Chemotherapy order review, activation, preparation, and administration redesign at a large academic cancer center.

Abstract

221 Background: Chemotherapy medication errors are potentially catastrophic due to the small window of therapeutic index, high toxicity, and the compromised clinical status of most recipients. Although compliant with major guidelines for chemotherapy administration, MGH Cancer Center still experienced chemotherapy medication errors tracked in the safety reporting system. Analysis of the safety report data prompted the chemotherapy order review, activation, preparation and administration redesign project with two aims: 1) establish the standard for safety checks for chemotherapy order review, mixing, product verification and administration across all areas of adult chemotherapy infusion by April 2013 and 2) reduce to zero the number of chemotherapy related medication errors by January 2014. Methods: A multidisciplinary team including nursing, pharmacy, and physicians was convened and a problem statement, aim statement, project scope, boundaries and measures of success were delineated. Process maps of each chemotherapy administration area (four in total) were created in an iterative fashion via meetings with front line staff and administration. Cause and effect diagrams were created by small groups of staff members from each area and improvement projects were brainstormed and implemented by nursing directors. Error data from safety reports was compiled quarterly and shared with all workers. Results: A single gold standard for MGH Cancer Center chemotherapy order review, activation, preparation and administration was created for all areas that administer chemotherapy to adults. This redesign project has led to several spin off improvement projects including a medication error awareness project led by nursing and a new competency assessment for oncology nurses. The total number of medication related safety reports has decreased by 67%. The time since our last major chemotherapy administration error is 239 days and we are on track to meet our second project aim. Conclusions: This project employed quality improvement tools and practices to redesign and standardize chemotherapy administration and decrease safety reports related to chemotherapy errors by 67%.