Improving Communication to Ensure Multidisciplinary Knowledge, Collaboration, and Participation in the Hematopoietic Stem Cell Transplant Chemotherapy Mobilization Process

Abstract

The University of Virginia (UVA) has adopted the BE SAFE initiative with the commitment of providing a safe environment for patients and staff, the BE SAFE platform utilizes the A3 process improvement tool to standardize and optimize workflow to eliminate waste and unnecessary practices, thereby increasing quality, value, and safety. In support of the BE SAFE initiative we utilized A3 methodology to examine the fragmented chemotherapy stem cell mobilization process. A multidisciplinary team was assembled including an A3 facilitator, pharmacist, physicians, transplant coordinators, and patient access personal. We used the A3 problem solving tool to review the current state, visually illustrating the process using Microsoft Visio, identify the root cause and analyze breaks in communication. Communication breaks included improperly scheduled patient appointments, incomplete documentation, limited time with patients to provide education, poor communication between departments as patients transitioned through the system, patient anxiety, as well as limited access to outpatient services. A standardized process was implemented to ensure chemotherapy mobilization orders were signed in a timely manner. The schedule of patient education was initiated at initial evaluation and continued throughout mobilization. A tentative calendar with a flow diagram is provided and reviewed with patients and caregivers frequently. Pharmacists were integrated into the education plan to allow for more support for patients and caregivers regarding medication regimens. The Mobilization Standard Operating Procedure (SOP) found on the UVA intranet is now being used to provide education to staff including apheresis, infusion, and hematology-oncology inpatient nurses. Patient Access created a registration process for weekends and holidays. Ongoing 1:1 education will continue as needed as staff members and/or resources change. This project demonstrated that the use of a standardized problem solving format is useful for optimizing processes. In an effort to measure outcomes the plan is to implement a questionnaire pre and post mobilization which will include rating the following: education received, ease of process and understanding related to educational material and did these interventions increase your knowledge about stem cell transplant mobilization or was additional information needed.