Upgrading the Chemotherapy Consent: Trading in Paper for Tablet

2021 ◽  
Author(s):  
Lesley Wu ◽  
Cardinale B. Smith ◽  
Jessica Parra ◽  
Mark Liu ◽  
Haley Hines Theroux ◽  
...  
Keyword(s):  
Quality Care ◽  
Care Plan ◽  
Innovative Technology ◽  
Chart Audit ◽  
Regulatory Requirements ◽  
Pareto Chart ◽  
Administrative Burden ◽  
Patients With Cancer ◽  
Three Phase ◽  
Oncology Care

PURPOSE: Our institution participated in the Oncology Care Model, which required us to include many of the 13 elements of the National Academy of Medicine (NAM) care plan into care pathways for our patients. We optimized our existing chemotherapy consent process to meet this need and maximized completion. METHODS: Our multidisciplinary committee developed a three-phase Plan-Do-Study-Act process in our breast cancer clinic: (1) update and educate providers on our paper chemotherapy form with multiple components of the NAM care plan including prognosis and treatment effects on quality of life; (2) piloted an electronic chemotherapy consent form to decrease the administrative burden; and (3) autopopulated fields within the electronic consent. We assessed feedback after cycle 1 and created a Pareto chart. The outcome measure was percent completion of chemotherapy consent documents. RESULTS: Baseline monthly random chart audit of 40 patients revealed 20% of paper chemotherapy consent forms were completed in their entirety among patients. When we re-educated clinicians about the new paper consent containing the NAM elements, compliance rose to nearly 30%. A Pareto chart confirmed that content redundancy and wordiness were leading to under-completion. After creating and piloting the electronic consent, compliance increased to 90%. Finally, autopopulation with drop-down selections increased and sustained completion to 100%. CONCLUSION: Incorporating regulatory requirements into an existing workflow using Plan-Do-Study-Act methodology can reduce administrative burden on clinicians. Additional use of innovative technology can further increase clinician compliance with regulatory requirements while delivering high-value quality care to patients with cancer.

Improving the chemotherapy consent: From paper to tablet.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 298-298
Author(s):  
Aarti Sonia Bhardwaj ◽  
Jessica Parra ◽  
Kavita Rampertaap ◽  
Katherine FitzPatrick ◽  
Raina Caridi ◽  
...  
Keyword(s):  
Electronic Version ◽  
Consent Form ◽  
Consent Process ◽  
Care Plan ◽  
Response To Treatment ◽  
Innovative Technology ◽  
Cancer Center ◽  
Institute Of Medicine ◽  
Pareto Chart ◽  
Administrative Burden

298 Background: A comprehensive chemotherapy informed consent process improves shared decision-making. Additionally, the Oncology Care Model (OCM) emphasizes providing patients with a documented care plan that contains the 13 components in the Institute of Medicine Care Management Plan. Within our health system, we incorporated the care plan into our existing chemotherapy consent process and utilized technology to increase compliance and reduce administrative burden. Methods: Our 2 phase PDSA included: 1) updating our existing paper chemotherapy form with the 13 components of the IOM care plan and then 2) piloting an electronic version of the chemotherapy consent form. We updated our new chemotherapy consent with the addition of Prognosis, Expected Response to Treatment, Potential Effect on Quality of Life, Potential Benefits/Goals of Treatment, and added more options for potential side effects/harm. Given the increased administrative burden, we created and piloted the use of an electronic version of the consent form in our breast oncology program. Results: Baseline, monthly random chart audit of 20-40 patients revealed compliance with completing every question of the paper chemotherapy consent at 30% of all patients receiving IV chemotherapy at our cancer center that month- 7/2018. When the new chemotherapy consent incorporating the IOM elements was rolled out, compliance initially rose to 50% (8/2018), however the following months dropped to 10-20% (9-11/2018) and then back up to 41% briefly (12/2018). The results were low and inconsistent. A pareto chart confirmed that redundancy and too many questions were the reasons for under-completion. By auto-populating fields for certain questions on the paper consent, compliance increased to 75% (2/2019). Finally within our breast cancer pilot group our compliance rose to 100% (3-4/2019), by converting to an electronic form with the maximum options for auto-population and drop-down selections for certain fields. Conclusions: Incorporating regulatory requirements into an existing workflow can reduce administrative burden. The use of innovative technology can further increase clinician and OCM compliance while delivering value to patients.

scholarly journals Oncology Pharmacist Opportunities: Closing the Gap in Quality Care

