Quality and safety of chemotherapy prescribing and delivery in - PowerPoint PPT Presentation

Quality and safety of chemotherapy prescribing and delivery in Victoria Presentation to the Victorian Therapeutic Advisory Group Annual General Meeting, 4 November 2016 Adam Chapman, Manager Cancer Services & Information

Background Changing modalities • Systemic/targeted/immunotx Later line treatments Ageing and surviving; 2 nd / 3 rd • line / salvage therapy Increasing complexity • Mix of older + newer agents; changing routes of administration Community expectations • Indications; genomics; cost; access; shared decision making

Background SOUTH AUSTRALIA August 2015 • Underdosing of cytarabine for 10 AML patients at Royal Adelaide and Flinders Hospitals identified November 2015 • Independent review – failures of governance and communication NEW SOUTH WALES February 2016 • Off protocol prescribing of carboplatin for a large cohort of head and neck cancer patients at St Vincent’s Hospital Sydney identified August 2016 • NSW Inquiry report - failures of governance and communication

Background Victorian response • February 2016 - Victoria’s Chief Cancer Advisor sought responses from Victorian Integrated Cancer Services on chemotherapy safety processes across participating health services (survey 1) • August 2016 – Director Performance & System Design & Ass.Dir Private Hospitals sought further assurances from health services regarding chemotherapy safety processes (survey 2)

Findings from the two surveys • Consistent responses from public health services for both surveys • Robust quality & safety processes around chemotherapy administration in place across the public sector • Based on nationally developed and accepted guidelines from the Clinical Oncological Society of Australia and EVIQ cancer protocols • Consistent protocols/systems for – dose checking by nurses and pharmacists prior to delivery to patients – reviewing and confirming any dose change – documenting and reviewing incidents • Opportunities for further review and improvement through regular auditing of compliance with chemotherapy protocols

Sample response

Survey findings Highest use of • Standardised chemotherapy protocols • Protocols for nursing verification • Incident reporting Medium use of • Protocols for pharmacy verification (poorer in private) • Morbidity and Mortality meetings (poorer in private) Poorest use of • Regular auditing of compliance with chemotherapy protocols • Electronic prescribing/management systems

Summary of responses – raw data Service does NOT… Public Private ..use a relevant EMS/EPS 50% 74% ..use documented & standardised chemo protocols 0% 0% ..have in place processes around protocol changes 19% 26% ..have in place processes to monitor variation or non-compliance from standard protocols 19% 26% ..undertake regular auditing of compliance with protocols 53% 53% ..have processes to monitor chemo use outside onc services 24% 45% ..have protocols for nursing verification of drug, dose & pt 0% 5% ..have protocols for pharmacy verification of drug, dose & pt 6% 21% ..have incidence reporting mechanisms 0% 0% ..regularly hold M&M review mtgs 9% 21% ..in place strategies to monitor all deaths - not just unanticipated deaths at M&M mtg 6% 26% ..strategies at the M&M mtg to review not just individual deaths but to look for potential ‘patterns’ 9% 26%

The new working environment “The inconsistent approach to safety and quality among health services does not necessarily mean that overall safety and quality outcomes in Victorian hospitals are poor or significantly different from those of other jurisdictions. However, the department does not have sufficient data or oversight to be sure of this, or to provide necessary assurance to government or the community that all hospitals are consistently providing high- quality, safe and continuously improving care.”

The new working environment “All hospitals need strong processes to minimise the risk and consequences of human error – and to ensure that when things do go wrong, problems are reported, reviewed and addressed.”

Considerations and next steps for chemo Q&S • Review EPS/EMS pipeline and what this provides e.g. a number of services indicated upcoming investment • Improve transparency and clear processes for reviewing chemotherapy administration against protocol e.g. capture EVIQ codes in VAED as part of day chemotherapy • Consider the role & function of MMR/Quality committees, and the types of patients reviewed at these • Consider opportunities for improving compliance auditing with chemotherapy protocols e.g. with VicTAG • Other…?

Some questions • What level of assurance do we wish for around the quality and safety of chemotherapy prescribing and administration? • What type of reporting against this would we want? • How clear is the evidence around what we believe is needed? Are there areas where we need to generate evidence? • …?