Abstract
38 Background: Executing an innovative investigational therapy within a pre-existing infrastructure, while incorporating the organizational mission and vision is a complex process. Literature supports the use of patient-centered framework and integration of evidence in standardizing nursing practice to promote efficient workflow, accountability, and ultimately, optimal patient-care outcomes. The aim of this presentation is to describe the experience of a step-down unit at a comprehensive cancer center in developing and implementing processes to safely administer immunotherapy. Methods: A multidisciplinary workgroup reviewed the pre-existing infrastructure, determined the financial impact of new clinical trials and availability of resources, distinguished roles and stakeholder responsibilities, and developed staff education and technology utilization. A unit-prospective analysis, using the Strengths, Weaknesses, Opportunities, and Threats (SWOT) methodology was performed to assist in planning and reducing variations in processes during initial implementation. Results: This initiative resulted in the standardization of immunotherapy treatment workflow and development of patient care tools. The workflow consisted of patient education and treatment pathways, whereas the tools included the treatment calendar and nursing assessment forms comprised of daily handwriting sentence construction and CAR-T Toxicity (CARTOX) Grading Assessment. EHR collaboration resulted in the incorporation of CARTOX into nursing documentation in EMR. These workflow and tools are essential in ensuring timely assessment and management of treatment-related toxicities, escalation of care needs, and reduction of potential missed care and adverse events that impact staffing needs and health care costs. Conclusions: A patient-centered approach provides a framework in implementing innovative changes that promote patient safety. Engaging the frontline staff throughout the journey promoted empowerment and accountability. Multidisciplinary planning and nursing leadership transparency in orchestrating multi-level routines for actualization of competence proved immensely invaluable.
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