A Journey to Improve Oncology Care Via A Focus on Quality, Safety, Improved Use of Technology, and Implementation of an Oncology Pharmacy Team
Katherine Hanger, Pharm.D., BCOP, Caron Sue, Pharm.D., Ph.D., Lisa Altenau, Pharm.D., David Burgas, Pharm.D., BCPS, Jonathan Egel, Pharm.D., Timothy Onady, Pharm.D., Michelle Wiest, Pharm.D., BCPS, FASHP
University of Cincinnati Medical Center, Cincinnati, Ohio
Consequences of chemotherapy-related errors can be devastating and potentially fatal. Several organizations have published guidelines to improve the safety and quality of cancer care. In 2011, we began a comprehensive analysis of our oncology program which revealed program-wide deficiencies in safety and quality. We developed an integrated, decentralized oncology pharmacy service line (DHON) to optimize care through improved use of technology, generation of data-driven quality metrics, and development of an integrated oncology pharmacy practice model.
The team was comprised of three clinical staff pharmacists (CSP), one electronic medical record (EMR) pharmacist, and an oncology pharmacy coordinator. Together, this team undertook the following challenges: 1) provide clinical and operational pharmacy support, 2) centralize preparation of hazardous drugs, 3) design, implement, and optimize an integrated ambulatory and inpatient EMR with oncology-specific functionality, 4) standardize oncology treatment plans, 5) operationalize barcode medication administration (BCMA), 6) redesign institutional chemotherapy processes to increase safety and efficiency, and 7) generate an oncology pharmacy quality dashboard.
Since the team’s inception, the cancer center has achieved 100% compliance with documentation of consent prior to treatment with chemotherapy. Outpatient infusion areas consistently exceed their 95% goal for BCMA. The cancer center has made improvements in 79 of 175 (45%) standards for the 2012 Institute for Safe Medication Practices International Medication Safety Self-Assessment® for Oncology and is now fully compliant with 85% of the standards. Since implementation of the new EMR, the mean number of errors in drug name, dosing, and/or frequency per 100 chemotherapy orders has decreased from 22.9 to 2.0 (p < 0.001). EMR enhancements have facilitated workflow, increased reporting opportunities, and improved documentation within the medical record. Increased efficiency has allowed DHON to expand its scope of service to include transitional care services, weekend and holiday coverage, increased involvement in formulary management, and focused efforts in medication safety and quality improvement initiatives. Through visibility of service and demonstration of impact, we have worked with leadership to expand our team and support three new clinical pharmacy specialist positions and multiple oncology CSP positions.
DHON is an innovative team structure that aligns clinical and operational initiatives to optimize teamwork and outcomes. We emphasize shared ownership of vision, processes, and outcomes. Faced with limited resources, we generated creative and collaborative solutions for common problems. DHON has become a pillar in the development, growth, and pursuit of excellence for oncology care at our institution.