Susan DiTaranto | PubMed Health

PubMed2004

Evolution of a Rapid Hydration Protocol.

The Oncology Division of the Children's Hospital of Philadelphia (CHOP) embarked on a comprehensive project to reduce chemotherapy errors. Careful review of all systems revealed many areas for improvement. Using a unique systems improvement approach, the interdisciplinary team carried out many concurrent change projects. This article describes a project carried out by the nursing staff to improve the safety of chemotherapy administration. Nurses realized that the majority of chemotherapy infusions occurred in the evening and nighttime hours after prolonged prehydration, leading to many "handoffs" and possibilities for error. Nurses developed a novel method of prehydration, delivering a large volume of fluid in a rapid infusion. The "Rapid Hydration Protocol" greatly reduced duration of hydration without adverse effects. Rapid hydration decreased the time needed for hydration and the number of nurses involved in the first day of chemotherapy, and contributed to having chemotherapy begin earlier. The project achieved the goals of improving systems and reducing handoffs. The impact of this project, in combination with the widespread efforts of the error reduction team at CHOP contributed to significant improvements in chemotherapy safety. Nurses developed and tested this innovative hydration strategy, which continues to be very effective.

Antineoplastic Agents↗

PubMed2002

Multidisciplinary systems approach to chemotherapy safety: rebuilding processes and holding the gains.

PURPOSE: The problem of medication safety came to public attention largely through a chemotherapy error, and the high toxicity and low therapeutic index of anticancer medications make safety in their prescription and administration critical. We have undertaken a thorough revision of our systems for inpatient chemotherapy. METHODS: We participated in a multi-institutional collaborative effort of the Institute for Healthcare Improvement, and used their rapid cycle change method. Particularly powerful systems change concepts were driving out fear, "trapping" errors and learning from them, focusing on outcome rather than on input, simplifying and standardizing, using constraints and "forcing functions," reducing handoffs, and paying attention to human factors. RESULTS: Applying these concepts to our chemotherapy delivery system, we have achieved an 84% decrease in the number of chemotherapy errors that actually reach patients per 1,000 chemotherapy doses, and have sustained that improvement for 5 years. CONCLUSION: Factors contributing to our success include the rapid cycle change method, strong support from hospital administration, grassroots participation, and a tradition of interdisciplinary cooperation. Computerized direct physician order entry and cooperative group participation have had mixed effects. Continued efforts at improvement have been key to holding our gains. Although specific problems and changes may not be relevant to other organizations, the concepts and methods we used are generally applicable.

Humans↗