bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medication reconciliation practices in ambulatory cancer care across Canada.
Authors: Mak Ernie , Powis Melanie Lynn , Dara Celina , Bouchard-Fortier Genevieve , Kukreti Vishal , Stuart-McEwan Terri , Dave Hemangi , Kirkby Ryan Lawrence , Bissonnette Jean-Pierre , Glinsky Victoria , Howell Doris , Julius Anet , Macedo Alyssa , Morley Lyndon , Krzyzanowska Monika K. 
Published: October 2019

248 Background: Substantial work has been done to implement medication reconciliation (MedRec) in the inpatient setting to reduce medical errors and drug discrepancies. However, this work has not extended to the ambulatory cancer setting, where care spans multiple providers and responsibility remains unclear. We undertook an environmental scan to understand current MedRec practices in ambulatory cancer care across Canada. Methods: Semi-structured telephone interviews were conducted with stakeholders from institutions across Canada during a 2-month period in 2019. Questionnaires were pre-circulated to participants to guide discussions. Questions probed participants on processes, policies, roles and responsibilities, definitions of target populations, information sources, and barriers and facilitators. Results: 21 of the 23 stakeholders contacted were interviewed, representing 9 of 10 Provinces. Most institutions had a process in place for collecting best possible medication history (BPMH; 81%); however, considerable variation in practice was noted and full MedRec was uncommon. Of those institutions with a process, BPMH was most often undertaken by a pharmacist or pharmacy tech (53%) using a comprehensive Provincial drug information system (65%) as a starting point, and targeted patients initiating systemic therapy (59%). Few institutions (22%) routinely collected performance measures evaluating the process or outcomes. Lack of resources (physical, human and financial), high patient volumes, and access to medication records from external institutions and community pharmacies were identified as significant barriers to routinely collecting BPMH. Understanding the value added, clinician buy-in, and patient education regarding the importance of bringing medication to the clinic were identified as facilitators. Leveraging patients to more actively participate in collection and maintenance of their own medication records was identified as an area for future work. Conclusions: While most centres were doing BPMH in some patients, MedRec was uncommon in the ambulatory cancer setting. Results indicate a lack of consensus regarding best practices for medication management in ambulatory cancer care.
Neoadjuvant chemoradiation (NCRT) for esophageal (EC) or gastroesophageal junction cancer (GEJC): A Canadian single institution real-world experience using the CROSS trial regimen.
Authors: Khalid Sidra , Hopman Wilma M. , Preti Beatrice , Tomiak Anna T. , Virik Kiran 
Published: October 2019

25 Background: NCRT followed by surgery per the CROSS trial regimen is an accepted standard of care in the treatment of EC and GEJC. When treatments are used in the real-world setting, there are often patient, treatment and potential outcome differences compared to the original clinical trial. The study aim was to assess the real-world application and outcomes of the CROSS trial protocol. Methods: A retrospective chart review was undertaken of 83 patients (pts) with EC or GEJC who were treated from June 2012 to June 2018 with CRT. 65 pts were with NCRT intent to proceed to surgery. Pts’ demographics, clinical, pathological, treatment and surgical characteristics were assessed and exploratory analyses were conducted to review these factors and outcomes. Analyses included Chi-square, t-tests and Kaplan-Meier. Results: For pts who underwent NCRT (n = 65): median age was 68 yrs (range 52-80), male 79%, adenocarcinoma 82%, median (m) tumor length 5 cm, GERD 43%, clinical stage II/III 95%, and BMI > 30 in 37%. 80% completed CRT with RT ≥ 41.4 Gy; of these 88% had ≥ 50.4 Gy. Delay/interruption in chemotherapy occurred in 46% and in RT 37%. Pts who underwent surgery were younger (p = 0.04) and weighed more (p = 0.05). mOS was 37 months (M) v 14 M in those who started CRT ≤ 8 weeks (w) from diagnosis v > 8 w (p = 0.10). The median time from CRT to surgery was 8.9 w. 40 pts had surgery with a complete response in 38% and a R0 resection in 98%. Postoperative major and minor complications occurred in 67%. Those < 75 yrs v ≥ 75 yrs had a mOS of 32 M v 15 M respectively (log rank p = 0.46). 25 pts did not get surgery; 28% was due to death/progression. Pts who proceeded to surgery had a mOS of 35 M v 12 M in pts who did not go to surgery (log rank p = 0.002). Further correlative outcome data will be presented. Conclusions: Real-world data in our center showed patient, tumor and treatment differences compared to the CROSS trial protocol. Despite the broadening of eligibility and treatment criteria, survival in a single institution setting is maintained with trimodality therapy compared to NCRT alone. Real-world data is of value in the assessment of therapeutic validity of clinical trial data.
Standardization of the inpatient oncology signout process.
Authors: Parikh Anish B , Aronson Elizabeth , Steinberg Amir S. , Smith Cardinale B. 
Published: October 2019

