Oral Chemotherapy Adherence: Monitoring for Better Outcomes
In an effort to help ensure that patients are taking their oral anticancer medications and refilling their prescriptions, a team of four nurses and a physician from NYU Langone’s Laura & Isaac Perlmutter Cancer Center integrated a novel tracking workflow documentation system into the electronic health record.
German Rodriguez RN, MSN
In an effort to help ensure that patients are taking their oral anticancer medications and refilling their prescriptions, a multidisciplinary team from NYU Langone’s Laura & Isaac Perlmutter Cancer Center integrated a novel tracking workflow documentation system into the electronic health record.
The pilot program began in April 2015 with the participation of 20 nurses. After identifying which patients were eligible for the adherence monitoring program, the pilot was implemented initially across four disease management groups (DMGs): gastrointestinal, breast, hematology, and neurology. A questionnaire and symptom assessment, including toxicity scale, was administered during office visits and via telephone assessments.
Of 226 patients with active oral chemotherapy orders, 71 enrolled in the pilot program. A total of 68 patients never missed a dose, 3 patients missed a dose, and the neurology DMG achieved a 100% adherence rate.
In a poster presentation on the project at the 41st Annual ONS Congress, German Rodriguez RN, MSN, Director of Clinical Operations at the Perlmutter Cancer Center, said nurses are satisfied with the positive results of the pilot program and that to date, 287 patients are enrolled.
“The questions allowed nurses to ask patients if they were taking medication, reviewed pill count, missed doses and if a patient needed a refill,” said Rodriquez. “Response to these questions were useful because it directly asked patients about their chemotherapy regimen and allowed nurses the opportunity to address any issue that the patient had promptly.”
Rodriguez added that patients took a liking to the adherence follow-up monitoring program too because it gave them an extra opportunity to ask questions and discuss side effects with healthcare professionals.
Importantly, nurses were actively engaged in creating the “best possible process workflow and impacting patient outcomes.” Oncology nurses can now schedule oral treatment visits for patients during their clinical hours, and multidisciplinary meetings are held every other month to discuss new processes for oral adherence.
Next steps for the project include having all DMGs use the new electronic workflow when assessing for oral chemotherapy adherence; obtaining the consent of 100% of the patients, looking at the role of Oral Chemotherapy Nurse, and expanding to other patient populations within the Perlmutter Cancer Center’s affiliates.
Rodriguez said the Oral Chemotherapy Nurse role would include, for example, helping patients with planning payments for their oral medications, monitoring adherence and adverse events, tracking prescriptions, and providing patients with resources, such as treatment calendars, electronic device apps, and medication reminders.