Cancer patients are at risk for harm due to the nature of their illness and the treatment and delivery of the care. High-quality cancer care requires timely and safe treatment, or the results can be devastating. The following strategies are essential to enhancing patient safety and mitigating risk.
Ensure Medication Safety
Because chemotherapeutic agents have narrow therapeutic ranges and are toxic even in the correct doses, meticulous attention to detail in calculations and administration is required. Errors with these types of agents can have dire consequences. The following strategies can help:
- Thoroughly train staff members who administer chemotherapy and document evidence of training.
- Develop standardized preprinted medication order forms (paper or electronic) in order to eliminate dosing errors, the omission of critical set elements, and errors in sequencing and intervals.
- Never permit verbal orders to initiate or modify oncolytic therapy.
- Use a standard, routine method to calculate drug doses.
- Organize the medical record in a way that makes it easy for staff to confirm that all prerequisites have been met.
Track Lab Tests and Imaging Results
While careful tracking of lab tests and imaging results is important in all settings, lost results can mean lost time for cancer patients.
- Rather than maintaining a system in your office that depends on passively waiting for test results or a return appointment, implement a system that alerts you if a result or report is not received so that prompt follow-up can occur.
- When your office receives a panic value or abnormal test result, be certain you have an established process for immediate patient notification and that actions are documented.
Document Review of Test and Imaging Results
Handling test results is a critical task that is often cited in allegations against physicians who practice office-based care.
- Do not file paper reports, tests, or correspondence of a clinical nature without the provider’s initials or signature and the date verifying that he or she reviewed the document.
- Sign off electronically on all results that come directly to the electronic health record.
- Follow a defined process for reviewing results that come in while the provider is away from the office to avoid any delay in addressing results of an urgent nature.
Partner with the Pathologist
- Ensure there is a defined and reliable process in place for ordering pathology tests, collecting samples, and transporting samples to the testing facility.
- Provide the pathologist with adequate clinical information when a biopsy is requested.
- In cases where the histology is sharply at odds with the clinical impression, call it to the pathologist’s attention and ask to have the slides reviewed.
Partner with the Radiologist
- Provide the radiologist with adequate clinical information to assist in determining the best treatment plan, including any comorbidities or medications that may impact the radiation therapy.
- Partner with the radiologist to effectively manage radiation side effects and monitor skin care, nutrition, and hydration.
Avoid Allegations of Delay in Diagnosis and/or Treatment
- Do not defer important tests because a patient is concerned about costs. If the patient refuses a test after being advised of its need and importance, document the patient’s refusal in the medical record.
- Use definitive diagnostic techniques and know the limitations of the tests ordered.
- Timely referrals for challenges in diagnosis and treatment are cost effective and medically appropriate.
- An established test and diagnostic tracking system will ensure that results are received in a timely manner and that patient follow-up is initiated. An effective process will reduce the likelihood of missed reports while reducing patient harm, improving quality, and avoiding a liability claim.
Develop a Culture of Safety
Cancer care is complex and, at times, hazardous work that requires attention to detail to maintain safety during care delivery for both patients and providers. The Agency for Healthcare Research and Quality has identified key elements in establishing a culture of safety:
- Acknowledge the high-risk nature of the organization’s activities and resolve to consistently achieve safe operations.
- Cultivate an environment that encourages reporting of adverse events and near misses without fear of reprimand or punishment.
- Encourage collaboration across ranks and disciplines to pursue solutions to safety problems.
- Commit resources to address safety concerns.
Establishing a fair and just culture is also important. While a culture of safety embraces human fallibility, it does not dismiss clinician and staff accountability entirely—such as in cases involving a reckless or willful disregard of policies and procedures. In a culture of safety, most human errors are addressed through coaching or counseling or through an emphasis on system issues that mitigate the risk of a similar error.
Creating a safe oncology environment is everyone’s responsibility. When the care team works together, it can create a safety culture that enhances the quality of care for oncology patients, decreases adverse events for patients and staff, and integrates a reporting system so that events and opportunities for improvement can be identified and studied.
ECRI Institute PSO Deep Dive: Safe Ambulatory Care, Strategies for Patient Safety and Risk Reduction, 2019. https://www.ecri.org/landing-ambulatory-care-deep-dive
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.