Oct 18, 2017
ASCO’s Quality Training Program is designed for teams made up of and representing all members of the professional oncology team, including physicians, nurses, and pharmacists. Since the entire team is dedicated to and invested in providing the highest-quality care, it makes sense that all members are represented. As we celebrate National Pharmacy Week (Oct. 15-21), which honors the contributions of pharmacy professionals to patient care and safety, Dr. Amy Morris shares her experience participating in the Quality Training Program in 2016.
By Amy Morris, PharmD
Clinical Pharmacist, Hematology/Oncology, University of Virginia Health System
In 2016, my team and I enrolled in ASCO’s Quality Training Program (QTP). My team members for the program were Mohammed Athar Naeem, MD, and Torey Murray, RN, as well as our QTP champion Michael Keng, MD. Dr. Keng had been involved with previous teams from the University of Virginia (UVA) that attended QTP, and he encouraged us to apply based off the excellent results and learning experience these previous teams had in the program.
We all work at the UVA Health System in beautiful Charlottesville, VA. At the UVA Cancer Center and our inpatient unit, we see a wide variety of oncologic conditions including my practice interests, acute leukemia and lymphoma.
Each team participating in the QTP selects a quality improvement project to work on that would benefit their practice. Our project was “Reducing invasive fungal infections in patients with acute myeloid leukemia receiving induction and re-induction chemotherapy at the University of Virginia Health System.” In 2014, I analyzed our institutional rate of invasive fungal infection in patients with acute leukemia and identified a high rate of infection in patients with acute myeloid leukemia receiving induction. Dr. Keng encouraged Athar and me to create a quality improvement project to address this issue, as we felt it was contributing to significant morbidity and mortality in our patients.
Our team goals were to decrease rates of invasive fungal infection and improve education about invasive fungal infection in this patient population, in line with the medical center’s goals of reducing infections, specifically central line-associated blood stream infections and catheter-associated urinary tract infections.
Athar—who at that time was a fellow at UVA—and I began looking at data early in 2016. When Dr. Keng advised us to apply for QTP, Athar and I felt strongly that we needed a nursing champion, as our oncology nursing colleagues are integral to any practice change on our unit. Torey is an insightful nurse with an interprofessional approach to patient care, recently promoted to a Clinician 3 role at the institution, so we were thrilled to have her round out our team.
The QTP helped our team formulate a clinical guideline to standardize antifungal prophylaxis and infection management, as well as taught us the skills needed to roll out this initiative appropriately to all stakeholders. Forming a collaborative, interdisciplinary QTP team was incredibly useful both for this project and going forward with other infectious disease-related oncology issues.
For example, each month we retrospectively review patients to ensure no breakthrough invasive fungal infections have occurred, and we also identify any guideline deviations to troubleshoot issues that might be occurring. We have already made a few amendments to the guideline based on identified issues as well as feedback from stakeholders.
In addition, we are now using the skills we learned at QTP to tackle other quality improvement initiatives on our service line. Currently our oncology pharmacy resident is process-mapping the workflow for ordering and administration of intrathecal chemotherapy, a process that involves other service lines and requires a high level of coordination. UVA also has two projects going through QTP workshop this year: “Reduce stress due to change in physical appearance for breast cancer patients,” led by second-year oncology fellow Puja Arora, MD, and “Improve percentage points having end-of-life discussion in outpatient setting,” led by second-year oncology fellow Lindsay Hathaway, MD.
We had a great experience with QTP, and I would absolutely recommend the program to other institutions. I strongly encourage clinical pharmacists to become involved in these teams, as many process and quality issues facing cancer centers involve medications, and pharmacists can have a huge impact when involved in quality improvement initiatives.
In the final article, George Carro, RPh, MS, BCOP, the director of pharmacy services at NorthShore University HealthSystem, shares his experience with the Quality Training Program in 2016.