ratio (INR). Although information about the total number of patients on warfarin or heparin was unavailable, it was possible to ascertain that the percentage of abnormal results for each year ranged from 39% in 2005 to 45%, 40%, and 38% in the years 2006 to 2008. The proportion of order requests that reported whether patients were on warfarin or heparin increased from 3% of the aPTT tests (253 of 8307) and 1.9% of the PT and INR requests (161 of 8433) in August through September 2005 (before the CPOE was implemented) to 3.9% (393 of 9990; P < .001) and 2.6% (282 of 10814; P  =  .009), respectively, in August through September 2008 (after CPOE implementation). During that period (2005–2008), the median turnaround time for the laboratory decreased from 28 to 21 minutes for the PT and INR test results (P < .001) and from 34 to 23 minutes for the aPTT test results (P < .001). The results show that CPOE and decision-support systems can enhance laboratory efficiency and improve its contribution to effective patient care.

Use of a physician order entry system to identify opportunities for intravenous to oral levofloxacin conversion

2000 ◽  
Vol 57 (suppl_3) ◽  
pp. S14-S16 ◽  
Author(s):  
Indy Glemaud
Keyword(s):  
Oral Therapy ◽  
Order Entry ◽  
Inappropriate Use ◽  
Oral Medications ◽  
Number Of Patients ◽  
The Cost ◽  
Physician Order Entry ◽  
Nursing Station ◽  
Oral Diet

Abstract Experience with a program for identifying, through a physician order entry system, potentially inappropriate use of expensive intravenous (i.v.) drugs, including levofloxacin, is described. The program identifies patients who are receiving i.v. levofloxacin and simultaneously receiving oral medications or an oral diet. A computerized report of such patients is printed every morning at the hospital and distributed to pharmacists according to their nursing station assignments. The pharmacists document their daily interventions to encourage switching from i.v. to oral therapy, and data are compiled and posted at the end of each month. From January 1 through September 30, 1999, the first 10 months of the program, the cost per day of levofloxacin therapy per patient decreased substantially. The program helped the institution decrease the number of patients receiving i.v. levofloxacin.

scholarly journals Implementation Strategies of a Quality Improvement Initiative for Hospital-Acquired Clostridioides difficile Infection Prevention

2020 ◽  
Vol 41 (S1) ◽  
pp. s279-s280
Author(s):  
Nicole Lamont ◽  
Lauren Bresee ◽  
Kathryn Bush ◽  
Blanda Chow ◽  
Bruce Dalton ◽  
...  
Keyword(s):  
Decision Support ◽  
Focus Groups ◽  
Clinical Decision Support ◽  
Implementation Strategy ◽  
Clinical Decision ◽  
Medication Administration ◽  
Quality Improvement Initiative ◽  
Order Entry ◽  
Clostridioides Difficile ◽  
Number Of Patients

Background:Clostridioides difficile infection (CDI) is the most common cause of infectious diarrhea in hospitalized patients. Probiotics have been studied as a measure to prevent CDI. Timely probiotic administration to at-risk patients receiving systemic antimicrobials presents significant challenges. We sought to determine optimal implementation methods to administer probiotics to all adult inpatients aged 55 years receiving a course of systemic antimicrobials across an entire health region. Methods: Using a randomized stepped-wedge design across 4 acute-care hospitals (n = 2,490 beds), the probiotic Bio-K+ was prescribed daily to patients receiving systemic antimicrobials and was continued for 5 days after antimicrobial discontinuation. Focus groups and interviews were conducted to identify barriers, and the implementation strategy was adapted to address the key identified barriers. The implementation strategy included clinical decision support involving a linked flag on antibiotic ordering and a 1-click order entry within the electronic medical record (EMR), provider and patient education (written/videos/in-person), and local site champions. Protocol adherence was measured by tracking the number of patients on therapeutic antimicrobials that received BioK+ based on the bedside nursing EMR medication administration records. Adherence rates were sorted by hospital and unit in 48- and 72-hour intervals with recording of percentile distribution of time (days) to receipt of the first antimicrobial. Results: In total, 340 education sessions with >1,800 key stakeholders occurred before and during implementation across the 4 involved hospitals. The overall adherence of probiotic ordering for wards with antimicrobial orders was 78% and 80% at 48 and 72 hours, respectively over 72 patient months. Individual hospital adherence rates varied between 77% and 80% at 48 hours and between 79% and 83% at 72 hours. Of 246,144 scheduled probiotic orders, 94% were administered at the bedside within a median of 0.61 days (75th percentile, 0.88), 0.47 days (75th percentile, 0.86), 0.71 days (75th percentile, 0.92) and 0.67 days (75th percentile, 0.93), respectively, at the 4 sites after receipt of first antimicrobial. The key themes from the focus groups emphasized the usefulness of the linked flag alert for probiotics on antibiotic ordering, the ease of the EMR 1-click order entry, and the importance of the education sessions. Conclusions: Electronic clinical decision support, education, and local champion support achieved a high implementation rate consistent across all sites. Use of a 1-click order entry in the EMR was considered a key component of the success of the implementation and should be considered for any implementation strategy for a stewardship initiative. Achieving high prescribing adherence allows more precision in evaluating the effectiveness of the probiotic strategy.Funding: Partnerships for Research and Innovation in the Health System, Alberta Innovates/Health Solutions Funding: AwardDisclosures: None

