Abstract
Background: Oral chemotherapy drug development and use has increased, and evidence in the literature suggests variability in practices nationally. Thus, there is a need for continuous review of the process of oral chemotherapy administration that focuses on improving adherence to national standards. Objectives: This quality improvement project evaluated provider and staff general knowledge on oral chemotherapy and national safety standards and the implementation and ease of use of an electronic medical record (EMR)-integrated chemotherapy documentation template geared toward improving compliance with national chemotherapy administration standards. Methods: This project utilized a pre-test and post-test design comparing provider and staff knowledge as well as the intervention of a chemotherapy documentation template to assess compliance with national chemotherapy administration safety standards in an academic medical center. Through chart review, 24 national safety standards relevant to oral chemotherapy administration were used to assess compliance prior to and following the introduction of the intervention. Additionally, feasibility, accessibility, and usability of the intervention were evaluated through a validated questionnaire. Findings: Knowledge gained from pre-test to post-test improved (p value of < .001). Additionally, from the 88 charts reviewed, there was a statistical improvement in compliance with national safety standards (p value of < .001). The participants (n = 29) scored the documentation template as above average, indicating overall ease of use and feasibility for continued use.
References
American Society of Clinical Oncology. (2023). About QOPI Certification. https://old-prod.asco.org/practice-patients/quality-improvement/quality-programs/qopi-certification-program/about-qopi
Brooke, J. (1996). SUS: A quick and dirty usability scale. Usability Evaluation in Industry, 189(194), 4-10.
Dreyfuss, J. H. (2010). New joint outpatient chemotherapy administration standards. CA: A Cancer Journal for Clinicians, 60(2), 66–67. https://doi.org/10.3322/caac.20065
Greer, J. A., Lennes, I. T., Gallagher, E. R., Temel, J. S., & Pirl, W. F. (2014). Documentation of oral versus intravenous chemotherapy plans in patients with metastatic non-small-cell lung cancer. Journal of Oncology Practice, 10(2), e103–e106. https://doi.org/10.1200/JOP.2013.001154
Krzyzanowska, M. K., & Powis, M. (2015). Extending the quality and safety agenda from parenteral to oral chemotherapy. Journal of Oncology Practice, 11(3), 198–201. https://doi.org/10.1200/JOP.2015.004002
LeFebvre, K. B., & Felice, T. (2016). Nursing application of oral chemotherapy safety standards: An informal survey. Clinical Journal of Oncology Nursing, 20(3), 258–262. https://doi.org/10.1188/16.cjon.258-262
Mackler, E., Scappaticci, G. B., Salgado, T. M., Petersen, L., Davis, E. J., Peltier, E.,…Farris, K. B. (2018). Impact of a statewide oral oncolytic initiative on five participating practices. Journal of Oncology Practice, 14(5), e304–e309. https://doi.org/10.1200/JOP.18.00058
McNamara, E., Redoutey, L., Mackler, E., Severson, J. A., Petersen, L., & Mahmood, T. (2016). Improving oral oncolytic patient self-management. Journal of Oncology Practice, 12(9), e864–e869. https://doi.org/10.1200/JOP.2016.011304
Mulkerin, D. L., Bergsbaken, J. J., Fischer, J. A., Mulkerin, M. J., Bohler, A. M., & Mably, M. S. (2016). Multidisciplinary optimization of oral chemotherapy delivery at the University of Wisconsin Carbone Cancer Center. Journal of Oncology Practice, 12(10), e912–e923. https://doi.org/10.1200/JOP.2016.013748
Neuss, M. N., Gilmore, T. R., Belderson, K. M., Billett, A. L., Conti-Kalchik, T., Harvey, B. E.,…Polovich, M. (2016). 2016 Updated American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards, Including Standards for Pediatric Oncology. Oncology Nursing Forum, 44(1), 31–43. https://doi.org/10.1200/JOP.2016.017905
Pronovost, P. J., Berenholtz, S. M., & Needham, D. M. (2008). Translating evidence into practice: A model for large scale knowledge translation. BMJ, 337, a1714. https://doi.org/10.1136/bmj.a1714
Sauro, J. (2015). SUPR-Q: A comprehensive measure of the quality of the website user experience. Journal of Usability Studies, 10(2), 68–86. https://uxpajournal.org/supr-q-a-comprehensive-measure-of-the-quality-of-the-website-user-experience/
Solomon, J. M., Ajewole, V. B., Schneider, A. M., Sharma, M., & Bernicker, E. H. (2019). Evaluation of the prescribing patterns, adverse effects, and drug interactions of oral chemotherapy agents in an outpatient cancer center. Journal of Oncology Pharmacy Practice, 25(7), 1564–1569. https://doi.org/10.1177/1078155218798150
Weingart, S. N., Li, J. W., Zhu, J., Morway, L., Stuver, S. O., Shulman, L. N., & Hassett, M. J. (2012). US Cancer Center Implementation of ASCO/Oncology Nursing Society Chemotherapy Administration Safety Standards. Journal of Oncology Practice, 8(1), 7–12. https://doi.org/10.1200/JOP.2011.000379
Weingart, S. N., Spencer, J., Buia, S., Duncombe, D., Singh, P., Gadkari, M., & Connor, M. (2011). Medication safety of five oral chemotherapies: a proactive risk assessment. Journal of Oncology Practice, 7(1), 2–6. https://doi.org/10.1200/JOP.2010.000064
Zerillo, J. A., Pham, T. H., Kadlubek, P., Severson, J. A., Mackler, E., Jacobson, J. O., & Blayney, D. W. (2015). Administration of oral chemotherapy: Results from three rounds of the quality oncology practice initiative. Journal of Oncology Practice, 11(2), e255–e262. https://doi.org/10.1200/JOP.2014.001842
Zhu, J., Zhang, T., Shah, R., Kamal, A. H., & Kelley, M. J. (2015). Comparison of Quality Oncology Practice Initiative (QOPI) Measure Adherence Between Oncology Fellows, Advanced Practice Providers, and Attending Physicians. Journal of Cancer Education, 30(4), 774–778. https://doi.org/10.1007/s13187-015-0798-z