SELECTION OF OPPORTUNITIES FOR IMPROVEMENT

Concurrent chemoradiation therapy (CCRT) is one of cancer treatment modalities where chemotherapy is given prior to radiotherapy on the same treatment day. In chemotherapy drug reconstitution pharmacy (CDR), there are established multiple inevitable safeguard checkpoints in processing chemotherapy prescriptions that are well known to cause long wait times. This delay for chemotherapy lead to dissatisfaction amongst both patients and staffs, increased operational cost and compromised safety. Despite this concern on time, no one to the best of our knowledge has set any production duration limits, understandably due to safety issue.

KEY MEASURES FOR IMPROVEMENT

By using the Cause and Effect analysis, 9 critical processes were identified from existing process of care which includes Prescription-In, Screening, Worksheet, Counterchecking, Component, Reconstitution, Packing, Quality Check and Call-ward. Each process was set a standard of 70-80%. From previous audit, 77% of the chemotherapy preparations were reconstituted within 1.5 hours after approval. As agreed upon management consensus, the standard is set to improve the proportion to 90%.

PROCESS OF GATHERING INFORMATION

This is a 2-phase (pre-intervention and post-intervention) cross sectional study conducted between January 2016 to April 2017. Universal sampling method was utilized where only valid CCRT prescriptions were included. Process maps representing chemotherapy preparation checkpoints was distinguished. Time spent in each checkpoints were collected using a structured data collection form. Outcome from phase-1 was analysed using qualitative method through focus group discussion to identify the remedial measures.

ANALYSIS AND INTERPRETATION

Phase 1 demonstrated low standard achievement in almost all processes, ranging from 32.7% to 78.9%. Longest delay was found to be at the Prescription-in process due to one-way processing method. The durations in all processes had improved after application of remedial actions.

STRATEGY FOR CHANGE

Strategies implemented role inter-changeability, Improved CCRT prescriptions in both workstation and clean rooms and next-day CCRT prescription anticipation. All these strategies were targeting critical business processes from Prescription-In to Call-ward.

EFFECTS OF CHANGE

Chemotherapy reconstitution durations were improved in most of the processes. The first cycle of remedial action had exceeded the standard set at 90%. Hence, the Achievable Benefit Not Achieved (ABNA) was now  -0.6%. Long wait times for CCRT chemotherapy can be potentially reduced by simple operational changes without expensive cost.

THE NEXT STEP

Better understanding towards this issue can be achieved by taking into consideration both patients’ and staffs’ satisfactions towards wait times.  A multidisciplinary involvement, including pharmacists, physicians, and radiation therapists, in improving delays while patients are being transitioned between one care to another would be highly beneficial in reducing patient wait times.