Abstract W P287: Does Comprehensive Stroke Certification Demonstrate a Significant Effect on Volume and Quality of Care?

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Laurie Paletz ◽  
Shlee Song ◽  
Nili Steiner ◽  
Betty Robertson ◽  
Nicole Wolber ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Quality Of Care ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Turnaround Time ◽  
Joint Commission ◽  
Stroke Patients ◽  
Number Of Patients ◽  
The Impact

Introduction/Background information: At the onset of acute stroke symptoms, speed, capability, safety and skill are essential-lost minutes can be the difference between full recoveries, poor outcome, or even death. The Joint Commission's Certificate of Distinction for Comprehensive Stroke Centers recognizes centers that make exceptional efforts to foster better outcomes for stroke care. While many hospitals have been surveyed, Cedars Sinai was the 5 th hospital in the nation to receive this certification. Researchable question: Does Comprehensive stroke certification (CSC) demonstrate a significant effect on volume and quality of care? Methods: We assembled a cross-functional, multidisciplinary expert team representing all departments and skill sets involved in treating stroke patients. We carefully screened eligible patients with acute ischemic stroke We assessed the number of patients treated at Cedars-Sinai with IV-T-pa t 6 months before and then 6 months after CSC and the quality of their care including medical treatment and door to needle time. Results: In the 6 months prior to Joint Commissions Stroke Certification we treated 20 of 395acute stroke patients with t-PA with an average CT turnaround time of 31±19minutes and an average Door to needle time (DTNT) of 68±32minutes. In the 6 months since Joint Commission Stroke Certification we have increased the number of acute stroke patients treated by almost double. There were 37 out of 489(P=0.02, Chi Square) patients treated with IV t-PA with an average CT turnaround time of 22±7minutes (p=0.08, t-test, compared to pre-CSC) and an average DTNT of 61± 23minutes (not different than pre-CSC). Conclusion: We conclude that Joint Commission Certification for stroke was associated with an increased rate of treatment with IV rt-PA in acute ischemic stroke patients. We were not able to document an effect on quality of care. Further studies of the impact of CSC certification are warranted.

Effect of Decentralized Computer Order Entry on Medication Turnaround Time

1983 ◽  
Vol 40 (6) ◽  
pp. 979-981
Author(s):  
Peter J. Lomonte ◽  
Robert A. Besser ◽  
Elliott C. Thomas
Keyword(s):  
Turnaround Time ◽  
Order Entry

scholarly journals P138: Using electronic health record data to assess emergency medicine trainees independent and interdependent performance: a qualitative perspective on measuring what matters

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S106-S106
Author(s):  
L. Shepherd ◽  
S. Sebok-Syer ◽  
L. Lingard ◽  
A. McConnell ◽  
R. Sedran ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Electronic Health Record ◽  
Performance Indicators ◽  
Clinical Performance ◽  
Turnaround Time ◽  
Health Record ◽  
Structured Interviews ◽  
Electronic Health Record Data ◽  
Number Of Patients ◽  
Electronic Health

Introduction: Competency-based medical education (CBME) affirms that trainees will receive timely assessments and effective feedback about their clinical performance, which has inevitably raised concerns about assessment burden. Therefore, we need ways of generating assessments that do not rely exclusively on faculty-produced reports. The main object of this research is to investigate how data already collected in the electronic health record (EHR) might be meaningfully and appropriately used for assessing emergency medicine (EM) trainees independent and interdependent clinical performance. This study represents the first step in exploring what EHR data might be utilized to monitor and assess trainees clinical performance Methods: Following constructivist grounded theory, individual semi-structured interviews were conducted with 10 EM faculty and 11 EM trainees, across all postgraduate years, to identify EHR performance indicators that represent EM trainees independent and interdependent clinical actions and decisions. Participants were presented with a list of performance indicators and asked to comment on how valuable each would be in assessing trainee performance. Data analysis employed constant comparative inductive methods and occured throughout data collection. Results: Participants created, refined, and eliminated performance indicators. Our main result is a catalogue of clinical performance indicators, described by our participants, as reflecting independent and/or interdependent EM trainee performance that are believed to be captured within the EHR. Such independent indicators include: number of patients seen (according to CTAS levels), turnaround time between when a patient is signed up for and first orders are made, number of narcotics prescribed. Meanwhile, interdependent indicators include, but are not limited to, length of stay, bounce-back rates, ordering practices, and time to fluids. Conclusion: Our findings document a process for developing EM trainee report cards that incorporate the perspectives of clinical faculty and trainees. Our work has important implications for distinguishing between independent and interdependent clinical performance indicators.

