Improving the Safety of Immunotherapy: A Systematic Approach

Abstract

RATIONALE: We examined our allergen vaccine immunotherapy (AVIT) practices in order to improve patient safety and quality of care.METHODS: A systematic review of the AVIT practice of a large academic medical center was conducted by a multidisciplinary team of physicians, nurses and allied health. From this analysis, we developed and implemented policies to improve patient safety, including a time-stamp policy to improve post-AVIT wait-times. For ten consecutive days, PEFR results were used as a marker of compliance pre-intervention and time-stamp data was used post intervention.RESULTS: For a typical course of AVIT, 113 steps were identified; 46 were considered high risk for patient safety. Fourteen areas of immediate potential improvement were identified, including post-AVIT wait times, annual allergist consultation, vial labeling and documentation. Seventy percent(102/144) of patients waited the full 30 minutes before the improved time-stamp policy compared with 98% (140/146) after implementation. Additional improvement interventions include: mandatory annual allergist consultation for all AVIT patients, a form with current medications and medical problems, improved documentation of extract lot number, an improved storage system separating new lots and bottles from old, and improved bottle labeling to call attention to vaccines that were scheduled to expire within one week.CONCLUSIONS: Our systematic quality improvement project identified several patient safety improvement areas. This intervention that led to significantly improved post-immunotherapy wait-times is one example of a successful quality assurance initiative that may be generalizable to care at other large medical centers. RATIONALE: We examined our allergen vaccine immunotherapy (AVIT) practices in order to improve patient safety and quality of care. METHODS: A systematic review of the AVIT practice of a large academic medical center was conducted by a multidisciplinary team of physicians, nurses and allied health. From this analysis, we developed and implemented policies to improve patient safety, including a time-stamp policy to improve post-AVIT wait-times. For ten consecutive days, PEFR results were used as a marker of compliance pre-intervention and time-stamp data was used post intervention. RESULTS: For a typical course of AVIT, 113 steps were identified; 46 were considered high risk for patient safety. Fourteen areas of immediate potential improvement were identified, including post-AVIT wait times, annual allergist consultation, vial labeling and documentation. Seventy percent(102/144) of patients waited the full 30 minutes before the improved time-stamp policy compared with 98% (140/146) after implementation. Additional improvement interventions include: mandatory annual allergist consultation for all AVIT patients, a form with current medications and medical problems, improved documentation of extract lot number, an improved storage system separating new lots and bottles from old, and improved bottle labeling to call attention to vaccines that were scheduled to expire within one week. CONCLUSIONS: Our systematic quality improvement project identified several patient safety improvement areas. This intervention that led to significantly improved post-immunotherapy wait-times is one example of a successful quality assurance initiative that may be generalizable to care at other large medical centers.