A Province- wide Patient Safety Innovation : : Longwoods. Cancer Care Ontario's Computerized Physician Order Entry System: A Province- wide Patient Safety Innovation Abstract.
More than one- third of all women and men in Canada will develop cancer during their lifetimes. Cancer patients typically require complex chemotherapy regimens, specific to their type and stage of disease, to slow or stop cancer cells from growing, multiplying, or spreading to other parts of the body. Despite the complexity of managing medication regimens for cancer patients and the associated risks to patient safety, current medical oncology practice throughout most of Canada is still to use paper- based tools, policies and procedures. To increase patient safety by reducing prescription errors and to offer clinical decision support to medical oncologists across the province, Cancer Care Ontario (CCO) developed and implemented Canada's first, cancer- specific computerized physician order entry (CPOE) system.
Healthcare Quarterly, 9(Sp) October 2006: 108-113.doi:10.12927/hcq.2006.18468 Using Information to Improve Safety. Cancer Care Ontario's Computerized Physician Order. Ontario Public Drug Programs Exceptional Access Program. The Exceptional Access Program (EAP) facilitates patient access to drugs not funded on the Ontario Drug.
This e- health innovation is currently in use in 1. CPOE implementation in Canada, with a 1. This paper describes the critical success factors in the design and implementation of CCO's CPOE system, including Web- based training and ease of administration to maximize physician adoption, incorporating point- of- care access to clinical practice guidelines into the tool, and the use of CPOE data to monitor and increase access to anti- cancer drugs and patient safety. Cancer Treatment: Prime Candidate for a CPOE Solution. When it comes to medication safety, few diseases pose as big a challenge as cancer.
Cancer encompasses over one hundred distinct diseases, and roughly half of all cancer patients will require chemotherapy in the course of treatment. A regimen of chemotherapy may be prescribed to destroy cancer cells, slow or control the growth and spread of a tumour, or relieve symptoms and improve a patient's quality of life. Chemotherapy is inherently toxic to cells and can cause a host of moderate to severe side effects. Since much of chemotherapy is infused intravenously, where the impact on the body is rapid and direct, there is little room for error, particularly in dosing. This is all the more important as cancer patients are likely to receive repeated infusions over time. To be both safe and effective, these regimens must be carefully tailored to the patient.
Pharmacy Smoking Cessation Program The Pharmacist’s Role in a Smoking Cessation System. Effective September 1, 2011 to Ontario Drug Benefit recipients. Watch videos from the BC Cancer Agency, an international leader in cancer research. The Oncology Services at QHC function in partnership with Cancer Care Ontario and works in collaboration with the Cancer Centre of South Eastern Ontario, the South. Health Care Improving For Cancer Patients In Mississauga Halton / Central West Regional Cancer Program New Report Shows Ongoing Progress.
Peel Regional Cancer Centre has shortest wait times for radiation treatment in Ontario July 22, 2011. Oncology Nursing Society (ONS) - Find your next career at Oncology Nursing Society Career Center. Check back frequently as new jobs are posted every day. In 2004, Cancer Care Ontario (CCO), the provincial agency responsible for cancer services in Ontario, changed its role from that of direct cancer service provision to.
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If a dose is too low, it will not be strong enough to attack cancer cells; if too high, it could prove intolerable or even fatal. Determining a safe and effective chemotherapy regimen is dependent on a patient's type of cancer; the size, spread and genetic expression of the tumour; the patient's age, body surface area (calculated from their height and weight), medication allergies and general health status; and other factors. Factors affecting the appropriateness of a given regimen include the intent of treatment (curative or palliative); the right medications; dosing schedule, and timing of treatment relative to surgery and radiation treatment; and the need for supporting medications to combat side effects. At the same time, the number of established and emerging drug therapies available to treat cancer is staggering. In 2. 00. 5, 4. 00 anti- cancer medications were under development (in clinical trials or awaiting FDA approval) in the US alone (Pharmaceutical Research and Manufacturers of America 2. This is two times the number of drugs that were under development in the US for mental illness, three times the number for heart and stroke, and five times the number for AIDS (ibid.). Worldwide, over 2,0.
