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Campbell M, Vu K, Pardhan A, Gallo-Hershberg D, Ku R, Redwood E, Simanovski V, Krzyzanowska MK. Toward a Common Goal: Improving Safety of Oral Chemotherapy Prescribing Practices at a Jurisdictional Level. JCO Oncol Pract 2020; 16:e1036-e1044. [PMID: 32427539 DOI: 10.1200/jop.19.00797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Extending the safety agenda from parenteral to oral chemotherapy was identified as a provincial improvement priority in the 2014-2019 Cancer Care Ontario (CCO) Systemic Treatment Provincial Plan. Elimination of handwritten prescriptions for oral chemotherapy was one of the specific goals and led to a provincial quality improvement (QI) initiative involving systemic treatment facilities across 14 regional cancer programs. METHODS The initiative was centrally organized by CCO but locally implemented by the regional partners. CCO provided templates and tools, such as preprinted orders (PPOs), project charters, and an evaluation plan, and facilitated cross-jurisdictional knowledge sharing and exchange. Regions had flexibility in determining their local implementation strategies and were responsible for conducting chart audits to evaluate implementation success. Each participating hospital completed 3 audits-at baseline, immediately after implementation (audit 1), and 1 year later (audit 2)-using either a clinic-based or an outpatient pharmacy-based assessment. RESULTS Thirty-five facilities providing systemic treatment participated. At baseline, the provincial average for the use of computerized physician order entry (CPOE) or PPOs for prescribing oral chemotherapy was 71%. After implementation of the QI initiative, the provincial average for the use of CPOE or PPO increased to 91% at audit 1 and 95% at audit 2. CONCLUSION Although not all facilities met the goal of 100% CPOE or PPO compliance, the QI initiative led to improvement in safe prescribing practices for oral chemotherapy. A coordinated QI approach between a central decision maker and local partners can be an effective strategy to encourage high-quality cancer care and promote a culture of safety across a jurisdiction.
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Affiliation(s)
| | - Kathy Vu
- Cancer Care Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | | | - Daniela Gallo-Hershberg
- Cancer Care Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Rosemary Ku
- Cancer Care Ontario, Toronto, Ontario, Canada
| | | | | | - Monika K Krzyzanowska
- Cancer Care Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada
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2
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Redwood E, Hyun K, French J, Kritharides L, Ryan M, D'Sousa M, Brieger D. 559 The Association Between Mode of Transport, Management and Outcomes of Patients Presenting With STEMI. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Krzyzanowska MK, MacKay C, Han H, Eberg M, Gandhi S, Laferriere NB, Powis M, Howell D, Atzema CL, Chan KKW, Kukreti V, Mitchell S, Nayer M, Pasetka M, Knittel-Keren D, Redwood E. Ambulatory Toxicity Management (AToM) Pilot: results of a pilot study of a pro-active, telephone-based intervention to improve toxicity management during chemotherapy for breast cancer. Pilot Feasibility Stud 2019; 5:39. [PMID: 30891308 PMCID: PMC6407231 DOI: 10.1186/s40814-019-0404-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/18/2019] [Indexed: 11/18/2022] Open
Abstract
Background Chemotherapy is associated with a significant risk of toxicity, which often peaks between ambulatory visits to the cancer centre. Remote symptom management support is a tool to optimize self-management and healthcare utilization, including emergency department visits and hospitalizations (ED+H) during chemotherapy. We performed a single-arm pilot study to evaluate the feasibility, acceptability, and potential impact of a telephone symptom management intervention on healthcare utilization during chemotherapy for early stage breast cancer (EBC). Methods Women starting adjuvant or neoadjuvant chemotherapy for EBC at two cancer centres in Ontario, Canada, received standardized, nurse-led calls to assess common toxicities at two time points following each chemotherapy administration. Feasibility outcomes included patient enrollment, retention, RN adherence to delivering calls per the study schedule, and resource use associated with calls; acceptability was evaluated based on patient and provider feedback. Impact on acute care utilization was evaluated post hoc by linking individual patient records to provincial data holdings to examine ED+H patterns among participating patients compared to contemporaneous controls. Results Between September 2013 and December 2014, 77 women were enrolled (mean age 55 years). Most commonly used regimens were AC-paclitaxel (58%) and FEC-docetaxel (16%); 78% of patients received primary granulocyte colony-stimulating factor prophylaxis. 