Reducing invasive fungal infections in patients with acute myeloid leukemia receiving induction and re-induction chemotherapy at the University of Virginia Health System.

Abstract

120 Background: At the University of Virginia Health System (UVaHS), antifungal prophylaxis was not routinely given to patients undergoing induction and re-induction chemotherapy for acute myeloid leukemia (AML) from 7/2011 to 9/2015. A retrospective chart review of 179 patient encounters identified a 19.7% rate of proven or probable invasive fungal infection (IFI); national averages for IFI are 8-10% in this population. Methods: To target an IFI rate of less than 10%, a multidisciplinary team comprised of oncology and infectious diseases physicians, clinical pharmacists, nurses, and information technology specialists was formed. Through participation in the 2016 ASCO Quality Training Program (QTP), the group developed current and ideal state process maps, a Pareto chart, and a priority matrix to determine an action plan. The group identified the most common problems contributing to IFI: inconsistent definition of IFI, no routine antifungal prophylaxis, and lack of education for the health care team. Results: From 9/2014 to 8/2016, the first PDSA cycle consisted of physicians ordering antifungal prophylaxis on an ad hoc basis, resulting in 11.7% IFI in 77 total patient encounters. During the second PDSA cycle starting in 8/2016, a clinical practice guideline standardized the definition of IFI and appropriate antifungal prophylaxis. Physicians, nurses, and pharmacists were educated on the new standard work. PDSA Cycle #2 is ongoing. As of 11/2016, zero of 8 patient encounters had an IFI. To ensure sustainability of the quality improvement study, monthly electronic medical record reports will capture guideline compliance, specifically the use of antifungal agents, and track future IFI. Future data will be statistically analyzed. Conclusions: Using quality improvement methods learned at ASCO QTP, a multidisciplinary team developed an action plan which to date has shown a clinically significant reduction in IFI; this outcome may lead to decreased hospital length of stay and improved patient quality of life. Further PDSA cycles are scheduled and continuous evaluation of the process is ongoing.