253 Background: Provider handoffs are prone to medical errors which in turn impact patient outcomes. Standardized signout tools have helped address this issue, however not in oncology. Methods: A pre-intervention survey (S1) was used to evaluate the current inpatient signout process and identify flaws by querying inpatient hematology/oncology fellows, attendings, nurse practitioners, and physician assistants. This data informed the development of a standardized electronic signout tool which was subsequently piloted on our bone marrow transplant unit. A post-intervention survey (S2) is currently evaluating the impact of this tool. Results: Of S1 respondents (54%, 71/131), 75% felt the signout process needs improvement, largely due to outdated (70%) or incomplete (24%) information and general disorganization (49%). Nearly half felt the signout contains too much (28%) or too little (18%) information. 18% felt that patient care had been compromised or delayed due to poor signout. Items requested for inclusion in the signout tool by more than half of respondents included patient identifiers, health care proxy, code status/goals of care, active issues summary, cancer details and treatment history, and a to-do list. Full S1 results are shown in Table; S2 results are pending. Conclusions: Use of a standardized, electronic signout tool can further enhance the inpatient handoff process in terms of safety and efficiency. [Table: see text]
Developing a standardized approach to cancer medication-related infusion reaction prevention and management in Ontario.
Authors: Crespo Andrea , Gallo-Hershberg Daniela , Enright Katherine , Kukreti Vishal , Martelli Lorraine , DeAngelis Carlo , Granic Anna , Mothersill Charmaine , Rashid Ferid , Spasic Lily , Young Leslie , Yu Jason , McBain Sarah , Forbes Leta Marie 
Published: October 2019

255 Background: Cancer medication-related infusion reactions (CMIRs) can lead to treatment delays, switching to less optimal therapy, or discontinuation. Variation in the prevention, management and reporting of CMIRs was identified as a quality and safety gap by Ontario clinicians. This initiative aimed to facilitate a standardized approach to CMIRs in Ontario through the development of user-friendly health-care provider and patient resources. Methods: A multidisciplinary working group of 15 oncology clinicians (oncologists, pharmacists, nurses, administrators) with experience in the management of CMIRs reviewed available literature on CMIR assessment, prevention and management. Recommendations were based on best available evidence and group consensus when only low-level evidence was available. Final guideline content was reviewed and validated by external experts. Complementary patient information was created based on best practices in health literacy and input from patient education experts, patients and caregivers. A mechanism for system-wide reporting to track CMIRs was explored. Results: A CMIR clinical practice guideline was created. Definitions, risk factors, prophylaxis strategies, an acute management algorithm and desensitization protocols are described. A CMIR severity grading system was proposed. A toolkit was developed and contains a table outlining risk factors, mechanism, incidence, symptoms, onset, prophylaxis, acute management and re-challenge by specific drug and a tool for calculating a three-bag 12-step desensitization. Patient-friendly information was also created. A new data element for collection of CMIR incidence and severity was added to the provincial Activity Level Reporting (ALR) data set to track CMIR trends. Conclusions: A review of current evidence and expertise from oncology clinicians resulted in an evidence-informed, consensus-based guideline. This guideline and the accompanying resources can help to facilitate safe and standardized prevention and management of CMIRs across Ontario. The collection of system-wide CMIR data based on the proposed grading system will inform future quality and safety improvement initiatives.
A standardized workflow to improve the consent process among patients initiating an oral anticancer drug.
Authors: Brown Jessica S. , Hershman Dawn L. , O'Neil Daniel , Brafman Lois , Fuentes Deborah A. , Graafland Laura , Law Cynthia , Trivedi Meghna S. , Kalinsky Kevin , Crew Katherine D. , Accordino Melissa Kate 
Published: October 2019

