218 Background: An oral chemotherapy safety event in 2017 prompted analysis of related workflows utilizing lean quality improvement methodology. Three kaizen workshops utilizing lean methodology with primary objectives to 1) develop safety standards for oral chemotherapy as rigorous as those for intravenous chemotherapy; 2) improve efficiency; and 3) design workflows that enable data collection and process control were conducted. Since 2017, our goal has been to sustain developed workflows to ensure oral chemotherapy patients have the right oral chemotherapy agent, at the right dose, at the right time, with independent and efficient safety checks by all care providers. Methods: After multidisciplinary teams participated in three kaizen workshops to develop workflows, education plans were developed and results were incorporated into the lean management system. The lean production method of Training Within Industry (TWI) was used to train physician, nursing, and pharmacy teams to the workflows. Results were communicated to key stakeholders weekly to monitor progress on workflow creation, spread, and process metrics designed to signal defects in the workflow. When processes were deemed ‘out of control,’ clinical team members provided regular and targeted interventions. Safety data were collected and correlated to surrogate outcomes for long-term impact assessment. Results: Interventions resulted in the following outcomes: 62 consecutive weeks with 99% reduction in oral chemotherapy defects reaching pharmacy. 86 consecutive weeks with 51% error reduction processing oral chemotherapy though a single EMR workflow. 57 consecutive weeks with 62% error reduction processing oral chemotherapy though a single EMR workflow. No serious safety events have occurred since 2017. Conclusions: Comprehensive quality improvement in our oral chemotherapy process has resulted in sustained safety, efficiency, and a data collection to signal when process defects occur. Multidisciplinary teams utilizing established lean methodology were critical to success.

Background: Cancer immunotherapy based on direct intratumoral injection of immunomodulators has been established at the end of 19th century using Coley's toxin. Our novel therapeutic strategy is based on the intratumoral injection of optimized mixture of TLR agonists, causing strong inflammatory infiltration. Infiltrating cells (mainly phagocytes) are directed to artificially opsonized tumor cells covered by phagocytosis stimulating ligands. Materials and methods: Immunotherapy was tested using B16-F10 murine melanoma model. Inflammatory infiltration was achieved using the mixture of resiquimod, poly(I:C), and lipoteichoic acid. Artificial opsonisation of tumor cells was elicited by mannan anchored to cell membranes using a hydrophobic anchor. The course of tumor infiltration was studied using flow cytometry. Cytotoxic effect of infiltrating immune cells on opsonized tumor cells was studied in vitro. Participation of acquired immunity was elucidated on the basis of intracellular IFN-gamma production by lymphocytes. Results: Optimized cancer immunotherapy based on the synergy of TLR agonists with artificially induced tumor opsonisation resulted in complete cure of 83% of mice with advanced melanomas. Moreover, cured mice acquired resistance to retransplantation of tumor cells. Applied therapy has a strong antimetastatic effect. In the first phase of immunotherapy, granulocyte predominance was observed, followed by involvement of acquired immunity. Conclusions: Intratumoral immunotherapy initiated by innate immunity based attack followed by joining of mechanisms of acquired immunity is a promising approach for future application in clinical practice as compounds used are safe for humans.

42 Background: Survivorship care plans (SCPs) are recognized by organizations including the American Society of Clinical Oncology and the American College of Surgeons Commission on Cancer, as a best practice for improving survivor care. Little evidence supports this and hospitals and cancer centers are scrambling to meet deadlines for SCP development and delivery. The University of Kansas Cancer Center (KUCC) addressed this utilizing electronic health record (EHR) integration, developing a health system wide approach to education and delivery, and building referral workflows to primary care and specialists. We report on this approach to developing and growing a survivorship care program. Methods: KUCC is a NCI designated cancer center within an academic medical center and health system, with 11 outpatient locations across the Kansas City. Under the guidance of a multidisciplinary team: providers, health care informatics, administrators, nursing, tumor registry, quality improvement, and researchers, KUCC developed a step-wise process to deliver comprehensive survivorship care across the health system. This multi-year initiative aligned with institutional accreditation standards and an ongoing focus on expanding evidence based, comprehensive cancer and supportive care. Results: In 2014 a formal survivorship program plan was put into action: Support from leadership, providers, research priority; Staff and patient survivorship education & training; Integrated delivery of survivorship care at all locations with direct interaction and feedback from cancer care teams; Short & long-term programmatic goals; Management and referral of late effects of cancer; EPIC integrated SCP template: auto-populated, customized, personalized; treatment summary uses tools that pull in data stored discreetly in the patient "file"; SCP delivery targeting COC phase-in timeline: 2015: n= 539 (10% projection n= 434); 2016: n= 1,355 (25% projection n=1,253). Conclusions: This step-wise, integrated approach to survivorship care has resulted in a health system wide delivery of SCPs and meeting national accreditation standards. Next steps include the evaluation of cost and clinical/patient reported outcomes.

266 Background: An oral chemotherapy safety event prompted analysis of related workflows utilizing lean quality improvement methodology. This analysis identified high variation in prescription processing, lack of standardized safety checks, inefficient use of pharmacy time, and inadequate data collection. Our goal was to create an oral chemotherapy protocol that could ensure patients have the right oral chemotherapy agent, at the right dose, at the right time, with independent and efficient safety checks by nursing, pharmacy, and providers. Methods: Multidisciplinary teams participated in two kaizen workshops. utilizing lean methodology. Primary workshop objectives were (1) develop safety standards for oral chemotherapy similar to those for intravenous chemotherapy; (2) make workflows more efficient; and (3) have workflows that enable data collection and process control. The first workshop standardized oral chemotherapy prescription processing though a single workflow in the EMR. This enabled robust data collection and established a platform for safety interventions. The second workshop developed standardized safety checks for and integrated those into the EMR workflow. Given the rarity of serious safety events, a validation measurement was not feasible to track in 30-day PDCA cycles. Consequently, surrogate measures of utilization of the EMR prescribing algorithm and reduction of non-clinical pharmacy interventions were used to assess progress. Safety data were collected and correlated to surrogate outcomes for long-term impact assessment. Results: Interventions resulted in the following outcomes: 100% reduction in oral chemotherapy order defects reaching pharmacy; 97% improvement processing oral chemotherapy though a single EMR workflow; 23% reduction in oral chemotherapy processing time; In spite of a 51% increase in oral chemotherapy volume, no serious safety events have occurred in the last year. Conclusions: Comprehensive quality improvement in our oral chemotherapy process increased safety and efficiency while developing data collection systems for continuous improvement. Multidisciplinary workshops with key stakeholders using established lean methodology were critical to success.