The integration of an Oral Chemo Smart Form within the electronic medical record (EMR) improved document oral chemotherapy plans and administration schedules, as well as created a standard process for monitoring adherence and dispensing issues, according to data presented at the 2021 ASCO Quality Care Symposium.

“As part of the 2020 Quality Oncology Practice Initiative Certification Program Fox Chase Cancer Center (FCCC), a NCCN Comprehensive Cancer Center, learned that only 33% of patients on oral chemotherapy had a documented oral chemotherapy plan, 7% were assessed for adherence, and 0% had documentation reflecting efforts to address non-adherence,” explained Peter Whooley, DO, MBA, and colleagues in their poster.

To address the variance and deficiencies, Dr Whooley and coresearchers developed the Oral Chemo Smart Form, which includes fields to record drug, indication, dose, schedule, duration of cycle, and initial start/end dates within the EMR. The Smart Form was added to nursing, pharmacy, and physician workflows with the goal of standardizing documentation of education and the management of toxicity and nonadherence.

Between March 15, 2021, and May 7, 2021, researchers conducted a series of Plan-Do-Study-Act cycles with two oncologists, two pharmacists, and several nurses who implemented the Smart Form into practice. Over 8 weeks, 223 patients on oral chemotherapy were seen in the pilot genitourinary and breast cancer clinics.

During the study period, pharmacists completed the Smart Form at the time of the initial oral chemotherapy prescription, 7 days post, and at each refill for oral chemotherapy dispensed from the FCCC. Pharmacists also used the form to identify patients receiving oral chemotherapy via a specialty pharmacy and were able to notify clinic nurses in the EMR, who were then prompted to follow up with patients within 2 weeks. Oncologists in the pilot clinics completed the Smart Form for each patient visit.

Upon completion of the study period, Smart Forms were completed for 45% of patients on oral chemotherapy. Oral chemotherapy plans were implemented for 41% of patients, an increase from 33% at baseline. Administration schedules increased from 81% to 87%.

Dr Whooley and colleagues observed a significant increase in the number of patients contacted after oral chemotherapy initiation—4% to 35%. Adherence and documented discussions both increased from 7% to 35% and 0% to 75%, respectively.

“[The Oral Chemo Smart Form] introduced a standard process for monitoring safety, assessing and addressing non-adherence, while troubleshooting specialty pharmacy dispensing issues,” concluded Dr Whooley and colleagues. “The Smart Form will be implemented throughout FCCC and further evaluated with efforts focused on adopting and streamlining this as standard work.”

Reference:
Whooley PD, Cerecino F, Weaver JK, et al. Implementation of an oral chemotherapy adherence tool at an NCCN comprehensive cancer center. J Clin Oncol.2021;39(suppl 28; abstr 265). doi:10.1200/JCO.2020.39.28_suppl.265