Implementation of a remote oncology-monitoring program for cancer patients in outpatient care unit

Abstract

Objective: To evaluate, using indicators, the impact of an oncology-monitoring program on activity and organizational fluidity in a Cytotoxic Preparation Unit (CPU) and clinical departments. To identify positive and negative points of this program. Method: Collection of clinical and biological data between two injections by calling up the patient two days prior chemotherapy is performed by a specialist nurse of an outsourced medical call center. Data security is guaranteed by a licensed healthcare data host. After medical and pharmaceutical validation, early preparations (D-1) for expensive and non-expensive molecules are performed. Results: The program started in February 2016. After 4 months, 430 patients were included into the program. 23 patients on average are called per day related to 1860 completed clinical questionnaires (87 %). 47 % of files are complete at D-2 (biological and clinical data). The early preparation rate of expensive drugs, zero before the program, has reached 37 % at 4 months. The destroyed preparation rate because of non-administration decreased from 5 % to 2 %. Discussion: Preliminary results show a significant patient compliance, feasibility of early preparation of expensive and non-expensive chemotherapy. These are preliminary results of a one year study. They will be completed by an evaluation of patients' and health professionals' satisfaction, reduction of waiting time, optimization of operations for clinical departments and CPU. The D-2 biological data collection is the significant difficulty and limits efficiency of this program. A reorganization of professional practices and a strong doctor /pharmacist collaboration are essential for better patient care pathway.

Advanced prescription of injectable anticancer drugs: Safety assessment in a European Comprehensive Cancer Centre using the risk matrix approach

“…The minimum CI was 1 (i.e., negligible criticality: acceptable risk situations as they are, corresponding to a low risk) and the maximum CI was 25 (i.e., maximum criticality: risky situations that are not acceptable as they are, requiring analysis and corrective measures to reduce the risk to at least one risk to watch). Criticality was classified as minor (1-5), medium (6)(7)(8)(9)(10)(11)(12)(13)(14)(15) or maximal (16)(17)(18)(19)(20)(21)(22)(23)(24)(25). See Table 1d in Appendix S2 (Supporting Information)…”

“…At the end of the procedure, the RC and CI values were used to calculate the residual criticality index rCI = RC * CI. The residual criticality index was classified as acceptable (1-9), to monitor (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) or to process . Each score was reviewed twice by the working team.…”

“…This enables advanced compounding by the Pharmacy Compounding Unit and may reduce patient waiting time for treatment in the day oncology unit. [23][24][25] Thus, advanced prescription can be carried out without having all the standard clinical and biological criteria, and sometimes before medical consultation. This generates a clinical risk for the patient and an economic risk through the loss of advanced preparations.…”

“…Nowadays, with the increasing number of patients and antitumour treatments available, prescriptions can also usefully be made in advance (i.e., prescription 48 to 24 h before the day of administration): this is referred to as advanced prescription (AP). This enables advanced compounding by the Pharmacy Compounding Unit and may reduce patient waiting time for treatment in the day oncology unit 23–25 . Thus, advanced prescription can be carried out without having all the standard clinical and biological criteria, and sometimes before medical consultation.…”

Errors in prescribing injectable anticancer drugs: benefits of a pharmaceutical long-term monitoring to improve patient safety in a European comprehensive cancer centre

“…In recent times, IV chemotherapy prescriptions have been increasingly anticipated and produced in advance to reduce patient waiting times 7. However, to our knowledge, there is limited data on the specific risks associated with this practice.…”