Significant and sustained reduction in chemotherapy errors though improvement science.

Abstract

37 Background: The majority of children with cancer are now cured with highly complex chemotherapy regimens incorporating multiple drugs and demanding monitoring schedules. The risk for error is high and can occur at any stage in the process, from order generation through pharmacy formulation to bedside drug administration. Our objective is to describe a program to eliminate errors in chemotherapy use among children. Methods: To increase reporting of chemotherapy errors, we supplemented the hospital-reporting system with a new chemotherapy near-miss reporting system. Following the model for improvement, we then implemented several interventions, including a daily chemotherapy huddle, improvements to the preparation and delivery of intravenous therapy, headphones for clinicians ordering chemotherapy, and standards for chemotherapy administration throughout the hospital. Results: Twenty-two months into the project, we saw a centerline shift in our U Chart of chemotherapy errors that reached the patient from a baseline rate of 3.82/1,000 doses to 1.9/1,000 doses. This shift has been sustained for over 4 years. In Poisson regression analyses, we found an initial increase in error rates, followed by a significant decline in errors after 16 months of improvement work (p < 0.001). Conclusions: Following the model for improvement, our improvement efforts were associated with significant reductions in chemotherapy errors which reached the patient. Key drivers for our success included error vigilance through a huddle, standardization, and minimized interruptions during ordering.

The process of oncology nurse practitioner patient navigation: navigation in the chemotherapy suite, navigation tools revisited

“…It utilizes an interprofessional team approach with the integration of evidence-based practices, which are continuously re-evaluated with the goal of continuously improving care Institute of Medicine. 6 The team huddle is one such tool; and in fact has been identified as a successful means of facilitating team communication, in addition to addressing root cause analyses of chemotherapy associated sentinel events Blough & Walrath 7 Morrissey et al, 8 Bunnell et al, 5 Weiss et al 1 For example, Bunnell et al, 5 as part of a process improvement initiative identified four major issues arising from lack of a team approach to oncology chemotherapy patients. These included:…”

“…Research pertaining to the role and process of Oncology Nurse Practitioner (ONP) patient navigation in the chemotherapy suite is limited, yet it is maintained that management of patients receiving chemotherapy requires a team effort Weiss et al, 1 and that the navigation process requires the use of navigation tools Johnson 2 A recent ethnographic study in the United Kingdom (UK), looked at the scope of clinical practice of nurse-lead clinics which included both chemotherapy nurses, and advanced practice nurses (APN's). It was found that different levels of care existed amongst the clinics, and that these levels of care were driven by the level of nursing autonomy and scope of practice, which was heavily influenced by medical consultants Farrell et al 3 Studies have confirmed the importance of good ONP or PA, oncologist, oncology nurses, and pharmacist.…”