SAN ANTONIO, Tex.–A nurse-facilitated oral chemotherapy care model has improved delivery times, patient satisfaction, and co-pay support at Smilow Cancer Hospital, according to an oral presentation at the ONS 41st Annual Congress.1
After a Quality Oncology Practice Initiative (QOPI) site visit identified gaps in prescribing practices, adherence, and monitoring of patients on oral chemotherapy, staff at Smilow Cancer Hospital in New Haven, Connecticut, created an Oral Chemotherapy Task Force to standardize a program that closes those gaps. Staff also acknowledges that the oral chemotherapy system was not fully optimized or integrated across Smilow Cancer Hospital and the Cancer Care Network.
The multidisciplinary task force consisted of nursing, pharmacy, physician, quality and safety, and a specialty pharmacy representation. The task force performed process mapping and gap analysis and identified 87 points in their current process that were potential gaps in care.
They then developed and implemented a nurse-facilitated care model that includes physician/advanced practice nurse orders via standardized and clinically reviewed treatment plan; prescription fulfilled by their specialty pharmacy; nursing and clinical pharmacist review, verification, and release of treatment plan to ensure accuracy; pill-in-hand patient/caregiver education; day 1, 5, and 21 patient adherence follow-up phone calls by pharmacist; and the use of a multidisciplinary EPIC flowsheet to document all process steps.
In addition, the task force created tools, such as contact lists, calendars, EPIC tips and tricks, standardized patient education, a medication guide, and EPIC patient tracking reports, to support implementation of the new process. An oral chemotherapy patient satisfaction questionnaire was also integrated into the process.
Since implementation in March 2015, 82 treatment plans have been created, more than 95% of disease teams and care centers participate in the program, 47% of prescriptions have been filled internally, and Medication Assistance Program co-pay support has exceeded $2.3 million. Furthermore, 80% of prescriptions are delivered to the patients within 72 hours of being ordered.
“The oral chemotherapy care model has created a new opportunity for collaboration between pharmacists, physicians, and nurses, and has elevated the practice of nursing within our institution,” said Mandeep Smith, BSN, RN, an oncology nurse at Smilow Cancer Hospital.
1. Smith M, Amport SB, Fradkin M, et al. Nursing role in improving safety and quality with oral chemotherapy. Oral presentation at: 2016 Oncology Nursing Society Annual Congress; April 28-May 1, 2016; San Antonio, TX.