Aims: Improve quality, safety and outcomes associated with inpatient chemotherapy; reduce clinical risk and non-value added length of stay (LOS), improve manufacturing services, develop an education program and improve home care between chemotherapy cycles.

Methods: Using Lean methodologies the following interventions were developed and piloted over a 3 month period. Consensus guidelines for the flexible dosing of chemotherapy in multi-day pathways and an electronic communication tool and business rules for the ordering,  manufacturing and delivery of chemotherapy to inpatient wards. A cycle one education program and patient home care critical observation and escalation parameter sheet were also developed. 

Results: Flexible dosing guidelines enabled staff to bring forward the timing of subsequent day chemotherapy, reducing the proportion of chemotherapy given after hours (reducing clinical risk) and the proportion of chemotherapy finishing after hours (facilitating same day discharge and reduced LOS). There was a 10% reduction in chemotherapy finishing after-hours and a significant reduction in LOS was achieved for multiple pathways projected to save 24 inpatient bed-days or over $20,000 annually. The electronic communication tool provided manufacturing staff with requested start times (previously unknown) providing greater lead time to manufacture chemotherapy on time. Releasing two days of chemotherapy facilitated earlier (on-time) administration without causing medication error. The developed education program was designed to facilitate commencement of education in ambulatory care clinics with completion during the inpatient stay. The package included an educational DVD, suite of information brochures (new and updated), newly developed patient held chemotherapy plan and a Medical Record (MR) education form. A set of agreed signs and symptoms for self-monitoring following discharge, with associated escalation procedures, was formulated and endorsed with implementation soon to commence.  

Conclusion: Applying a multidisciplinary approach to improving quality and safety outcomes resulted in four separate improvement interventions targeting chemotherapy administration, manufacturing, education and home care.