Impact of Oral Chemotherapy Management Program on Capecitabine Toxicity Management.

PURPOSE: Increasing use of oral chemotherapy has created unique challenges related to patient safety and compliance. To address this issue, the Henry Ford Cancer Institute at Henry Ford Health System developed and implemented a system-wide, multidisciplinary program named the Oral Chemotherapy Management Program (OCMP). The purpose of this study was to evaluate the impact of OCMP on patient outcomes in those receiving capecitabine. METHODS: This was a retrospective, quasi-experimental study that compared outcomes in patients receiving capecitabine before and after OCMP implementation. The co-primary outcomes were incidence(s) of grade 1-4 and grade 3-4 adverse effects (AEs) associated with capecitabine. Secondary outcomes were emergency department (ED) visits, hospitalizations because of toxicity, and adherence rate. RESULTS: OCMP patients had significantly lower overall incidence of AE of any grade (58.9% v 70.3%; 95% CI, 0.39 to 0.94; P = .03). OCMP implementation significantly lowered incidence of any grade and grade 3-4 nausea, vomiting, and/or diarrhea, and grade 3-4 hand-foot syndrome. It resulted in the decreased number of ED visits (8.9% v 18.9%; P = .005) and hospitalizations (6.3% v 17.1%; P = .002), as well as improved medication adherence rates (0.94 v 0.97; P = .03). CONCLUSION: Most patients who developed capecitabine-related AE required intervention by OCMP. Implementation of OCMP reduced the incidence of high-grade AE, decreased the number of ED visits and hospitalizations because of AE, and improved the medication adherence rate.

Improving adherence to the Epic Beacon ambulatory workflow.

Computerized physician order entry has been shown to significantly improve chemotherapy safety by reducing the number of prescribing errors. Epic's Beacon Oncology Information System of computerized physician order entry and electronic medication administration was implemented in Henry Ford Health System's ambulatory oncology infusion centers on 9 November 2013. Since that time, compliance to the infusion workflow had not been assessed. The objective of this study was to optimize the current workflow and improve the compliance to this workflow in the ambulatory oncology setting. This study was a retrospective, quasi-experimental study which analyzed the composite workflow compliance rate of patient encounters from 9 to 23 November 2014. Based on this analysis, an intervention was identified and implemented in February 2015 to improve workflow compliance. The primary endpoint was to compare the composite compliance rate to the Beacon workflow before and after a pharmacy-initiated intervention. The intervention, which was education of infusion center staff, was initiated by ambulatory-based, oncology pharmacists and implemented by a multi-disciplinary team of pharmacists and nurses. The composite compliance rate was then reassessed for patient encounters from 2 to 13 March 2015 in order to analyze the effects of the determined intervention on compliance. The initial analysis in November 2014 revealed a composite compliance rate of 38%, and data analysis after the intervention revealed a statistically significant increase in the composite compliance rate to 83% ( p < 0.001). This study supports a pharmacist-initiated educational intervention can improve compliance to an ambulatory, oncology infusion workflow.