Improving the Safety of Ambulatory Intravenous Chemotherapy in Canada

Team
HumanEra
Timeline
May 2008 to January 2011

Summary

Incidents with IV ambulatory chemotherapy, including the death of a patient in 2006 due to a fluorouracil overdose in Edmonton, have highlighted the safety risks of this particular therapy. Sponsored by the Canadian Patient Safety Institute (CPSI), the Canadian Association of Provincial Cancer Agencies (CAPCA), the Institute for Safe Medication Practices (ISMP) Canada, and five provincial cancer care agencies, HumanEra conducted a pan-Canadian research study with the following objectives:

  1. Identify the current practices for ordering, preparing, labeling, verifying & administering ambulatory IV chemotherapy in Canada.
  2. Identify sources of risk in a wide variety of environments.
  3. Recommend strategies to reduce risks.

Multiple methodologies were employed to achieve these objectives, including a national survey of cancer care providers, field studies in six cancer treatment facilities across Canada and in-depth idenfication and analyses of key safety themes.

Knowledge Translation and Uptake

Outputs from the study included:

  • Final report with recommendations for safety improvements for all issues and themes
  • Guidelines for developing ambulatory chemotherapy preprinted orders (PPOs)
  • Editable PPO templates for three commonly used chemotherapy regimens
  • Educational materials for elastomeric ambulatory infusion pumps developed in collaboration between the research team and a manufacturer, including: posters for clinical areas explaining the factors affecting flow rate; clinician guides; and patient guides

Deliverables were circulated widely across Canada through conference presentations and webinars to over 2,000 participants, targeted mail-outs, manufacturer distribution, and peer-reviewed publications. Practice changes are now underway in centres all over Canada as a direct result of this research. Recommendations have been incorporated into Accreditation Canada standards and other professional practice guidelines. A manufacturer is adapting materials for an international audience. This study has served as the impetus for further research pertaining to the work processes and safety of pharmacy admixtur and has been unmatched in the scope of its interdisciplinary and inter-jurisdictional collaboration and its proactive approach to patient safety.

Funding Agencies

Canadian Patient Safety Institute (CPSI)

BC Cancer Agency (BCCA)

Alberta Cancer Board (ACB)

CancerCare Manitoba (CCMB)

CancerCare Ontario (CCO)

New Brunswick Cancer Network (CCNB)

Canadian Association of Provincial Cancer Agencies (CAPCA)

Project Sponsor

Tony Easty

 

Refereed Journals

  • White, R., Cassano-Piche, A., Fields, A., Cheng, R., & Easty, A. (Submitted). Intravenous chemotherapy preparation errors: Patient safety risks identified in a pan-Canadian exploratory study. Submitted to the Journal of Oncology Practice.
  • Jeon, J., White, R., Hunt, R., Cassano-Piche, A., & Easty, A. (In press). Optimizing the design of preprinted orders for ambulatory chemotherapy: Combining oncology, human factors and graphic design. Journal of Oncology Practice. Accepted for Publication Aug 2011.
  • Trudeau, M., Green, E., Cosby, R., Charbonneau, F., Easty, A., Ko, Y., Marchand, P., U, D., Berger, N., & Hertz, S. (In press). Key components of intravenous chemotherapy labelling: A systematic review and practice guideline. Journal of Oncology Pharmacy Practice. Accepted for publication Aug 2010.
  • White, R., & Easty, A. (In press). Human factors: Lessons for oncology pharmacy practice. European Journal of Oncology Pharmacy Practice. Accepted for publication Aug 2011.
  • Green, E., White, R., Janes, K., Fields, A., & Easty, A. (2011). Courage, collaboration, complexity and chemotherapy safety: The view from the sharp end. Canadian Oncology Nursing Journal Spring 2011.

Refereed Proceedings

  • Jeon, J., White, R., Hunt, R., & Easty, A. (2011, Jun). Developing guidelines for improving ambulatory chemotherapy preprinted orders. Proceedings of the Canadian Medical & Biological Engineering Society Annual Conference, [CD-ROM].

Research Reports

Non-refereed Publications

  • White, R., Janes, K., & Green, E. (2010, Oct). Changing the cancer system: Applying what we have learned from research on intravenous chemotherapy safety. CANO/ACIO Connections Ask the Expert: Canadian Association of Nurses in Oncology.