2018 ◽  
Vol 14 (6) ◽  
pp. e403-e411 ◽  
Author(s):  
Vera Vulaj ◽  
Shannon Hough ◽  
Louise Bedard ◽  
Karen Farris ◽  
Emily Mackler
Keyword(s):  
Clinical Care ◽  
Quality Care ◽  
Patient Counseling ◽  
Incentive Payment ◽  
High Performing ◽  
Patients With Cancer ◽  
Oncology Care ◽  
Oncology Practice ◽  
Best Fit

Purpose: ASCO has worked to facilitate the improvement in quality oncology care via the development of the Quality Oncology Practice Initiative (QOPI). The extent to which the ASCO QOPI identifies areas in which pharmacists may enhance care is not known. These findings are important, as pharmacists are an integral part of the care team, providing direct clinical care in addition to medication use guidelines and practice-based policies. In addition, high-performing practices may receive reimbursement from the Centers for Medicare and Medicaid Services. Methods: Three pharmacists reviewed 200 QOPI measures for potential pharmacist involvement. We used the Hematology/Oncology Pharmacy Association Scope of Practice document and a validated summary of services provided by board-certified oncology pharmacists to identify which practice domains and pharmacy services would best fit the care provided by the selected QOPI measures. Results: A total of 177 QOPI measures were analyzed. Potential areas of pharmacist impact were identified in 67 (38%) of the included metrics. Measures largely related to optimizing drug therapy through the development and implementation of pharmacy guidelines. Patient counseling and symptom management are services that best described the majority of QOPI measures deemed actionable by a pharmacist. We also found that several QOPI measures pharmacists can intervene upon overlap with metrics currently assessed for reimbursement via the Centers for Medicare and Medicaid Services Merit-Based Incentive Payment System. Conclusion: Oncology pharmacists are uniquely positioned to improve the quality of care provided to patients with cancer within the team-based setting.

Improving oral chemotherapy documentation in a breast medical oncology outpatient practice.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 71-71
Author(s):  
Aarti Sonia Bhardwaj ◽  
Katherine FitzPatrick ◽  
Kathleen Hynes ◽  
David Bivens ◽  
Micheal McLean ◽  
...  
Keyword(s):  
Patient Safety ◽  
Oral Chemotherapy ◽  
Care Plan ◽  
Chart Audit ◽  
Meaningful Improvement ◽  
Improvement Project ◽  
Efficient System ◽  
Pareto Chart ◽  
Number Of Components ◽  
Phone Calls

71 Background: The safe administration of oral chemotherapy is a challenging yet important process to ensure patient safety. Comprehensive initial and subsequent documentation especially regarding dosage and toxicities in the plan of care for patients receiving oral chemotherapy can be instrumental in improving patient safety by ensuring comprehensive health information is available to all health team members. Methods: We are undertaking a rapid cycle improvement project to improve initial and subsequent documentation of new oral chemotherapy care plans by increasing our compliance with the number of components of an oral chemotherapy care plan (as outlined by QOPI’s 13 standards). We performed a baseline chart audit to confirm our current low level of compliance. We then created a process to use smart phrases that include necessary QOPI elements for progress notes upon new prescription of oral chemotherapy as well as smart phrases for subsequent patient initiated telephone encounters regarding oral chemotherapy, that feed into a universal “med note” location. Post implementation, we will perform a chart audit to determine our updated compliance. Staff satisfaction with the old vs the new process will be compared to verify that we have created a more efficient system to answer patient questions regarding oral chemotherapy. Results: Baseline chart audit revealed the number of components of an oral chemotherapy care plan (as per QOPI standards) documented in the EMR was 43% (i.e contained 5/13 components). A Pareto chart confirmed that underutilization of current EMR resources and lack of knowledge regarding QOPI standards were common reasons for poor oral chemotherapy documentation. Implementation of smart phrases for documentation for initial patient encounters and subsequent telephone encounters is currently in process to determine our new level of compliance with QOPI standards for a sustained and meaningful improvement. Conclusions: This quality improvement initiative was designed to improve patient safety by enhancing documentation of an oral chemotherapy care plan in the EMR and also to create a more efficient system to answer and document patient phone calls regarding oral chemotherapy.

