In response to incidents where patients were identified as receiving a flat, non-protocol dose of chemotherapy in one New South Wales (NSW) medical oncology practice, an inquiry was held by the NSW Ministry of Health in relation to “off-protocol” prescribing of chemotherapy across NSW. The sensitivity of the issue has resulted in a retrospective review of cancer patient management in NSW public hospitals being recommended. Dose tailoring allowing for patient comorbidities, age and toxicity is appropriate although the proportion where this occurs is sparsely reported.
To develop and implement an audit tool that monitors the prescribing of chemotherapy in an electronic oncology information system that identifies off-protocol prescribing of chemotherapy, medication dose variance of > ±5% of the protocol calculated dose, and the documentation of dose adjustment reasons.
This project was conducted across three facilities within the local health district (LHD). Chemotherapy orders prescribed in the Elekta’s MOSAIQ® oncology information system (OIS) between 1/9/2016 and 31/07/2017 where included. SAP® Crystal Reports 2011 was used for data extraction and visualisation. SAP® Crystal Reports Server XI was used to schedule and distribute the reports. Requirements of the audit tool were collated through a working group aimed to conduct a complete review of chemotherapy practices in the LHD.
There were 8961 chemotherapy drug orders prescribed in the OIS. 55% were prescribed using a protocol and 14% of these had a dose variation of >±5%. 63% of chemotherapy orders prescribed using a protocol had a documented dose adjustment reason. Improvements were seen after implementation.
We have developed a quality audit tool that monitors chemotherapy prescribing practices. Our project has enabled us to put in place quality control measures that reduces the risk of off-protocol prescribing. Benchmarking against other health services is recommended to understand the extent of dose variations.