Medication Reconciliation in Ambulatory Cancer Care

Lead: Celina Dara

Background:  Medication errors and drug interactions are common and can lead to serious side effects and hospitalizations.  Having an up to date and complete list of medications can help avoid these issues. While there has been a lot of work to implement processes for medication reconciliation (MedRec) in hospitalized patients, this work has not extended to the outpatient setting where patients receive complex care spanning multiple providers and many medications.

Objectives:

  • Undertake an environmental scan consisting of semi-structured interview to understand current MedRec practices at cancer centres across Canada (complete)
  • Development and pilot testing of a standardized MedRec process in ambulatory clinics (complete)
  • Develop a MedRec strategy to be implemented in the virtual care environment (underway)

Choosing Wisely Oncology

Lead: Vishal Kukreti

Background:  Unnecessary tests, treatments, and procedures require significant time and resources, potentially expose patients to harm and contribute to unnecessary stress for patients and their families. While significant effort and resources have gone into the development of the Choosing Wisely Campaign, it is unclear if the recommendations have been optimally implemented into clinical practice.

Objectives:

  • Conduct a scoping review of the literature to determine the uptake of the Choosing Wisely recommendations in cancer care (complete)
  • Implement recommendations that are cross cutting rather than discipline specific at Princess Margaret Cancer Centre (planned)

Impact of COVID on Quality of Cancer Care

Lead: Melanie Powis

Background:  The disruption of health services due to the coronavirus disease (COVID) pandemic is expected to dramatically alter cancer care. Numerous guidelines and consensus statements have been published to guide the reduction of in-person visits, and mitigate resource shortage issues; however, the extent to which cancer care has been modified in practice, and the implications for care quality and outcomes remain poorly understood.

Objectives:

  • Undertake a scoping review of the literature to understand how cancer treatment has been modified globally as a result of the COVID pandemic (complete)
  • Create a conceptual map of the inter-relationships between global care modifications and potential downstream impacts (complete)
  • Generate a database to characterize and compare patterns of cancer care delivery at Princess Margaret during the peri-COVID-19 period, relative to the same period in the year prior (underway)
  • Administer a survey to patients to understand the impact of COVID-19 on their experience with cancer care (underway)

International Quality and Research Exchange – Oncology (INQUIRE-ONC)

Lead: Alyssa Macedo

Background:  There is substantial interest in the practice of quality measurement and improvement at cancer centres across the Globe.  The Princess Margaret Cancer Centre has existing relationships with several international cancer centres which to date has focused on education and research initiatives.  Some centres have expressed interest in expanding the collaboration to include the area of healthcare quality.  We have recently began holding monthly virtual seminars on quality related topics’ 

Objectives:

  • To develop a network of international collaborators interested in quality and safety in oncology with a focus on peer mentorship, collaboration and quality innovation.

New Oncology Early Warning System

Leads:
Dr. Auro Viswabandya and Dr. Jenna Spring
Victoria Glinsky

Background: The NEWS2 scoring system aims to track the degree of deviation of multiple vital sign measures in order to calculate a weighted aggregate score. Predetermined thresholds and clinical response guides are then used to inform nursing and medical staff when to escalate for further assessment.

Objectives:

  • Provide clear guidance for when to escalate to the appropriate medical professional, to ensure deteriorating patients on inpatient oncology units are identified and treated in a timely fashion through the use of the NEWS2 scoring system.

Celina Dara

Bio coming soon

Publications:

  1. Bacopoulos AJ, Ho L, Yang A, Ng P, Dara C, Loach D, Deotare U, Michelis FV, Viswabandya A, Kim DD, Lipton JH, Messner HA, Thyagu S. Safety of two-hour intermittent intravenous infusions of tacrolimus in the allogeneic hematopoietic stem cell transplantation unit. J Oncol Pharm Pract. 2021 Jan;27(1):33-39.
  2. Ng P, Incekol D, Lee R, Paisley E, Dara C, Brandle I, Kaufman M, Chen C, Trudel S, Tiedemann R, Reece D, Kukreti V. Tolerability of Velcade (Bortezomib) subcutaneous administration using a maximum volume of 3 mL per injection site. J Oncol Pharm Pract. 2015 Aug;21(4):285-92.

Dr. Vishal Kukreti MD FRCPC

Bio coming soon

Publications:

  1. Pardhan A, Vu K, Gallo-Hershberg D, Forbes L, Gavura S, Kukreti V. Evolving Best Practice for Take-Home Cancer Drugs. JCO Oncol Pract. 2020 Oct 20:OP2000448. doi: 10.1200/OP.20.00448.
  2. Moradian S, Krzyzanowska M, Maguire R, Kukreti V, Amir E, Morita PP, Liu G, Howell D. Feasibility randomised controlled trial of remote symptom chemotherapy toxicity monitoring using the Canadian adapted Advanced Symptom Management System (ASyMS-Can): a study protocol. BMJ Open. 2020 Jun 17;10(6):e035648.
  3. Grant RC, Moineddin R, Yao Z, Powis M, Kukreti V, Krzyzanowska MK. Development and Validation of a Score to Predict Acute Care Use After Initiation of Systemic Therapy for Cancer. JAMA Netw Open. 2019 Oct 2;2(10):e1912823.

