Standardizing the Oral Chemotherapy Prescription and Administration Process in the Inpatient Settin

Introduction.;Varying practices for oral chemotherapy prescription and administration in the inpatient setting led to a need for a standardized process. The Iowa Model of Evidenced-Based Practice to Improve Quality Care was used as a framework to guide the project and establish a standardized process. Thus, the purpose of this project was to standardize the prescription and administration of oral chemotherapy throughout the Hawai'i Pacific Health (HPH) healthcare system in a manner that complies with the American Society of Clinical Oncology (ASCO) and the Oncology Nursing Society (ONS) Chemotherapy Administration standards.;Methods.;The practice change included an algorithm that standardized the process for oral chemotherapy prescription by requiring orders to be prescribed by an appropriate specialty prescriber. Non-specialty prescribers were considered appropriate prescribers when ordering antiandrogens, aromatase inhibitors, and selective estrogen receptor modulators that meet specific criteria and are screened by a pharmacist. The administration process included the integration of a chemotherapy-competent nurse for the first dose administration to ensure patient and staff education. Additionally, a SMART phase was created for standardized nursing documentation.;Results.;The new oral chemotherapy prescription and administration process was successfully implemented. The average monthly volume of oral chemotherapy orders decreased during the implementation phase although the overall volume for oncology services remained consistent. At baseline, the average number of doses was 13 per month. After implementation, the average decreased by 70% to four per month. Appropriate specialty-provider prescribing of oral chemotherapy increased from 7% to 64%, administration by a chemotherapy-competent nurse increased from 5% to 64%, and patient education at first administration increased from 9% to 55%.;Discussion.;Implementation of the project to standardize the process oral chemotherapy prescription and administration resulted in and higher quality care for patients receiving oral chemotherapy in the inpatient setting at SMC. Results revealed project objectives were met with an increased compliance in prescription, administration, and education for oral chemotherapy orders.