National Institutes of Health 2. Over 2. 00 of these are for breast cancer alone (ibid.). For approved chemotherapy medications, over 3. Agency for Healthcare Research and Quality 2. For providers, staying on top of all of the available and emerging therapies, their precise indications and recommended dosing in the absence of clinical decision support is extremely challenging at best. Despite the complexity of prescribing and managing medication regimens for cancer patients, current medical oncology practice throughout most of Canada is still to use paper- based tools, policies and procedures.
Chemotherapy delivery occurs in outpatient settings by a multidisciplinary team of physicians, pharmacists and nurses. From the time a physician handwrites an order, the order gets interpreted, transcribed and dispensed by a pharmacist, and a nurse administers the chemotherapy at bedside, there is the potential for minor to severe adverse drug events to occur. It is well known that over 2. Canada are drug- or fluid- related (Baker et al.
There are no Canadian data to date on cancer- specific adverse events. However, in the US, it is estimated that 4% of all newly diagnosed cancer patients will experience some type of adverse event in the course of treatment, and that at least 2/3 of these are preventable (Dinning et al. In a recent study in the ambulatory chemotherapy setting at Dana- Farber Cancer Institute, Gandhi et al. The most common of these were in drug ordering, followed by administering and dispensing errors. In the same study, it was shown that chemotherapy- related errors were significantly more likely to be serious than non- chemotherapy- related medication errors (4. The ability of computerized physician order entry (CPOE) systems to prevent medication errors has been shown in primary care (Tamblyn et al. Kaushal et al. 2.
As with patient safety in general, there is little data specific to cancer on the benefits of CPOE systems. However, a recent study evaluating the impact of a Web- based dose calculator on reducing errors in pediatric intravenous infusions found an 8. Lehmann et al. 2.
Researchers at the same children's hospital found that CPOE implementation in the pediatric chemotherapy department resulted in a 7. Kim et al. 2. 00.
From a technical perspective, chemotherapy ordering is a very difficult process to automate. It involves a multitude of inputs, including the drugs themselves, drug- to- drug interactions, disease- to- drug interactions, dosing and scheduling, and the interface of these inputs with all the variables within a particular patient's profile. This unusual set of circumstances makes a cancer- specific approach to CPOE technology essential. More generic CPOE systems would simply not support the degree of functionality required. Cancer Care Ontario's CPOE strategy uniquely meets the challenges of cancer care. In 2. 00. 3, CCO surveyed 1. The key findings were as follows: Currently available versions of more generic hospital information systems cannot support the specific needs of computerized physician order entry for systemic therapy.
It is not feasible for individual hospitals to maintain common chemotherapy drug formulary and clinical decision support rules. Physicians and pharmacists will support a well- managed provincial system, tied to Cancer Care Ontario and its mandate to improve quality of cancer services. CCO has reconfirmed these findings on a regular basis over the past three years. Cancer Care Ontario's CPOE System: OPIS 2. In 1. 99. 6, Cancer Care Ontario (CCO), the Ontario government's principal advisor on cancer care, began the design and implementation of the first jurisdiction- wide, cancer- specific CPOE system. CCO's OPIS (Oncology Patient Information System) 2. To date, versions of the system have been implemented in 1.
This e- health innovation, with greater than 9. Canada. In addition to its role in improving patient safety, CCO's CPOE system is a critical component of the organization's clinical knowledge transfer and brokerage functions. As new clinical guidelines are developed and integrated within the clinical decision support components of OPIS 2.
On the basis of 1. CPOE system.[Figure 1]Figure 1 shows the current use of OPIS/OPIS 2.
