Implementation of intraoperative radiation therapy (IORT) for breast cancer treatment: An emphasis on radiation and patient safety and quality using a Provonost checklist approach.

Abstract

e11537 Background: IORT is being evaluated as a novel approach to radiation delivery as part of breast conserving surgery. To improve the quality, patient safety and radiation safety issues with this technology we utilized a checklist approach to streamline treatment delivery. Methods: IORT is delivered as a single-dose Intraoperative radiation treatment. The treatment requires a high level of radiation and surgical expertise. We developed a model of implementation that would improve quality, and radiation safety for patient and staff and reduce the possibility of radiation errors associated with treatment delivery. To achieve this goal, we developed a pre op and Intraoperative “Provonost checklist” approach. We streamlined implementation by developing lists using an “Lean thinking method”. 1) Initial meeting with senior management for OR, Nursing and Physicians, with brainstorming to create checklists, timelines and identify IORT quality and safety issues 2) Communicated IORT quality and safety plan to all involved staff. In-services presentations were designed for the nursing, surgical and anesthesia staff as well as well-designed quizzes 3) Safety checklist for nursing, physics, OR staff and separate “time out” for the Intraoperative radiation portion of the procedure. 4) Two end-to-end dry runs prior to the procedures were performed, modifying the list(s) when necessary. This was found to be a necessary step toward the final goal. 5) Evaluated results of the test run, encouraged feedback 6) stabilized the results and by using evaluations to improve efficiency with IORT procedure. Results: IORT was able to be incorporated as part of our cancer center and operating room practice smoothly and successfully, with all radiation and patient safety procedures followed by staff. Conclusions: We performed a thorough and rigorous implementation program, dedicated to potential quality and radiation safety issues in every aspect of implementing IORT. This allowed for decreased OR time, minimal radiation exposure, to staff and reduced anesthesia time during our implementation of this IORT treatment to our Cancer Center.