Melanie Powis MSc RAQC PhD Student

Melanie Powis is a toxicologist and health services researcher.  She completed her Master of Science in Pharmacology (specialization: molecular toxicology) from the University of Toronto.  She is currently completing her PhD in Health Services Research- Outcomes and Evaluation in the Institute for Health Policy, Management and Evaluation at the University of Toronto.  Her research focuses on designing and evaluating interventions to address the high rates of acute care utilization due to treatment-related toxicities in the cancer patient population.

Publications:

  1. Howell D, Powis M, Kirkby R, Amernic H, Moody L, Bryant-Lukosius D, O’Brien MA, Rask S, Krzyzanowska M. Improving the quality of self-management support in ambulatory cancer care: a mixed-method study of organisational and clinician readiness, barriers and enablers for tailoring of implementation strategies to multisites. BMJ Qual Saf. 2021 Mar 16:bmjqs-2020-012051.
  2. Phillips C, Deal K, Powis M, Singh S, Dharmakulaseelan L, Naik H, Dobriyal A, Alavi N, Krzyzanowska MK. Evaluating Patients’ Perception of the Risk of Acute Care Visits During Systemic Therapy for Cancer. JCO Oncol Pract. 2020 Jul;16(7):e622-e629.
  3. Powis M, Sutradhar R, Gonzalez A, Enright KA, Taback NA, Booth CM, Trudeau M, Krzyzanowska MK. Establishing achievable benchmarks for quality improvement in systemic therapy for early-stage breast cancer. Cancer. 2017 Oct 1;123(19):3772-3780.

Alyssa Macedo MSc OT

Alyssa is the Quality Project Manager for the Department of Medical Oncology and Hematology and Princess Margaret Cancer Centre. She has a Master of Science in Occupational Therapy (OT) from Brunel University in the UK, a Bachelor of Science in OT from the University of Toronto as well as a Bachelor of Science, Honors Biochemistry from McMaster University. Alyssa has practiced as an OT at the University Health Network (UHN) and in the UK.

Publications:

  1. Elliott M, Macedo A, Escaf M. Building Resilience within Institutions Together with Employees (BRITE): Preliminary experience with implementation in an academic cancer centre. Healthc Manage Forum. 2021 Mar;34(2):107-114.
  2. Li M, Sanders C, Lee CH, Gascon B, Macedo A, Molloy S, Laframboise S, Leung YW. Symptom screening for constipation in oncology: getting to the bottom of the matter. Support Care Cancer. 2019 Jul;27(7):2463-2470.
  3. Li M, Macedo A, Crawford S, Bagha S, Leung YW, Zimmermann C, Fitzgerald B, Wyatt M, Stuart-McEwan T, Rodin G. Easier Said Than Done: Keys to Successful Implementation of the Distress Assessment and Response Tool (DART) Program. J Oncol Pract. 2016 May;12(5):e513-26.

Dr. Auro Viswabandya MD DM FRCP FRCPC

Bio coming soon

Publications:

  1. Law AD, Bhella S, Pasic I, Lam W, Michelis FV, Gerbitz A, Viswabandya A, Kumar R, Lipton JH, Mattsson J, Kim DDH. Moderate-severe grade of chronic graft versus host disease and younger age (less than 45 years old) are risk factors for avascular necrosis in adult patients undergoing allogeneic hematopoietic cell transplantation. Ann Hematol. 2021 Mar 12.
  2. Pasic I, Alanazi W, Dranitsaris G, Lieberman L, Viswabandya A, Kim DDH, Lipton JH, Michelis FV. Subcutaneous immunoglobulin in allogeneic hematopoietic cell transplant patients: A prospective study of feasibility, safety, and healthcare resource use. Hematol Oncol Stem Cell Ther. 2021 Feb 23:S1658-3876(21)00001-7.
  3. Al-Shaibani E, Cyriac S, Chen S, Lipton JH, Kim DD, Viswabandya A, Kumar R, Lam W, Law A, Al-Shaibani Z, Gerbitz A, Pasic I, Mattsson J, Michelis FV. Comparison of the Prognostic Ability of the HCT-CI, the Modified EBMT, and the EBMT-ADT Pre-transplant Risk Scores for Acute Leukemia. Clin Lymphoma Myeloma Leuk. 2021 Feb 3:S2152-2650(21)00039-2.