Search

The Infusion Centers at a large multi-site teaching hospital system use only two features of the BBraun Smart Pump due to lack of Oncology drugs in the pump library. The "set/time/volume" feature which allows the RN to input the volume to be administered and the length of time; the pump then calculates the rate of administration. The "titration" mode allows a program to be set to administer medications on a preset schedule. Patient safety reports are continuously mined by leadership for trends/repeating errors. In Spring of 2020 with the launch of Epic Beacon, there were multiple errors related to the programming of the pumps. In the 10-month period prior to the go- live of Beacon there were 5 noted pump programming errors. In the 6 months post Beacon implementation there were 14 documented pump programming errors, a significant increase and concern for patient safety. The implementation of Beacon was a move from paper orders to electronic orders and barcode scanning. The focus may have shifted away from the programming activity at the pump and contributed to the errors since the RN's focus was on performing Beacon-related skills. A Pump Programming Task Force was formed and concentrated on reducing external distractions and increasing RN focus. A scripted time out process was formulated, in addition to two RNs completing an independent double check on chemotherapy. Time out scripting was to be used everytime a medication was being programmed. The three keywords, time out, quiet, and safety, were required. For data collection, ten weekly audits for scripting were done and tabulated. A laminated 3x5 inch card was placed on each IV pole as a visable reminder to staff. Time out compliance of 100% was achieved and sustained across all campuses by the 6 week mark. This correlated with a significant decrease in pump programming errors. Medication event reports were monitored for errors related to pump programing. There were zero errors reported from the implementation for the first 4 months. At the 6-month mark, there were 2 reported. This demonstrated a 71% decrease in pump errors and an achievement of the stated AIM to reduce errors by 60%. Audit reports continued to demonstrate almost 100% compliance with the process. The 71% reduction of errors still proved true at one year. [ABSTRACT FROM AUTHOR]

Chronic graft versus host disease (cGVHD) remains the leading cause of non-relapse mortality in patients post-allogeneic transplant. Novel agents are becoming available for patients with cGVHD, increasing the need for a personalized approach and evaluation of symptom control to guide treatment decisions. The National Institutes of Health (NIH) Consensus Development Project on Criteria for Clinical Trials in cGVHD has proposed use of the Lee Symptom Scale (LSS) in clinical trials to measure efficacy. Patient understanding of this questionnaire is essential to accurately capture data, minimize the impact of survey fatigue, and evaluate evidence of symptom improvement. Here we provide methods utilized to educate patients enrolled in SNDX-6352-0503 evaluating the use of axatilimab in patients with cGVHD. SNDX-6352-0503 is a Phase 1/2 study assessing the safety/efficacy of axatilimab in patients with active cGVHD despite ≥2 prior lines of systemic therapy. Key secondary objectives included improvement in LSS from baseline. LSS was assessed day one of each cycle and evaluates symptoms via 30-questions clustered by organ systems routinely affected by cGVHD. Total scores range from 0-120 and a 7-point improvement indicates clinical benefit. Study coordinators worked closely with participants to collect LSS data, used verbal instructions to educate on LSS value and addressed the sense of survey burden. Paper forms were provided with instructions to consider changes in their symptoms in the past 30-days. Ample time and a quiet space were provided with coordinators readily available to provide necessary clarifications. Areas typically requiring clarification included questions related to unintended weight loss and scoring of skin changes. Forms were then collected and scanned for completeness. The FDA and other regulatory bodies require an assessment of patient-reported symptoms when evaluating a new agent. Patients must receive appropriate education in the importance of the LSS questionnaire and completion to enable effective and reliable evaluation of novel agents in cGVHD. Applying these methods decreased questionnaire fatigue and led to the collection of a robust data set illustrating a 7-point improvement in 50% (n=19/38) of pts and contributing to axatilimab's continued development. AGAVE-201 and other studies in cGVHD will continue to utilize the original or modified LSS to assess symptom control, highlighting the importance of patient education in the utilization of these tools. [ABSTRACT FROM AUTHOR]

Purposeful hourly rounding (PHR) is a well described nursing intervention that proactively addresses the needs of patients and improves patient safety outcomes and satisfaction scores. Tracking PHR can present a challenge. Methods of tracking include EHR documentation, flip charts, paper logs and staff locator data, however these audits only track the presence of staff in the patient room and not the quality of the interaction. RN's are overwhelmed with the amount of documentation and auditing required. The Clinical Nurse Specialist group at this NCI-designated comprehensive cancer center wanted to reinvigorate PHR and engage staff in this project. The goal was to improve and track the quality of PHR interactions through direct patient feedback. All units received refresher training on PHR. Direct patient feedback was obtained by the Clinical Customer Service Coordinators (CCSC) during their routine patient rounds. Patient were asked two questions. "Our goal is to check on you frequently, can you tell me how often your care team has checked on you?" and "when we check on you, do we consistently ask about your specific comfort and personal needs (pain control, toileting needs, positioning and possessions in reach)?" The CCSC's collected ten audits per month on each unit. The results were logged into a hospital audit system. Between February and August 2021, question 1 responses indicate patients perceive they are being checked on at least every 1-2 hours 90-100% of the time. Question 2 responses indicate patients perceive they are specifically being asked about their comfort and personal needs 98-100% of the time. Patient comments were also tracked, which were important in providing feedback to the staff on PHR and promoting staff engagement. PHR has a positive impact on patient safety outcomes. Nurses are asked to engage in many different initiatives simultaneously, and it is important to identify ways that both measures success and motivates staff to continue to value the work. Direct patient feedback is a means to measure success that does not add to nursing workload. Specific examples from patient/family comments reflect how PHR is valued and recognized by patients and contributes to patient satisfaction. To ensure sustainability audits will continue monthly to evaluate for compliance. If negative trends are identified, direct observation of PHR will be implemented. [ABSTRACT FROM AUTHOR]