Eleven-year experience with a web-based medication occurrence (MO) reporting tool in a community oncology practice.

Abstract

53 Background: At ASCO 2007, we presented 2 year experience with a web-based Medication Occurrence (MO) reporting tool. We now report the 11 year experience in a single outpatient oncology practice. Methods: Since December 2003, Texas Oncology (TxO) sites have entered information on Medication Occurrence (MO) reports in an electronic Variance Reporting tool. The pharmacy management team generates reports monthly for the Texas Oncology Quality Oversight Committee and each site Quality Committee for analysis and follow-up action. The data are analyzed according to a pre-set group of parameters (retail vs. clinic, near miss vs. actual occurrence, severity level 1-8, categories of occurrence). Recently these data were analyzed for the years 2004-2014 to assess trends in MOs. Results: Over 11 years there were 2,163,249 transactions for a chemotherapy infusion or injection. There were 10845 MOs of which 5,143 were adverse drug reactions (ADRs). Near misses accounted for 16.7% of unadjusted MO rate and 31.8% when ADRs were excluded. MO rate with ADR was 0.46%, without ADR 0.24%. Retail MO rate was 0.02% on 1,771,148 transactions. Rituximab was 20.9% and paclitaxel 16.4% of ADRs. Tying reporting to clinic performance increased reporting by site and number of sites. EHR related MOs and Near Misses were each reported as MOs and artificially inflate numbers due to double counting. There were 10 deaths over 11 years. With these data, we were able to 1) Promote an epinephrine protocol for severe drug reactions, 2) Obviate the need for AEDs at every site, 3) Find no difference in rituximab reactions by geographic region, 4) Make assessments regarding cost and toxicity of iron compounds, 5) Target specific drugs for ADR risk. 6) Assess prophylactic corticosteroid regimens in taxane administration. Conclusions: Web-based reporting in the outpatient community setting is feasible and identified many topics for quality improvement initiatives. The importance of double-checking and a culture of safety is reinforced by the number of avoided MOs indicated by the near miss percentage.