Six months ago, patients at the Dr. H. Bliss Murphy Cancer Centre often had a three-hour wait for their chemotherapy treatments. This was stressful not only to patients, but also to nursing and pharmacy staff. All that has changed. Today, we are proud to say that when a patient sits in the chemotherapy chair and is ready for treatment, his/her treatment drug is ready and waiting.
How did we decrease this wait time?
Our journey began in June 2013 when Rick Abbott, our oncology pharmacy manager, told us we were successful in getting an Eastern Health Lighthouse Grant for Innovation to carry out a quality improvement project in the pharmacy chemotherapy preparation room. Our goal was simple: “to prepare the right drug, for the right patient, at the right time and at a reasonable pace” – but not easy to achieve.
The Lighthouse Grant allowed us to engage an external consultant that specializes in human factors, HumanEra, to look at our working patterns and to introduce new safety techniques. We also partnered with Eastern Health’s LEAN experts to improve the way we work. We were undertaking a new project, and we were feeling hesitant and somewhat apprehensive about what it all meant.
Preparing – or mixing – one chemotherapy drug takes approximately 25 steps. It includes handling hazardous materials, working in enclosed and sterilized environments, and wearing personal protective equipment such as masks and gowns. It is a highly precise and methodical process that involves varying degrees of complexity and strict safety checks.
We are large team, consisting of 12 chemotherapy pharmacy technicians and 12 clinical oncology pharmacists. The human factors and lean experts embedded themselves into our work routine, asking us about our processes, and what we would change – given the opportunity. What surprised me most is that we were never told what to do – rather, through coaching, we were forced to open our minds, to think outside the box and come up with our own solutions.
“Much of my job is to coach and ask the questions that may not get asked,” says Dean MacIsaac, manager of process improvement with Management Engineering Services at Eastern Health. Dean points that bringing in a different perspective can often mean new insights for change. “The people side is where the magic really happens. A company is its people, and any change is the result of their daily decisions.”
So, as part of the process, I shadowed a nurse at the Dr. H Bliss Murphy Cancer Centre. I was with the nurse when she received the chemotherapy drugs, and I was with her when she began to administer them. I saw the pain and fear in the patient’s eyes when the nurse described the side effects the patient would soon experience, and suddenly realized: the stress in our chemotherapy room was meaningless compared to the stress patients experience as they fight for their lives! Patients are depending on our team to be there for them – that was my motivation for change – my “ah-ha” moment during this process.
To effect change and improve patient care, we:
- engaged front-line staff,
- used trial-and-error methods, and
- worked together with nursing staff.
Every patient is different, and depending on his/her diagnosis and treatment, a patient may for example require five drugs during a one-day treatment session. In the past, we would ‘mix’ all five drugs at once, even though the patient only needed one, or two, at any given point. Multiply this by 10 patients and you’ll realize how quickly we would fall behind!
Every idea and suggestion was considered, tested and measured for its worth. What worked was kept, and what didn’t work was modified or disregarded. Outcomes were documented and communicated back to the team. As a result, the physical layout of the chemotherapy preparation room was altered; a chart on the wall showing patients’ schedules and providing visual cues was introduced; and weekly staff meetings set up – these elements continue to play a vital role in our success.
Most important of all – now we mix only the drug the patient needs at the time he/she needs it, and slot other drugs for mixing before they are due. In short, following a chronological time schedule meant shorter wait times for patients.
We had naturally – and collectively – adopted a new and improved practice.
“Before the new approach, you never had a sense of accomplishment until the whole day was complete,” pharmacy technician Ryan Lethbridge says. “Now, with our new method of doing things, we reach our goals every hour. We have a daily game plan that is clearly identified for everyone to see and understand.”
Natalie Lethbridge, pharmacy technician, adds: “It feels great to know that our patients are getting their chemotherapy on time, that shouldn’t be something they need to worry about.” Through this process, we improved safety, efficiency and patient care. We didn’t increase our resources – we invested in our people, and what started as a proposed evolution in our chemotherapy practice turned into a revolution of a new era, a transformation of culture that supports excellence in patient care.
A sense of pride has replaced our sense of stress. Our way of thinking had to change and with everyone on the same page, the feeling of accomplished teamwork is obvious to anyone walking into the chemo room. Lynn Hartery, clinical oncology pharmacist, says: “Through hard and renewed focus on patient care we achieved shorter wait times for patients using one “mix” at a time. This is a monumental success. Equally as exciting is the new culture among our staff. We are more of a team than ever before, striving to reach new goals and always keeping our focus on patient care and safety.”
The Lighthouse Grants for Innovation
The Lighthouse Grants for Innovation were introduced in 2007 to support innovation and new approaches to the work within Eastern Health’s departments, programs, divisions, professional groups or teams. Innovation can be defined in any number of ways: the introduction of something new; a new idea, method or device; change that creates a new dimension of performance; or a new idea that needs to be implemented. Grants are awarded annually, during Recognition Week, to employees and departments of Eastern Health. To date, 46 grants have been awarded.
If you would like more information about the Lighthouse Grants for Innovation, please contact the Planning Department at (709) 777-8255. ■
This story was written by April Legrow, pharmacy technician with Eastern Health. Photography by Phil Simms, graphic designer with Eastern Health.