Ontario. On the basis of a 2. Cancer Care Ontario survey of OPIS physician users, the vast majority of respondents said the system improved efficiency and safety and that they would be unwilling to practise without it: If you remove OPIS 2. Medical oncologist, Ottawa Hospital Regional Cancer Centre). The system is easy to use, and it has everything we need. Medical oncologist, Kingston Regional Cancer Centre)We have been trying to get our hospital administration to let us use OPIS 2.
Medical oncologist, Kingston Regional Cancer Centre)How do I get Grand River to be one of the first sites to implement OPIS 2. Glen Kearns, CIO, Grand River Regional Hospital)Of course, as with any clinical system, there are areas that require additional development, identification of issues and concerns by users and an upgrade of the technical infrastructure and platform. Building on its business model of stakeholder and expert input into improving the quality and accountability of cancer services in Ontario and its tight ties to the community of users, Cancer Care Ontario's CPOE strategy includes regular and active involvement of clinical and technology leaders in identifying, and prioritizing system improvements to meet evolving needs. Integrated Clinical Decision Support (CDS)Not only is the system tailored to medical oncology practice; it is also built to integrate with a facility's existing information management system. OPIS 2. 00. 5 is designed to interface with any facility's hospital information system (HIS) so that complete information in a patient's profile, including demographics, disease, allergies and medication history, is pulled up as the order is being placed, dispensed and administered. This being the case, the real- time clinical decision support features include: Cumulative dosing. This feature keeps track of chemotherapy medications that have a maximum cumulative dose that can be given to a patient in his or her lifetime and alerts the ordering clinician when this maximum is reached.
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Peel Regional Cancer Centre has shortest wait times for radiation treatment in Ontario(MISSISSAUGA) —The Carlo Fidani Peel Regional Cancer Centre (PRCC) at The Credit Valley Hospital (CVH) has achieved the shortest wait times for patients awaiting radiation treatment in the months of April and May 2. Cancer Care Ontario.
The PRCC, which has held the number two spot for the last six months, achieved a rating of 9. Entitled Ready to Treat to Treatment, these statistics measure the time from when a specialist is confident the patient is ready to begin treatment to the time the patient receives the treatment within a targeted time period, in this case 1. At the PRCC, 9. 9. The next closest centres on the list were the Sudbury Regional Hospital’s Cancer Program, and the Regional Cancer Care Northwest, each with a rate of 9. The results for June and July will be released later in August. PRCC has been working hard to improve the wait times for radiation treatment for our patients,” said Leslie Starr- Hemburrow, Patient Care Program Director, Cancer & Renal Programs, CVH. Our move into the top position reflects both our increased capacity due to the addition of a sixth linear accelerator (machine used in radiation treatment) and our attention to patient- centred care, with an increased focus on data quality, scheduling efficiency, and coordination ensuring timely access to the important radiation services our patients require.”“Our position in the top spot on this list is significant, because a large number of patients from this community still travel to the cancer centres in Toronto to receive treatment,” said Dr.
Sheldon Fine, Chief of Oncology, CVH, and Regional Vice President of Cancer Care Ontario. These results demonstrate that patients in this community can consistently receive prompt access to high quality care right here at home.”To view the Radiation Therapy Wait Times by Regional Cancer Centre, please visit www. Cancer Care Ontario is the provincial agency responsible for continually improving cancer services. As the government’s cancer advisor, Cancer Care Ontario works to reduce the number of people diagnosed with cancer, and make sure patients receive better care every step of the way.
The Credit Valley Hospital provides community- based patient and family- centred care to approximately one million people in Mississauga and the surrounding region. Our community hospital also has a teaching affiliation with The Academy of Medicine at the University of Toronto Mississauga. The Credit Valley Hospital has consistently achieved the highest awards from Accreditation Canada meeting national safety and patient care standards. The Credit Valley Hospital values excellence, leadership, diversity and partnership so that Together We Create Better Health Care.- 3. Media Contacts: Liz Leake.
Manager, Communication and Public Affairs The Credit Valley Hospital Tel: 9.