83.8% of calls were delivered per schedule; mean call duration was 9 min. The intervention was well received by both patients and clinicians. Comparison of ED+H rates among study participants versus controls showed that there were fewer ED visits in intervention patients [incidence rate ratio (IRR) (95% CI) = 0.54 (0.36, 0.81)] but no difference in the rate of hospitalizations [IRR (95% CI) = 1.02 (0.59, 1.77)]. Main implementation challenges included identifying eligible patients, fitting the calls into existing clinical responsibilities, and effective communication to the patient’s clinical team. Conclusions Telephone-based pro-active toxicity management during chemotherapy is feasible, perceived as valuable by clinicians and patients, and may be associated with lower rates of acute care use. However, attention must be paid to workflow issues for scalability. Larger scale evaluation of this approach is in progress. Electronic supplementary material The online version of this article (10.1186/s40814-019-0404-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Monika K Krzyzanowska
- 1Cancer Care Ontario, Toronto, ON Canada.,2University Health Network, Toronto, ON Canada
| | | | | | | | - Sonal Gandhi
- Sunnybrook Regional Health Sciences Centre, Toronto, ON Canada
| | | | | | | | - Clare L Atzema
- Sunnybrook Regional Health Sciences Centre, Toronto, ON Canada
| | - Kelvin K W Chan
- Sunnybrook Regional Health Sciences Centre, Toronto, ON Canada.,Canadian Centre for Applied Research in Cancer Control, Toronto, ON Canada
| | | | | | | | - Mark Pasetka
- Sunnybrook Regional Health Sciences Centre, Toronto, ON Canada
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Crespo A, Redwood E, Vu K, Kukreti V. Improving the Safety and Quality of Systemic Treatment Regimens in Computerized Prescriber Order Entry Systems. J Oncol Pract 2018; 14:e393-e402. [PMID: 29813012 DOI: 10.1200/jop.17.00064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Systemic treatment (ST) computerized prescriber order entry (CPOE) and preprinted orders (PPO) are proven to reduce errors. There is no known guidance in oncology to facilitate high-quality, accurate regimen development and review; hence, this was identified as a system-wide gap. This provincial initiative aimed to improve the quality of oncology regimens through a comprehensive review of systemic treatment (ST) regimens and the development of standards. METHODS A system-wide analysis of all active regimens (both CPOE and PPO) to ensure they were built as intended was conducted in 2015. Thirty-five hospitals (on behalf of 75 treatment facilities) were asked to report any unintentional discrepancies and details of the maintenance review process. Discrepancies were compiled, categorized, and analyzed for potential to cause harm. In addition, a multidisciplinary expert working group was formed to create best practice recommendations. RESULTS The review yielded a 94% response rate and took a total of 18 months to complete (70% completed within 9 months). The average number of regimens reviewed was 336 (range, 15 to 700; n = 9). Unintentional discrepancies were reported by nine hospitals (27%). A total of 369 discrepancies were reported (average, 55 per hospital), and 28 were deemed to have a moderate potential for harm. Only two hospitals (6%) had an established maintenance process; now, all have standard processes for review. Consensus-based recommendations for ST-CPOE and PPO regimen development and maintenance were developed. CONCLUSION The review identified unintentional discrepancies and, because of the potential for patient harm, corrective action has been taken. Identified discrepancies have been amended, and standard regimen development and maintenance review processes are now implemented system-wide to improve the quality and safety of systemic treatment delivery.
