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Cancer & Blood Disorders Quality Improvements

2017 Cancer & Blood Disorders Quality Improvements

Akron Children’s is committed to maintaining and improving the quality and safety of our care. We collaborate with other groups, accrediting bodies and pediatric hospitals on quality improvement initiatives to create and maintain the highest standards of pediatric care.

The Division of Hematology-Oncology has had an active quality improvement committee since 2006. The team, which meets monthly, includes a dozen staff members from various disciplines. Here is a summary of 2017 projects.

Reducing Central Line-Associated Blood Stream Infections

We participate in the Solutions for Patient Safety national collaborative to reduce central line-associated blood stream infections (CLA-BSI) among hospitalized hematology-oncology patients. Inpatient data submission started in November 2009. Baseline infection rates were submitted and we began staff education on central line care in December 2009. In addition to existing interventions, including a maintenance line care bundle and oral care bundle, we added an environmental care bundle in 2017 to decrease our infection rate.

The environmental care bundle includes daily patient care, daily cleaning of high-touch surfaces within patient rooms and deep-cleaning of all rooms at least every 30 days. In 2017, our infection rate once again dropped below the national average.

Patient/Family Satisfaction

Hematology-oncology patients were surveyed in 2017 through Press Ganey, a nationally recognized organization that provides information to improve patient experience by assessing satisfaction with our care. Our division scored in the top 10 percent of participating pediatric hematology-oncology programs in the following categories:

  • Overall doctor rating
  • Physician communication quality
  • Listening carefully to you
  • Showing respect for what you say
  • Spending enough time with you

Sample comments received include:

  • “The care and concern for my daughter from everyone was beautiful to see and feel. Thank you.”
  • “We are always impressed and very grateful for the care we receive at [Akron Children’s Hospital]. Thank you!”
  • “I am very grateful for all the staff and the level of care at Children’s. For a hospital experience, it was the best ever!”
  • “My son was very ill. [The provider] did everything she could to make it a good experience and to help him feel better... including personally making him some chicken noodle soup.”
  • “We can’t say enough good things about our regular nurses – they have become like family – loving and supportive during these stressful times.”

Safe Administration of Chemotherapy

Our chemotherapy administration safety initiative began in 2014 to address chemotherapy-related medical errors. The ongoing goal is to decrease the number of potentially harmful errors to below 15 percent of all chemotherapy-re­lated errors. Errors are given a grade from A to I based on a standardized grading system, MIDAS, or Minor Incident Decision Analysis Software. Potentially harmful errors are those with a MIDAS grade of D or higher that required intervention or resulted in patient harm.

In 2017, while we saw a low number of chemotherapy errors, the percentage of errors with a grade of D or higher was stable. We will continue with our current chemother­apy safety program, which includes daily chemotherapy huddles, a two-provider review of chemotherapy orders, and delivery of chemotherapy orders to the pharmacy 48 hours before administration for additional review.

We are also developing an improved reporting process so the Chemotherapy Task Force can generate reports for review by the Quality Committee. This may lead to further initiatives to decrease error rates.

Revaccination of Bone Marrow Transplant Patients

Based on information and data gathered by the CDC, Infectious Disease Society of America (IDSA), and American Society of Blood and Marrow Transplantation (ASBMT), it is well known that antibody titers to vaccine-preventable diseases decline during the first four years after an allogeneic or autologous stem cell transplant. While vaccine-preventable illnesses are uncommon, they pose a particular risk to bone marrow/stem cell transplant patients. Therefore, in 2017, we developed a revaccination program for these patients based on the consensus guideline published by the CDC, IDSA and ASBMT.

Timely revaccination was defined as revaccination for all eligible post-transplant patients within two months of the recommended time. The goal is to have 100 percent of eligible patients receive timely revaccination.

Antibiotics in High-Risk Patients with Fever

Since mid-2009, we have been improving systems so that febrile hematology-oncology patients with central lines, who are also at risk for serious infection, receive intravenous antibiotics within one hour of arrival at the hospital, regardless of point of entry (outpatient clinic, emergency department, inpatient unit). Our goal is to ensure that 90 percent of these patients receive IV antibiotics within one hour.

An area where we continued to struggle was in the Emergency Department on our Akron campus. In 2017, a team with members from the Emergency Department, Hematology-Oncology, Informatics, Infectious Disease and Pharmacy developed a patient alert process and provider order sets, resulting in a more uniform and streamlined process. This collaborative effort has significantly improved the timing of antibiotic administration for patients arriving at our Akron Emergency Department.

Timely Revaccination for Transplant Patients

Allogenic Transplants

  • Before intervention: 18%
  • After intervention: 67%

Autologous Transplants

  • Before intervention: 0%
  • After intervention: 75%