The most frequently entered near-miss events were incorrect dose, wrong frequency or day of treatment, wrong drug, incomplete order, and protocol deviation. Senior Oncology Nurse, Chemotherapy Template Development At the bedside, two chemotherapy-competent RNs verify patient identities, pump settings (if applicable), and administration initiation. Implementation of checklists to improve safe practice surrounding chemotherapy administration. When autocomplete results are available use up and down arrows to review and enter to select. Maguire R, Kotronoulas G, Donnan PT, Paterson C, McCann L, Connaghan J, et al. Note that even if you have an account, you can still choose to submit an innovation as a guest. VNs work with designated DMTs and develop expert knowledge of the specific treatment regimens for those diseases. The administration of chemotherapy is a very significant task. Its development can highly contribute to the hospital practices and also assure the completeness of chemotherapy administration. The incidence of adverse drug events in two large academic long-term care facilities. The authors take full responsibility for the content of the article. The checklist ensures uniformity in providing care to the patients. Chemotherapy administration checklist was a valid and reliable checklist. Kano T, Kanda K. Development and validation of a chemotherapy-induced taste alteration scale. Study duration was 1 year (January 20212022). The implementation of the VN workflow as an additional safety standard has demonstrated its unique contribution to enhancing the safe delivery of chemotherapy. The VN contacts the provider and determines that an error in prescription occurred. The University of Texas MD Anderson Cancer Center, Daniel Melzer, PharmD, BCOP [3] Literature was focused on the symptom assessment of patients with cancer and self-management scales for cancer patients. Abramson Cancer Center at the University of Pennsylvania, Alix Dabb, PharmD The costs of adverse drug events in community hospitals. Research: David W. Bates, MD, MSc, Brigham and Women's Hospital. Chemotherapy administration checklist is completed, signed by administering RN, and returned to the file for auditing. From 20092014, 506 chemotherapy-related events, out of 700,000 patient chemotherapy visits, were entered as level 1 events; this number represents about 0.07% of all chemotherapy visits during that time period. Hence, all the items were retained in the chemotherapy administration checklist as shown in Table 1. The medication order for chemotherapy and targeted therapy should present the treatment information in a clear, consistent and unambiguous manner and include all supportive therapy . below. To discuss the information in this article with other oncology nurses, visit the ONS Communities. Ranchon F, Moch C, You B, Salles G, Schwiertz V, Vantard N, Rioufol C. Predictors of prescription errors involving anticancer chemotherapy agents. Health apps and health policy: what is needed? Despite the recent expansion of checklist use in other areas of medicine, there is currently no published evidence that checklists are being widely used by pharmacists in the evaluation of chemotherapy orders. Standard practices for computerized clinical decision support in community hospitals: a national survey. Aita M, Belvedere O, De Carlo E, Deroma L, De Pauli L, Gurrieri L, Fasola G. Chemotherapy prescribing errors: An observational study on the role of information technology and computerized physician order entry systems. Impact of multidisciplinary team huddles on patient safety: a systematic review and proposed taxonomy. Preventing medication errors in cancer chemotherapy. The ordering process can be unsafe and inefficient, putting patients at risk for medication errors. Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Sally Barbour, PharmD, BCOP, CPP, FHOPA Ensure the enclosure of discharge summary plan including date of next chemotherapy cycle and laboratory tests required. As the checklist started with the prescription of chemotherapy administration and ends up with the patient's discharge time requires to fill this checklist was conditional. Jeri Angelo, PharmD, BCOP chemotherapy errors, prescribing errors, medication errors, verification nurse, chemotherapy administration, patient safety. sharing sensitive information, make sure youre on a federal All documents in this guide are Adobe Acrobat PDF documents. Policies, HHS Digital Walsh KE, Dodd KS, Seetharaman K, Roblin DW, Herrinton LJ, Von Worley A, Gurwitz JH. Ethical clearance was obtained from the Institutional Ethical Committee of All India Institute of Medical Sciences, Jodhpur. Doffing of the personal protective equipment, remove shoe cover, outer gloves, face shield/goggles, gown, cap, inner gloves, and face mask. The poster was titled Implementation of Checklists to Improve Safe Practice Surrounding Chemotherapy Administration.. Develop and validate nutrition screening tool for hospitalized cancer patients. Related Resources From the Same Author(s), Search All AHRQ These seven items had their significant contribution to the checklist, the reason behind that might be their less use in daily practices. FOIA Hence, all were retained as shown in Table 2. 