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Affiliation(s)
| | | | - Kathy Vu
- Cancer Care Ontario, Toronto, Ontario, Canada
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Redwood E, Chow V, Naoum C, Kritharides L, Ng A. Impact of Handheld Cardiac Ultrasound Device on the Workflow in a Tertiary Institution: A Pilot Study Experience. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Crespo A, Redwood E, Vu K, Kukreti V. Establishing best practice recommendations for systemic treatment regimen development and maintenance. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.8_suppl.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
40 Background: A province-wide review of oncology regimens identified discrepancies in a number of regimens in systemic treatment computerized prescriber order entry (ST CPOE) systems. The potential patient harm from such discrepancies includes unnecessary toxicities and reduced treatment efficacy. The regimen review highlighted the need for a high-quality process to improve the safety of systemic treatment prescribing in Ontario. The objective of this work was to develop recommendations on best practices for the development and maintenance of oncology regimens. Methods: An expert multidisciplinary group of oncology clinicians and administrators was formed to review available literature and leverage their expertise to establish oncology-specific recommendations. These were then circulated to broader stakeholder groups for feedback and consensus. Results: Practical, consensus-based best practice recommendations for ST CPOE and pre-printed order regimen development and maintenance were created. Detailed processes for new regimen development are outlined in the table below. Moreover, broad areas of roles and responsibility, frequency of review, and sign-off were highlighted. This was repeated for regimen changes (not shown). Conclusions: There is a lack of guidance in the literature on best practices for oncology regimen development and maintenance. Careful analysis and application of the expertise of oncology professionals resulted in consensus-based best practice recommendations that will enable the advancement of safe, standardized, systemic treatment prescribing.[Table: see text]
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Affiliation(s)
| | | | - Kathy Vu
- Cancer Care Ontario, Toronto, ON, Canada
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Vu K, Santaera D, Redwood E, Krzyzanowska MK. Survey of community pharmacists regarding their role and desire for managing chemotherapy related toxicities in cancer patients. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.8_suppl.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
104 Background: There is little published about the readiness and needs of community pharmacists to manage chemotherapy related toxicities in cancer patients. A survey was conducted to understand community pharmacists’ current toxicity management practices and their education and communication needs in this area. Methods: A 21 question electronic survey was sent to community pharmacists in Ontario, Canada from April 1 – June 30, 2016. The survey asked about demographics, toxicity management behaviours/preferences, communication and training needs/preferences. Results: Out of 559 responses received, 167 were excluded due to ineligibility giving a final response of 392 surveys. The majority of respondents were full time pharmacists practicing for more than 10 years in community pharmacy. While many pharmacists reported providing assessment (80%), advice (92%) and/or monitoring (70%) at least sometimes, few reported providing assessment (10%), monitoring (10%) or advice (18%) routinely. Types of toxicities encountered and their frequency are summarized in Table 1. There was a high level of interest (96%) among the respondents in being involved in assessing and managing chemotherapy toxicity, however, only 13% reported that they felt sufficiently trained to do so. Conclusions: Community pharmacists encounter chemotherapy-related toxicities in their daily work. While there is a strong interest in managing toxicity symptoms, many community pharmacists feel that they are not adequately trained to do so. Continuing education programs for this provider group may improve toxicity management in community pharmacy settings. [Table: see text]
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Affiliation(s)
- Kathy Vu
- Cancer Care Ontario, Toronto, ON, Canada
| | - Daniella Santaera
- University of Toronto Leslie Dan Faculty of Pharmacy, Toronto, ON, Canada
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Crespo A, Redwood E, Vu K, Kukreti V. Reviewing systemic treatment regimens to reduce unintentional errors. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.8_suppl.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
51 Background: Use of systemic treatment computerized prescriber order entry (ST CPOE) and pre-printed orders (PPO) are proven error reduction measures. Such systems are not failsafe, as regimen development depends on cognitive input at critical points and is susceptible to human error. No known guidance currently exists in oncology to ensure regimens are of high quality and built as intended. The purpose of this initiative was to improve the quality of oncology regimens in Ontario. Methods: A review of 35 centres, representing 75 treatment centres in a hub-and-spoke model, was conducted for all active regimens (PPO and CPOE) to ensure they were built as intended, with respect to drugs and doses. Centres completed an exploratory survey to report any unintentional discrepancies and existing maintenance review processes. The survey collected centre demographics and contained descriptive questions to document details of the regimen review and maintenance processes. Results: The review yielded