Abstract
95 Background: With the explosion of oral chemotherapy agents, cancer care is shifting from the hospital to the home. The many safeguards developed for parenteral chemotherapy have not translated to oral chemotherapy. Patients are responsible for adherence to complex medication regimens while managing the side effects of chemotherapy at home. Many clinicians at Massachusetts General Hospital (MGH) improvise systems to monitor patients on oral agents, and practices remain varied. The 2013 American Society of Clinical Oncology/Oncology Nursing Society (ASCO/ONS) addressed standards for safe administration and management of oral chemotherapy, which served as the framework for improving follow up care at MGH. Methods: Theclinicians in the thoracic and gastroenterology disease centers were surveyed and selected standardization for the first follow up appointment after initiation of oral chemotherapy as a safety initiative. The team, which consisted of the thoracic clinicians, delineated a process map from writing the prescription for erlotinib or crizotinib to the follow up appointment, as well as identified barriers to ensuring a standardized time for follow up. A second survey established a consensus of a 28 day ceiling for time to first follow up for both oral agents. The aim was for 95% of patients to be seen within 28 days of initiating oral chemotherapy. An education campaign for providers regarding the standardized algorithm for time to follow up and a text template to incorporate in the clinic note was instituted. Results: Prior toan intervention, patients initiated on erlotinib or crizotinib were seen in follow up within 19 days (on average), and 82% reached the aim of within 28 days. A time frame for return to follow up was established as well as required documentation for initiation of each drug. Conclusions: The process of implementing standardized drug specific time to follow up highlighted a number of key lessons. It is crucial to evaluate and measure the current process prior to developing interventions. Support of local leadership and “buy in” from all clinicians and staff is essential to the success of the intervention. Additionally, a regular setting to discuss and present updates on the process improvement is vital.
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