259 Background: The American Society of Clinical Oncology and The Oncology Nursing Society’s guidelines recommend that consent be obtained and patient education provided prior to oral anticancer drug (OACD) initiation. The aim of this quality improvement project was to improve documentation rates of consent and education prior to OACD initiation in an outpatient breast oncology clinic. Methods: Plan-Do-Study-Act (PDSA) methodology was used to identify the root causes of inadequate OACD documentation; and to evaluate a standardized OACD workflow that included a multidisciplinary (physician, nurse practitioner [NP], and administrative staff) checklist on the disposition sheet and standardized patient education material, used in the Columbia University Irving Medical Center Breast Oncology Clinic. New OACD prescriptions were identified in the electronic health record (EHR) from 2/1/18-4/1/18 (pre-intervention) and 6/5/18-8/17/18 (post-intervention). Documentation of consent and education were evaluated by EHR review. Consent (yes/no) was determined by physician documentation in either the corresponding clinic note or scanned consent form, and education (yes/no) was determined by NP documentation in the education section of the clinic note. Documentation rates were compared pre- and post-intervention. Results: Pre-intervention, 19 patients received a new OACD, and 0 (0%) had documentation of consent or patient education. Root cause analysis revealed the driver of inadequate documentation was the inability to identify patients with a new OACD prescription at the time of their clinic visit. After implementation of the OACD workflow, 23 patients initiated a new OACD, 15 (65.0%) had documentation of consent and 7 (30.0%) had OACD education documented in the EHR. Conclusions: After the first PDSA cycle, documentation of consent and education improved from baseline. However, improvement in both metrics are still needed. Patient volume, staff changes, and the format of the OACD checklist may have limited the efficacy of this intervention. In the next PDSA cycle, the consent process will be linked to the required OACD pre-approval process to further increase OACD documentation.
Time to treatment for lung cancer patients at an urban safety net institution.
Authors: Narra Kalyani , Lu Yan , Ghabach Bassam , Ojha Rohit P. 
Published: October 2019

26 Background: Lung cancers are rapidly fatal, but no guidelines currently exist in the US for the optimal time between symptomatic presentation and treatment. A recent study from multiple institutions estimated a median of 52 days from symptomatic presentation to treatment, but this estimate was based on patient self-report and the study under-represented settings that provide care to patients with socioeconomic barriers to care that could affect time to treatment. Therefore, we aimed to assess time to treatment for lung cancer patients at an urban safety-net institution. Methods: We used institutional registry data from the JPS Center for Cancer Care (Fort Worth, TX), an accredited Comprehensive Community Cancer Program. Eligible patients were aged ≥18 years and had a pathological diagnosis of lung cancer between January 1, 2018 and December 31, 2018. We estimated the median overall and stage-specific time from abnormal imaging (chest X-ray or CT scan) to initiation of treatment, which were documented in medical records. Results: Our study population comprised 75 lung cancer patients. The majority of patients who received treatment ( n=46) were aged 55–64 years (54%), female (52%), and racial/ethnic minorities (54%). The overall median time to treatment was 81 days (interquartile range [IQR]=48–111) which varied by stage: stage I=108 (IQR=92–140), stage II=123 (IQR=111–134), stage III=85 (IQR=45, 102), stage IV=59 (IQR=39–72). In particular, the median time from ordering chemotherapy to start was 22 days (IQR= 13–30). Conclusions: Time to treatment for lung cancer patients at our institution is substantially longer than reported in the literature, which may partially reflect the patient population but warrants interventions (e.g. enhanced care coordination) to reduce this interval. Nevertheless, without an optimal time to treatment that is associated with improved outcomes among lung cancer patients, we and other institutions lack a meaningful benchmark.
Care coordination for oral oncolytics through pharmacy integration and cycle 1-day 1 documentation.
Authors: Peacock Nancy Walker , McCullough Stacey , Crumb Jared , Owens Leah , Kaufman Laura , Arrowsmith Edward , Patton Jeffrey , Taylor Jack L. , Lyss Aaron J. , Kelsey Carolyn J. , Senneke Kimberly , Frailley Susan A 
Published: October 2019

