The CATCH: In Support of Proper Chemotherapy Sequencing

Laura Kaminski, BSN, RN, OCN, CBCN

Because our navigators are highly specialized, this regimen and associated error were easy to recognize.

—Laura Kaminski, BSN, RN, OCN, CBCN

A CATCH is a navigation success story where a navigation tactic improved a patient’s situation. The CATCH Initiative, short for Catching & Addressing Threats to Care & Health, tracks and acknowledges positive outcomes of navigation tactics.

The CATCH of the Month

Background: A 42-year-old female was receiving chemotherapy for triple-negative breast cancer. The patient’s chemotherapy regimen was incorrectly scheduled out of sequence.

The Incident: Upon chart review, Laura noted that the patient was scheduled to start part 2 of her chemotherapy (dose-dense doxorubicin and cyclophosphamide) at the next infusion visit. However, the patient had not yet completed part 1 of chemotherapy, as she still needed 3 more cycles of paclitaxel/carboplatin.

The CATCH (Intervention): Promptly determining that the patient was incorrectly scheduled for the wrong portion of her chemotherapy treatment, Laura notified the infusion nurse, oncologist, and pharmacist about the finding. This CATCH and intervention prevented the patient from receiving the wrong drug at the wrong time.

Outcome: The patient was able to continue the recommended treatment per the National Comprehensive Cancer Network guidelines for triple-negative breast cancer. Further, the medical team subsequently conducted a safety assessment and corrected procedures within the electronic record system to prevent future discrepancies.

The Importance of the CATCH

As Tracy Wyant, DNP, RN-BC, AOCN, CHPN, CPPS, reported in the ONS Voice, “Sequencing of cancer treatment regimens is based on multiple factors, including the pharmacokinetic properties of the agents in the regimen and their effectiveness based on cell-cycle specificity. Because of potential interactions and effects, some regimens have critically important administration sequencing.”¹

Understanding the significance of completing the first phase of the treatment plan, the navigator was able to recognize the medication error before any harm happened to the patient.

This CATCH directly impacted the patient, as interrupting her original treatment sequence would have inhibited the patient from receiving the full dose, potentially impacting her overall response and outcome to treatment. This CATCH also impacted the cancer center, as they subsequently conducted a safety evaluation and assessment of their protocols to prevent future errors and provide the most optimal care to their patients.

Reference

1. Wyant T. Does the sequence of chemotherapy and biotherapy agents matter? ONS Voice. https://voice.ons.org/news-and-views/does-the-sequence-of-chemotherapy-and-biotherapy-agents-matter. Published August 18, 2016. Accessed January 13, 2023.

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