Cancer Clinic Overview Provides comprehensive cancer care for a variety of oncologic conditions Located in the same building as the imaging, radiology, and patient education departments 9500 chemo visits per year (approximately 25/day) 11000 non-chemo visits per year Internal and external research programs Genetic counseling services/program
Implementation Phase August 2007, implement practice management suite of epic products (Prelude/Cadence/PB) July 2008: Medical Assistants, Nurses, Physicians, entered allergies, home medications, vitals, notes Dec 2008: Project Team-Pharmacists and Oncologists backloaded treatment plans Jan 2009: CPOE for in-clinic preformed procedures, labs, and Beacon orders March 2009: Beacon orders in the Hospital May 2009, upgraded to Epic Spring08
Protocol Structure Take Home Medications Labs Treatment Conditions Nursing Communication Pre-ChemotherapyChemotherapy Intrathecal Chemotherapy Post-Chemotherapy
Lessons learned & Optimization Scope Documentation Project Team Structure Plan for ongoing "at the elbow" support Complexity and time for order entry Comprehensive reports Data/Documenation across encounters Inpatient vs In-Clinic (outpatient)
The St. Cloud Hospital CentraCare Health System St Cloud, MN
Coborn Cancer Center Outpatient Cancer and Infusion Center 4 Medical Oncologists, 2 Radiation Oncologists,1 Physician’s Assistant and 1 Nurse Practitioner 14 Nurses, 3 Pharmacists and 4 Pharmacy Technicians Staffed Daily Average 54 pts/day (43 Cancer Pts, 11 Infusion Pts) PICC/Port Lab draws-average 20 per day 18,880 patient visits last fiscal year
Partial to Full Beacon Implementation February 2007: Pharmacist Order Entry for Beacon Protocols containing Meds Only (including research studies). RNs had to work with both paper and Epic In Epic, RNs entered Allergies, Home Meds, Height/Weight and documented on eMAR to drop charges upon administration. October 2008: CPOE for Beacon Protocols. Communication (provider and nursing) along with take home meds were added.
Protocol Structure Oncologist Provider Communication Verification Order (Inpt, Outpt, Research) Take home meds Treatment conditions Line care (Flush bags, Heparin, etc) Pre-treatsChemotherapy/Biotherapy Nursing Communication
Order Conversion About 300 paper orders to convert prior to partial implementation (Feb 07). It took pharmacists a total of 42 hours (8.4 minutes/plan) to convert all paper orders. (Over twice as long as Epic’s Estimate) Build fixes were done on-the-fly during pharmacist order conversion. Conversion Stages: Week 1 orders, then Week 2 orders, then all others.
Post Go-Live Findings Get RPh (and MDs) involved early in validation which will help increase speed during order conversion. Partial implementation- Issues were resolved prior to CPOE, but pharmacists overwrote Epic calculations (mg/m2) in order to match the paper orders. (Lost the mg/m2 ordered in Epic) RN’s had to work in paper and Epic world (some duplication of documentation). Imaging and Labs are still in question.
Where we were, where we’re going: Beacon Oncology
HCMC: Comprehensive, public teaching hospital in downtown Minneapolis, MN. Minnesota’s first Level 1 Trauma Center with many nationally recognized programs and specialties – 425 beds. 13 straight years on US News & World Report list of top hospitals. Safety net hospital providing care for low-income, the uninsured and vulnerable populations. About Hennepin
The Cancer Center team includes 4 medical oncologists, 2 surgical oncologists and 1 radiation oncologist along with 2 specially trained R.N.s. Cancer Center draws all of their own labs. 5-15 daily patients receiving chemotherapy. Approximately 15 patients per day receiving non- chemotherapy treatment such as iron, port flushes, etc. Sage Cancer Screening Program – provides free screening and follow-up services to uninsured and underinsured women. Cancer Center Highlights
The Cancer Center and Infusion Center went live as an HOD (Hospital Outpatient Department) November 13, 2008: Big Bang - with the exception of Radiation Oncology Providers and Nurses: Blended learning approach December 3, 2009: Radiation Oncology - 1 Oncologist and 1 Nurse Implementation & Training Strategy
Mid October 2009: Back loading began 40 – 50 active treatment plans at the time of implementation At the time of Go-Live the following week’s orders were completed Protocols are comprised of Nursing orders, Treatment conditions, Pre meds, Chemo, Labs and Take home meds Back Loading and Protocol Structure
Complexity and high volume of discharge orders Struggles with the choice to put labs in the treatment plans Comprehensive reports to show all orders Contact redirection of visits between departments Lessons Learned & Optimization