Addressing Quality and Safety Issues in At-Home Chemotherapy Use

A poster presented during the Oncology Nursing Society (ONS) Congress evaluated quality and safety improvement measures targeting at-home chemotherapy.

Kerstin Scheper, MSN, RN-BC, OCN, CHPN, who presented the poster, is the chair of the Atlantic Health System Adult Oncology Practice Committee.

“Through this committee, we found that we were experiencing a patient safety and quality problem with our home infusion therapies,” she shared. “Four of our five outpatient infusion hospital sites were reporting that patients were coming back to the infusion center at the time that their chemotherapy should be completed and there was still some drug, or not all of the drug had fully infused, or patients were experiencing leaking from their port needle site, usually at the Y site or around the hub of the Y site.”

The committee knew right away they had to address these issues. First, they started tracking such problems when they occurred using a tracking tool. They also queried their electronic medical records to determine how many patients were going home with infusion pumps. An interdisciplinary team of nurses and pharmacists was created to strategize effective interventions.

Interventions that were implemented included:

  • pharmacy reeducation
  • nursing reeducation
  • change in port needles
  • revised discharge instructions
  • additional chemotherapy stickers
  • new 5FU education videos

Prior to implementing these changes, 791 home pumps were prepared and administered, with 21 pump incidents. Post-intervention, 686 home pumps were prepared and administered, and only two incidents were recorded—both of which were cases of the pump not infusing properly; no leaks were reported. All five sites that were experiencing issues pre-intervention saw significant improvements, with overall changes ranging from 84% to 100%.

Scheper said the team will continue to track and monitor these incidents when they do occur to continue improving outcomes and identifying any new issues.

“We’re going to sustain our project and out success through annual pharmacy and nursing reeducation. We really do believe that our educational video that we’ve developed for our patients is going to be a big key to sustaining our success in this project,” Scheper concluded.