Development and implementation of an evidence-based malignant hematology clinical pathway program.

Authors

Amanda Brahim

Amanda Brahim

Memorial Healthcare System, Pembroke Pines, FL

Amanda Brahim, Fernando Manuel Vargas Madueno, Robert Wilkinson, Melissa Hardwick, Yehuda Ethan Deutsch, Jose David Sandoval-Sus, Hugo Francisco Fernandez

Organizations

Memorial Healthcare System, Pembroke Pines, FL, Moffitt Cancer Center at Memorial Healthcare System, Pembroke Pines, FL

Research Funding

No funding received
None.

Background: Clinical pathways provide a means to maximize value-based care for cancer patients. They have been associated with decreased costs and outcome improvements. Our institution entered a transformative partnership with an NCI designated comprehensive cancer center for the treatment of hematologic malignancies. As part of the collaboration, a multidisciplinary task force was established to adapt clinical pathways within our system. Given the multiple new drug approvals for the treatment of Acute Myeloid Leukemia (AML), this was the first pathway created. Methods: The taskforce consisted of physicians, pharmacists, nurses, quality manager, and information technology staff. The group met weekly to draft algorithms in accordance with national guidelines, updated evidence and institutional preferences. Electronic Medical Record (EMR) treatment plans were reviewed in a secondary multidisciplinary workgroup and validated to ensure compliance with the AML pathway. When applicable, specific criteria for use were developed to aid in medication use optimization. The finalized pathway and treatment plans were presented and approved at our clinical standards committee meeting. A chart audit was performed one year after pathway implementation to assess adherence, with a goal of 80% or higher. The results were compared to an audit assessing adherence to best available clinical evidence for the year prior to implementation. Results: The group established a consensus on treatment, laboratory testing, and supportive care, including anti-emetic, anti-microbial, and tumor lysis syndrome (TLS) prophylaxis. Electronic order sets were created for bone marrow biopsies, transfusion support, TLS and febrile neutropenia. Thirty-two EMR treatment plans for AML were built and/or revised, while five were inactivated. A total of 88 patient charts were included in the pathway adherence audit (44 before and 44 after implementation). Pre and post pathway adherence was 64% and 89%, respectively (p=0.006). Deviations were categorized by type (table). Conclusions: AML pathway development and implementation resulted in standardization of treatment regimens, supportive care and higher adherence to institutional evidence based practices.

DeviationPre PathwayPost Pathway
Medication omitted21
Medication added22
Dose variation10
Different regimen52
Supportive care60
None2839
Total4444

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Abstract Details

Meeting

2020 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

On-Demand Poster Session: Technology and Innovation in Quality of Care

Track

Technology and Innovation in Quality of Care

Sub Track

Use of Clinical Pathways

Citation

J Clin Oncol 38, 2020 (suppl 29; abstr 304)

DOI

10.1200/JCO.2020.38.29_suppl.304

Abstract #

304

Poster Bd #

Online Only

Abstract Disclosures

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