COVID-19 in patients suffering from Cancer: Review article

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 1494-1499
Author(s):  
Shahid Ahmad Siddiqui
Keyword(s):  
Cancer Patients ◽  
Immune Status ◽  
Review Article ◽  
Care Plan ◽  
Patients With Cancer ◽  
Corona Virus ◽  
Cancer Review ◽  
Ideal System ◽  
Lethal Infection ◽  
Set Up

The episode of Covid19 (CORONA VIRUS) has become one of the greatest worldwide dangers around the world, which has now tainted over 1.7 million individuals with deaths of over 100,000 lives far & wide. Under these extraordinary conditions, there are no entrenched rules for cancer patients. The danger for genuine infection & passing in CORONA VIRUS cases increments with propelling age & existing co-morbid medical issue. After the rise of primary suspects in China during last month of 2019, enormous exploration endeavors have been in progress to comprehend the instruments of infectivity & contagiousness of coronavirus, a lethal infection liable for wretched endurance results. To limit the death rate, it gets judicious to distinguish indications quickly & utilize medicines suitably. Despite the fact that no fix has been set up, different clinical preliminaries are in progress to decide the most ideal system. Overseeing patients with cancer in these conditions is a fair task, considering their weak immune status & their ill health. Through this thorough audit, we talk about the effect of CORONA VIRUS on wellbeing & the immune system of who are infected, assessing the most recent care plan draws near & progressing clinical preliminaries. Also, we talk about difficulties confronted while treating cancer patients & propose possible ways to deal with these weak populace during pandemic.

scholarly journals Eva between anxiety and hope: integrating anthroposophic music therapy in supportive oncology care

2015 ◽  
Vol 3 (3) ◽  
Author(s):  
Eran Ben-Arye ◽  
Yotam Ben-Arye ◽  
Yael Barak
Keyword(s):  
Music Therapy ◽  
Well Being ◽  
Recurrent Ovarian Cancer ◽  
Anthroposophic Medicine ◽  
Patients With Cancer ◽  
Therapy Goals ◽  
Chemotherapy Side Effects ◽  
Oncology Care ◽  
Supportive Oncology ◽  
Therapy Interventions

Music therapy is a significant modality in the treatment of patients with cancer, who suffer emotional and spiritual distress as well as chemotherapy side effects that impair their quality of life. In this article, we present a case study of a patient challenged with recurrent ovarian cancer who received, concomitant with chemotherapy, a special form of music therapy based on anthroposophic medicine (AM) aimed at alleviating anxiety and improving her general well-being. AM-centered music therapy goals are discussed in regard to two modes of treatment: receptive listening and clinical composition. Next, these two treatment modes are discussed in a broader context by reviewing conventional music therapy interventions during chemotherapy on two axes: a. standardized vs. individualized treatment; b. patient’s involvement on a passive to active continuum. In conclusion, psycho-oncology care can be enriched by adding anthroposophic medicine-oriented music therapy integrated within patients’ supportive care.

scholarly journals Genomic Consideration in Chemotherapy-Induced Ovarian Damage and Fertility Preservation

Genes ◽  
2021 ◽  
Vol 12 (10) ◽  
pp. 1525
Author(s):  
Seongmin Kim ◽  
Sanghoon Lee ◽  
Hyun-Tae Park ◽  
Jae-Yun Song ◽  
Tak Kim
Keyword(s):  
Fertility Preservation ◽  
Quality Care ◽  
Young Patients ◽  
Young Female ◽  
Patients With Cancer ◽  
Female Cancer Patients ◽  
Ovarian Damage ◽  
Prevention Methods ◽  
Gonadal Damage ◽  
Gene Alterations

Chemotherapy-induced ovarian damage and fertility preservation in young patients with cancer are emerging disciplines. The mechanism of treatment-related gonadal damage provides important information for targeting prevention methods. The genomic aspects of ovarian damage after chemotherapy are not fully understood. Several studies have demonstrated that gene alterations related to follicular apoptosis or accelerated follicle activation are related to ovarian insufficiency and susceptibility to ovarian damage following chemotherapy. This may accelerate follicular apoptosis and follicle reservoir utilization and damage the ovarian stroma via multiple molecular reactions after chemotherapy. This review highlights the importance of genomic considerations in chemotherapy-induced ovarian damage and multidisciplinary oncofertility strategies for providing high-quality care to young female cancer patients.