Presentations: Refereed Conference Presentations and Posters

  • White, R. & Bourrier, V. (2010, Oct). Improving the safety of ambulatory IV chemotherapy in Canada: Results of a two-year exploratory study. Presented at the National Oncology Pharmacy Symposium 2010, Winnipeg, MB.
  • Green, E., White, R., Janes, K., Easty, A. & Fields, A. (2010, Sep) Merck Lectureship Award Presentation: Improving the safety of ambulatory IV chemotherapy in Canada. Presented orally at the Canadian Association of Nurses in Oncology annual conference, Edmonton, AB.
  • White, R., Cassano-Piche, A., Jeon, J., Fields, A., & Easty, A. (2010, Sep). Improving the safety of intravenous ambulatory chemotherapy in Canada. Poster presented at the University of Toronto Patient Safety Symposium. Toronto, ON.
  • White, R. (2010, Apr). Improving the safety of ambulatory intravenous chemotherapy in Canada: A study overview. Presented at Canada’s Forum on Patient Safety and Quality Improvement, Toronto, ON.
  • White, R. (2009, Aug). Improving the safety of ambulatory IV chemotherapy in Canada. Presented orally at the Canadian Society of Hospital Pharmacists Summer Education Sessions, Winnipeg, MB.
  • White, R., Dobish, R., Bourrier, V., Fields, A., & Easty, A. (2010, May). Improving the safety of ambulatory IV chemotherapy in Canada. Presented orally at the International Society for Oncology Pharmacy Practice XII Symposium, Prague, Czech Republic.
  • White, R., & Easty, A. (2010, Apr). Improving the safety of ambulatory chemotherapy in Canada: A study overview. Presented orally at the 2nd Annual Canada’s Forum on Patient Safety and Quality Improvement, Toronto, ON.
  • Incekol, D., Stewart, J., Lee, R., Savage, P., & White, R. (2010, Mar). In search of closed IV and drug-transfer system for hazardous drugs in our cancer center. Presented orally at the 16th International Conference on Cancer Nursing, Atlanta, USA.
  • Janes, K., White, R., & Green, E. (2010, Mar). Improving the safety of ambulatory intravenous chemotherapy in Canada. Presented orally at the 16th International Conference on Cancer Nursing, Atlanta, USA.
  • White, R., Dobish, R., & Bourrier, V. (2010, Jan – Feb). Improving the safety of ambulatory IV chemotherapy in Canada. Presented orally at the Canadian Association of Hospital Pharmacists Professional Practice Conference, Toronto, ON.

Invited Presentations/Workshops

  • White, R. (2011, Nov). Guest lecturer. Quality assurance in oncology: Human factors and chemotherapy safety. University of Toronto Hematology and Medical Oncology Joint Academic Day, Toronto, ON.
  • White, R. (2011, Jun). Improving the safety of ambulatory IV chemotherapy in Canada: A two-year exploratory study. Presented at the Atlantic Canada Oncology Group (ACOG) 15th Annual Symposium, Charlottetown, PEI.
  • White, R. (2011, Apr). Issues and challenges related to high risk medication delivery. Presented at Cancer Care Ontario’s Regional Systemic Treatment Program Patient and Provider Safety Collaborative Learning Session, Toronto, ON.
  • White, R., & Janes, K. (2011, Apr). Improving the safety of ambulatory IV chemotherapy in Canada: Results and recommendations from a 2-year exploratory study. CANO/ACIO Webinar. Retrieved from: http://www.cano-acio.ca/past-webinars/.
  • White, R., & Bourrier, V. (2011, Mar). Improving the safety of ambulatory IV chemotherapy in Canada: Results and recommendations from a 2–year exploratory study. ISMP Canada Webinar. Retrieved from: http://www.ismp-canada.org/education/webinars/20110330_IV_chemo_safety/.
  • White, R. (2011, Feb). Improving the safety of ambulatory IV chemotherapy in Canada. Presented at Baxter Canada sales team conference. Toronto, ON.
  • White, R., & Jeon, J. (2010, Nov). Improving the safety of ambulatory IV chemotherapy in Canada. Presented at the Cancer Care Nova Scotia Provincial Cancer Network Meeting, Halifax, NS.
  • Easty, A. (2010, Oct). Improving the safety of ambulatory intravenous chemotherapy in Canada. Halifax 10: The Canadian Healthcare Safety Symposium, Halifax, NS.
  • White, R. (2010, Oct). Chemotherapy safety research and knowledge transfer. Presented at the Canadian Association of Provincial Cancer Agencies Annual Strategic Priorities Meeting, Winnipeg, MB.
  • White, R. (2010, Oct). Technology, human factors, automation. Presented at the Baxter Satellite Symposium, National Oncology Pharmacy Symposium 2010, Winnipeg, MB.
  • Easty, A. & White, R. (2009, Nov). Improving the safety of ambulatory IV chemotherapy in Canada. Presentation and workshop at University of Toronto Division of Medical Oncology and Hematology Patient Safety Retreat, Toronto, ON.
  • White, R. (2009, Nov). Guest lecturer. Quality assurance in oncology: Human factors and chemotherapy safety. University of Toronto Hematology and Medical Oncology Joint Academic Day, Toronto, ON.
  • White, R. (2009, Oct). Collaborating for chemo… A coast to coast perspective. Presentation at Baxter Satellite Symposium at the National Oncology Pharmacy Symposium, Ottawa, Ontario.
  • White, R., & Easty, A. (2009, Oct). Improving the safety of ambulatory IV chemotherapy in Canada: A study summary. Presented at the Canadian Association of Provincial Cancer Agencies General Meeting, Toronto, ON.
  • White, R. (2009, Jun). Improving the safety of ambulatory intravenous chemotherapy in Canada. Presented at 7th National Summit on Community Cancer Control, Prince George, BC.
  • Cassano-Piché, A. (2009, Feb). Pan-Canadian research study on chemotherapy safety: Improving the safety of ambulatory IV chemotherapy in Canada. Presentation at the Oncology Nursing Program Committee, Toronto, ON.
  • Cassano-Piché A. (2008, Oct). Improving the safety of ambulatory IV chemotherapy in Canada. Presentation at the National Oncology Pharmacy Symposium, Calgary, AB.
  • Easty, A. (2008). Invited presenter. Canadian Association of Provincial Cancer Agencies, Annual General Meeting, Halifax, NS.
  • Easty, A. (2008). Invited presenter. Canadian Healthcare Safety Symposium 8 Conference; one of five selected presentations from grants funded by the Canadian Patient Safety Institute, Winnipeg, MB.

Organizations

University Health Network (UHN)

ISMP Canada

Project Team

Rachel White
Andrea Cassano-Piche
Jennifer Jeon
Kim Vicente
Debbie Chan (student)

For more information about this project, contact:

Rachel White