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Search results for "Health Care Executives and Administrators"

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Journal Article > Commentary

An ethical framework for allocating scarce life-saving chemotherapy and supportive care drugs for childhood cancer.

Unguru Y, Fernandez CV, Bernhardt B, et al. J Natl Cancer Inst. 2016;108:djv392.

Drug shortages have become increasingly common in recent years, especially in the United States. Some pediatric chemotherapeutics have frequently been in short supply, posing serious risks to patient safety. This commentary describes an ethical framework developed by a multidisciplinary group of experts and a panel of peer consultants. The framework seeks to guide clinicians' decision-making around allocating life-saving chemotherapies and associated drugs for children with cancer. The authors describe methods for managing shortages by reducing waste. The guideline also provides clear reasoning for actual prioritization across and within common pediatric cancers during a drug shortage. For example, in cases where shortages lead to the inability to provide the standard of care for some children, the authors propose emphasizing curability and prognosis in determining who is likely to have the most benefit. In 2013, the FDA released a strategic plan for preventing drug shortages, but the problem has continued largely unabated.

Journal Article > Study

Electronic trigger-based intervention to reduce delays in diagnostic evaluation for cancer: a cluster randomized controlled trial.

  • Classic

Murphy DR, Wu L, Thomas EJ, Forjuoh SN, Meyer AND, Singh H. J Clin Oncol. 2015;33:3560-3567.

Trigger tools are algorithms that prompt clinicians to investigate a potential adverse event. These tools are in routine practice for detection of adverse drug events and have been used to identify diagnostic delays. Investigators randomized physicians to either no intervention or to receive triggers related to cancer diagnosis; each trigger was an abnormal diagnostic test result for which follow-up testing is recommended. Delays in acting on abnormal test results are a known cause of adverse events. Sending reminders to physicians based on the trigger process led to higher rates of recommended diagnostic evaluation completion and a shorter time to completion for two of the three studied conditions. These promising results suggest that trigger tools could play a role in improving diagnosis across a range of conditions.

Journal Article > Study

Safety and diagnostic accuracy of tumor biopsies in children with cancer.

Interiano RB, Loh AHP, Hinkle N, et al. Cancer. 2015;121:1098-1107.

This study sought to evaluate the safety and diagnostic accuracy of biopsies in pediatric patients with cancer. Analysis of biopsy procedures in children with suspected cancer over a 10-year period found few safety incidents and a low risk of diagnostic error.

Book/Report

Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis.

Levit L, Balogh E, Nass S, Ganz PA, eds. Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population, Institute of Medicine. Washington, DC: National Academies Press; 2013. ISBN: 9780309293099.

Cancer patients are particularly vulnerable to preventable errors in both inpatient and outpatient settings, as their care involves exposure to high-risk medications and requires closely coordinated care. Seen in that light, this Institute of Medicine report, which bluntly concludes that the current system of cancer care is untenable, is particularly concerning. The report highlights numerous deficiencies in the current system, such as insufficient compliance with evidence-based guidelines, high rates of medication errors, and failure to incorporate patient preferences into advanced care planning. To reshape how cancer care is delivered, the report recommends leveraging information technology to augment care coordination and real-time analysis of treatment data, better end-of-life planning, and improving communication with patients and families around prognosis and the risks and benefits of treatments. Multiple AHRQ WebM&M commentaries discuss safety issues in oncology patients, including a case of a chemotherapy medication error detected by the patient himself and a near-fatal error ascribed in part to poorly coordinated care.

Perspectives on Safety > Perspective

Organizational Change in the Face of Highly Public Errors—I. The Dana-Farber Cancer Institute Experience

with commentary by James B. Conway; Saul N. Weingart, MD, PhD, Errors in the Media and Organizational Change, May 2005

A decade ago, two tragic medical errors rocked one of the world’s great cancer hospitals, Dana-Farber Cancer Institute (DFCI) in Boston, to its core. The errors led to considerable soul searching and, ultimately, a major change in institutional practices a...

Journal Article > Commentary

Ethical dilemma in missed melanoma: what to tell the patient and other providers.

Vangipuram R, Horner ME, Menter A. J Am Acad Dermatol. 2017;76:365-367.