260 Background: The growing number of oral oncolytic therapies (OOTs) necessitates a standardized EMR workflow that integrates pharmacy activities for dispense and patient management and standardizes cycle-1/day-1 (C1D1) documentation. Our practice’s treatment plans contain appropriately timed OOT follow-up activities including labs, physician follow-up visits, and pharmacy calls for toxicity and adherence checks, however complications in prescription fulfillment such as prior authorization, co-pay assistance, or inability of in-practice pharmacy to dispense limit the predictability of C1D1 dates of OOTs. Methods: An EMR query identified patients at a single clinic location of 5-medical oncologists (MDs) for whom oral oncolytic treatment plans were entered from January 1 to June 30, 2018. C1D1 date entered by the MD in the EMR was compared to the pharmacy processing system dispense date. Ten patients were identified, and 10% (1/10) had an accurate C1D1 documented within the EMR. As part of the ASCO Quality Training Program, to improve the accuracy of C1D1 documentation, a new workflow was implemented whereby: (1) a “hold” activity was added to new EMR treatment plans so that C1D1 remained pending until patients had received medication; (2) clinic checkout staff provided patients with information on the in-practice pharmacy and expectations for next steps; (3) pharmacists utilized existing reporting tools to identify newly entered treatment plans and transcribed orders into e-prescriptions sent to our practice pharmacy; (4) the pharmacy workflow ensued with pharmacy staff leading patient engagement, drug counseling; (5) pharmacists confirm C1D1, document within EMR (6) subsequent treatment plan activities were scheduled. Results: Following education and process changes within the clinic and pharmacy, accurate C1D1 documentation occurred in 90% (9/10) of patients initiating OOTs. Conclusions: Including pharmacy fulfillment time in EMR workflow can improve C1D1 documentation accuracy and associated management of OOTs. Education regarding roles and processes of prescribing MDs, pharmacy staff and clinic staff will be required to scale this process improvement throughout the organization.
Compliance of protocol-driven hepatitis B serological screening in patients receiving anti-CD20 monoclonal antibody therapy.
Authors: Schluenz Lauren , Jeffers Kate , Kalis Joseph 
Published: October 2019

261 Background: The US Food and Drug Administration has issued a boxed warning for anti-CD20 monoclonal anti-bodies for the reactivation of Hepatitis B virus (HBV) infection. The National Comprehensive Cancer Network (NCCN) Non-Hodgkin Lymphoma and Infectious Diseases Society of America guidelines recommend routine serologic testing for all patients receiving anti-CD20 antibody therapy. NCCN specifies serologic screening of HBV surface antigen (HBsAg) and hepatitis B core antibody (HBcAb) should be completed prior to initiation of anti-CD20 therapy. In March 2018, UCHealth included HBV screening into the EHR oncology templates which include an anti-CD20 monoclonal antibody. The purpose of this study was to assess the impact of this template modification on compliance to guideline recommended screening for patients receiving anti-CD20 monoclonal antibody therapy. Methods: This was a retrospective chart review of patients who received an anti-CD20 monoclonal antibody for an oncologic indication between April 1, 2017 to November 30, 2017 (pre-template change) and April 1, 2018 to November 30, 2018 (post-template change) at any of the UCHealth Cancer Care and Hematology Centers. The primary objective was the composite compliance rate of HBsAg and HBcAb screening completed prior to receipt of treatment. Secondary objectives included compliance rate of each screening test, days between screening and treatment, screening for initial compared to relapse therapy, and rate of hepatitis C virus screening. Results: The addition HBV serologic screening to the EHR oncology templates containing an anti-CD20 agent improved screening compliance of HBsAg and HBcAb by 6.7% as a system (2017: 89.7% vs 2018: 96.4% [p = 0.133]). Secondary endpoints saw an increase in testing of each individual screening, testing for patients in the relapse setting, and HCV screening. Additionally, a reduction was seen in median days between screening and start of therapy (2017: 11 (4.5-30.3 IQR) vs 2018: 7 (2-14 IQR) [p = 0.008]). Conclusions: The addition of HBV serologic screening to EHR oncology templates increased compliance to guideline recommended screening for patients receiving anti-CD20 antibody therapy.
A multimodal, interprofessional training program on chemotherapy safety for nurses and pharmacists: Development and preliminary evaluation.
Authors: Friese Christopher Ryan , Aebersold Michelle L. 
Published: October 2019

