The demand for chemotherapy services is growing, with more than 4 million new cancer patients in Europe each year1. Against this backdrop, oncology departments are struggling with patient treatment backlogs and staff shortages caused by the Covid-19 pandemic2. This results in workforce pressures.
Looking for ways to help relieve these pressures without reducing quality of care is crucial.
As an oncology nurse, you strive to deliver high-quality care for people with cancer. Your work is essential, not only in administering treatment, but also providing information to patients about their disease and emotional support. However, workforce pressures often result in you having to do more without additional staff, which can make it a challenge to continue to deliver the high level of care you aspire to.
We will discuss some of the specific issues along the oncology care pathway that contribute to the workload pressures of nurses working within oncology, and present solutions to them to help you not only improve oncology efficiency, but also patient safety.
Traditional workflow processes often involve considerable amounts of paper files and phone calls to transfer patient data. This creates opportunities for losing vital information and the potential for miscommunication. Departments that this information is transferred between are often disconnected, and it is difficult to have oversight of the full patient pathway with a paper-based workflow process; did the patient receive their full regimen last time without incident? Has pharmacy finished compounding their medication that is due now?
Added to this, paper-based workflow processes can often be time consuming, and prone to error due to missing, incorrect or illegible documentation. Not only does this take nurse time away from patient-facing or other value-added tasks but can also negatively impact patient safety.
Oncology treatment plans are becoming increasingly complex, and new drugs continually being approved for use. The administration process therefore requires high levels of concentration, and often a second member of staff to perform verification checks. This isn’t easy in a busy environment where staffing levels are already short, and there are frustrated patients waiting for their treatment.
The implications of medication errors within oncology can be severe. Not only may they result in the use of resources to investigate and rectify the error, a patient requiring additional treatment, increased length of hospital stay, and possible damage to an organisation’s reputation, but they can also have a significant psychological impact on the nurse and other healthcare staff involved in the error. Implementing solutions to improve oncology efficiency and reduce the chance of error, therefore, benefits both patients and staff involved in their care.
Streamlining workflows by moving from paper-based processes to automated systems can help improve oncology efficiency and deliver time savings. This can result in an increased capacity of the service and allow nursing staff to invest more time in direct patient care and other value-added activities.
An example of an automated system that achieves this is BD Cato™.
BD Cato™ an integrated, automated* software solution that provides support through all stages of intravenous (IV) chemotherapy prescribing, preparation and administration. It allows nurses to track what stage a patient’s medication is at within the compounding process, reducing the need for constant phone calls to pharmacy. Amendments to a patient’s treatment are updated in real-time within the system, allowing clear communication to the nurse. Bed plans can be electronically scheduled, helping to ensure effective organisation of the day unit workflow. As BD Cato™ can interface with hospital information systems, nurses can easily view patient information relevant to their therapy plan, such as the results of their recent blood tests.
Another automated solution to improve efficiency for oncology nurses is with barcoded medication administration technology, such as BD Cato™ ReadyMed.
BD Cato™ ReadyMed is a simple and intuitive documentation, checking and tracking solution used by nurses during the drug administration process. The hand-held device is used to scan the patient’s wristband and the barcode on the medication, and through interfacing with BD Cato™ confirms the medication is correct for that patient, and so the nurse can proceed with the administration of it. For administrations that traditionally required a second nurse check, this manual check will no longer be required with BD Cato™ ReadyMed.
Through electronic verification and documentation, BD Cato™ ReadyMed can improve the efficiency of the oncology administration process for nurses by reducing 50% of the steps compared to a standard manual IV chemo administration workflow3. The improvement in efficiency was demonstrated by a study at East Tallinn Central Hospital in Estonia. The study reported a reduction in the time for medication administration on the oncology day unit from around 6 minutes per item to 41 seconds – a mean average saving of 5 minutes, 19 seconds per item. When calculated against the unit’s throughput of 14,000 items per annum, this gives a saving of 3 hours, 24 minutes of nursing time per day, equivalent to 0.425 full-time nurses per annum4.
