Reducing infusion wait time: Redesigning medication order verification workflow at a comprehensive cancer center.

Abstract

129 Background: Many factors contribute to long wait times for cancer patients on the day of their infusion. At Dana-Farber Cancer Institute (DFCI), a contributing factor is patient flow between exam and infusion. Order verification affects patient flow and begins when the following two criteria are met: provider signed an order and the patient’s scheduled infusion appointment arrives. Patients often check-in to infusion before their scheduled infusion appointment. Order verification has three sequential steps: nurse verification, pharmacist 1 verify (V1), and pharmacist 2 verify (V2). Methods: A team of pharmacists, nurses, providers, and process improvement leads designed a pilot in which V1 moved before nurse verification, concurrent with patient check-in to infusion. Further, V1 began as soon as an order was signed; the pharmacist did not wait for a patient’s scheduled infusion appointment. Nurse verification and V2 occurred in sequence after V1. Timestamp data were extracted from Epic and analyzed via Tableau to assess reduction in verification throughput, defined as time between infusion check-in and V2. Fourteen providers and one pharmacist joined a 6-week pilot to adopt the redesigned workflow beginning 4/23/18. Results: At baseline, time between check-in and V2 was consistent for pilot and non-pilot orders. During the pilot, time between check-in and V2 was shorter for pilot orders, showing a sustained decrease of approximately 10 minutes. The table below provides time in minutes between infusion check-in and V2 for pilot and non-pilot orders at baseline (3/12/18-4/20/18) and following workflow redesign (4/23/18-6/1/18). Conclusions: Implementing the pilot workflow reduced order verification throughput time and enabled drug preparation to begin sooner. Expanding this workflow to all medication orders can decrease infusion wait time at DFCI.[Table: see text]

Improving Outpatient Infusion Clinic Wait Times at a Comprehensive Cancer Center

“…Areas that have demonstrated causing delay in chemotherapy infusion in the ambulatory setting include failure in timely communication, order signing delay by physicians, poor sequencing of order verifications, delayed chemotherapy preparation and delivery, and excessive pharmacy turnaround times. [19][20][21][22][23][24][25] We found a similar theme at our center and focused our interventions on communication, chemotherapy turnaround time, and drug delivery time.…”