Are we really good to go? Can we do better?

Abstract

251 Background: ASCO/ONS (2016) stated that health care continues to see errors regarding chemotherapy administration. ASHP (2015) recommends that institutions establish checkpoints to ensure that chemotherapy orders are correct. These critical safety checks involve stakeholders on the frontline. The institute uses the pharmacy intervention program to combat this critical need. Pharmacy interventions are reviewed monthly and defined as any medication order that pharmacy reviews and recognizes a discrepancy, requiring follow up. An interdisciplinary workgroup of pharmacists and nurses was established to address pharmacy interventions identified. Methods: The workgroup met over two months to revise the existing medication administration criteria and developed a standardized Good to Go worksheet. A mandatory training video was assigned to infusion nurses. The worksheets were piloted over three weeks and reviewed for completion and notes. Pharmacy interventions were collected prior to and during implementation to track compliance and improvement to patient safety. Nurses and pharmacists were identified as team members. Daily debriefing huddles were held during implementation with feedback incorporated and revisions made to the worksheet for the following day(s). This project was approved by the DFCI IRB as a Quality Improvement Project. Results: The pilot unit had a pharmacy intervention rate of 8.8 % for one week prior to implementation. During week one of the pilot the pharmacy interventions decreased to 4.1% and one month after pilot the rate was 4.6% and 4.7%. The most recent pharmacy interventions were communicated to staff. May data showed a further reduction to 2.8%. Nurses reported feeling better organized and more focused, while pharmacists report less phone calls to infusion. Statements from frontline staff and leadership including the positive results of the pilot were added to the training video. Conclusions: With the positive impact on patient safety, the Good to Go project will be implemented throughout the institute in the summer of 2018. Team members will include infusion nurses and pharmacists from all units. A standardized team approach to chemotherapy administration has the potential to minimize medication errors.