Background: Challenges related to access to cancer medications is an increasing global problem that has far-reaching impact on patients and healthcare systems. In this article, we are enlisting suggested solutions at the hospital or practice level to maximize the access to these important treatment modalities. Methods: An expert panel of practicing oncologists, clinical pharmacists, and health economists convened using a framework approach. The panelists identified individuals and entities that impact the use of cancer therapeutics and how they can improve the utilization and access to them. They enlisted the potential actions that hospital management and staff can take to enhance access to cancer therapeutics, then they grouped them into specific categories. Results: List of potential strategies and related action items were compiled into different categories including hospital leadership, drug evaluation entities, pharmacy, physicians, patients and families, and other parties. Recommendations included various actions to be considered by each group to achieve set goals. Conclusion: Our expert panel recommend multiple strategies and approaches to reduce the cost of cancer medications and improve patients' access to them. These recommendations can be adapted by the decision-makers and staff of the hospitals to their own settings and the current circumstances.

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Occupational health is a sensitive area in many developing countries where occupational exposure needs attention due to lack of awareness among industrialists as well as workers. Industries such as iron, textile, leather, and paper use a vast number of toxic chemicals during different industrial processes. Workers of these industries come in direct contact with these chemicals including dyes, solvents, and finishers, which are known to be mutagenic and genotoxic. In the absence of risk assessment programs, these chemicals pose serious health risks. Risk management is one of the key factors in health safety of the workers. Agencies of central, state, and local levels need to work harder in the field of occupational health and safety. These agencies should develop relevant risk assessment programs to minimize the exposure health impacts. In the present article, various exposure risks to workers of different industries including iron, textile, leather, and paper industry along with levels of risk management system and the need for regular health assessment programs have been discussed to put them into real practice.

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Objective: Blood culture is an important laboratory test to determine bacteremia in Fungemia in patient's blood. Frequent blood culture contamination (BCC) leads to unnecessary treatment, waste of laboratory resources, and false-positive blood culture. The College of American Pathologist Accreditation states that monitoring of BCC rate should be within average 2%–3%. Based on May 2015 to May 2016 data at King Khalid University Hospital, it showed that we had experienced a consistent increase in BCC rate with an average of 4.6%. Emergency department (ED) had the highest contamination rate (5.7%). The aim of this study was to reduce the rate of contamination to <2%. Methods: A multidisciplinary quality team has been formed, (IHI) the institute for healthcare improvement model, used for improvement and other relevant quality tools for testing and implementing the choice of solution. Several plan-do-study-act (PDSA) cycles have been conducted to test the proposed solutions. All PDSA cycle data on the project measures were extracted from the lab information system to be analyzed and presented on run and control charts. Results: Over a 6-month period, a reduction in the BCC rate at the emergency department (ED) of the University Hospital reached 1.5% compared with the baseline at 4.0%. There was a significant reduction in BCC in the adult ED, which reached zero rates. However, BCC in the pediatrics ED was reduced to 1.5%, resulting from changes that were proposed, tested, and implemented during the running period. Essentially, the results of this initiative both met and exceeded the benchmark by 2%–3%. Conclusion: Standardizing work processes based on updated policy and procedures, conducting regular audits, and sending feedback are practical evidence-based strategies that lead to reducing BCC in the ED.

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Oncology is a medical branch devoted to the study, diagnosis, treatment, and prevention of cancer. Cancer prevalence is increasing. By 2030, the global cancer burden is expected to grow to 21.7 million new cases and 13 million deaths. Developing as well as developed nations have cancer burden, but there is a gap. Ideally, cancer management involves a multidisciplinary team composed of qualified individuals from different specialties collaborating to optimize the care. This team must follow evidence-based medicine principles, considering three questions: What is the problem? How can we manage it? And why are we selecting this pathway? To fill the gaps in care, we present 10 questions that can help those who are managing patients with cancer globally. We concluded that although there is no “one-size-fits-all” approach, adhering to basic principles can help guide provision of evidence-based patient-centered care and fill some of the gaps in oncology.

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Background: Family involvement is a critical component of patient‑centered care that impacts the quality of care and patient outcome. Our aim was to develop a patient‑ and family‑based communication model suitable for societies with extended families. Methods: A multidisciplinary team was formed to conduct a situational analysis and review the patterns of family involvement in our patient population. Patient complaints were reviewed also to identify gaps in communication with families. The team proposed a model to facilitate the involvement of the family in the patient's care through the improvement of communication. Results: A communication model was developed keeping the patient in the center of communication but involving the family through identifying the most responsible family member. To assure structured measurable contact, mandatory points of communication were defined. The model streamlines communication with the family but maintaining the patients' rights and autonomy. Conclusion: Our proposed model of communication takes into account the importance of communication with the family in a structured way. The team believes that it is going to be accepted by patients who will be explored in the pilot implementation stage as the next future step

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Background: Family involvement is essential in providing patient-centered care. It is very challenging to adapt into the health-care system. Our project aims at implementing a culturally tailored communication model to systematically involve a family in patient care. Materials and Methods: A multidisciplinary team was established to implement our previously developed communication model. We used rapid plan–do–study–act (PDSA) cycles of improvement to test the set of interventions to incorporate learned lessons into the project activities. The communication model was implemented in stages starting from the emergency department (ED) and expanding to different hospital units. Result: Fifteen PDSA cycles were conducted in the ED, intensive care unit, and inpatient wards. A clear algorithm on how to appoint the most responsible family members was developed and points of communication with the family were identified. Educational materials were developed for patients and families in addition to staff education about the program. There was a strong acceptance of the concept from families and staff, and the process is being implemented into our electronic health records. Conclusion: Our communication model was well accepted by patients, their families, and our staff. The plan is to automate the process for sustainability by making it an integral component of the electronic medical records and to introduce it throughout our system.

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Background: On the basis of our patient satisfaction survey, we initiated a quality improvement project at our institution to decrease waiting times for patients scheduled for chemotherapy. The mean waiting time until a patient started his or her session was 183.5min. Our aim was to reduce the waiting time by 50% (<90min) over a 6-month period and to sustain it. Materials and Methods: We used a multidisciplinary approach to identify the root causes and contributing factors of prolonged waiting times for patients in the chemotherapy unit. We implemented three Plan–Do–Study–Act cycles over a 10-month period (February to December 2016). First, we redesigned the nursing triage process, treatment process, and nursing awareness programs. Second, we improved nursing documentation to ensure accurate tracking of patients who declined their appointment or were overbooked. Third, pharmacy forms and chemotherapy preparation were accomplished with the help of an electronic system. We implemented a department-wide standard of care to provide an early assessment of the patient on arrival, and we activated a specific chemotherapy clinic for patient booking and laboratory tests, which were supervised by a trained qualified oncologist. Results: Median time to chemotherapy administration was reduced by 40% in the first 3 months, 64% in 6 months, and 51% in 18 months. We checked every 2 weeks for sustained action and tracked the time from when the patient checked in until he or she received treatment, guided by electronic pharmacy confirmation. The mean waiting time continued to improve and no complaints were reported during the last 6 months of the post-intervention period. Conclusion: Our project resulted in a 40%–64% reduction in waiting times for patients in the chemotherapy unit over an 18-month period. Our plan is to sustain this improvement by continually monitoring waiting times and addressing any emerging issues.

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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 5 pm. 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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