i n 2014, Washington Cancer Institute at MedStar Washington Hospital Center continues to grow as a regional leader and national model for comprehensive, interdisciplinary and patient-focused cancer diagnosis and treatment by adding new physicians in Medical Oncology, Breast Surgery and through renovation of our infusion center. is year’s report focuses on the many quality initiatives implemented and on community outreach programs aimed to meeting the needs of the community we serve. As we move forward, we want to build on our successes to continue offering services to our community and beyond, to better understand, treat and fight cancer. We take our commitment to our patients seriously. Our mission is to ensure each of our patients has the best possible diagnostic and treatment options. Patient safety, which is now a national quality measure, is part of the core of what our medical community is achieving. Our culture embraces innovation and seeks to improve services, through self examination and quality improvement. Patient wait times are also kept to a minimum, allowing the Cancer Institute to continue to increase their patient satisfaction scores. In 2012, a generous donation from the Elsie & Marvin Dekelboum Family Foundation significantly increased our medical oncology space, allowing us to see patients more efficiently and in a much more pleasant environ- ment. Additional logistical challenges were identified in the infusion center through a process improvement program which included expanding the present area of the infusion center. Once again, the Elsie & Marvin Dekelboum Family Foundation generously provided a donation to renovate the infusion center from 19 infusion bays to 31 bays. e last phase of the project will be completed in April, 2015. Our team of doctors at the Washington Cancer Institute, continue to participate in various research programs. We are currently engaged in an intraoperative radiation therapy trial (IORT), the TARGIT-US trial that delivers a single dose of radiation at the time of surgery to suitably qualified patients with breast cancer, rather than requiring the patient to undergo six weeks of daily radiation to the breast aer surgery. Additionally, patients with early stage breast cancer, who are also found to possess a special protein known as HER2, have been considered for a research protocol that delivers the drugs Herceptin® and Perjeta®, to evaluate the benefits of these drugs on breast tumors, as well as a study with Herceptin® being given along with radiation to the breast. e Cancer Institute is participating in an expanded access program for a new drug, Pablociclib for patients with advanced hormone positive breast cancer. It is hoped, that this drug will be approved by the FDA later in 2015. is drug has been shown to slow the progression of advanced breast cancer and it is our hope that participating in these trials will help us gain more knowledge in our mission to cure cancer. Community Outreach continues to be a strong focus and a recent assessment found that a staggering number of women seeking treatment have advanced breast cancer rates despite having insurance. Based on this outcome, we were awarded a grant from the AVON Foundation for Women to explore the reasons behind this disparity. is project is led by Dr. Elmer Huerta, MD, MPH, director, Cancer Preventorium. To assist with this project the community navigators are conducting door-to-door visits, as well as events at local churches, community centers and businesses. eir objective is to interview women in need of mammograms. Dr. Huerta is also focusing on the relationship between diabetes and cancer, and how managing diabetes can have a positive impact of the management of cancer. Our social workers now intervene at an earlier point in a patient’s journey by assessing for social needs that may have an impact on their access to care, which can ultimately help improve their outcomes. e MedStar Georgetown Cancer Network which is MedStar’s regional cancer program has been successful in fostering collaboration across the MedStar hospitals with a focus on ambulatory practices and research. A Message from Our Leadership Adedamola Omogbehin, MD Chair, Cancer Committee Washington Cancer Institute e Region’s Choice for Cancer Care MEDSTAR WASHINGTON HOSPITAL CENTER 2014 ANNUAl RePORT
Transcript
in 2014, Washington Cancer Institute at MedStar Washington Hospital Center continues to grow as a regionalleader and national model for comprehensive, interdisciplinary and patient-focused cancer diagnosis andtreatment by adding new physicians in Medical Oncology, Breast Surgery and through renovation of our
