Improving oral oncolytic education in a safety-net outpatient hematology-oncology practice.

Abstract

266 Background: Oral oncolytics (OO) offer convenient administration and reduce the burden of cancer treatment, while creating particular challenges regarding safety monitoring and adherence. A baseline review of oral oncolytic education (OOE) at our safety-net institution identified that none of the patients who started OO therapy from September to December 2019 had complete documentation of OOE and a care plan. This results in potential increased risk of toxicity, non-adherence to therapy, and poor adherence to follow-up schedule for lab monitoring, dose adjustment, and toxicity assessment. Therefore, we sought to increase the percentage of completed components of an OOE and care plan that are documented in the EHR prior to new oral oncolytic initiation to 60% over a 6-month period. Methods: A multidisciplinary Quality Training Program team consisting of 2 physicians, an oncology pharmacist, and an oncology RN specialist was created. With stakeholder engagement, we identified barriers to quality OOE and documentation, including: unfamiliarity of staff with ASCO-ONS standards, adoption of a new EMR, lack of standardized structure and documentation for OOE, and limited number of staff. PDSA cycle 1 defined RN role as staff in charge of oral oncolytic prior-auth, coordination, and education process, reinforced communication of providers with RNs, and defined the components of oral oncolytic education and care plan that meets QOPI & ASCO-ONS standards. PDSA cycle 2 implemented a new simplified workflow which included (1) EHR worksheet to document oral oncolytic education, (2) in-person RN teaching, (3) printed education materials, pill box, and thermometer, and (4) 1-week follow up calls. Results: Our baseline data revealed that only 55% of patients had any documentation of OOE. Content of documented OOE varied significantly with only a mean of 37% ASCO-ONS safety standards being documented. During PDSA cycle 1 documentation improved to a mean 54% standards, and with PDSA cycle 2 82% standards of an OOE documented. Overall documentation of OOE, increased to 83% by PDSA cycle 2. Symptom check 1-week follow-up calls increased from 22% at baseline to 78% after PDSA cycle 2. Conclusions: Over a 6-month period, we improved OOE and documentation by meeting our goal of increasing the number of documented components from 40% to 82%. Review of processes with stakeholders is imperative to practice improvement. Implementation of an EHR tool is an easy way to improve quality standardized OOE and has the potential to increase OO adherence and decrease toxicity.