scholarly journals Implementation of an internal check of oral oncolytics: a single-center, specialty pharmacy safety initiative

2019 ◽  
Vol 8 (sup1) ◽  
pp. 25-25
Author(s):  
Mitchell Hughes ◽  
Richard Kriska ◽  
Gregory Strong ◽  
Jennifer Chung ◽  
Lily Nguyen ◽  
...  
Keyword(s):  
Single Center ◽  
Internal Check ◽  
Specialty Pharmacy ◽  
Oral Oncolytics ◽  
Safety Initiative

Process Improvements to Decrease Pharmacy Turnaround Time

2001 ◽  
Vol 36 (7) ◽  
pp. 750-752
Author(s):  
Gary F. Kilsdonk ◽  
Lori W. Henke ◽  
Diana L. Perley
Keyword(s):  
Community Hospital ◽  
Turnaround Time ◽  
Order Entry ◽  
Pharmacy Staff ◽  
Staff Morale ◽  
Process Improvements ◽  
Working Through

This case study will describe the steps taken to improve pharmacy turnaround times at a 450-bed community hospital. Working through a pharmacy/nursing committee, the pharmacy implemented changes to streamline the order entry process and reorganize workflow. An upgrade of unit-based dispensing cabinets improved floorstock levels and pharmacy control over this stock. Gains were made by faxing medication orders to pharmacy and by decentralizing pharmacy staff during peak hours. Turnaround times ranged between 80 to 147 minutes before the changes and 26 minutes to 33 minutes following the changes. Pharmacist turnover decreased and staff morale improved.

scholarly journals Intensive diagnostic management of coronavirus disease 2019 (COVID-19) in academic settings in Japan: challenge and future

2020 ◽  
Vol 40 (1) ◽  
Author(s):  
Tokio Hoshina ◽  
Hiroka Aonuma ◽  
Manabu Ote ◽  
Tatsuya Sakurai ◽  
Erisha Saiki ◽  
...  
Keyword(s):  
Diagnostic Testing ◽  
Basic Research ◽  
Diagnostic Value ◽  
Turnaround Time ◽  
Patient Treatment ◽  
Emerging Infections ◽  
University Hospitals ◽  
Number Of Patients ◽  
Academic Settings ◽  
The Impact

Abstract Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first emerged in Wuhan, China, and has spread globally to most countries. In Japan, the first COVID-19 patient was identified on January 15, 2020. By June 30, the total number of patients diagnosed with COVID-19 reached 18,000. The impact of molecular detection of pathogens is significant in acute-care settings where rapid and accurate diagnostic measures are critical for decisions in patient treatment and outcomes of infectious diseases. Polymerase chain reaction (PCR)-based methods, such as quantitative PCR (qPCR), are the most established gene amplification tools and have a comprehensive range of clinical applications, including detecting a variety of pathogens, even novel agents causing emerging infections. Because SARS-CoV-2 contains a single-stranded RNA genome, reverse-transcription qPCR (RT-qPCR) has been broadly employed for rapid and sensitive quantitative measurements of viral RNA copy numbers. The RT-qPCR method, however, still requires time-consuming reactions with two different enzymes in addition to isolation of RNA from patient samples, limiting the numbers of testing institutions for diagnosing SARS-CoV-2 infection. Japan is known to have performed a relatively small number of PCR tests as well as confirmed cases among developed nations; as of June 30, 2020, approximately 390,000 people in Japan had undergone PCR tests. Given the devastating impact on medical services and the scale of demand for diagnostic testing of COVID-19, it has been proposed that academic settings such as basic research departments in university/college can be engaged in diagnosing, especially in university hospitals or academic medical centers. In collaboration with established diagnostic laboratories, academic facilities can divert their function to detecting virus from patients with suspected COVID-19, adopting existing specialized expertise in virus handling, molecular work, and data analysis. This in-house testing strategy facilitates the rapid diagnosing of thousands of samples per day and reduces sample turnaround time from 1 week to less than 24 h. This review provides an overview of the general principles, diagnostic value, and limitations of COVID-19 diagnosis platforms in Japan, in particular in-house testing at academic settings.

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