infusion center. is year’s report focuses on the many quality initiatives implemented and on communityoutreach programs aimed to meeting the needs of the community we serve. As we move forward, we want to build on our successes to continue offering services to our community and beyond, to better understand, treat and fight cancer.We take our commitment to our patients seriously. Our mission is to ensure each of our patients has the best possible diagnostic and treatment options. Patient safety, which is now a national quality measure, is part of thecore of what our medical community is achieving. Our culture embraces innovation and seeks to improve services, through self examination and quality improvement. Patient wait times are also kept to a minimum, allowing the Cancer Institute to continue to increase their patient satisfaction scores.In 2012, a generous donation from the Elsie & Marvin Dekelboum Family Foundation significantly increasedour medical oncology space, allowing us to see patients more efficiently and in a much more pleasant environ-ment. Additional logistical challenges were identified in the infusion center through a process improvementprogram which included expanding the present area of the infusion center. Once again, the Elsie & MarvinDekelboum Family Foundation generously provided a donation to renovate the infusion center from 19 infusion bays to 31 bays. e last phase of the project will be completed in April, 2015.Our team of doctors at the Washington Cancer Institute, continue to participate in various research programs. We are currently engaged in an intraoperative radiation therapy trial (IORT), the TARGIT-US trial that delivers a single dose of radiation at the time of surgery to suitably qualified patients with breast cancer, rather than requiring the patient to undergo six weeks of daily radiation to the breast aer surgery. Additionally, patientswith early stage breast cancer, who are also found to possess a special protein known as HER2, have been considered for a research protocol that delivers the drugs Herceptin® and Perjeta®, to evaluate the benefits ofthese drugs on breast tumors, as well as a study with Herceptin® being given along with radiation to the breast. e Cancer Institute is participating in an expanded access program for a new drug, Pablociclib for patientswith advanced hormone positive breast cancer. It is hoped, that this drug will be approved by the FDA later in2015. is drug has been shown to slow the progression of advanced breast cancer and it is our hope that participating in these trials will help us gain more knowledge in our mission to cure cancer.Community Outreach continues to be a strong focus and a recent assessment found that a staggering number of women seeking treatment have advanced breast cancer rates despite having insurance. Based on this outcome, we were awarded a grant from the AVON Foundation for Women to explore the reasons behind this disparity. is project is led by Dr. Elmer Huerta, MD, MPH, director, Cancer Preventorium. To assist with this project thecommunity navigators are conducting door-to-door visits, as well as events at local churches,community centers and businesses. eir objective is to interview women in need of mammograms. Dr. Huerta is also focusing on the relationship between diabetes and cancer, and how managing diabetes can have a positive impact of the management of cancer. Our social workers now intervene at an earlier point in a patient’s journey by assessing for social needs that may have an impact on their access to care, which can ultimately help improve their outcomes. e MedStar Georgetown Cancer Network which is MedStar’s regional cancer program has been successful in fostering collaboration across the MedStar hospitals with a focus on ambulatory practices and research.
A Message from Our Leadership
Adedamola Omogbehin, MDChair, Cancer Committee
Washington Cancer Institute
e Region’s Choice for Cancer CareMEDSTARWASHINGTONHOSPITALCENTER
2014 AnnuAl RepoRt
Using a daily radio programbroadcast from his office at the Cancer Institute and aweekly television program, Elmer Huerta, MD, MPH, director of the CancerPreventorium, has providedcontinuous health promotionand disease prevention healthinformation to the Latinocommunity since 1989.e Cancer Preventoriumwas started at MedStar Washington Hospital Center
in 1994 to provide cancer prevention and early detectionservices to the underserved populations of the Washington,DC metropolitan area. During 2013, 1,600 patients wereseen at the Center and approximately 33,000 patients havebeen seen since its inception.
Services provided include personalized cancer risk assessment and behavioral counseling on diet modification,exercise and tobacco cessation. In addition, age-appropriateand risk-based cancer screening tests are given to patients.e Cancer Institute also conducts periodic cancer screening activities in the community. An annualmelanoma skin cancer screening is conducted every year at
the United States Senate Health Fair. During the 2014 fair,753 educational pieces were distributed and 70 Senatestaffers were examined, 19 of whom were referred for specialized exams.