Integrative Oncology

2021 ◽  
pp. 470-478
Author(s):  
Santhosshi Narayanan ◽  
Gabriel Lopez ◽  
Jun J. Mao ◽  
Wenli Liu ◽  
Lorenzo Cohen
Keyword(s):  
Symptom Management ◽  
Care Plan ◽  
Integrative Approach ◽  
Evidence Based ◽  
Patient Centered ◽  
Open Communication ◽  
Patients With Cancer ◽  
Comprehensive Plan ◽  
Body Practices

Patients with cancer often seek an integrative approach to their care in hope of a cure or symptom management. The integrative care plan requires a patient-centered approach that involves attention to their concerns and developing a comprehensive plan involving physical, mind-body, and social modalities in collaboration with the patient’s main oncology team and colleagues in palliative care, pain management, psychiatry, and rehabilitation. A personalized symptom management strategy utilizing an evidence-based application of conventional and nonconventional therapies can help improve quality of life and optimize treatment outcomes. Recommendation of modalities such as acupuncture, massage, and mind-body practices, as well as open communication and discussion on herbs and supplements, their safety, and interactions with cancer and chemotherapy, is critical to achieve optimal clinical outcomes.

scholarly journals Development and implementation of a structured ward round in acute adult psychiatry

2018 ◽  
Vol 7 (3) ◽  
pp. e000035 ◽  
Author(s):  
Anna Rebecca Mattinson ◽  
Sarah Jane Cheeseman
Keyword(s):  
Improve Patient Safety ◽  
Quality Care ◽  
General Medicine ◽  
Multidisciplinary Care ◽  
Ward Round ◽  
Care Plan ◽  
Care Plans ◽  
Adult Psychiatry ◽  
Paired Male ◽  
Ward Rounds

Delivering high quality care in acute psychiatry requires a coordinated approach from a multidisciplinary team (MDT). Weekly ward rounds are an important forum for reviewing a patient’s progress and developing a personalised care plan for the coming week. In general medicine, structured ward rounds and check lists have been shown to prevent omissions and improve patient safety; however, they are not widely used in psychiatry. At the Royal Edinburgh Hospital, the format of ward rounds differed between psychiatry wards and clinical teams, and care plans were not standardised. An audit in October 2015 found only 5% of acute psychiatric inpatients had a documented nursing care plan. It was agreed that a clear multidisciplinary care plan from the weekly ward round would be beneficial. A group of consultant psychiatrists identified seven key domains for ward round (Social needs, Community Mental Health Team liaison, Assessments required, Mental Health Act, Prescriptions: medication electroconvulsive therapy (ECT), T2/T3, Engagement with relatives and carers, Risk Assessment and Pass Plans). This was given the acronym SCAMPER. Following this, a clinical MDT on a paired male and female ward, developed and introduced a structured ward round sheet. Within 8 weeks this was being used for 100% of patients. It was subsequently introduced into three other acute adult psychiatry wards and the intensive psychiatric care unit. Staff feedback was sought verbally and via a questionnaire. This was positive. The form was widely accepted and staff felt it improved patient care and ward round quality.

scholarly journals Patient Perspectives on the Ethical Implementation of a Rapid Learning System for Oncology Care

2017 ◽  
Vol 13 (3) ◽  
pp. e163-e175 ◽  
Author(s):  
Rochelle D. Jones ◽  
Aaron N. Sabolch ◽  
Erin Aakhus ◽  
Rebecca A. Spence ◽  
Angela R. Bradbury ◽  
...  
Keyword(s):  
Ethical Issues ◽  
Learning System ◽  
Patient Perspectives ◽  
Attitudes And Beliefs ◽  
Sensitive Data ◽  
Rapid Learning ◽  
Patients With Cancer ◽  
Interview Guide ◽  
Oncology Care ◽  
Virtuous Cycle

Introduction: A rapid learning system (RLS) of health care harnesses data generated from routine patient care to create a virtuous cycle of data collection and analysis for quality improvement and research. The success of such systems depends on understanding patient perspectives regarding the ethical issues that arise from the ongoing implementation of this transformative concept. Methods: An interview guide was designed to evaluate patient perspectives to inform the ethical implementation of an oncology RLS. A purposively selected, diverse sample of 32 patients with cancer was recruited from two institutions to participate in semistructured, in-depth interviews for formal qualitative analysis. Results: The extent to which respondents expressed discomfort with more permissive system features (less formal notification/consent, broader uses/users, inclusion of sensitive data) reflected their trust, which in turn seemed to vary by sociodemographic features. It was also influenced by their familiarity with technology and their attitudes and beliefs regarding privacy and the use of electronic medical records more generally. Distrust of insurers and the pharmaceutical industry led subjects to desire greater oversight and restriction of these potential users of the system. Subjects were most comfortable when doctors were the primary users, engaged patients directly in the notification and consent discussion, and oversaw the system. Conclusion: Those actively developing RLSs should recognize the critical importance of trust and the key role that doctors will need to play in order for such systems to be successful and to ensure that their implementation is ethically palatable to the patients whose data are being included.

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