# Presentation: 759577

## Raising the Safety Bar: Using BCMA for Outpatient Antineoplastic Administration

- Pam Pickett RN, BSN, MSHSA, BC
- White River Junction, Vermont VAMC

## 

Antineoplastic medication administration high risk 
 Most antineoplastic agents administered in outpatient setting
 BCMA software is inpatient only

- Antineoplastic medication administration high risk
-  Most antineoplastic agents administered in outpatient setting
-  BCMA software is inpatient only

## “tipping point” medication error and 11 “near misses” were catalyst for practice change

 Medication Error – parenteral antineoplastic agent hung on wrong patient. No harm to patient
- Contributing factors included: increased workload, complex protocols with multiple medications and delivery / storage processes.
- Near miss review:  problematic areas included ordering (paper vs electronic), timeliness of ordering process and delivery of medications.

-  Medication Error – parenteral antineoplastic agent hung on wrong patient. No harm to patient
- - Contributing factors included: increased workload, complex protocols with multiple medications and delivery / storage processes.
- - Near miss review:  problematic areas included ordering (paper vs electronic), timeliness of ordering process and delivery of medications.

## Multidisciplinary team chartered by Associate Director for Nursing and Patient Care Services

 Flow chart current process

 Opportunities for improvement:

Ordering process: combination of paper and electronic   orders
Dispensing: Handwritten orders entered into pharmacy software by pharmacy technician representing an additional “handoff”
Delivery: common area
Administration – manual 

-  Flow chart current process
-  Opportunities for improvement:
- Ordering process: combination of paper and electronic   orders
- Dispensing: Handwritten orders entered into pharmacy software by pharmacy technician representing an additional “handoff”
- Delivery: common area
- Administration – manual

## Development of New Process

- Evidence based – studies reviewed indicated that with a manual system, most errors occur at the ordering step and administration step.
-  Use of electronic provider order entry and BCMA may decrease the likelihood of medication errors at those common points
-  Multiple cycles of refinement

## New Process

-   Patient is checked into clinic appointment
-   Patient is admitted to a ward “Same Day Chemo”
-  Provider enters orders into CPRS using inpatient   “quick orders”
-  Meds administered using BCMA
-  Admission is deleted

## Lessons learned

- Clinic check in / admission must be timely
- Timely pharmacy verification of pre–meds is essential
-  Process for consecutive days of chemo was needed and was developed

## Lessons learned (cont)

- Correct progress note location essential for billing / workload
-  Number of patients not accurate representation  of workload with complex protocols
-  Use of “just in time training” and cognitive aids necessary

## Outcomes

- Use of BCMA – no medication errors or near misses reported since new process implemented.  685 patient visits since Oct 2006
-  Reduction of cycle time
-  Replicable process without variation

## Outcomes

- Risk mitigated with provider order entry
-  Quick order set development and deployment
-  Spreading the change
-  expansion to include non-antineoplastic agents April 2007
-  Pilot in ED – May 2007