Beginning in 2014, a breast cancer education program inWashington, D.C.’s Ward 5 has been started with fundingfrom the Avon Foundation. e program is geared to understand the reasons behind the startling fact that 97percent of women with Stage III-IV seen at the MedStarWashington Hospital Center between 2006 and 2011 havehealth insurance.An initial analysis of 400 questionnairesadministered to women living in Ward 5 by two Community Health Workers working for the project, showsthat fear is the number one reason to explain the disparity.Lack of knowledge on breast health and women’s personalfactors such as lack of time and busy lives are also important reasons to explain the surprising fact. e surveyalso revealed that only 3.2 percent of women living in Ward5 do not have health insurance. is finding stresses theneed of conducting educational campaigns directed to dispel fear and empower women living in Ward 5.
For information regarding the Cancer Preventorium,please call 202-877-7929.
more than half of the cancer occurring today is preventable by applyingknowledge that we already have. Tobacco, obesity, and physical inactivityare the modifiable causes of cancer that generate the most disease.
Cancer burden can be reduced by alterations in individual and population behaviors andby public health efforts as long as these changes are driven by sound scientific knowledgeand social commitment to change. e obstacles to these efforts are societal and arise
from the organization of institutions, including academia, and in the habits of dailylife. To achieve maximal possible cancer prevention, we will need better ways toimplement what we know and improved infrastructure that will better incentivizeand support transdisciplinary, multilevel research and successful intervention.
—Colditz et. al., Sci Transl Med 4 (127), 2012
Community OutreachPrevention and screening programs
roviding clinical trials that fit our patient population is the cornerstone of research success.
Clinical Research
ese studies can help develop new treatments fordisease and illnesses in our diverse community.
Clinical trials are the most effective tool for making possiblethe many advances and improvements in patient survival.Under the direction of Medical Director David J. Perry,MD, the Clinical Research Department maintains a broadscope of clinical trial opportunities for oncology patients of Washington Cancer Institute at MedStar WashingtonHospital Center. Our research program continues to provide a strong blend of National Cancer Institute (NCI)-sponsored research, industry-sponsored research and original research developed by the physician investigators atthe Cancer Institute. Washington Cancer Institute providesaccess to a variety of important research studies. e CancerInstitute actively contributes to the advancement of healththrough research discovery by conducting a wide range ofresearch projects, including therapeutic trials to treat thepatient’s cancer and basic science research conducted in the laboratory. In addition, the Cancer Institute conducts othertypes of complimentary research studies in the areas of improved quality of life and symptom management. In asummary recap of 2013, 213 patients were enrolled. In 2014,193 patients were enrolled. In both years, more than 75 research trials were made available to Cancer Institute patients, and nearly 500 continued to participate in the long term follow-up and survivorship portion of the variousclinical trials.
Among the Cancer Institute’s original institutional researchin both 2013 and 2014 were:
� A study of a continuous regimen of Sunitinib in patientswith differentiated thyroid cancer (DTC) to minimizetumor escape during treatment. e resulting datademonstrated that Sunitinib exhibits significant anti-tumor activity in patients with advanced DTC. Since Sunitinib was relatively well tolerated, there is thepotential for clinical benefit in these patients, and furtherinvestigation of this agent is warranted.
� A study for breast cancer patients with decreased cardiacfunction, allowing them to begin or resume treatmentwith HER2 agents. Using these agents, oncologists havebeen successful in prolonging disease-free survival, and
overall survival with patients not being forced to hold orcompletely discontinue receiving these drugs due to amild decrease in cardiac function. In this setting we areable to resume HER2 treatments for these patients whilesimultaneously providing close cardiac monitoring andmedications.
� Building upon the Federally funded Challenge grant-funded research, a study, INSPIRE, was begun to increasetherapeutic clinical trial participation rates (primary objective) among African American breast cancer patients. It further examines the relationship between the intervention and attitudes/beliefs on the decision toparticipate. Currently, over 130 patients have participatedin the whole MedStar Georgetown Cancer Network and10 patients have gone on to enroll in therapeutic clinicaltrials aer participating in this study.
