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.

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.

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 US Cancer Center Implementation of ASCO/Oncology Nursing Society Chemotherapy Administration Safety Standards

2012 ◽  
Vol 8 (1) ◽  
pp. 7-12 ◽  
Author(s):  
Saul N. Weingart ◽  
Justin W. Li ◽  
Junya Zhu ◽  
Laurinda Morway ◽  
Sherri O. Stuver ◽  
...  
Keyword(s):  
Cancer Center ◽  
Oncology Nursing ◽  
Cancer Centers ◽  
Safety Standards ◽  
Chemotherapy Administration

Given wide variation in the implementation of ASCO/Oncology Nursing Society chemotherapy administration safety standards at US cancer centers, there are significant opportunities for improvement.

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.

Chemotherapy safety initiative.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 226-226
Author(s):  
Maria Tomaro ◽  
Paula Silverman ◽  
Wendy Rowehl Miano ◽  
Amy Wakeling ◽  
Kathleen Gonzalez
Keyword(s):  
Medication Errors ◽  
Gap Analysis ◽  
Safety Margin ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Institute Of Medicine ◽  
University Hospitals ◽  
Minor Variation ◽  
Order Sets ◽  
Order Set

226 Background: The 2006 Institute of Medicine report "Preventing Medication Errors," stated that “medication errors harm at least 1.5 million patients every year…” Chemotherapy (CT) has a narrow therapeutic index and safety margin which can and does lead to fatal errors. University Hospitals Seidman Cancer Center (UHSCC), an National Cancer Institute (NCI) designated Comprehensive Cancer Center, dispensed 10,500 CT doses in 2012 and has taken an active approach to enhance CT safety. Methods: In the last quarter of 2012, a nurse coordinator (NC) for chemotherapy orders and a Chemotherapy Safety Governance Committee (CSGC) was conceptualized. The NC’s role would be to incorporate CT safety best practices into order set development. The charter for the CSGC includes 1) to establish cancer CT standards and operating procedures across the adult and pediatric oncology population; 2) to develop and oversee cancer CT order set infrastructure applicable to our hybrid electronic/paper current state; and 3) to lead performance improvement initiatives related to CT safety. Leading organizations involved in oncology practice and medication safety standard-setting (ASCO, Oncology Nursing Society, Institute For Safe Medication Practices, National Comprehensive Cancer Network, Journal of Cancer Research) were reviewed for recommendations for standards for CT order sets. Results: Thirty standards for a CT order template were identified by the NC. A comprehensive gap analysis was completed to compare the current inpatient and ambulatory CT order sets to these standards. Results of the gap analysis were brought to the CSGC, a multi-disciplinary group of cancer and quality clinicians and leaders over 6 meetings. Consensus was achieved on the application of these standards to CT order sets. Our new orders will adopt 100% of all identified standards for CT orders. Conclusions: The gap analysis led to the development of a CT order set template that maximizes safety by applying best-practice standards. This template is designed to be applicable to electronic and paper-based order sets and with minor variation, appropriate to all disease-based order sets. This template is currently being utilized to revise 330 electronic and 398 paper CT order sets at UHSCC. [Table: see text]

The impacts of a pharmacist-managed outpatient clinic and chemotherapy-directed electronic order sets for monitoring oral chemotherapy

2016 ◽  
Vol 23 (8) ◽  
pp. 582-590 ◽  
Author(s):  
Brandon Battis ◽  
Linda Clifford ◽  
Mostaqul Huq ◽  
Edrick Pejoro ◽  
Scott Mambourg
Keyword(s):  
Chemotherapy Regimen ◽  
Therapy Monitoring ◽  
Oral Chemotherapy ◽  
Close Monitoring ◽  
Medication Therapy ◽  
Order Sets ◽  
Lost To Follow Up ◽  
Chemotherapy Agents ◽  
Electronic Order

Objectives Patients treated with oral chemotherapy appear to have less contact with the treating providers. As a result, safety, adherence, medication therapy monitoring, and timely follow-up may be compromised. The trend of treating cancer with oral chemotherapy agents is on the rise. However, standard clinical guidance is still lacking for prescribing, monitoring, patient education, and follow-up of patients on oral chemotherapy across the healthcare settings. The purpose of this project is to establish an oral chemotherapy monitoring clinic, to create drug and lab specific provider order sets for prescribing and lab monitoring, and ultimately to ensure safe and effective treatment of the veterans we serve. Methods A collaborative agreement was reached among oncology pharmacists, a pharmacy resident, two oncologists, and a physician assistant to establish a pharmacist-managed oral chemotherapy monitoring clinic at the VA Sierra Nevada Healthcare System. Drug-specific electronic order sets for prescribing and lab monitoring were created for initiating new drug therapy and prescription renewal. The order sets were created to be provider-centric, minimizing clicks needed to order necessary medications and lab monitoring. A standard progress note template was developed for documenting interventions made by the clinic. Patients new to an oral chemotherapy regimen were first counseled by an oncology pharmacist. The patients were then enrolled into the oral chemotherapy monitoring clinic for subsequent follow up and pharmacist interventions. Further, patients lacking monitoring or missing provider appointments were captured through a Clinical Dashboard developed by the US Department of Veterans Affairs (VA) Regional Office (VISN21) using SQL Server Reporting Services. Between September 2014 and April 2015, a total of 68 patients on different oral chemotherapy agents were enrolled into the clinic. Results Out of the 68 patients enrolled into the oral chemotherapy monitoring clinic, 31 patients (45%) were identified as having a therapy-related problem with their oral chemotherapy regimen on a gross measure for safety and appropriateness of medication management during the course of eight months follow-up between September 2014 and April 2015. In addition, the clinic helped to reestablish care for three patients (4.4%) who were lost to follow-up. The clinic identified 12 patients (17.6%) non-adherent to their prescribed regimen in some degree, where patients were suspected to miss doses due to delay in refilling prescriptions at least three days later than the expected date. However, these patients denied non-adherence. Among them, six patients (8.8%) were truly non-adherent. These patients stated that they had missed at least one day of therapy or were not taking the medication as prescribed. Medication regimen errors were discovered for five patients, accounting for a 7.3% medication-related error rate. Finally, seven patients (10.3%) were found to have an adverse reaction attributed to their oral chemotherapy. Two of them (2.9%) developed severe adverse reactions (Grade 3 and 4), which required hospitalization or immediate dose de-escalation. Conclusions The pilot clinic was able to identify current deficiencies and gaps in our practice settings for managing oral chemotherapy in a Veterans population. The oral chemotherapy monitoring clinic played a proactive role to identify preventable medication errors, monitor medication therapy, improve adherence, manage adverse drug reactions and re-establish care for patients who were lost to follow-up. The results suggest that close monitoring and follow-up of patients on oral chemotherapy is crucial to achieve therapeutic goals, improve patient safety and adherence, and to reduce drug adverse events and health care cost.

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.

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