Sickle cell disease (SCD) affects millions of people throughout the world. Hemoglobin S (HbS) polymerization is the fundamental cause of SCD pathophysiology, which leads to hemolysis, increased viscosity, and acute vaso-occlusive episodes. Novel agents have been developed to target the pathophysiology of SCD and decrease the frequency of SCD complications. Voxelotor (Oxbryta) is an HbS polymerization inhibitor that is approved by the U.S. Food & Drug Administration for the treatment of SCD in adults and pediatric patients 12 years and older.
75 Background: Inpatient chemotherapy requires an interdisciplinary approach to achieve shorter hospital stays and decrease cost. A quality improvement project at Hahnemann University Hospital was undertaken to identify delays in the process from admission to chemotherapy initiation in this population. Methods: Time stamps were recorded for patient arrival (door to floor), order placement (floor to order), and administration (order to chemo) to establish a baseline. A multidisciplinary team of pharmacy, nursing, and physicians was developed to address inefficiencies. There were three evaluation intervals: May - October 2015 (Part I), January 2017 - October 2018 (Part II) and October - December 2018 (Part III). Data collected from Part I established a baseline door-to-chemo time (DTC) of 7.2 hrs. Post Part I, prompt communication of patient arrival and delays in chemotherapy hanging were addressed. Part II interventions were outpatient consents and labs, timely order placement, and utilization of order sets. Pharmacy-nurse communication and equal distribution of patients through the week was implemented in Part III. The primary outcome measure was difference in DTC. Results: 200 admissions were reviewed. Results of the evaluation intervals are shown in Table. After the first evaluation interval, DTC improved from 7.18 to 5.96 hrs. DTC further decreased to 5.78 hrs post intervention II. The longest delay was between chemotherapy order and administration. Conclusions: DTC significantly improved between intervals with the above interventions. Utilizing a standardized nursing checklist and biweekly multidisciplinary meetings to emphasize prioritization will further decrease DTC. DTC reduction will decrease cost and increase patient satisfaction. [Table: see text]
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