an 86% response rate (12 regional and 18 community cancer centres). Upwards of 700 regimens were reviewed by a multidisciplinary team at each participating centre. Unintentional discrepancies were reported by 7 of the 30 (23%) centres (range of 2 – 141 per centre); types and examples are presented in the Table. Only 2 of 30 centres (7%) had an established regimen maintenance process. Conclusions: The review identified unintentional discrepancies and, due to the potential for patient harm, corrective action has been taken. There is a need for guidance and adoption of a standardized approach in order to sustain a high-quality regimen build and review process across the province. Consensus-based recommendations for ST CPOE and PPO regimen development and maintenance have been developed. Identified discrepancies have been amended and maintenance review processes are now implemented to improve the quality and safety of systemic treatment delivery. [Table: see text]
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Affiliation(s)
| | | | - Kathy Vu
- Cancer Care Ontario, Toronto, ON, Canada
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9
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Redwood E, Vu K, Fung R, Han H, Teimoortagh M, Meertens E, Forbes L, Kukreti V, Santaera D. Understanding the financial impact of beyond use date in a publicly funded cancer system. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.8_suppl.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
13 Background: According to USP 797 and the National Association of Pharmacy Regulatory Authorities standards, the Beyond Use Date (BUD) based on sterility for single-dose vials is 6 hours, after which the contents must be discarded. In Ontario, centres have traditionally based BUD on stability data, not sterility data. This change presents concern about potential drug waste so an analysis was done to estimate the financial impact to the 76 systemic treatment facilities in Ontario. Methods: Using an administrative database that records the daily total dose of drugs administered by facility, annual drug waste cost was calculated using daily dose administered, cost per milligram, and available vial size(s) for 26 publicly funded drugs. Two different methods were used to determine the amount of drug waste. Method 1 used the largest vial size matched to the closest amount of drug required. Method 2 used the optimal vial size mix, when there are multiple vial sizes, to minimize wastage across all configurations of vial size. Some assumptions made include: 1) each facility had access to all available vial sizes, and 2) single-dose vial contents were true to the stated quantity as per the manufacturer. Results: The 10 facilities with the highest waste estimates are summarized in the table. The total waste estimates for all facilities are $25,927,861 (method 1) and $12,945,353 (method 2). Waste estimates were also calculated by drug, with rituximab, bevacizumab and pemetrexed having the highest waste costs. These drugs are only available in vials with a large range in size (100 and 500 mg), but could waste more than drugs with more size options or less variance between sizes. Conclusions: Assigning a BUD based on 6 hour sterility standards will have significant financial implications to facilities in Ontario. Development of mitigation strategies should be explored to provide guidance to Ontario and other jurisdictions on how to curtail the budget impact.[Table: see text]
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Affiliation(s)
| | - Kathy Vu
- Cancer Care Ontario, Toronto, ON, Canada
| | - Ron Fung
- Cancer Care Ontario, Toronto, ON, Canada
| | | | | | | | | | | | - Daniella Santaera
- University of Toronto Leslie Dan Faculty of Pharmacy, Toronto, ON, Canada
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10
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Redwood E, Vu K, Wright M, Fox C, Ahmad N, Simanovski V, Kaizer L, Krzyzanowska MK. Patients as partners in managing cancer treatment-related toxicity. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.7_suppl.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
215 Background: Cancer Care Ontario is the government agency responsible for improving cancer services across Ontario’s 14 regions. To promote advances in best practices related to systemic treatment, Cancer Care Ontario hosts annual Systemic Treatment Safety Symposia, which serve as a platform to discuss quality and safety issues and results of quality improvement (QI) initiatives in alignment with the Systemic Treatment Provincial Plan. For the first time, the 2015 Symposium brought together patients and providers to discuss gaps and opportunities for improvement in relation to toxicity management (TM) during chemotherapy. The main goal of the event was to define improvement priorities. Methods: The Symposium presents a valuable engagement opportunity with regional stakeholders including medical oncologists, nurses, pharmacists, administrators and patient and family advisors. An interactive agenda was designed to elicit direction from these stakeholders. At the event attendees identified and prioritized improvement opportunities using a simulated investment scenario, where marked bills were given to participants to finance the solutions they felt would best address the challenges posed by current TM. The mock money was counted and analyzed based on the role of the ‘investors’ and the prioritized theme. Results: The Symposium had 92 attendees including 17 patients and caregivers. Themes that emerged are presented in the Table below. Endorsement varied depending on stakeholder group. For example, Access was the top improvement priority for patients, whereas Communication was highest for providers. Conclusions: A one day engagement event that brings together patients and providers can be successful in identifying priority areas for quality improvement. Based on the outcomes of the prioritization exercise, improving access to oncology providers for TM 24/7 was identified as a focus area for provincial and regional QI initiatives. [Table: see text]
