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Using process elicitation and validation to understand and improve chemotherapy ordering and delivery.

Wilson C Mertens¹, Stefan C Christov, George S Avrunin

¹Tufts University School of Medicine, Boston, USA.

Joint Commission Journal on Quality and Patient Safety

|November 24, 2012

Summary

Process formalism improved chemotherapy ordering and administration by identifying and resolving errors. This software engineering technique enhanced patient safety through rigorous process definition and validation, leading to significant error reduction.

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Area of Science:

Oncology
Health Informatics
Process Engineering

Background:

Chemotherapy ordering and administration errors carry severe risks.
Process formalism, a software engineering technique, was used for evaluation.
This method rigorously describes complex healthcare processes.

Purpose of the Study:

To quantitatively and qualitatively evaluate the chemotherapy ordering and administration process.
To identify and address potential errors and exceptional situations.
To improve patient safety through process optimization.

Main Methods:

Elicitation of the process through informal interviews with an interdisciplinary team.
Rigorous process description using software engineering notation.
Validation through direct observations and semistructured interviews.

Main Results:

The process definition included 467 steps, with 44% addressing 59 exceptional situations.
Validation identified 82 unique process events, including new steps and exceptional situations.
Chemotherapy error rates significantly declined during and after the project.

Conclusions:

Elicitation and validation methods uniquely contributed to understanding the process.
The study supported rapid adoption of changes and improved communication.
The implemented changes led to a demonstrable reduction in chemotherapy errors.