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Addressing issues in patient safety.

© Journal of the National Comprehensive Cancer Network | Volume 5 Number 4 | April 2007 Addressing Issues in Patient Safety Patient safety has long been recognized as an integral component of quality medical care. In the past decade, the spotlight on safety has only become brighter, with the publication of reports such as the Institute of Medicine’s To Err is Human in 2000 and the growing attention to patient safety and medical error by the media. The stakes are especially high in oncology, and avoiding error is imperative in delivering chemotherapy. Because safety is central to the delivery of high-quality oncology care, representatives from the National Comprehensive Cancer Network (NCCN) member institutions convened in October of 2006 for the 2nd Annual NCCN Patient Safety Summit to share best practices and discuss ongoing challenges in the delivery of safe cancer care. The Summit was hosted by NCCN member Memorial Sloan-Kettering Cancer Center in New York City. Physicians, nurses, pharmacists, cancer center directors, and quality and safety administrators participated in the Summit, which focused on safe chemotherapy delivery and how NCCN member institutions are tackling safety issues as they relate to new developments in cancer treatment. Discussions ranged from the implementation of computerized ordering systems to the growing availability and use of oral chemotherapeutic agents. Several themes and lessons emerged from the wide-ranging discussions. First, safety is not the responsibility of one person or specialty but is a multidisciplinary concern. Programs that impact safety must be implemented with buy-in from individuals across the care spectrum. Second, communication is imperative to delivering safe care, whether the communication is between various electronic ordering and pharmacy systems for chemotherapeutics or between a physician and retail pharmacist treating a patient with an oral chemotherapeutic agent. Lastly, making a strong investment in safety can directly impact a cancer center’s bottom line. Safety programs can be tied to quality indicators and payor incentives. An environment that focuses on patient safety can create a financial benefit by reducing a health system’s direct liability and insurance premiums. Nearly two thirds of NCCN member institutions are investing in safety by adopting electronic systems for order entry. Regardless of the vendor or system chosen for computerized physician order entry (CPOE), the cancer centers have faced similar triumphs and challenges. CPOE completely replaces handwritten orders, which present ample opportunities for error. These systems have with interfaces that, in some cases, display relevant laboratory values and interrupt with a “red flag” when an order is unexpected, illogical, or inappropriate. Lawrence Shulman, MD, Chief Medical Officer and Senior Vice President for Medical Affairs at the Dana-Farber Cancer Institute, part of Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center in Boston, Massachusetts, gave a keynote speech on oncology CPOE implementation. Dr. Shulman stressed the need for a multidisciplinary team and high-level support in bringing a CPOE system to life. CPOE among the Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center community has evolved from a first-generation system, pioneered by the Brigham & Women’s Hospital in 1994, to a second-generation system implemented not only at the central hospitals but also in a satellite affiliate practice. Dr. Shulman Jennifer Hinkel, MSc