Chemotherapy Safety Initiative May 2010

Implementation updates

The big news of the month is the deployment of IntelliDose to our final VISN 23 site, the Fargo VAMC. Reports from Fargo indicate that the clinical staff are doing well, and no unexpected technical problems have surfaced. Fargo is using the software for combination chemotherapy and for IV chemotherapy. Monotherapy with oral agents will be implemented in October 2010 after corresponding order sets have been approved and refinements to workflow have been completed.

The major sites in scope for Phase I of the Chemotherapy Safety Initiative were: Minneapolis, Des Moines, Iowa City, Omaha, Sioux Falls, Fort Meade, and Fargo. Lincoln and Grand Island were initially considered collateral, but in retrospect, they are delivering more chemotherapy than initially thought. This may reflect evolution to more use of tele-oncology services, a pro-active approach that the Omaha VAMC has pioneered. Patients see the medical oncologist “on TV”, but the chemotherapy is compounded and administered in a location closer to the patient’s home. This is a very positive model that is aligned with other VA initiatives surrounding the Patient Centered Medical Home. However, the additional burden on the local facility was underestimated when the software training was planned, and we are arranging for additional site training and support to enhance the proficiency of the pharmacists and nurses in the field.

Apart from Grand Island and Lincoln, which continue to request support, all other sites are now self-sufficient and reportedly doing very well. Because we can “look” into all of the sites’ chemotherapy software, we’ll be able to begin doing some Patterns of Care assessments and continuing with the work of sharing the Best Practices and emerging therapies.

JCAHO

The Des Moines VAMC, which implemented the system in September, was reviewed by JCAHO this past month. There were three patient “tracers”, all following patients on chemotherapy. Feedback from multiple sources indicates that the JCAHO reviewers were deeply impressed and pleased at the process in Des Moines and the enhanced safety and documentation that the site showcases. Bravo, Des Moines!

VistA Chemo Manager ** [VCM]

The long-awaited “fixes” to VCM are now to the point that we are starting active testing of the software. Some of the features that were present in IntelliDose but not used by the VA (eNurse, MAR, etc.) have been stripped out of the new software to allow the developers to manipulate code more cleanly. DSS would re-insert the modules with appropriate interfaces if and only if requested by the VA. For the time being, the key function that we are looking for is the ability to populate all of the pharmacy fields, including creation of complex orders. The latter is definitely “working” – if an order set contains the same drug on multiple lines, the software combines these into an order with AND/THEN logic, just like a complex CPRS order. The VCM software isn’t quite ready for clinical use – there are some mapping and other minor modifications to make. Once those are done, we will begin planning for pre-testing prior to Phase II (roll-out of the pharmacy interfaced software).