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Jennifer Hinkel

Patient safety has long been recognized as an integral component of quality medical care. In the past decade, the spotlight on safety has only become brighter, with the publication of reports such as the Institute of Medicine's To Err is Human in 2000 and the growing attention to patient safety and medical error by the media. The stakes are especially high in oncology, and avoiding error is imperative in delivering chemotherapy. Because safety is central to the delivery of high-quality oncology care, representatives from the National Comprehensive Cancer Network (NCCN) member institutions convened in October of 2006 for the 2nd Annual NCCN Patient Safety Summit to share best practices and discuss ongoing challenges in the delivery of safe cancer care. The Summit was hosted by NCCN member Memorial Sloan-Kettering Cancer Center in New York City. Physicians, nurses, pharmacists, cancer center directors, and quality and safety administrators participated in the Summit, which focused on safe chemotherapy delivery and how NCCN member institutions are tackling safety issues as they relate to new developments in cancer treatment. Discussions ranged from the implementation of computerized ordering systems to the growing availability and use of oral chemotherapeutic agents. Several themes and lessons emerged from the wide-ranging discussions. First, safety is not the responsibility of one person or specialty but is a multidisciplinary concern. Programs that impact safety must be implemented with buy-in from individuals across the care spectrum. Second, communication is imperative to delivering safe care, whether the communication is between various electronic ordering and...
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Jennifer M. Hinkel

The issues of patient safety and preventing medical errors routinely make headlines, with reports of thousands of preventable deaths and costs in the billions of dollars per year. Far less noticeable, but potentially more important, is the work taking place on a daily basis to develop new systems and processes of safety and use of technology in the effort to reduce preventable adverse events. The NCCN Third Annual Patient Safety Summit examined 3 processes central to maintaining patient safety in the oncology setting: medication reconciliation, communication during patient hand-offs, and reporting of events, including “near-miss” events that do not reach a patient or result in harm. The NCCN Patient Safety Summit included a multidisciplinary audience of safety experts, clinicians, and hospital administrators from NCCN member institutions, with speakers from member institutions sharing clinical and practical experiences in implementing safety improvements. Common themes included transitions from paper to electronic systems, education and training for individuals and teams as new methods are put into place, and the need for all members of the multidisciplinary care team to recognize their impact on patient safety.

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Jennifer M. Hinkel, Edward C. Li and Stephen L. Sherman

Management of anemia in patients with cancer presents challenges from clinical, operational, and economic perspectives. Clinically, anemia in these patients may result from treatment (chemotherapy, radiation therapy, or surgical interventions) or from the malignancy itself. Anemia not only contributes to cancer-related fatigue and other quality of life issues, but also affects prognosis. From the operational perspective, a patient with cancer who is also anemic may consume more laboratory, pharmacy, and clinical resources than other patients with cancer.

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Jennifer L. Lyle, Jonathan L. Vandergrift, Jennifer M. Hinkel, Eva M. Lepisto, Kristie A. Cortazzo, Stephen Sherman and F. Marc Stewart

Insight into factors important to fellows' decision-making about their career paths is critical to successfully developing program curricula, making capacity projections, and recruiting oncology physicians. This study was performed to determine the factors associated with post-fellowship career decision-making. Program evaluation surveys were administered to oncology fellows who attended the Fellows Recognition Program at the 2009 NCCN Annual Conference. A total of 125 (75%) fellows completed the initial survey. Overall, 73% of fellows reported participating in clinical research and 58% received formal training as part of their fellowship program. Receipt of formal training was correlated with greater program satisfaction (rs = 0.20; P = .03), feeling more prepared for a post-fellowship career (rs = 0.30; P < .001), and greater interest in clinical research post fellowship (rs = 0.32; P < .001). Interest in post-fellowship clinical research (rs = 0.49; P < .001) and importance of protected academic time (rs = 0.57; P < .001) were strongly correlated with interest in practicing in an academic environment, whereas institutional reputation (rs = 0.18; P = .04) and a multidisciplinary practice environment (rs = 0.22; P = .02) were moderately associated with interest. Location, salary, multidisciplinary environment, and flexible scheduling were the most important controllable lifestyle (CL) factors. These results suggest that fellowship programs may be able to foster a desire to participate in research and subsequent interest in practicing in an academic institution through providing opportunities for formal training in clinical research skills. However, even in an academic setting, CL factors are important to attracting and retaining faculty.

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Rowena N. Schwartz, Kirby J. Eng, Deborah A. Frieze, Tracy K. Gosselin, Niesha Griffith, Amy Hatfield Seung, Jennifer M. Hinkel, Philip E. Johnson, Shirley A. Johnson, Edward C. Li, Audrea Hotsko Szabatura and Michael K. Wong

The use of specialty pharmacies is expanding in oncology pharmacy practice. Specialty pharmacies provide a channel for distributing drugs that, from the payor perspective, creates economies of scale and streamlines the delivery of expensive drugs. Proposed goals of specialty pharmacy include optimization of pharmaceutical care outcomes through ensuring appropriate medication use and maximizing adherence, and optimization of economic outcomes through avoiding unwarranted drug expenditure. In oncology practice, specialty pharmacies have become a distribution channel for various agents. The use of a specialty pharmacy, and the addition of the pharmacist from the specialty pharmacy to the health care team, may not only provide benefits for care but also present challenges in oncology practice. The NCCN Specialty Pharmacy Task Force met to identify and examine the impact of specialty pharmacy practice on the care of people with cancer, and to provide recommendations regarding issues discussed. This report provides recommendations within the following categories: education and training of specialty pharmacy practitioners who care for individuals with cancer, coordination of care, and patient safety. Areas for further evaluation are also identified.