Charles Nock, MD

At the beginning of the COVID-19 pandemic, the Hematology Oncology Department at VANEOHS looked for ways to continue safe oncologic care delivery while limiting unnecessary in-person visits for our Veterans. The Hematology Oncology team considered extending the interval between maintenance flushes for implanted ports, however wanted to confirm the change aligned with safe practice recommendations. A literature review supported changing the medical center’s current practice of maintenance flushing from every four to six weeks to every twelve weeks. The literature review suggested that this change was safe and effective. Our goal was to ensure this change in practice did not cause an increase in alteplase usage or an increase in port related complications such as infection. A pre-intervention data review from August 1, 2019 to February 2, 2020 (n = 217) showed that 8 orders (4%) were placed for alteplase for oncology patients receiving maintenance port flushes and there were no implanted port infections reported during that timeframe. Interventions included: updating the implanted port order set in Computerized Patient Record System (CPRS) and providing education to Veterans and nurses regarding the change. A post-intervention data review from August 1, 2020 to February 28, 2021 (n = 94) demonstrated that 2 orders (2%) were placed for alteplase for oncology patients receiving maintenance port flushes and there were no implanted port infections reported during that timeframe. This trial confirmed that an implanted port flush maintenance schedule of up to twelve weeks aligned with safe practice recommendations and did not increase port related complications. Due to the positive outcome of implementing an extended interval between maintenance port flushes the medic

At the beginning of the COVID-19 pandemic, the Hematology Oncology Department at VANEOHS looked for ways to continue safe oncologic care delivery while limiting unnecessary in-person visits for our Veterans. The Hematology Oncology team considered extending the interval between maintenance flushes for implanted ports, however wanted to confirm the change aligned with safe practice recommendations. A literature review supported changing the medical center’s current practice of maintenance flushing from every four to six weeks to every twelve weeks. The literature review suggested that this change was safe and effective. Our goal was to ensure this change in practice did not cause an increase in alteplase usage or an increase in port related complications such as infection. A pre-intervention data review from August 1, 2019 to February 2, 2020 (n = 217) showed that 8 orders (4%) were placed for alteplase for oncology patients receiving maintenance port flushes and there were no implanted port infections reported during that timeframe. Interventions included: updating the implanted port order set in Computerized Patient Record System (CPRS) and providing education to Veterans and nurses regarding the change. A post-intervention data review from August 1, 2020 to February 28, 2021 (n = 94) demonstrated that 2 orders (2%) were placed for alteplase for oncology patients receiving maintenance port flushes and there were no implanted port infections reported during that timeframe. This trial confirmed that an implanted port flush maintenance schedule of up to twelve weeks aligned with safe practice recommendations and did not increase port related complications. Due to the positive outcome of implementing an extended interval between maintenance port flushes the medic

At the beginning of the COVID-19 pandemic, the Hematology Oncology Department at VANEOHS looked for ways to continue safe oncologic care delivery while limiting unnecessary in-person visits for our Veterans. The Hematology Oncology team considered extending the interval between maintenance flushes for implanted ports, however wanted to confirm the change aligned with safe practice recommendations. A literature review supported changing the medical center’s current practice of maintenance flushing from every four to six weeks to every twelve weeks. The literature review suggested that this change was safe and effective. Our goal was to ensure this change in practice did not cause an increase in alteplase usage or an increase in port related complications such as infection. A pre-intervention data review from August 1, 2019 to February 2, 2020 (n = 217) showed that 8 orders (4%) were placed for alteplase for oncology patients receiving maintenance port flushes and there were no implanted port infections reported during that timeframe. Interventions included: updating the implanted port order set in Computerized Patient Record System (CPRS) and providing education to Veterans and nurses regarding the change. A post-intervention data review from August 1, 2020 to February 28, 2021 (n = 94) demonstrated that 2 orders (2%) were placed for alteplase for oncology patients receiving maintenance port flushes and there were no implanted port infections reported during that timeframe. This trial confirmed that an implanted port flush maintenance schedule of up to twelve weeks aligned with safe practice recommendations and did not increase port related complications. Due to the positive outcome of implementing an extended interval between maintenance port flushes the medic

BACKGROUND: Platinum-based chemotherapy is very effective in treating a variety of cancer types however, it has the potential to cause dose limiting ototoxicity that may result in permanent hearing loss. Studies have shown that hearing loss can affect quality of life by interfering with relationships and degrading communication. Early detection of hearing loss assists the oncologist in determining drug dosing and selecting the appropriate treatment regimens. It also allows the audiologist the opportunity for early intervention with rehabilitative measures. At our facility, Veterans starting cisplatin did not consistently have an audiology consult placed or a baseline audiogram completed prior to initiating treatment. A literature review was conducted, and an interdisciplinary team was formed with key stakeholders from medical oncology, audiology, pharmacy, and nursing.

