Oral Chemotherapy Program: Promoting Adherence Through Process Improvement

Background: In June 2015, ONS published guidelines and evidence-based recommendations to promote safe practices and improve adherence for oral chemotherapy. Adherence to oral agents for cancer (OACs) is an important topic in oncology care. OACs can have significant toxicities and pose safety risks without proper adherence (ONS Connect. January 5, 2016).

Our practice identified the need for a process improvement (PI) when lack of consistent practice and documentation was found leading to inefficiencies and potential patient misses.

Objectives: Create a formalized and consistent practice when starting patients on OACs in an effort to improve patient safety.

Use collaborative approach to provide comprehensive patient education, ensure patient’s ability to obtain medication with little or no cost, and monitor adherence with timely follow-up.

Methods: To begin the PI, formal chart audits were performed to determine if patients on OACs had signed consent and formal teaching was documented. Prior to PI implementation, we identified 65% of our patients who did not have a signed consent in the chart.

The oncology nurse navigator was designated as point person to maintain/update oral chemo spreadsheet and spearhead multilayer process. To ensure effective communication among the interdisciplinary team, we created and initiated use of an Excel spreadsheet to track patients on OACs; created an Oral Chemo Tracking form and a Patient Communication form (tools used to improve communication); implemented a follow-up call from a nurse practitioner within 7 days of therapy initiation to reinforce education and assess toxicity and adherence, and to ensure routine follow-up per ONS guidelines.

Results: The implementation period was over 6 months, and we have been successful in creating a streamlined process resulting in: new tracking system to monitor patients on OACs; collaborative team effort with improved streamlined communication and more efficient work flow; and improved patient experience and safety when starting OACs.

Of the 30+ patients who started on OACs, 100% have documented formal teaching, signed consent, received 1-week follow-up phone call, 2-week and 4-week provider visit, and continue with routine follow-up visit per recommended guidelines.

Conclusion: Through our PI we were able to successfully implement an oral chemotherapy program focusing on promoting adherence through education, excellent communication, and scheduled follow-up. A collaborative approach with the oncology social worker, nurse navigator, doctors, nurse and nurse practitioner was instrumental to our success.