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Affiliation(s)
| | - Kathy Vu
- St. Michael's Hospital, Toronto, ON, Canada
| | | | | | - Noor Ahmad
- Cancer Care Ontario, Toronto, ON, Canada
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Krzyzanowska MK, McKay C, Han H, Gandhi S, Laferriere NB, Atzema C, Chan KK, Howell D, Kukreti V, Leung Y, Pardhan A, Mitchell S, Nayer M, Pasetka M, Yao J, Redwood E. Feasibility, acceptability, and efficacy of a proactive telephone intervention to improve toxicity management during chemotherapy. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.7_suppl.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
105 Background: Chemotherapy (chemo) is associated with a significant risk of toxicity, which often peaks between ambulatory visits. Consequently, effective remote symptom management support is essential to optimize self-management and resource use, including emergency department visits and hospitalizations (ED+H) during chemo. The aim of this study was to examine the feasibility, acceptability and effects of a telephone management intervention on symptomatic toxicity and resource use during chemo for early stage breast cancer (EBC). Methods: A prospective study of telephone-based toxicity management among women receiving neo-adjuvant or adjuvant chemo for EBC was undertaken at one urban and one rural site in Ontario, Canada. The intervention consisted of two standardized calls by nurses assessing common toxicities after each chemo (call 1 within 3 days and call 2 within 8-10 days). Primary outcome measures were feasibility and acceptability based on patient (pt) and clinician feedback. Efficacy was evaluated by self-reported ED+H. Results: Between 09/2013 and 12/2014, 77 women with EBC were enrolled (mean age 55 years). Most commonly used regimens were AC-paclitaxel (58%) and FEC-docetaxel (16%). 78% of pts received primary GCSF prophylaxis. Adherence with calls was 82%; mean call duration was 9 minutes. The intervention was well received by both pts and clinicians. 97% of pts indicated they liked receiving the calls and 94% would recommend this protocol be offered to all pts receiving chemo. Clinicians and pts felt the calls reduced pt anxiety by providing just-in-time education and counselling. Twenty five (33%) pts reported at least one ED+H during chemo, lower than the historical rate of 44% for this population in Ontario. Challenges included introducing an intervention that involved both routine clinical personnel and research staff and incorporating the calls into existing work responsibilities. Conclusions: Telephone-based toxicity management during ESB chemo is feasible, perceived as valuable by clinicians and pts, and may be associated with lower rates of acute care use. Larger scale evaluations of this approach focusing on effectiveness are warranted.
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Affiliation(s)
| | | | | | - Sonal Gandhi
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | | | - Clare Atzema
- Sunnybrook Health Science Centre, Toronto, ON, Canada
| | | | - Doris Howell
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Yvonne Leung
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | - Mark Pasetka
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - Jane Yao
- Cancer Care Ontarrio, Toronto, ON, Canada
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Redwood E, Smith R, Garay CR, Truscott R, Umar S, Kaan M, Kraetschmer N, Lee G, Kukreti V. Meeting patient and provider eTechnology needs: A provincial approach. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.7_suppl.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
153 Background: Cancer Care Ontario is the government agency responsible for improving cancer services across Ontario, and for implementing standards such as quality care, benchmarking and system navigation. In this role, a provincial information management and information technology (IM/IT) strategy across the patient continuum of care is essential to achieve the goal of improving the performance of the healthcare system and enhancing quality of care. Methods: Cancer Care Ontario developed a standardized approach for an IM/IT strategy through clinical engagement, needs assessment, gap analysis, clinical standardization influencing product build, usability testing, change management and post-implementation evaluation. Results: See table below. Conclusions: Ontario’s strategy for IM/IT initiatives includes a repertoire of eTools for system, patient and clinician level end user needs. An ongoing evaluation strategy including real-time patient experience measures will further strengthen the approach. [Table: see text]
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Affiliation(s)
| | | | | | | | - Shama Umar
- Cancer Care Ontario, Toronto, ON, Canada
| | | | | | - Gemma Lee
- Cancer Care Ontario, Toronto, ON, Canada
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Simanovski V, Ahmad N, Kaizer L, Redwood E, Vu K, Fox C, Meertens E, Krzyzanowska MK. Bringing provincial improvements to oral chemotherapy prescribing through co-ordinated regional initiatives. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.7_suppl.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
