Multidisciplinary Optimization of Oral Chemotherapy Delivery at the University of Wisconsin Carbone Cancer Center

• Published in: Journal of oncology practice Vol. 12; no. 10; pp. e912 - e923
• Main Authors: Mulkerin, Daniel L, Bergsbaken, Jason J, Fischer, Jessica A, Mulkerin, Mary J, Bohler, Aaron M, Mably, Mary S
• Format: Journal Article
• Language: English
• Published: United States American Society of Clinical Oncology 01-10-2016
• Subjects: Administration, Oral; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; Cancer Care Facilities - standards; Drug Monitoring; Drug Utilization Review; Electronic Health Records; Hospitals, University - standards; Humans; Medication Adherence; National Cancer Institute (U.S.); Patient Safety; Pharmacy Service, Hospital - standards; Special Series: Quality Care Symposium; United States
• ISSN: 1554-7477; 1935-469X
• DOI: 10.1200/JOP.2016.013748

Use of oral chemotherapy is expanding and offers advantages while posing unique safety challenges. ASCO and the Oncology Nursing Society jointly published safety standards for administering chemotherapy that offer a framework for improving oral chemotherapy practice at the University of Wisconsin Carbone Cancer Center.
With the goal of improving safety, quality, and uniformity within our oral chemotherapy practice, we conducted a gap analysis comparing our practice against ASCO/Oncology Nursing Society guidelines. Areas for improvement were addressed by multidisciplinary workgroups that focused on education, workflows, and information technology. Recommendations and process changes included defining chemotherapy, standardizing patient and caregiver education, mandating the use of comprehensive electronic order sets, and standardizing documentation for dose modification. Revised processes allow pharmacists to review all orders for oral chemotherapy, and they support monitoring adherence and toxicity by using a library of scripted materials.
Between August 2015 and January 2016, revised processes were implemented across the University of Wisconsin Carbone Cancer Center clinics. The following are key performance indicators: 92.5% of oral chemotherapy orders (n = 1,216) were initiated within comprehensive electronic order sets (N = 1,315), 89.2% compliance with informed consent was achieved, 14.7% of orders (n = 193) required an average of 4.4 minutes review time by the pharmacist, and 100% compliance with first-cycle monitoring of adherence and toxicity was achieved.
We closed significant gaps between institutional practice and published standards for our oral chemotherapy practice and experienced steady improvement and sustainable performance in key metrics. We created an electronic definition of oral chemotherapies that allowed us to leverage our electronic health records. We believe our tools are broadly applicable.