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   Table of Contents - Current issue
January-March 2019
Volume 2 | Issue 1
Page Nos. 1-20

Online since Tuesday, January 22, 2019

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Measurement approaches to improve delivery of care for patients with cancer p. 1
Tricia Woodhead
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Strategic improvement of oral antineoplastic investigational agents compliance p. 5
Anas Alshawa, Jing Gong, Valerie Marcott, Rabia Khan, Valentine Boving, Lakeshia Brown, Jeff Beno, Ed Kheder, Siqing Fu
Background: The use of oral antineoplastic agents has increased in cancer medicine. However, the convenience of oral medication carries the risk of nonadherence and dosing errors, which could jeopardize therapeutic benefits and patient safety. This is a quality improvement project to investigate reasons for nonadherence and medication errors in patients receiving oral investigational treatment at the Phase 1 Department at MD Anderson Cancer Center, Houston, Texas. Early-phase clinical trials have an enormous impact on drug development and patient safety, not much has been done to evaluate adherence in patients receiving investigational oral antineoplastic agents. Materials and Methods: We examined our clinic dynamic including the initial encounter, follow-up phone calls, medication administration, and patient adherence the following visit. Then we explored and classified the main possible reasons for nonadherence and medication error across the workflow. Results: When examining potential deficiencies in the clinic flow, which are actionable and carry high impact, we found the initial encounter had a significant room for improvement and errors happened when instructions provided were unclear, not correct, or contradicted with the prescription or the label. Furthermore, the follow-up calling was also an important step to monitor and improve compliance. However, it was not a consistent practice and lacked a standardized format. Lastly and although the multistep reconciliation process for oral medication is important to monitor compliance, it was complex, had multiple manual aspects, and added substantial burden on the research staff. Conclusion: In this project, our goal was to shed light on the possible causes of oral medication errors and nonadherence in clinical trials. We proposed feasible measures including educational, training, and adherence monitoring tools. We will continue to monitor and evaluate our data to see any positive or negative impact from our interventions.
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The “Frequent Attendee” project: A multidisciplinary approach to identifying important factors, which influence frequent attendances to the emergency department p. 11
Angela T Caswell
Background: During routine emergency department (ED) patient attendance validation, a trend began to emerge, related to the reason for frequent attendance among individuals. Dialogue among staff in the department who referred to this client group as “regulars” was concerning, as it was believed that it might lead to a degree of unintentional complacency that might result in a potentially vulnerable group slipping through the net. The aim was to examine the unique profile of frequent attendees, establish preventative factors, and develop action plans to offer more specific support. A multidisciplinary team was formed to examine the profiles of these cases and develop specific action plans to address their unique needs in an attempt to prevent unnecessary admissions to the ED at Cwm Taf University Health Board, South Wales. Materials and Methods: Using a Plan–Do–Study–Act methodology over 18 months, a trend analysis identified specific demographic characteristics of age and sex of the sample group (n = 11). The main reasons for attendance were related to alcohol, substance misuse, and learning disabilities. Results: Results showed that the group included eight males, five of which fell into the 18–25 age group and attended on weekdays, with peak times between 9 am and 5pm. The other three men fell into the 26–35 age group and attended most frequently after 5 pm, with the peak day being Thursdays. Weekend activity was sustained among the 18–25 age group, and the 26–35 age group had the highest attendances on Sundays. Three females from this group fell into the 26–35 age group and reflected no difference in attendance patterns. Common factors of the sample were unemployment and a socially deprived location. Conclusion: The project resulted in a 75% reduction in visits to the ED from this group of patients. Networking with other hospitals in the area yielded reports that only one of the patients had changed areas and attended another department.
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Reengineering the communication process to reduce patient no-show rates in hospital outpatient clinics p. 16
Mastourah D Al Shammari, Talal Al Harbi, Abdulmohsen Al Saawi, Khaled Al-Surimi
Background: Patient “no-shows” cause significant concern for healthcare organizations as it affects continuity of care provided to the patient, quality of care, waiting times for new patients, and wastes clinic resources. This project aimed to reduce the rate of no-shows in a general pediatric clinic to less than 10% to be consistent with the international benchmark range of 5%–10% of primary care clinics. Materials and Methods: A multidisciplinary team was formed to address the rate of no-shows using a quality improvement–driven approach in August 2017. Retrospective data analysis showed that 33% of patients who were referred to the general pediatric clinic at King Abdullah Specialist Children Hospital did not show up for their appointments in March 2017. Results: The impact of reengineering the patients’ appointment communication process led to a noticeable reduction in the rate of no-shows in the general pediatric clinic, reaching 14% in 1 month (November to December 2017) compared with the baseline of 33%. Data analysis for the post-intervention period showed a progressive decline in the no-show rate, reaching below 10% in the general pediatric clinic, indicating a big shift in the rate of no-shows among the patients attending the general pediatric clinic. Conclusion: Reengineering the communication process and increasing awareness to update contact information are effective strategies for improving communication with patients and reducing the rate of no-shows for scheduled appointments. The next step is to share project findings with healthcare workers and leaders to sustain the improvement.
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