12 h shifts and rates of error among nurses: a systematic review. Arrange the items for chemotherapy drug preparation: PPE, medications, IV fluids, syringes, needles, and IV set/Codon set. Costs of adverse events in intensive care units. This checklist is highly relevant and has a significant role in healthcare. Jan, Cancer Chemotherapy. Clipboard, Search History, and several other advanced features are temporarily unavailable. The value of VNs is validated by their high rate of identifying errors, most commonly in prescribing, prior to the point of service. Implementation of the VN role augments the safety advantages provided by these systems. Figure 2 shows that there was a continuous deflection of the curve after the 8th component, which shows that the eigenvalue of less than 1. The National Quality Forum safe practice standard for computerized physician order entry: updating a critical patient safety practice. The result shows that the checklist was feasible and there was adequacy in the availability of subjects. Methodological research design was used in this study. The systems implementation can further influence its function by allowing advanced entry of orders and copying of previous orders to a future date if these orders are identical. Team training in the neonatal resuscitation program for interns: teamwork and quality of resuscitations. Decrease in hospital-wide mortality rate after implementation of a commercially sold computerized physician order entry system. However, the sophistication of such a system is largely dependent on the extent to which it is maintained and updated. This article explains a flexible checklist called PRONTO (Patient, Regimen, Organ Function, Numbers, Toxicity, Order Verification) that has been successfully used by pharmacists in variety of practice settings in two academic centers in North Carolina. Debriefing in the OR: a quality improvement project. An official website of In addition, the ISMP stressed the importance of conducting a comprehensive review of the medication order rather than simply comparing product to order; doing so has been determined to be valuable in catching prescribing errors. Although the actual rate of chemotherapy errors reported in the literature is low (Walsh et al., 2009; Watts & Parsons, 2013), the margin of error allotted when administering toxic, antineoplastic drugs to patients with cancer is very small. From January 2009 to December 2014, almost 700,000 patient chemotherapy visits occurred, and about 1 million chemotherapy orders were prescribed and reviewed by VNs (see Figure 5). Medication administration errors by nurses: adherence to guidelines. Epub 2016 Jan 21. No portion of this Site or any NCCN Content may be copied, transferred, reproduced, modified, or otherwise used for any purpose without NCCNs express written permission.See Legal Notices Section for additional notices and terms governing your use of this Site. Speaking up about safety concerns: multi-setting qualitative study of patients' views and experiences. After 5 months of interventions, there was a reduction of 19% in the number of order forms with at least one deviation. To analyze the rotated component matrix for the checklist, the method of principal component analysis along with varimax rotation with Kaiser normalization was used. These guidelines serve as a resource to healthcare providers, including nurses and pharmacists. Amjad MT, Chidharla A, Kasi A. Treasure Island (FL): StatPearls Publishing; 2022. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Moffitt Cancer Center, Prateek Mendiratta, MD Your prescription is then sent to the pharmacy of your choice. An official website of the United States government. They are required to be oncology certified through the Oncology Nursing Certification Corporation (ONCC) and have a BSN. National Library of Medicine Elledge, C., Krivoy, M., & Downey, C. (2016). To sign up for updates or to access your subscriber preferences, please enter your email address In addition to reviewing chemotherapy orders, VNs participate in several multidisciplinary activities, as well as in the creation, review, and revision processes of new and current chemotherapy and biotherapy guidelines. The delivery of chemotherapy is a high-risk clinical activity, meaning that the potential for patient harm can be great. Once chemotherapy orders arrived at the infusion clinic, a first check was carried out as required by safety regulations. City of Hope National Medical Center, Deborah McCue, PharmD, BCOP For manual systems and electronic order entry systems that cannot provide a hard stop, clarify all daily orders The scoring was done dichotomously; a score of 1 was given for done and 0 was given for not done and not applicable. Validation of drafts was done by modified Delphi technique. 3.6 Before initiation of each chemotherapy administration cycle, the practitioner who is administering the chemotherapy confirms the treatment with the patient, including, at a minimum, the name of the drug, infusion time, route of administration, and infusion-related symptoms to reportfor example, but not limited [Opportunities for medication errors and pharmacist's interventions in the context of computerized prescription order entry: a review of data published by French hospital pharmacists]. The employment of safeguards and standardized protocols is imperative to ensure the accurate prescribing and administration of chemotherapy treatments (Jacobson et al., 2012). Simulation based adverse event reporting system: development and feasibility. However, the functionality of electronic systems depends on the people who maintain and update them. Perform hand hygiene and follow aseptic technique. In the workflow of the comprehensive cancer center discussed in this article, these standards are met by the implementation of the VN role. the There was a total of 26 items on the chemotherapy administration checklist. In 1995 when a patient died from a chemotherapy overdose at a major medical center, many cancer centers began reexamining their processes for safe chemotherapy administration and putting measures in place to reduce errors. The authors see future applications of the checklist as a cross-training and educational cognitive aid for practitioners and students. As the healthcare environment expands in volume and complexity, new challenges must be faced in the delivery of quality cancer care to patients. Confirm the chemotherapy admission form/prescription form. The site is secure. It took place in five phases: preliminary phase includes literature review, focussed group discussion, assessment of current practices, generation of item pool, and preparation of preliminary draft; then its validation by modified Delphi technique, pilot testing; final try out, and evaluation phase. Confirm and administer the prescribed premedication as ordered. Cohen MR, Anderson RW, Attilio RM, Green L, Muller RJ, Pruemer JM. The healthcare provider did not write a note on the order explaining the rationale for the change; therefore, the VN contacts the healthcare provider for clarification. 