1. A Journey to Improve Oncology Care Via A Focus on Quality, Safety, Improved Use
of Technology, and Implementation of an Oncology Pharmacy Team
Katherine Hanger, Pharm.D., BCOP, Caron Sue, Pharm.D., Ph.D., Lisa Altenau, Pharm.D., David
Burgas, Pharm.D., BCPS, Jonathan Egel, Pharm.D., Timothy Onady, Pharm.D., Michelle Wiest,
Pharm.D., BCPS, FASHP
University of Cincinnati Medical Center, Cincinnati, Ohio
Consequences of chemotherapy-related errors can be devastating and potentially fatal. Several
organizations have published guidelines to improve the safety and quality of cancer care. In 2011, we
began a comprehensive analysis of our oncology program which revealed program-wide deficiencies in
safety and quality. We developed an integrated, decentralized oncology pharmacy service line (DHON)
to optimize care through improved use of technology, generation of data-driven quality metrics, and
development of an integrated oncology pharmacy practice model.
The team was comprised of three clinical staff pharmacists (CSP), one electronic medical record (EMR)
pharmacist, and an oncology pharmacy coordinator. Together, this team undertook the following
challenges: 1) provide clinical and operational pharmacy support, 2) centralize preparation of
hazardous drugs, 3) design, implement, and optimize an integrated ambulatory and inpatient EMR
with oncology-specific functionality, 4) standardize oncology treatment plans, 5) operationalize
barcode medication administration (BCMA), 6) redesign institutional chemotherapy processes to
increase safety and efficiency, and 7) generate an oncology pharmacy quality dashboard.
Since the team’s inception, the cancer center has achieved 100% compliance with documentation of
consent prior to treatment with chemotherapy. Outpatient infusion areas consistently exceed their
95% goal for BCMA. The cancer center has made improvements in 79 of 175 (45%) standards for the
2012 Institute for Safe Medication Practices International Medication Safety Self-Assessment® for
Oncology and is now fully compliant with 85% of the standards. Since implementation of the new
EMR, the mean number of errors in drug name, dosing, and/or frequency per 100 chemotherapy
orders has decreased from 22.9 to 2.0 (p < 0.001). EMR enhancements have facilitated workflow,
increased reporting opportunities, and improved documentation within the medical record. Increased
efficiency has allowed DHON to expand its scope of service to include transitional care services,
weekend and holiday coverage, increased involvement in formulary management, and focused efforts
in medication safety and quality improvement initiatives. Through visibility of service and
demonstration of impact, we have worked with leadership to expand our team and support three new
clinical pharmacy specialist positions and multiple oncology CSP positions.
DHON is an innovative team structure that aligns clinical and operational initiatives to optimize
teamwork and outcomes. We emphasize shared ownership of vision, processes, and outcomes. Faced
with limited resources, we generated creative and collaborative solutions for common problems. DHON

2. has become a pillar in the development, growth, and pursuit of excellence for oncology care at our
institution.