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ORIGINAL ARTICLE
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Year : 2016  |  Volume : 53  |  Issue : 2  |  Page : 331--332

Innovation in chemotherapy administration process

A Aziz 
 Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan

Correspondence Address:
A Aziz
Department of Oncology, Aga Khan University Hospital, Karachi
Pakistan

Abstract

Introduction: This project was started after patient's complaints of increased cost burden on patients with increase stay of patient in hospital for chemotherapy administration for 3–4 days, how to decrease this hospital stay and financial burden and how can we improve services to decrease hospital stay and expedite the process of chemotherapy administration. Methods: A total of 100 patients' confidential files reviewed from February 12, 2013 to May 15, 2013, patients, who were admitted for chemotherapy administration only in inpatient area and all services timings, were reviewed and documented on sheet named as delays chemotherapy sheet, nine processes timings checked against their benchmarks. Results: All services process timings analyzed and compared with their benchmarks, results of all services timings are nearly close to benchmark except lab test results of patients who were admitted without labs test for chemotherapy administration delays seen in collecting blood sample and sending this sample to the laboratory, significant delay is seen in chemotherapy order entry by physician if patient is admitted after 4 p.m. for chemotherapy administration. Delays also identified in administration of chemotherapy. Conclusion: After identifying the reasons of delays in chemotherapy administration, improvement and innovation in chemotherapy administration process done which not only decrease hospital stay, but also decrease the cost of chemotherapy administration.



How to cite this article:
Aziz A. Innovation in chemotherapy administration process.Indian J Cancer 2016;53:331-332


How to cite this URL:
Aziz A. Innovation in chemotherapy administration process. Indian J Cancer [serial online] 2016 [cited 2019 Dec 11 ];53:331-332
Available from: http://www.indianjcancer.com/text.asp?2016/53/2/331/197733


Full Text

 Introduction



Patient when admitted for chemotherapy administration wants timely administration of chemotherapy with no delays many patients complaints that chemotherapy administration delays which causes increase in length of stay in hospital associated with increased cost causing dissatisfaction among patients and families, a cross-sectional survey done to find out reasons of delays to correct the problems find the ways to remove constraints and expedite the services of chemotherapy administration in in-patient area chemotherapy administration process includes four areas, which are admission office, physician order entering, pharmacy drug review and dispense and chemotherapy administration process, delays can occur in any of these four areas The process, which patient follows when enter the hospital for administration of chemotherapy is that patient has accommodation paper with this patient come to the admission office and if bed available patient admitted and come to unit where unit receptionist attach all required papers in a folder and call given to record room for confidential file of the patient and inform nurse and resident, nurse check height and weight of patient and vital signs and document these findings in nursing notes and physician do the initial assessment of patient document these findings in initial assessment form, check confidential for last consultant orders for chemotherapy, check the lab test and if labs are normal enter the prechemotherapy and chemotherapy orders in computer system through physician order entry and document these chemotherapy orders in physician order sheet, pharmacy review these chemotherapy orders and dispense the medicines, nurse receive and administer these chemotherapy to patient. Delay can occur in any of this process, if bed not available than patient has to wait till bed available and delays occur in chemotherapy administration process similarly if patient is admitted without lab test then after admission blood sample is taken and sent to the lab and waited for lab results causing delay in chemotherapy administration process.

 Methods



Patients confidential files reviewed from February 12, 2013 to May 15, 2013 and all services timings were reviewed and documented on delays chemotherapy sheet, 100 patients files reviewed to find the reasons of delays in chemotherapy administration, nine processes timings are checked, which are checked against their departmental made benchmarks these includes admission time, patients arrival in unit time, patients confidential receiving time, patient height and weight check time, blood specimen sent to lab time, arrival of lab results time, chemotherapy order entry time, pharmacy review time and dispense of chemotherapy drugs time and prechemotherapy and chemotherapy administration time. All services timing were analyzed, and delays identified in between admission and physician orders, delays identified in collecting and sending the blood sample to lab and lab test results, delays identified between pharmacy dispensing and administration of chemotherapy.