2. Preventable adverse drug events and their causes and contributing factors: the analysis of register data. Director, Drugs & Biologics Programs This study was supported, in part, by a National Institutes of Health/National Cancer Institute Cancer Center Support Grant (P30 CA008748). National Comprehensive Cancer Network, Amanda Visnick, BSN, RN, OCN Verification Nurse (VN) Orientation Competencies. Conflict of interest, Dr Charles Denham and the Journal of Patient Safety. This commentary describes a six-step checklist designed to improve the reliability of the chemotherapy order review that was used by oncology pharmacists. HHS Vulnerability Disclosure, Help VNs review chemotherapy orders for completeness and accuracy, including correct dose, route, frequency, and duration of treatment. Vardenafil is used to treat male sexual function problems (impotence or erectile dysfunction-ED). Keywords: Scree plot of chemotherapy administration checklist. [O#Oq"2 u[1= &:q#~\:;u,@00303000300700%;@Th``pfHJ00u0B42 ja0o`` Verification by VNs: Chemotherapy is not mixed until a VN reviews the orders. Making polypharmacy safer for children with medical complexity. The prevalence of medication errors associated with chemotherapy administration is not precisely known. National Comprehensive Cancer Network, Madeline Joyce, BSN, RN, OCN For extraction communality of each item of the checklist, the extraction method of principal component analysis was used. Senior Oncology Pharmacist, Drugs & Biologics Programs St. Jude Children's Research Hospital/The University of Tennessee Health Science Center, Vanessa C. Copeland, PharmD, BCOP Electronic health record use and the quality of ambulatory care in the United States. The study can be repeated on a large population and at multifarious centers to validate the findings of the study. Prospective daily review of discharge medications by pharmacists: effects on measures of safety and efficiency. An official website of the United States government. Kanda K, Fujimoto K, Mochizuki R, Ishida K, Lee B. Wears PPE and applies safety principles for handling and administering cancer chemotherapy drugs and cytotoxic wastes. VNs employ this comprehensive review by checking orders for completeness and accuracy, and then evaluating the appropriateness of the drug with regard to the patients diagnosis and treatment plan as laid out by the physician. On the application of the corrected item to the total correlation on all the items on the checklist, 17 items had a score between 0.2 and 0.6 and nine items had a score less than 0.2. Five-Minute In-Service is a monthly feature that offers readers a concise recap of full-length articles published in the Clinical Journal of Oncology Nursing (CJON) or Oncology Nursing Forum. Can electronic clinical documentation help prevent diagnostic errors? Despite the lack of research, some evidence suggests that errors are related to prescribing (Aita et al., 2013; Ranchon et al., 2012). You'll want to keep your port accessible, so consider wearing a V-neck shirt. Senior Oncology Pharmacist, Drugs & Biologics Programs The publisher's final edited version of this article is available at. View more articles from the same authors. Mixed results in the safety performance of computerized physician order entry. and transmitted securely. Conclusion For interrater reliability, the Cohen kappa's value was found to be 0.91. Generation of item pool: The item pool was generated from a review of literature, assessment of current practices, and focused group discussion. Please select your preferred way to submit an innovation. A new order is entered and verified by the VN. The VN identifies the reason and informs the pharmacist and treating nurse. D. SCOPE : Registered nurses and practitioners credentialed in the administration of cancer chemotherapy . The VN ascertains the reason for the treatment deviation and shares this information with the pharmacist and treating nurse. As cancer care continues to shift to the outpatient setting and trends in patient volume increase, oncology settings need to create processes that respond to this growth while ensuring safe delivery of treatment. Before 2018;24(8):609-616. doi:10.1177/1078155217722594. QI initiatives can lead to implementing modifications in workflows, order sets, and chemotherapy guidelines to further enhance patient safety. Annual Reporting to Improve Safety and Quality System Data by Event Type (20092014) Compared to Annual Patient Chemotherapy Visit Volume. During that time, 3,767 level 0 events related to chemotherapy were entered into the RISQ system; this represents about 0.4% of the total orders in that time period. The chemotherapy administration checklist was developed in five phases. Oncology Pharmacist, Drugs & Biologics Programs The order populates a waiting to be verified list for the pharmacist. hbbd``b`^$2L y "D$$fXy 2016 Feb; 20(1): 5965. 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