Congress Abstracts 2005

61

CHEMOTHERAPY/BIOTHERAPY SAFETY ASSURANCE PROJECT: NETWORK SAFETY THROUGH INTERDISCIPLINARY COLLABORATION. Patricia Shearburn, RN, MSN, AOCN^®, Janine Barnaby, RPh, Gregory Harper, MD, PhD, Melissa Kratz, RN, MSN, AOCN^®, Dave Pucklavage, RN, and Marlene Ritter, MBA, RRT, Lehigh Valley Hospital, Allentown, PA.

Chemotherapy agents are associated with serious and potentially life threatening side effects. Multiple practice settings involved in patient care and an interdisciplinary administration process creates high risk for potential and life threatening errors. An interdisciplinary team from five practice settings evaluated and revised the hospital practices for the safe use of antineoplastics. One outcome was the development of a computer assisted order entry system for chemotherapy.

The purpose of this project was to identify potential areas for errors in the antineoplastic pathway across oncology practice settings, and to establish systems aimed at error prevention. Multiple national organizations have identified medication mistakes as a major cause of patient morbidity and mortality. Error report data from 2001–2003 demonstrated an error rate of 0.43, however because of the potential consequences of even one chemotherapy error steps were taken to further reduce our error rate.

Interventions included: computerizing standardized chemotherapy/biotherapy order sheet with a forced function feature to prevent omissions of critical patient data, computer generated BSA, creatinine clearance and dose calculations to prevent math errors, embedded anti-emetogenic protocols, and antineoplastic protocol selections embedded with dosages, routes, schedules and specific administration directions. Education was provided to all stakeholders regarding sheet utilization and generalized safety precautions.

Legibility, missing data and math errors has been totally eliminated. Greater than a ninety- five percent utilization of the computerized order sheets exists. An audit of the order sheets (n = 588) demonstrated: 99 changes in the selected protocol, 22 orders written for more than 1 cycle, 3 lab parameters missing, and 2 wrong schedule of drugs.

The most important discovery was the enormous variation in individual physician practices in the ordering of “standard” treatment protocols. While not truly “errors,” these variations contribute to confusion among the nurses and pharmacists, and represent a significant opportunity to achieve greater safety through diminished variance. The program contains more than 120 antineoplastic protocols. Continued development of electronic antineoplastic process will include: toxicity tracking, treatment summaries, and an on line flow sheet to be shared across treatment sites for enhance continuity of care.