In 2014, the Washington Cancer Institute’s research program became a new member of Academic and Community Cancer Research United (ACCRU) and the International yroid Oncology Group (ITOG) in order tobroaden the portfolio of research studies accessible to ourpatient population. ACCRU is a clinical research group withoperations based at the Mayo Clinic Cancer Center inRochester, Minn. ACCRU includes a network of more than60 academic and community-based cancer treatment clinicsand hospitals in the United States and Canada, and was established to conduct clinical trials to improve cancer care.More specifically, ACCRU was established to improve the duration and quality of life for cancer patients by performing high quality clinical trials in the academic andcommunity setting, and to improve the understanding ofcancer biology and biological consequences of cancer treatment (ACCRU orientation packet). ITOG’s mission isto catalyze a cure for the most challenging thyroid cancersthrough the collaborative efforts of unique multidisciplinaryteam of leading physicians, scientists, and advocates to design, coordinate, and prioritize state-of-the-art clinicaltrials and correlative science (www.itog.org).
For information about clinical research at WashingtonCancer Institute, call 202-877-8839.
p
About Washington Cancer Institute
Oncology Information ManagementThe Washington Cancer InstituteOncology Information Management(OCIC)/Cancer Registry Departmentis the largest hospital repository forcancer data in Washington, D.C. The data collected is based on datasets established by the AmericanCollege of Surgeon’s Commissionon Cancer (CoC) and The NorthAmerican Association of CentralCancer Registries (NAACCR), andthe National Cancer Institute’s Surveillance, Epidemiology, andEnd Results (SEER) program. The data collected is used for compliance with database management for the following accreditations: CoC, the NationalAccreditation Program for BreastCenters (NAPBC), American Societyof Clinical Oncology’s Quality Oncology Practice Initiative (QOPI),and compliance with other regula-tory agencies. In addition, the datahas been used by clinicians for developing studies; to track compliance with the National Quality Form’s performance measures for breast and colorectalcancer; and to establish internalquality metrics. Data is also used for clinical research, community outreach activities, and various national and private grants.
A Summary of the 2013 Cancer Experience
d uring 2013, the OCIC/Cancer Registry department analyzedover 5,000 cancer cases seen at MWHC, of these 2,350 caseswere captured in the cancer database to analyze for outcome
analysis (see Table 1, Site Distribution).
Of the newly diagnosed cases seen at MWHC, the following werethe most common sites among men and women: Breast-Female(280) and Male (2);yroid-Female (219) and Male (61); Prostate-247; Lung-Female (109) and Male (109); Melanoma & non-epithelialcancers: Female (64) and Male (88); Colon/Rectal-Female (92) andMale (103); Bladder & Kidney-Female (59) and Male (108); Pancreas-Female (43) and Male (39); and Corpus Uteri (94).
Of the new patients seen at the Washington Hospital Center, 55 percent were female and 45 percent were male. Fiy-three percent(53%) of the patients resided in Maryland, with 26 percent fromPrince Georges County, 14 percent from Montgomery County, and 4 percent from St. Mary’s County. e second largest new patientpopulation (36%) was from the District of Columbia, and 10 percentfrom Virginia, with the majority of the patients coming from theNorthern Virginia Counties. Countless of other patients come fromout of state for either their initial diagnosis or to be treated for theirinitial diagnosis of cancer.
Furthermore, 58 percent were African-American, 35 percent werenon-Hispanic White, and 2 percent were Hispanic, and 5 percentwere of other races.
MedstAR WAshington hospitAl centeR
2013 site distRibution tAble(tAble 1)
SEX STAGE DISTRIBUTION - ANALYTIC CASES ONLYPRIMARY SITE TOTAL PERCENT M F STG 0 STG I STG II STG III STG IV 88 UNK BLANK/INV
is study evaluated MedstarWashington Cancer Institute(MWCI) compliance with evidence-based National Comprehensive Cancer Network(NCCN) Clinical Practice Guide-lines (CPGs) for the diagnosis andtreatment of the thyroid cancerwith RAI ablation therapy. eCancer Data Registry Databasewas used to review all cases for
the period of 2008-2012 for inclusion criteria. Of all cases reviewed, n=336 met the inclusion criteria and were included in the study. Medical records were reviewed for diagnostic evaluation and documentation of the following:primary tumor site, tumor stage per the American JointCommittee on Cancer (AJCC) TNM Staging for yroid
Cancer, histology, tumor size and RAI ablation therapy administration/recommendation per NCCN CPGs guide-lines. Descriptive statistics (frequencies and percentages)were used to report the study findings.