Despite the emphasis on open discussion of errors as a component of transparency, clinicians remain reluctant to disclose the errors of their peers to patients. This commentary discusses an incident involving a diagnosis of melanoma missed during the initial examination with a podiatrist that was later detected during a dermatology evaluation and describes how to manage such conversations between the providers as well as with the patient.

Journal Article > Study

Performance of a trigger tool for identifying adverse events in oncology.

Lipitz-Snyderman A, Classen D, Pfister D, et al. J Oncol Pract. 2017;13:e223-e230.

Investigators developed and validated a trigger tool to identify a range of harms in cancer care. Although their final tool had only a modestly accurate positive predictive value, they advocate refining and automating the trigger approach to enhance the detection of adverse events in oncology.

Journal Article > Commentary

2016 Updated American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards, including standards for pediatric oncology.

Neuss MN, Gilmore TR, Belderson KM, et al. J Oncol Pract. 2016;12:1262-1271.

Administration errors involving chemotherapeutic agents can result in patient harm. This set of standards provides guidance to help ensure reliable use of these high-alert medications for both adult and pediatric patients. Components of the revised standards are expanded to include two-person verification, vinca alkaloid mini-bag administration, and labeling enhancements for home-based chemotherapy.

Web Resource > Multi-use Website

Just Bag It.

National Comprehensive Cancer Network.

Vincristine is a chemotherapy agent that can have serious consequences if administered incorrectly. Drawing from guidelines and expert opinion regarding vincristine administration, this campaign advocates for diluting vincristine via a mini-IV drip bag to reduce the likelihood of dangerous dosage mistakes.

Journal Article > Study

The impacts of a pharmacist-managed outpatient clinic and chemotherapy-directed electronic order sets for monitoring oral chemotherapy.

Battis B, Clifford L, Huq M, Pejoro E, Mambourg S. J Oncol Pharm Pract. 2016 Oct 12; [Epub ahead of print].

Oral chemotherapy regimens are complex and may lead to severe adverse drug events. In this pilot study, nearly half of patients enrolled in a pharmacist-run oral chemotherapy monitoring clinic experienced a medication-related problem. This finding is consistent with prior studies that demonstrated pharmacist oversight improves safety of oral chemotherapy.

Journal Article > Study

Determinants of patient–oncologist prognostic discordance in advanced cancer.

Gramling R, Fiscella K, Xing G, et al. JAMA Oncol. 2016;2:1421-1426.

Suboptimal communication between patients and physicians can result in patients misunderstanding important aspects of their care. This study found that the majority of patients with cancer reported a more optimistic survival prognosis than their oncologists. These findings suggest the need to improve physician–patient communication about prognosis in order to ensure appropriate discussion of treatment decisions and goals.

Journal Article > Study

The multidisciplinary approach to GI cancer results in change of diagnosis and management of patients. Multidisciplinary care impacts diagnosis and management of patients.

Meguid C, Schulick RD, Schefter TE, et al. Ann Surg Oncol. 2016;23:3986-3990.

Multidisciplinary team discussions are thought to make cancer care safer and more effective. This pre–post study found that the use of a multidisciplinary program for evaluation of gastrointestinal cancer cases led to changes in diagnosis and treatment. These results support closer collaboration among providers to augment diagnosis, as recommended in the recent Improving Diagnosis report.

Journal Article > Study

Evaluation of 12 strategies for obtaining second opinions to improve interpretation of breast histopathology: simulation study.

Elmore JG, Tosteson AN, Pepe MS, et al. BMJ. 2016;353:i3069.

This study found that eliciting second opinions in pathology improved the accuracy of breast histopathology specimens. This work provides further evidence that diagnostic accuracy can be enhanced with second opinions. The authors suggest that implementing multiple clinician review may augment the diagnostic process.

Journal Article > Study

Medication double-checking procedures in clinical practice: a cross-sectional survey of oncology nurses' experiences.

Schwappach DLB, Pfeiffer Y, Taxis K. BMJ Open. 2016;6:e011394.

Chemotherapy medications can cause severe patient harm if incorrectly dosed or administered. This cross-sectional survey of oncology nurses revealed that most chemotherapy double-checking is conducted jointly rather than independently. Of note, many nurses reported being interrupted to engage in a double-check.

Journal Article > Study

Effect of using the same vs different order for second readings of screening mammograms on rates of breast cancer detection: a randomized clinical trial.