266 Background: Chemotherapy is a high-volume, high-risk clinical intervention that requires interprofessional clinical teams. With increased demand for chemotherapy, a record number of newly-approved drugs, and health system cuts to professional development, we sought to develop and deliver an evidence-based educational program for nurses and pharmacists on safe handling of hazardous drugs, management of oncology emergencies, extravasations, oral oncolytic therapy, and promoting clinical practice change. Methods: After mail and web-based recruitment activities, selected participants completed pre-workshop online modules. Live workshops included a blend of faculty-led interactive sessions and four simulations to reinforce content. Post-simulation debriefing sessions clarified concepts and identified participant action plans for clinical practice change. Attendees have access to lecture videos, handouts, resources, and a discussion board. Applying Kirkpatrick’s framework, we assessed participant confidence to meet program objectives before and after the workshop, a 27-item knowledge assessment before and after the workshop, and satisfaction with specific learning activities on a 5-point Likert scale. Results: To date, faculty have led two workshops. 266 nurses and 72 pharmacists applied and we accepted 77 (29%) and 30 (42%), respectively. Participants' change scores in confidence to meet program objectives increased from pre- to post-workshop (range 0.51-1.00). Knowledge scores increased between pre- and post- workshop (16.3 vs. 18.76, p < .01). Overall satisfaction was high across all content areas (range 4.76 - 4.98). Nearly all participants (n = 104, 97.2%) reported they were extremely satisfied with the program. Conclusions: An interprofessional education program with online modules, in-person interactive sessions, and simulation activities is a promising strategy to deliver chemotherapy safety content to practicing oncology nurses and pharmacists. Future efforts include recruiting a more diverse pool of participants, and expanding the program to include advanced practice providers.
Increasing compliance of an oral oncolytic program in a multi-location practice.
Authors: Patel Amita , Woerner Shannon , Flocco Tina , Carroll Rachel , Shander Ellen 
Published: October 2019

267 Background: Over the past two decades the rise in number of oral oncolytics has significantly changed the landscape of cancer treatment. Although these medications offer patients the convenience of home administration, they pose different challenges. Two examples are adherence and education of associated toxicities. In an ongoing effort to provide quality cancer care, the Central Jersey Division of Regional Cancer Care Associates (CJD RCCA) has reconstructed its oral oncolytic program. Methods: In 2016 the CJD of RCCA developed an oral oncolytic program to educate patients on how to safely manage their medications. After the provider sent the prescription, a flowsheet is entered into the EMR, triggering the chemotherapy teaching session and appropriate follow up visits. During this visit patients are provided drug specific educational sheets which include lab monitoring, common adverse effects, and calendars to document adherence. Due to failure of entering flowsheets into the EMR, patients lost to scheduling while waiting for medication delivery, or patient refusal of teaching, compliance remained low. The program was modified to include running a daily report to identify all new oral oncolytic prescriptions. Schedulers are immediately calling patients to schedule a teaching session. A field in the EMR was created to document “patient refusal”. By making these improvements, CJD RCCA has increased compliance along with upholding quality care for patients receiving oral oncolytics. Results: Since re-structuring the program the RCCA CJD APNs have performed teaching on 124 of 172 (72%) patients from January to May of 2019. This is compared to only 79 of 144 (54%) in all of 2018. Of the patients identified in 2019 30 refused, 13 were completed by the physician, and 5 expired. This dramatic rise of 18% is largely due to running the daily oral oncolytic reports and entering the flowsheet into the EMR. Conclusions: Patient compliance has increased by identifying new patients and prompt enrollment into the program. It provides them the tools to safely navigate through treatment. At CJD RCCA, the oral oncolytic program is vital to ensuring positive clinical outcomes for these patients.