RESULTS: The initial data review from January 1, 2016 to August 8, 2018 (n=85) showed only 17 Veterans (20%) had an audiology consult placed prior to initiating treatment. The target timeframe determined by the audiology department for baseline audiogram completion was eight weeks prior to or up to 24 hours post initial cisplatin administration. Following these guidelines, only seven (8%) of the 17 audiology consults were placed and completed within the recommended timeframe. Our goal was to increase the number of Veterans receiving audiograms prior to cisplatin administration from 8% to 100% by January 1, 2020.

INTERVENTIONS: enhanced provider education for early identification of Veterans starting cisplatin, creation of an email group for increased communication between nursing and audiology, trialing a portable audiometer in the outpatient infusion clinic, and adding a quick order set to the audiology consult on all cisplatin templates. A post-intervention data review from January 1, 2020 to April 30, 2020 (n=17) demonstrated all 17 (100%) Veterans had an audiology consult placed prior to the first dose of cisplatin. The data review also showed that 17 out of 17 Veterans (100%) had an audiogram completed within the target timeframe. This quality improvement project is aimed at maintaining quality of life for our Veterans throughout their cancer journey.

BACKGROUND: Platinum-based chemotherapy is very effective in treating a variety of cancer types however, it has the potential to cause dose limiting ototoxicity that may result in permanent hearing loss. Studies have shown that hearing loss can affect quality of life by interfering with relationships and degrading communication. Early detection of hearing loss assists the oncologist in determining drug dosing and selecting the appropriate treatment regimens. It also allows the audiologist the opportunity for early intervention with rehabilitative measures. At our facility, Veterans starting cisplatin did not consistently have an audiology consult placed or a baseline audiogram completed prior to initiating treatment. A literature review was conducted, and an interdisciplinary team was formed with key stakeholders from medical oncology, audiology, pharmacy, and nursing.

RESULTS: The initial data review from January 1, 2016 to August 8, 2018 (n=85) showed only 17 Veterans (20%) had an audiology consult placed prior to initiating treatment. The target timeframe determined by the audiology department for baseline audiogram completion was eight weeks prior to or up to 24 hours post initial cisplatin administration. Following these guidelines, only seven (8%) of the 17 audiology consults were placed and completed within the recommended timeframe. Our goal was to increase the number of Veterans receiving audiograms prior to cisplatin administration from 8% to 100% by January 1, 2020.

INTERVENTIONS: enhanced provider education for early identification of Veterans starting cisplatin, creation of an email group for increased communication between nursing and audiology, trialing a portable audiometer in the outpatient infusion clinic, and adding a quick order set to the audiology consult on all cisplatin templates. A post-intervention data review from January 1, 2020 to April 30, 2020 (n=17) demonstrated all 17 (100%) Veterans had an audiology consult placed prior to the first dose of cisplatin. The data review also showed that 17 out of 17 Veterans (100%) had an audiogram completed within the target timeframe. This quality improvement project is aimed at maintaining quality of life for our Veterans throughout their cancer journey.

BACKGROUND: Platinum-based chemotherapy is very effective in treating a variety of cancer types however, it has the potential to cause dose limiting ototoxicity that may result in permanent hearing loss. Studies have shown that hearing loss can affect quality of life by interfering with relationships and degrading communication. Early detection of hearing loss assists the oncologist in determining drug dosing and selecting the appropriate treatment regimens. It also allows the audiologist the opportunity for early intervention with rehabilitative measures. At our facility, Veterans starting cisplatin did not consistently have an audiology consult placed or a baseline audiogram completed prior to initiating treatment. A literature review was conducted, and an interdisciplinary team was formed with key stakeholders from medical oncology, audiology, pharmacy, and nursing.

RESULTS: The initial data review from January 1, 2016 to August 8, 2018 (n=85) showed only 17 Veterans (20%) had an audiology consult placed prior to initiating treatment. The target timeframe determined by the audiology department for baseline audiogram completion was eight weeks prior to or up to 24 hours post initial cisplatin administration. Following these guidelines, only seven (8%) of the 17 audiology consults were placed and completed within the recommended timeframe. Our goal was to increase the number of Veterans receiving audiograms prior to cisplatin administration from 8% to 100% by January 1, 2020.

INTERVENTIONS: enhanced provider education for early identification of Veterans starting cisplatin, creation of an email group for increased communication between nursing and audiology, trialing a portable audiometer in the outpatient infusion clinic, and adding a quick order set to the audiology consult on all cisplatin templates. A post-intervention data review from January 1, 2020 to April 30, 2020 (n=17) demonstrated all 17 (100%) Veterans had an audiology consult placed prior to the first dose of cisplatin. The data review also showed that 17 out of 17 Veterans (100%) had an audiogram completed within the target timeframe. This quality improvement project is aimed at maintaining quality of life for our Veterans throughout their cancer journey.