Taylor-Phillips S, Wallis MG, Jenkinson D, et al. JAMA. 2016;315:1956-1965.

Interpretation of mammograms is a repetitive task, and a vigilance decrement—decreased attention after many repetitions of the same task—could impair diagnostic accuracy. However, this large randomized trial found no evidence for vigilance decrement. Investigators also determined that radiologists were equally accurate at identifying abnormalities regardless of the order in which they reviewed the studies.

Journal Article > Commentary

Chemotherapy errors: a call for a standardized approach to measurement and reporting.

Lennes IT, Bohlen N, Park ER, Mort E, Burke D, Ryan DP. J Oncol Pract. 2016;12:e495-e501.

Chemotherapy is a complicated process, and it is vulnerable to error due to factors that can affect the various steps involved. This commentary describes how one multidisciplinary cancer center designed and applied a taxonomy to report and monitor chemotherapy errors. The authors summarize the results of the work and provide suggestions for organizations that seek to develop similar tracking and analysis methods.

Journal Article > Commentary

Best practices for chemotherapy administration in pediatric oncology: quality and safety process improvements (2015).

Looper K, Winchester K, Robinson D, et al. J Pediatr Oncol Nurs. 2016;33:165-172.

Chemotherapy is a high-risk treatment that requires specific safety protocols. This commentary describes an effort that successfully determined and implemented best practices for chemotherapy administration in children. The intervention included an interdisciplinary program that reviewed current processes and evidence, utilized quality improvement tools, and established standardized techniques, exact times, and consistent documentation to augment safety associated with use of this medication.

Journal Article > Commentary

Two fatal cases of accidental intrathecal vincristine administration: learning from death events.

Chotsampancharoen T, Sripornsawan P, Wongchanchailert M. Chemotherapy. 2015;61:108-110.

Incorrectly administered vincristine can lead to serious adverse consequences. Discussing two incidents involving accidental intrathecal vincristine administration, this commentary describes how the health care organization implemented changes (including using different bags for drugs and label colors for syringes) following the first event and made further revisions when the second incident occurred 7 years later (such as ensuring drugs are delivered during different times and in certain settings).

Journal Article > Review

Quantifying the burden of opioid medication errors in adult oncology and palliative care settings: a systematic review.

Heneka N, Shaw T, Rowett D, Phillips JL. Palliat Med. 2016;30:520-532.

Opioids are commonly used to manage pain in patients with cancer and those near the end of life. Although opioids offer many therapeutic benefits, they are also a known high-risk medication. Deaths due to inadvertent opioid overdose are a major patient safety issue in ambulatory care, and this review sought to quantify how often opioids were implicated in adverse drug events in oncology and palliative care patients. Despite a broad literature search, the authors identified only a few relevant studies, most of which examined errors associated with opioid prescribing in hospitalized patients. As a result, it was not possible to estimate the incidence of opioid-related medication errors in this population. This lack of data hinders better understanding of the balance between risks and benefits of opioids in ambulatory care patients, which is very important given how frequently opioids are used for cancer pain. The AHRQ Health Care Innovations Exchange offers tools for organizations seeking to optimize opioid prescribing. A WebM&M commentary discussed a case of a death due to an unintentional opioid overdose.

Journal Article > Study

Primary care physicians' willingness to disclose oncology errors involving multiple providers to patients.

Mazor K, Roblin DW, Greene SM, Fouayzi H, Gallagher TH. BMJ Qual Saf. BMJ Qual Saf 2016;25:787-795.

Despite widespread calls for full disclosure of medical errors, physicians often choose their words carefully rather than explicitly detail how errors may have occurred. This study used two hypothetical vignettes to explore primary care providers' willingness to disclose errors involving multiple providers. The first vignette included a diagnosis of breast cancer that may have been delayed due to miscommunication with a covering physician. The second vignette described a breakdown in care coordination between providers responding to a patient's telephone call concerns, resulting in an adverse outcome. The majority of respondents said they would provide only a partial disclosure in either situation. More than three-quarters of physicians in the breast cancer case said they would offer either no information or would make vague references to miscommunication. In a prior WebM&M interview, Dr. Thomas Gallagher, the senior author of this study, discussed error disclosure.

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