QIM21-079: Improving the Process to Timely Administration of Inpatient Chemotherapy

Authors: Jamie Chin PharmD1, Abhinav Rohatgi MD1, and Alexander Hindenburg MD1
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  • 1 NYU Langone Hospitals - Long Island, Mineola, NY

Purpose: Delays in inpatient chemotherapy initiation in our oncology service for elective admissions lead to increased length of stay (LOS) and patient dissatisfaction. Our multidisciplinary team, of oncology providers, pharmacists, and nurses performed a QI project to improve clinical care. An average of 10 hours from admission to chemotherapy administration lead to patient dissatisfaction and increased LOS. We sought to improve inefficiencies in our process and reduce the time from admission to chemotherapy administration by 25% within 10 months. Methods: A process map was developed to identify bottlenecks to target interventions for the plan-do-study-act (PDSA) cycles. Inconsistencies such as poor communication between admitting, nursing, residents, and fellows, central line access, in accurate weights, and incomplete chemotherapy orders, were identified. After the first 3 PDSA cycles, an optimized workflow provided time goals for each step. A value stream map was developed and distributed. Time from arrival to chemotherapy start was measured from time stamps in the electronic medical record (EMR). Results: Retrospective baseline data of 20 patients showed an average of 10 hours from admission to chemotherapy administration. Data from approximately 20-30 patients was collected for each PDSA cycle. The first intervention engaged admitting in our weekly emails communicating and streamlining planned admissions. The second intervention led by pharmacist education to providers about chemotherapy requirements. In the third intervention, the pharmacist educated nursing assistants to submit heights/weights within 30 minutes of patient arrival for chemotherapy orders. The median time to chemotherapy administration was reduced to 5.5 hours. Conclusions: By developing a process map with LEAN methodology, we were able to identify key processes that affect the workflow for inpatient chemotherapy administration. With iterative PDSA cycles and interdisciplinary team collaboration between admitting, residents and fellows, and nursing we were able to achieve and sustain a 55% reduction in time to chemotherapy administration (from 10 hours to 5.5 hours) to improve patient care/satisfaction and length of stay.

Corresponding Author: Jamie Chin, PharmD
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