All of the 336 reviewed cases met the evidence-basedNCCN CPGs for diagnosis and treatment of differentiatedthyroid cancer with RAI ablation therapy (see Table 1, Summary of Findings). All of the cases had documented the primary tumor site, tumor stage per the AJCC TNMStaging for yroid Cancer, histology, tumor size (≥ 20 millimeters) and RAI ablation therapy. Of all caseswith a tumor size ≥ 20 millimeters, 92 percent received RAIablation therapy. RAI ablation was contraindicated or declined by 28 patients (8 percent) due to poorprognosis/mortality.
Monitoring Compliance with Evidence-Based Guidelines
coMpliAnce With evidence-bAsed nAtionAl coMpRehensive cAnceR netWoRkclinicAl pRActice guidelines foR the diAgnosis And tReAtMent of diffeRentiAtedthyRoid cAnceR With RAdioActive iodine AblAtion theRApy duRing 2008-2012
Study Leader: Kenneth D Burman, MD, Section Director, Endocrinology, Diabetes and Metabolism
Rehabilitation is is an exploratory study. is study measures the incidence of patient reported significant fatigue (≥5) among all screened post-treatment patients (all diagnoses)at MWCI. e navigator’s screening/monitoring results forfatigue among post-treatment
patients with all diagnoses was used. Post-treatment patients are typically patients who are being seen for theirfirst or second post-treatment completion visit. is datawas compared to the national benchmark/literature review.
Between July 1 and November 30, 2014, a total of 200 patient electronic medical records were reviewed for documentation of moderate to severe self-reported fatiguelevel (≥5) during the first and second post treatment visits.e fatigue was measured using a Likert Scale 0-10, where0 indicates no fatigue and 10 indicates the worst fatigue.Out of 200 patients, 20percent (40) reported significant(moderate to severe) (≥5) levels of post-treatment fatigue.Fourteen percent (27) patients reported an average 7/10 fatigue level during the first post-treatment visit. e period from treatment completion to the first post-treatment visit ranged between 10-30 days. Eight percent(15) patients reported an average 6/10 fatigue level duringthe second post-treatment visit. e period from treatment completion to the second post-treatment visitranged between two-six months. Two patients reportedmoderate to severe fatigue during both the first and secondpost-treatment visits.
Self-reported moderate to severe post-treatment fatigueamong MWCI patients was below 33percent of the national
benchmark/literature review (see Table 1, Incidence of Self-reported Significant Fatigue). Documentation of interventions addressing significant fatigue, such as referrals to NRH or referrals for further evaluation, increased from 71 percent in July to 91 percent in November 2014.
is study provided background knowledge on the incidence of self-reported significant fatigue among post-treatment patients (all diagnoses). e incidence of patient reported significant post- treatment fatigue waslower (20%) at the MWCI, in comparison to the nationalbenchmark/literature review (33%).
Studies of Quality and Quality Improvement
incidence of significAnt fAtigue (≥5), As deteRMined by the pAtient’s RepoRtedfAtigue scoRe, AMong All scReened post-tReAtMent pAtients (All diAgnoses)
Study Leader: Eric M Wisotzky, MD, FAAPMR- Physiatrist and Director, Cancer
incidence of self RepoRted significAnt fAtigue(≥5) AMong All scReeened pAtients duRing
the fiRst & second post tReAtMent visit July-noveMbeR 2014
n=200(tAble 1)
Number of Patients Reporting Post Treatment Fatigue ≥5; n=40
Number of Patients ReportingFatigue ≥5 During First
Post Treatment Visit; n=27
Number of Patients ReportingFatigue ≥5 During Second
Post Treatment Visit; n=15
National Benchmark
20%
14%
8%
33%
Patients diagnosed with cancerwho have preexisting diabetes areat increased risk for long-term,all-cause mortality compared withthose cancer patients without diabetes. On average, 30 percent of all newly diagnosed cancer patients who attend chemother-apy education class at MWCI haveDiabetes Mellitus (DM) docu-mented as secondary diagnosis.
