Because oral chemotherapy agents are administered by the patient at home without direct supervision from a nurse, patients often call with questions and concerns about their medications. Seeking to prevent lost time and patient confusion, Robin Esposito, RN, BSN, OCN®, undertook a project aimed at improving communication and education regarding oral chemotherapy agents for patients in ambulatory care settings. In this interview with i3 Health, Ms. Esposito discusses the implementation and results of her project, which she presented at the Oncology Nursing Society (ONS) 44th Annual Congress in Anaheim, California.
What led you to undertake this project?
Robin Esposito, RN, BSN, OCN®: I saw a gap in communication. There was a high volume of phone calls to the nursing staff from patients being prescribed oral oncolytics, and the main questions were the same. This led me to wonder why. Was the information not told to them when they were in the doctor's office? Most likely it was, but patients are often overwhelmed when being told of a new health concern or a new treatment, and they do not absorb all of the information given to them. This is normal. How could we fix it? That question led to my desire to make a simple handout to clarify the process of procuring oral medication and to remind patients of some safe handling tips.
Can you describe the intervention that you implemented?
Ms. Esposito: Working collaboratively with the nursing staff, administration, and our own pharmacy team, we devised a small, two-sided patient communication handout. In order to keep the process non–labor-intensive for the physician, we only included three blank spaces for the physician to write the name of the medication, how it is being prescribed, and the specific office phone number to call with concerns. The rest is streamlined and standardized. It explains how we internally verify the appropriateness of the medication and dosing, find the most cost-effective mail order specialty pharmacy that can fill the prescription, and verify insurance and medication assistance options. In addition, the handout explains how our internal pharmacy handles calling the patient to educate them and inform them of the medication status. The back of the form also reviews safe handling and a few other tips, along with a direct phone number to our outpatient pharmacy, which handles this process.
Once approved, this tool was sent to marketing. It is currently being used in six of our 10 ambulatory care sites.
What was the response from patients and staff concerning the new communication tool?
Ms. Esposito: Anecdotally, patients noted that it helped to clarify and serve as a reminder of what they had been told. Staff members felt that it was very helpful, but they had a few recommendations for use in case we update it in the future.
Is there anything in particular that it took to implement this project that other organizations would need to keep in mind if they were to attempt something similar?
Ms. Esposito: You have to put yourself in the shoes of the patient. Think like you would think if you were in their situation. Many members of the health team are lucky not to have experienced a similar situation, but I have. Both your common sense and your knowledge go out the window when you are under stress. Handouts that are written in medical jargon aren't successful.
What are some key takeaways from this process that you could share with other oncology nurses?
Ms. Esposito: If you see something that could be improved in your area of practice, you CAN make a change! I am lucky that my organization is extremely supportive of nurse-driven process improvement projects. It only takes one idea to make a difference.
About Ms. Esposito
Robin Esposito, RN, BSN, OCN®, has been an oncology infusion nurse since 2007 with Yale New Haven Hospital Smilow Cancer Care Centers. She is a member of Yale's Shared Governance Oncology Cluster and a member of the Magnet Committee. Her inspiration to work in oncology was her mother's own battle with cancer, which she fought bravely until last year. Outside of work, Ms. Esposito has been a volunteer and/or committee member with her local American Cancer Society's Relay for Life for 13 years.Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily represent the views of i3 Health.