The initiation of a multi-site advanced practitioner (AP)-led quality improvement (QI) initiative has laid the groundwork for an ongoing project focused on creating and implementing a best practice model for oral antineoplastic therapy programs (OAPs). Results of the first phase of the initiative were presented at the Journal of the Advanced Practitioner in Oncology (JADPRO) Live 2022 meeting.
“The trend for oral antineoplastic agents is expected to continue to grow, thus supporting the need for developing best practice models to ensure safety and the highest quality patient care is provided,” said corresponding author Andrea Edwards, PA-C, AP supervisor at Virginia Oncology Associates in Norfolk.
Five hematology and oncology practices were included in the initiative. Inclusion criteria included that the sites employ an AP who is a member of the Advanced Practitioner Society for Hematology and Oncology (APSHO) and who has access to patients with chronic lymphocytic leukemias who are receiving Bruton kinase inhibitors. An oral adherence program blueprint was used as a tool for practice analysis and program development and optimization. The plan-do-study-act (PDSA) method was used to guide the initiative via continuous data collection and project adaptation based on analysis of each PDSA phase.
In the first four months of the initiative, an APSHO project core team, steering committee, and project working group were established. Site AP leads conducted an initial practice analysis using the OAP blueprint as a guide.
“Practice analysis revealed key stakeholders who are critical for implementing OAPs strategically within their practices, and the most common barriers were identified. In addition, the most important changes that were needed were also identified,” Ms. Edwards explained.
Key stakeholders included pharmacists, pharmacy technicians, registered nurses, physicians, and APs. The most common barriers included time within the practitioner’s schedule, staffing shortages, and competing priorities. Meanwhile, the most essential changes planned included clearer documentation in the electronic health record, bringing awareness to the importance of a formal OAP, and advocating for a more streamlined and cohesive OAP that includes APs and physicians. Further essential changes included that pharmacists should review the drug interactions for all patients initiating oral agents and that patients starting on a new oral antineoplastic agent should be given an appointment with an AP within two weeks.
The next steps are to refine and revise practice-specific OAP workflows and to identify practice-specific outcomes that are expected to have a measurable effect on adherence to oral antineoplastic therapy within one year.
While the process structure was constant, “each practice is unique in their key stakeholders and workflow,” the authors noted. The second phase of the project will focus on implementing the changes identified in the practice analysis and recommendations for best practice for OAPs.
“Overall, this quality improvement project has provided the foundation for the development and optimization of OAPs across practices,” Ms. Edwards concluded. “Next steps are to develop practice-specific workflows, implement and maintain OAPs,” and calculate “how to measure success with the goal of improving patient outcomes.”
Any conflicts of interest declared by the authors can be found in the original meeting materials.
Reference
Kurtin S, May M, Edwards A, et al. Building best practice for oral antineoplastic therapy programs – phase 1. A model for multi-site, advanced practitioner led, quality care initiatives. Presented at JADPRO Live 2022, Aurora, Colorado.