This was an exploratory study. The purpose of this studywas to examine if newly diagnosed Lung and Head &Neck cancer patients with secondary diagnosis of DM,and treated with chemotherapy at MWCI, had docu-mented HbA1c results, and blood glucose levels within100-250 mg/dl. A convenience sample of n=40 partici-pants who met the inclusion criteria was used in thisstudy. A retrospective chart review of electronic healthrecords and document repository databases was used fordata abstraction.
Out of 40 participants, seven (18 percent) had documented DM as a secondary diagnosis, four (10 percent) developed hyperglycemia/hypoglycemia and two(5 percent) non-diabetic patients developed hyperglycemia(blood glucose level >300 mg/dl) (see Graph 1, Diabetes management of newly diagnosed cancer patients). None of the patients with documented DM had documented HbA1c in their health records.
Based on the study findings, an action plan was developedto improve the quality of care of newly diagnosed cancerpatients with documented DM. e implementation willoccur during the period of February 1-July 31, 2015. Datacollection and analysis will start on August 1, 2015. Studyfindings will be reported at the Cancer Committee meetingin December 2015.
ReinfoRceMent of self-MAnAging behAvioR thRough educAtion of diAbeticpAtients With neWly diAgnosed lung And heAd & neck cAnceR pRioR to initiAtionof cheMotheRApy to iMpRove glucose contRol duRing tReAtMent
Study Leader: Elmer E Huerta, MD-Attending Physician, Internal Medicine
diAbetes MAnAgeMent of neWly diAgnosedlung And heAd & neck cAnceR pAtients
n=40(gRAph 1)
5%
3%
3%
0%Total Number of Patients with
Documented HBA1c Test Results;n=0
Number of Non-Diabetic PatientsWho Developed Hyperglycemia
(>300mg/dl); n=2
Number of Patients Who Developed Hypoglycemia; n=1
Number of Patients Patients Who Required Hospitalization
Due to Hyperglycemia; n=1
Number of Patients With Documented DM Type II Who
Developed Hyperglycemia (250-500mg/dl); n=2
Number of Patients With Documented DM Type II; n=7
5%
18%
0% 5% 10% 15% 20%
Study of Quality
e purpose of this quality improvement initiative was to examine the effect of targeted intervention on the compliancewith antibiotic infusion prophylaxis practice guidelines (antibiotic selection, infusion time to surgical incision and redosing) in all breast surgery cases.
A retrospective chart review wasconducted to measure compliance with antibiotic infusionprophylaxis practice guidelines (antibiotic selection, infusion time to surgical incision, and redosing) in all breast surgery cases aer the targeted intervention imple-mentation. A convenience sample was used in this study.e post intervention data collection period was September1-31, 2014. All cases were identified based on the DRGcodes and screened for inclusion criteria. Electronic HealthRecords and Document Repository databases were used.Data from a total of 35 participants who met the inclusioncriteria was extracted during retrospective chart reviews.
Out of 35 patients, 33 (94 percent) received Cefazolin according to antibiotic infusion prophylaxis practice guide-lines (see Graph 1, Cefazolin Prophylaxis Compliance).
PDSA was used to develop performance improvement action plan to meet antibiotic infusion prophylaxis practiceguidelines in all breast surgery cases.
MultidisciplinARy effoRt to ensuRe Antibiotic infusion pRophylAxis pRActicesARe Met in All bReAst suRgeRy cAses
Study Leader: Marc Boisvert, MD, FACS, Medical Director, Center for Breast Health, Washington Cancer Institute, and Director, MedStar Regional Breast Health Program
cefAzolin pRophylAxis coMpliAncen=35
(gRAph 1)
2
0 10 20 30 40
33
35
Did Not Meet Guidelines
Met Guidelines
Total Population
Quality Improvement
e purpose of this quality improvement initiative was to examine the effect of targeted intervention on compliance withantibiotic infusion prophylaxispractice guidelines (antibiotic selection, infusion time to surgicalincision and redosing) in allbreast surgery cases with documented beta-lactam antibiotic allergy.