There is considerable overlap between efficiency and errors. For example, an accurate and appropriate treatment plan that is correctly prescribed by a physician, prepared by pharmacy, and administered by a nurse prevents inefficiencies occurring, such as having to use time and resources to remake a dose when there has been a compounding error. However, apart from improving process efficiency, error prevention is crucial in improving patient safety.
Chemotherapy prescribing is often a complex process, and the risks of incorrect prescribing can be severe on a patient. The use of Computerised Physician Order Entry (CPOE) systems, such as the prescribing module of BD Cato™, can reduce the risk of prescribing errors when compared to paper-based prescribing. This has been demonstrated by two independent studies which showed CPOE systems cut oncology medication error rates in hospitals by approximately two-thirds when compared to handwritten prescriptions5,6. Not only does this give nurses more confidence that a patient is receiving the correct treatment when they come to administer it, but also electronic prescriptions help ensure legible, complete prescriptions for the nurses to follow.
Compounding accuracy within the pharmacy aseptic department is, of course, also critical in ensuring patients receive the correct dose of medication. With a manual volumetric compounding method, often errors that occur can go undetected and potentially reach the patient. This was demonstrated by a large-scale European multi-center study. The study involved 759,060 chemotherapy preparations and showed the mean out-of-tolerance error rate during compounding to be 10.44%.7 These errors were detected by an automated gravimetric technology system and able to be corrected. The study concluded that it was unlikely these errors would have been detected using a manual compounding process.7
The use of an automated* IV workflow software solution within the compounding process that integrates with barcode scanners, gravimetric scales and cameras - such as BD Cato™- helps ensure the correct preparation of a drug. This can provide reassurance to nurses that the medication they administer has been correctly prepared.
BD Cato™ ReadyMed helps oncology nurses perform the “5 rights” prior to drug administration - right drug, right dose, right route, right patient, at the right time – upholding patient safety. BD Cato™ ReadyMed also guides nurses with regards to the correct sequence of medication administration. Soft and hard stops are displayed immediately after scanning the barcode if an error or deviation has been detected, informing the nurse. This helps prevent incorrect administration of a medication.
Ultimately, it is nurses who administer oncology medication to patients and who need to have total confidence in the pathway. BD solutions help provide nurses with this confidence by improving oncology efficiency and patient safety, reducing the risk of clinical and operational errors occurring during the prescribing, compounding and administration processes.
Additionally, by automating processes and connecting workflows with BD solutions, many resource-intensive tasks can be reduced, such as those associated with manual documentation, manual compounding, and nurse second checks.
BD Oncology is committed to improving oncology efficiency and patient safety by providing connected workflows and automating manual processes. Find out more today at www.bd.com/en-uk/our-solutions/oncology.
1
Drug prescription
Clinician prescribes chemotherapy on BD Cato™ Prescribe
BD Cato™ Prescribe:
Prescription is sent electronically to the pharmacy.
2
Venous access
A port is a vascular access device implanted into the patient to provide repeated access to the vascular system. Safe chemotherapy treatment rely on safe vascular access.
3
Order verification
Pharmacist-verified order is sent electronically to BD Cato™ Pharmacy. BD Cato™ Pharmacy automatically prioritizes orders according to the patient scheduler. Pharmacist can select the shortest dated vial to ensure that drug wastage is limited.
4
Drug preparation
BD PhaSeal™ close system transfer device is used for preparation and the BD MicroBore secondary set is used to spike the bag
5
Gravimetric analysis
Gravimetric scales checks the right dose is drawn via drug density calculation. Scan the barcode on the vial to identify the right drug. Camera capture each step.
6
Drug verification
Unique barcode medication label is printed once all steps are a corrected followed. Pharmacist verifies preparation.
7
Patient preparation
Nurse prepares patient for administration of hazardous drugs utilizing closed system transfer device BD MicroBore set.
8
Patient assessment
BD Cato™ ReadyMed check if it is the right part in and right drug and will automatically document this is the system.
9
Pump programming
Use BD BodyGuard™ Duo with its two independent infusion channels in one intuituve, user-friendly interface, which can help simplify the infusion of even the most complex therapies.
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