Reducing chemotherapy administration time on an inpatient oncology unit

Due to the multifaceted chemotherapy workflow within the hospital, many patients often experience delays in receiving their treatment. This study aims to evaluate the causes for chemotherapy administration delays and implement new methods to reduce delays from order release to chemotherapy administration on an inpatient oncology unit at a community-focused academic medical center.

In this prospective quality improvement study, we developed a process map to track baseline time stamps and utilized performance improvement tools to identify causes for chemotherapy delays. Based on recognized areas for improvement, the Plan-Do-Study-Act (PDSA) model was used to implement one cycle of interventions. Chemotherapy orders were collected, and benchmark time stamps were documented from the electronic medical record.

The primary outcome for the number of chemotherapy delays, based on compliance rate, was reduced from 63/100 (63.0%) to 48/100 (48.0%), a 15% reduction (p = 0.046). Our primary outcome of chemotherapy delays, based on our institutional benchmark of <3 hours, did not show statistical significance. Median time from chemotherapy order release to administration decreased from 7.08 hours at baseline to 6.10 hours post-intervention, a 13.8% reduction (p < 0.0001). Median verification, preparation, and delivery times were all reduced post-intervention by 13.0% (p < 0.0001), 3.9% (p = 0.024), and 14.8% (p < 0.0001) respectively.

This study allowed our institution to evaluate our current practice and reformulate the chemotherapy administration process. With the continuing education on the chemotherapy administration process and additional PDSA cycle interventions, it will help standardize our process and ultimately continue to reduce chemotherapy delays.