A retrospective chart review was conducted to measurecompliance with antibiotic infusion prophylaxis practiceguidelines (antibiotic selection, infusion time to surgical incision and redosing) in all breast surgery cases with documented beta-lactam antibiotics allergy aer the targeted intervention implementation. A total of 43 caseswere identified based on DRG codes and screened for inclusion criteria. A convenience sample of n=8 participantswho met inclusion criteria was used in this study. e postintervention data collection period was September 1-September 31, 2014. Electronic Health Records and Document Repository databases were used.
A total of eight participants had documented beta-lactamantibiotics allergy, and all had selected antibiotics (Vancomycin and Clindamycin) per antibiotic infusion prophylaxis practice guidelines. Out of all participants, 75percent received antibiotic prophylaxis per timing and redosing guidelines. ree (60 percent) participants in the Vancomycin group received Vancomycin per antibioticinfusion prophylaxis practice guidelines (see Graph 1, Vancomycin Prophylaxis Compliance).
ree participants (100%) in the Clindamycin group received antibiotic infusion prophylaxis per practice guide-lines (see Graph 2, Clindamycin Prophylaxis Compliance).
PDSA was used to develop performance improvement action plan to meet antibiotic infusion prophylaxis practiceguidelines in all breast surgery cases.
MultidisciplinARy effoRt to ensuRe Antibiotic infusion pRophylAxis pRActices ARe Met in All bReAst suRgeRy cAses With docuMented betA-lActAMAntibiotics AlleRgy
Study Leader: Marc Boisvert, MD, FACS, Medical Director, Center for Breast Health, Washington Cancer Institute, and Director, MedStar Regional Breast Health Program
vAncoMycin pRophylAxis coMpliAncen=5
(gRAph 1)
0 1 2 3 4 5 6
3
5
2Did Not Meet Guidelines
Met Guidelines
Total Population
clindAMycin pRophylAxis coMpliAncen=3
(gRAph 2)
0 0.5 1 1.5 2 2.5 3 3.5
0
3
3
Did Not Meet Guidelines
Met Guidelines
Total Population
Quality Improvement
Purposee purpose of this patient care improvement project is to improve satisfaction with pain management of surgicaloncology patients. Monthly data collected by the NRCpicker during post-discharge survey phone calls was abstracted from the unit specific database and reported to the Cancer Committee. e data measured patient satisfaction (all diagnoses) with pain management. Unit2NW surgical oncology provides care to patients with oncologic and other illnesses. Surgical oncology patientsconstitute on average 27-30 percent of daily unit censusand, for that reason, the NRC picker’s survey did not provide a sufficiently sensitive tool to measure surgical oncology population satisfaction with pain management.
To measure directly surgical oncology patient satisfactionwith pain management, unit leadership developed a datacollection tool and methodology. e tool contained questions, similar to the NRC picker survey questions, utilizing a teach back method to assess patient true understanding of post-operative pain management, patientsatisfaction with pain medication regimen and patient perception is staff were doing everything to help with pain.Unit leaders, during daily leaders rounding, collected dataon surgical oncology patients only. Patient care needs identified during leader rounding were immediately addressed with the interdisciplinary teams.
During August 26- November 26, 2014, 2NW leadershipcollected and analyzed data on satisfaction with pain management of surgical oncology patients only. e collection of daily data helped to manage patients’ painbetter. Nurses were able to know earlier if the medicationwas working effectively, if the dose needed to be increased,or a new medication needed to be prescribed. Ninety-eightpercent of surgical oncology patients verbalized satisfactionwith pain management/control and 97 percent of patientsverbalized that nurses did everything to help with pain. eunit reached targeted goal (see Table 1, Patient Satisfactionwith Pain Management).
iMpRoveMent of pAtient sAtisfAction With pAin MAnAgeMent on suRgicAloncology unit thRough pAin focused dAily leAdeR Rounding
Study Leader: Bernadette Denis, RN-2NW Surgical-Oncology Unit Nursing Director
2nW suRgicAl oncology pAtient sAtisfAction With pAin MAnAgeMent
n=147(tAble 1)
0% 20% 40% 60% 80% 100%
Was Pain Well Controlled?Did Everything to Help With Pain?