 Results



Results derived as shown in [Figure 1] analyzed by management engineers team from 100 patients data delays identified in between admission and physician orders, delays identified in collecting and sending blood sample to lab and lab test results, delays identified between pharmacy dispensing and administration of chemotherapy. Improvement can be made in administration of prechemotherapy and chemotherapy as timings of drug administration is very close to the benchmark.{Figure 1}

 Discussion



There is a great stress on the chemotherapy unit to give treatment timely and safely. Once patient enter the hospital, they have the right to expect that every effort is made to their care and treatment are both safe and effective with no delays, the chemotherapy process involves team which include physician, nurses and pharmacist delay can occur in any of these three areas, good communication is required between the clinical areas, pharmacy, nursing staff and clinical staff. There is a need for effective communication between the medical staff and the chemotherapy unit. The chemotherapy unit streamlining the dispensing process can improve the timeliness of cytotoxic drugs administration. Patient's physical discomfort associated with long waits and emotional distress is common among patients resulting in depression [1] and patients physical discomfort and mental disturbance associated with delays in cytotoxic drugs dispensing and administration, research suggests that long waits are a major cause of dissatisfaction with chemotherapy services and patient become aggressive and mentally disturbed if they wait >60 min for administration of chemotherapy, extended waits for chemotherapy dispensing and administration have been shown to increase psychological distress [2] this has been linked to severely related problems like nausea and vomiting in cancer patients most of the patients said that they feel nausea while thinking of coming to chemotherapy unit.[3] There is a need for better communication between the medical staff, the pharmacy and nurse in the chemotherapy day care unit. The chemotherapy head nurse has the role within the chemotherapy service to communicate patient's complaints so as to improve the chemotherapy process and also developing the role of the chemotherapy services case manager nurse whose role includes ensuring that prescriptions are organized and completed before the patient attends the day unit and ensuring that blood results are available before treatment is administered. That person would also act as a care coordinator between the different groups involved in the process of chemotherapy administration and develop effective communication between the physician, pharmacist and chemotherapy administering nurse.[4],[5],[6]

 Conclusion



After identifying the reasons of delays in chemotherapy administration, improvement and innovation in chemotherapy administration process done by introduction of 46 h and 96 h 5-fluorouracil infusions at home through portable pump, patient admitted with laboratory test reports done 1-day before chemotherapy which decreases hospital stay and in turn decreases cost of chemotherapy administration. Booking system for patients who are coming for chemotherapy administration to avoid long waiting's of patients at admission office is started, need for oncology nurse coordinator responsible to check the labs are done 1-day before chemotherapy and coordinate between all three areas physician, oncology pharmacist and oncology nurse to streamline the process of chemotherapy administration so as to prevent delays and speed up the process of chemotherapy administrations.

 Acknowledgment



We are thankful to Professor Mohammad Khurshid Hematologist and Chair of Oncology Department and Dr Nehal Masood Section Head of Medical Oncology for their suggestions and introduction 46 h and 96 h 5-FU infusion through portable pump.

References

1Aboumater HJ, Winner LE, Davis RO, Trovitch PB, Berg MM, Violette KM, et al. No time to waste: Decreasing patient wait times for chemotherapy administration using automated prioritization in an oncology pharmacy system. Am J Manag Care 2008;14:309-16.
2Rondeau KV. Managing the clinic wait: An important quality of care challenge. J Nurs Care Qual 1998;13:11-20.
3Sitzia J, Wood N. Patient satisfaction with cancer chemotherapy nursing: A review of the literature. Int J Nurs Stud 1998;35:1-12.
4Royal College of Radiologists. Principles to Underpin the Delivery of NHS Radiotherapy or Chemotherapy Services in Cancer Units in the UK. 2006.
5Hayes MS. The impact of workload changes and staff availability on IV chemotherapy services. J Oncol Pharm Pract 2003;9:123-8.
6General Medical Council. Good Medical Practice. London, UK: General Medical Council; 2006.