e19222 Background: Use of EOL CTx is an established quality metric in patients with advanced malignancies but less is known about which types of CTx are most commonly used and association with ED and ICU utilization. We sought to describe the different types of EOL CTx and to quantify the frequency of EOL ED and ICU care associated with them. Methods: Patients in the cancer registry of an urban cancer center who died between January 1, 2018 and October 10, 2019, and ever received CTx were included. EOL CTx was defined as any CTx given within 30 days of death, while any ED visits or ICU admissions in the last 30 days of life were defined as EOL ED and ICU care, respectively. CTx was categorized by administration route (intravenous (IV), oral (PO), other), and by type (immunotherapy (IMT), non-immunotherapy biologics (NIB), other). We used Pearson’s chi-squared to measure associations between EOL CTx and EOL ED and ICU care, logistic regression to assess how CTx type modulates those associations, and Mood’s median test to compare median IMT doses between groups. Results: Among 390 eligible patients, 32% received EOL CTx, 30% EOL ED care, and 11% EOL ICU care. Most received IV CTx (78%), and 10% received IMT. Median age at diagnosis was 69 years (interquartile range (IQR) 62 - 77), and median days from diagnosis to death was 390 (IQR 185 - 665). Most common malignancies were pancreatobiliary (40%), other gastrointestinal (15%), lung (13%) and hematologic (6%). Patients treated with EOL CTx were significantly more likely to receive IMT (p = 0.03). Receipt of any EOL CTx was significantly associated with EOL ED care (p < 0.0001) and EOL ICU care (p < 0.0001). Subgroup analyses showed significant modulatory effect of IMT on association of EOL CTx with EOL ED care (b = -0.89, p = 0.046), but was not significant for ICU care (b = -0.67, p = 0.29). Median doses of IMT was 2.5 (IQR 2 - 3.8) among patients who were given EOL IMT and 4 doses (IQR 2 - 6) in those that discontinued IMT before EOL (p = 0.06). Conclusions: EOL CTx is associated with significantly increased rates of EOL ED and ICU care, which may indicate poorer quality of life. While rates of use of other CTx modalities did not significantly differ at EOL, patients were more likely to receive IMT within 30 days of death, which could be due to the belief that IMT is more tolerable or more effective than other CTx modalities at EOL. IMT at EOL is associated with a reduced risk of EOL ED care, but not ICU care. Further research on strategies to reduce EOL CTx and appropriateness of IMT at EOL is warranted.

369 Background: Recently, there has been a dramatic increase in the use of oral antineoplastics for the treatment of various malignancies. The development of these agents has been so rapid that the infrastructure needed for their appropriate supervision has trailed their availability. Previously at Virginia Mason, there was no standard work established for the management of patients starting these agents and consequently there were defects noted, including delays in the medications’ delivery to the patient, lack of appropriate teaching regarding potential medication toxicities and even delayed provider follow-up. The goal of this project was to create standard work around the treatment initiation and follow-up of all patients starting outpatient oral antineoplastic therapy. Methods: A multi-disciplinary team of providers, nurses, and pharmacists held a flow mapping session to identify defects and waste points in the process between the prescription being written until the first provider follow-up visit after medication delivery. The team focused on decreasing the amount of time between prescription initiation and first clinic follow up, as well as increasing the percentage of RN teaching sessions performed and documented. This involved the creation of a dedicated inbox in the Electronic Medical Record (EMR) to which pharmacy and care manager nurses had exclusive access to facilitate rapid communication between team members. The work also resulted in the creation of an antineoplastics teaching template which was used to document teaching on potential treatment toxicities. Results: Standard work was created for the outpatient oral antineoplastic administration process and teaching documentation. Using the new tools, lead time was improved by 21.7% and teaching documentation was improved by 185% at the 30-day mark. These metrics were monitored over a 3 month period, and at the end of 90 days the lead time improvement was maintained at 21.2% and teaching documentation improvement at 110% (Table). Conclusions: The rapid development of oral antineoplastic medications has required Oncology practices to develop more robust workflow infrastructure to administer these medications properly and safely. We created standard work for the proper initiation and follow-up of oral antineoplastic therapy. In doing so we identified specific defects and instances of waste and were able to improve the workflow process to address these issues, resulting in measurable quality improvements and overall better patient care.[Table: see text]