Category: Federal Forum Posters
Purpose: Chemotherapy errors are posed to occur at a rate of one to four in one-thousand orders, affecting one to three percent of the population. Disruptions in workflow and lack of standardized procedures in chemotherapy clinics pose a higher risk of medication errors and impede patient care. Currently, the oncology practice at our medical center has several barriers to optimal workflow. These barriers have hindered the oncology pharmacists from utilizing their full scope of practice and capturing the interventions they perform. This project is designed to correct gaps in workflow to improve efficiency, , pharmacist’s workload capture, and patient outcomes.
Methods: The institutional review board (IRB) reviewed the project and determined it as non-research QI project. A gap analysis will be conducted to identify key areas in oncology pharmacy and infusion clinic workflow that can be improved upon. Standardized progress note templates will be developed for pharmacist documentation of monitoring patients prescribed both intravenous (IV) and oral chemotherapy agents. Quick-order sets will be created linking laboratory monitoring to the corresponding chemotherapy agent order entry to standardize monitoring and follow up for patients undergoing routine treatment. Communication between oncology pharmacy and infusion clinic staff will be standardized in the form of patient assessment templates built into the electronic medical record. A retrospective chart review will be conducted to determine the rates of hospitalization and adverse drug reactions caused by chemotherapy agents between July 1, 2017 and June 30, 2018. These parameters will be prospectively used to modify current progress note template to follow-up patients seen by the oncologist from September 1, 2018 to May 31, 2019. Further, progress note template for capturing oncology pharmacist’s encounter will be standardized and data on encounter will also be evaluated prior to and during the project.
Results: Final results will be presented at the Western States Conference in May 2019.
Conclusion: Improvements in workflow for the oncology pharmacy clinic are to be expected. We expect patient wait times in the infusion clinic to decrease. We also expect to optimize pharmacist and provider time by standardizing documentation and ordering procedures.
Aaron Stewart– Pharmacy Resident, VA Sierra Nevada Health Care System, Reno, NV