98%
97%
49%
71%
70%
70%
Leader Rounding(2NW Medical Oncology Only)
NRC Picker (2NW Population)
Unit Goal
Quality Improvement
e purpose of this Patient CareImprovement project was to improve oncology and hematol-ogy patient population experiencescores, measured by the NRCpicker, by increasing patient satisfaction in two areas: communication (communicationregarding medications, side effects, symptoms managementand participation in self-care)
and staff responsiveness, through implementation of nurse-physician rounding.
Monthly data collected by the NRC picker during post-discharge survey phone calls was abstracted from the unitspecific database and reported to the Cancer Committee.e data measured patient perception (all diagnoses) withcommunication (communication regarding medications,side effects, symptoms management and participation inself-care), and staff responsiveness.
Unit 3NE medical oncology provides care to patients withoncologic, hematologic and other illnesses. Oncology/hematology patients constitute on average 26-30 percent of daily unit census and, for that reason, the NRC picker’ssurvey did not provide a sufficiently sensitive tool to measure oncology/hematology population satisfaction withcommunication (communication regarding medications,side effects, symptoms management and participation inself-care) and staff responsiveness.
To measure directly the impact of nurse-physician roundingintervention on oncology and hematology patient reportedsatisfaction with communication (communication regarding medications, side effects, symptoms managementand participation in self-care), and staff responsiveness, unit leadership developed a data collection tool andmethodology. e tool contained questions, similar to theNRC picker survey questions, utilizing a teach back methodto assess patient true understanding of medications, side effects, symptoms management and participation in self-care, and perceived staff responsiveness. Unit leaders,during daily leaders rounding, collected data on oncology
and hematology patients. Patient care needs identified dur-ing leader rounding were immediately addressed with the interdisciplinary teams. e data collection period was August 26- November 26, 2014. Utilization of the tool allowed for the identification of patients with additional educational and care needs, and provided an easy methodto measure patient readiness for a transition of care, and patient satisfaction with care received at MWHC.
e 3NE unit goal for improvement of inpatient experience scores by increasing satisfaction in two areas:communication regarding medications and responsivenessof staff was established as 61 percent and 64 percent respectively. Unit achieved 99 percent for a measure “communication about medications” and 98 percent for ameasure “responsiveness of staff ” for medical oncology and hematology patient population, exceeding unit goal for both measures (see Table 1, Patient satisfaction withCommunication and Staff Responsiveness).
is patient care improvement project was based on evidence based RN practice project by 3NE nursing residents Amy Wilkins, RN, Alyssia Lanfranci, RN, and Melissa Rice, RN.
iMpRove pAtient sAtisfAction With coMMunicAtion (RegARding MedicAtions, side effects, syMptoMs MAnAgeMent And pARticipAtion in self-cARe) And stAff Responsiveness.
Study Leaders: Vera Malkovska, MD-3NE Medical Director, Lan Anh Phan, RN, PCM, and Benjamin Otoo, RN, PCM
3ne MedicAl oncology pAtient sAtisfActionn=140(tAble 1)
0% 20% 40% 60% 80% 100%
Communication About MedicationsStaff Responsiveness
99%
98%
53%
58%
61%
64%
Leader Rounding(3NE Medical Oncology Only)
NRC Picker (3NE Population)
Unit Goal
Quality Improvement
Washington Cancer Institute2014 Annual Report
How to Reach OurPhysiciansIf you are a health careprofessional and would like to personally speak with one of the physicians atWashington Cancer Institute, call202-877-3901. We’ll get back toyou within 24 hours duringnormal business hours.
Cancer Experts Availablefor Speaking Engagements
Washington Cancer Institutephysicians are available to speakat grand rounds, CME programs,community events and othereducational activities. For moreinformation, call 202-877-3901.
