Pharmacy contributions to improving care and sustaining change in a comprehensive cancer center.

Abstract

150 Background: Delivery of care in an outpatient hematology/oncology clinic is complex and requires the coordination of numerous services for timely and efficient treatment of patients. The Norris Cotton Cancer Center in Lebanon, NH, began a comprehensive assessment of clinic and infusion operations in 2012 and developed a system-wide initiative to address inconsistent performance in infusion, clinic and pharmacy services. Methods: Cancer center staff and leadership were trained on lean six-sigma methodology to initiate system-wide improvements through targeted project work. We collaborated with quality improvement experts and our analytics team to obtain and analyze data from our EMR. Then we established process measures for all operational areas and a key performance indicator (KPI) for hem/onc infusion: “on time performance.” The pharmacy contributed to on-time performance by focusing improvement initiatives on turn-around time (TAT) for clinical reviews and order verification, TAT for drug preparation, and initiating a process for pre-making chemotherapy. Results: "On-time performance” was initially defined as the percentage of patients whose first medication began within 45 minutes of their scheduled infusion start time. The baseline of 63% in 2012 was improved to 86% in 2018. Through sustained process improvement work and concerted efforts to further improve the patient experience and utilization of resources, an interdisciplinary team targeted a 15 minute on-time performance measurement; this baseline of 28% was improved to 47% in less than a year. In 2012 the pharmacy set a goal of reviewing and verifying orders within 30 minutes, and completing drug preparation within 45 minutes of order verification. The baseline percentage of orders reviewed within 30 minutes was 47% and this increased to 93% in 2018. Our baseline percentage of doses prepared within 45 minutes was 37% and the current median time for drug preparation across all orders is 45 minutes. The pharmacy currently pre-makes approximately 11% of doses. Conclusions: The cancer center pharmacy increased efficiency and improved on-time performance in delivery of care by using data-driven continuous improvement methods.