Analysis of Intervention Employability in Pharmacy-Related Medication Safety Reports at a Tertiary Medical Center.

Background: The Institute for Safe Medication Practice (ISMP) suggests that patient safety reports be addressed with systematic, fail-safe, actions to prevent error recurrence. ISMP's hierarchy of effectiveness of risk reduction strategies places education-related interventions as the least effective and fail-safes at the top. UNM Hospitals creates a positive environment for safety reporting, but often we are limited to education interventions due to resource and technology constraints. This study analyzes the intervention potential and quality of pharmacy-related medication safety reports. Methods: One thousand medication-related safety reports from selected time points between 2012 and 2022 were selected. Safety reports were included in our study if they were actionable by the pharmacy department. Each safety report was categorized by type of safety event and given an intervention potential score of 1 to 10 (1 indicating education-only, 10 being forcing function) by 2 student pharmacists and 1 pharmacy director based on their potential place on ISMP's hierarchy. Safety report quality was graded based on professionalism, organization, clarity, and completeness. A standardized evaluation form was used for evaluation for all elements. Results: Six-hundred-sixty-five safety reports were pharmacy-related and evaluated by all 3 study team members for analysis. The 3 most common pharmacy-related safety reports were medication delivery, inappropriate order verification, and transcribing errors which accounted for over half of the reports (59.5%) and on average the intervention potential score of these types of safety reports was education only. Overall, safety reports were limited to a maximum actionability of education-only 75.4% of the time. Safety reports were found to be professionally written and well organized. Conclusion: The actionability of most pharmacy-related medication safety reports was limited to low leverage interventions likely because high leverage solutions were addressed with systematic change and did not recur. Errors limited to education interventions repeated and this increased relative counts of low leverage actionability of safety reports. The ISMP hierarchy of effectiveness of risk-reduction strategies is an important guide to intervening in medication-related safety events, but pharmacy staff should not be discouraged if most of the safety reports cannot be addressed through high-leverage interventions.

Safety outcomes of rapid- versus standard-infusion rate oxaliplatin.

PURPOSE: The National Comprehensive Cancer Network guidelines state that the oxaliplatin dose of 85 mg/m2 used in various gastrointestinal cancer regimens may be infused over a rapid rate of 85 min instead of the standard time of 120 min. We evaluated the safety outcomes of rapid administration of oxaliplatin compared to standard infusion. METHODS: We performed a retrospective, cohort study by chart review. Adult patients who received oxaliplatin as part of a FOLFOX, FOLFOXIRI, or FOLRINOX chemotherapy regimen from January 1, 2018, through June 30, 2021, were included. Primary outcomes were the incidence of hypersensitivity reaction (HSR) and treatment modification of oxaliplatin due to adverse drug events. Secondary outcomes included peripheral neuropathy (PN), myelosuppressive signs, and oxaliplatin-related emergency department visit and/or hospital admission. RESULTS: A total of 178 patients were included (90 and 88 in the rapid-rate and standard-rate groups, respectively). Rapid-rate oxaliplatin was not associated with increased HSR or difference in toxicity requiring dose reduction, delayed dose, or slowed infusion rate, but was associated with increased rate of permanent discontinuation of oxaliplatin, 7.8% and 1.1% in the rapid-rate group and standard-rate groups, respectively (p = 0.032). Peripheral neuropathy occurred in 72.2% and 42% of patients in the rapid-rate group and standard-rate groups, respectively (relative risk for PN, 2.09; 95%, CI: 1.43-3.04; p < .001). There were no differences in any other adverse drug event measured. CONCLUSION: Rapid-rate oxaliplatin was associated with minimal treatment modifications; however, there was an increase in PN incidence. A faster rate of oxaliplatin administration may not be worth the increased risk of PN.

Improving Outpatient Infusion Clinic Wait Times at a Comprehensive Cancer Center.

PURPOSE: Many factors contribute to long wait times for patients on the day of their chemotherapy infusion appointments. Longer wait time leads to nonoptimal care, increased costs, and decreased patient satisfaction. We conducted a quality improvement project to reduce the infusion wait times at a Comprehensive Cancer Center. METHODS: A multidisciplinary working group of physicians, infusion center nurses, pharmacists, information technology analysts, the Chief Medical Officer, and patient advocates formed a working group. Wait times were analyzed, and the contributing factors to long wait time were identified. Plan-Do-Study-Act cycles were implemented and included labeling patients ready to treat earlier, loading premedications into the medication dispensing system, increasing the number of pharmacy staff, and improving communication using a secure messaging system. The outcome measure was time from patient appointment to initiation of first drug at the infusion center. The secondary outcome measure was patient wait time satisfaction on the basis of Press Ganey score. RESULTS: Postintervention, the mean time from appointment to initiation of first drug decreased 17.6 minutes (P < .001; 95% CI, 16.3 to 18.9), from 58.1 minutes to 40.5 minutes (43.5% decrease). Patient wait time satisfaction score increased 8.9 points (P < .001; 95% CI, 6.0 to 11.82), from 76.2 to 85.1 (11.7% increase). CONCLUSION: Exploring real-time data and using a classic quality improvement methodology allowed a Comprehensive Cancer Center to identify deficiencies and prevent delays in chemotherapy initiation. This significantly improved patient wait time and patient satisfaction.