107 Background: Oral chemotherapy delivery is complex, making safe medication practices a high priority. Cancer Care Ontario, the provincial government agency responsible for continually improving cancer services in Ontario, undertook a jurisdiction-wide quality improvement initiative to ensure that all oral chemotherapy drugs are prescribed using Computerized Prescriber Order Entry (CPOE) or standardized Pre-printed Orders (PPO). The initiative was further enabled by changes to the provincial funding approach that flows facility funding for oral chemotherapy delivery. Methods: All 35 facilities prescribing chemotherapy in Ontario across 14 regions implemented strategies to work towards the common aim of reducing handwritten/verbal oral chemotherapy prescribing to zero by June 30th, 2015. Baseline audits were completed between Sept-Nov 2014; repeat audits were performed between Mar-May 2015. Each facility reported the number of patients that received an oral chemotherapy prescription, and the method of prescribing. Results: At baseline, 30% of audited prescriptions across the province were handwritten or verbal, which decreased to 9% by June 2015. Improvements were seen in thirteen of the 14 regions. Thirteen out of 35 facilities met the aim of 0 handwritten/verbal orders, with an additional 16 facilities seeing an improvement. Alignment with funding mechanisms, an early physician engagement strategy, and education of key stakeholders on CPOE systems were identified as key enablers to implementation. Conclusions: Though the goal of zero handwritten/verbal prescriptions was not met by all facilities, the initiative encouraged a change in implementing safe prescribing practices for oral chemotherapy. Further audits will assess that the gain was sustained and that the provincial goal is achieved. This initiative is part of a larger strategy to standardize care for systemic treatment patients and promote a culture of safety in hospitals. [Table: see text]
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Affiliation(s)
| | - Noor Ahmad
- Cancer Care Ontario, Toronto, ON, Canada
| | | | | | - Kathy Vu
- Cancer Care Ontario, Toronto, ON, Canada
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Vu K, Wan M, Pardhan A, Redwood E, Crespo A, Lakhani N, Kaizer L. Influencing antiemetic prescribing practices and funding changes through evidence-based guidelines. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.7_suppl.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
31 Background: In 2013 Cancer Care Ontario released updated antiemetic recommendations supporting the use of aprepitant-based combinations as 1st line therapy for highly emetogenic and 2nd line therapy for moderately emetogenic chemotherapy and discouraging the prolonged use of 5-HT3 antagonists. In 2014 changes were made in the Ontario drug formulary to align public funding to those recommendations. The impact of the changes in guidance and public funding on prescribing practices are now being analyzed. Methods: Using the Ontario Drug Benefit (ODB) database, data was extracted to analyze the prescribing practices of aprepitant, granisetron and ondansetron for chemotherapy-induced emesis between the pre-funding period (November 2013 to September 2014) and post-funding period (October 2014 to July 2015). Results: Prior to funding changes, an average of 197 prescriptions/month of aprepitant were billed to the ODB program totaling $22,422. After funding, an average of 1,165 prescriptions/month of aprepitant were billed totaling $132,145. This represented a 490% increase in utilization. The combined 5-HT3 receptor antagonists prescriptions/month billed during the respective time periods were 5,592 ($405,604) and 5,536 ($402,628). This represented a 1% decrease in utilization. Conclusions: There was a significant increase in aprepitant utilization and total expenditure to the ODB program indicating strong uptake of the triple-drug recommendation for highly emetogenic regimens. However, there was minimal change in prescribing practices related to the 5-HT3 receptor antagonists, indicating a reluctance to decrease utilization. Further work is necessary to discourage the prolonged use of 5-HT3 receptor antagonists.
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Affiliation(s)
- Kathy Vu
- Cancer Care Ontario, Toronto, ON, Canada
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Abstract
Three pigeons were trained on a modified six-key matching-to-sample procedure. The third peck on the figure-sample key (which presented a bird, hand, face, beetle, rabbit, fish, flower, or red hue, as the sample) lighted only one comparison key. Every three additional pecks on the sample lighted another comparison key, up to a maximum of five keys. Pecks on keys of matching figures produced grain. Pecks on nonmatching keys (mismatches) turned off all lights on the comparison keys and repeated the trial. Three figures were used during acquisition. The birds learned to peck each sample until the matching comparison stimulus appeared on one of three comparison stimulus keys, and then to peck that key. Later, five novel stimuli, employed as both sample and comparison stimuli, and two additional matching keys were added. Each bird showed matching transfer to the novel samples. The data suggest that the birds may have learned the concept of figure matching rather than a series of two-component chains or discrete five-key discriminations.
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Pisacreta R, Gough D, Redwood E, Goodfellow L. Auditory word discriminations in the pigeon. J Exp Anal Behav 1986; 45:269-82. [PMID: 3711775 PMCID: PMC1348238 DOI: 10.1901/jeab.1986.45-269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Four pigeons were trained on a multiple variable-interval 30-s extinction schedule with various pairs of spoken English words presented as the discriminative stimuli. The birds typically produced discrimination indices of 70% to 90% accuracy. Discrimination accuracy was improved by shortening the interval between auditory stimulus presentations, and by increasing the number of syllables in the words.
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