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

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.