Maintenance of Certification (MOC) Part 4 Initiative
The following institutions have been slected for the Home Medication Education Pilot Project:
Providence Alaska Medical Center
Mercy Children's Cancer and Hematology, St. Louis
University of Texas Health Science Center at San Antonio
St. Joseph's Children's Hospital
Aflac Cancer and Blood Disorders Center of Children
Texas Children's Cancer and Hematology Centers, Baylor College of Medicine
Patient adherence is a crucial factor contributing to the efficacy of a therapeutic regimen (Kondryn. Lancet Oncol. 2011). Despite the dangerous nature of missed and/or incorrect home medication administration, 50%-55% of chronically ill pediatric patients are non-adherent (Malla. World J Psychiatry. 2013). Key Medications are therapeutics used to treat, control, and prevent disease in hematology, oncology, and bone marrow transplant patients. Comprehensive parental education of Key Medications at hospital discharge is an important component of medication compliance. Adequate home medication education must include instruction on: the storage, handling, preparation, administration, and disposal of key medications; concurrent treatment and supportive care medications/measures (when applicable); possible drug/drug and drug/food interactions; and the plan for missed doses. These recommendations are based on guidelines found in the 2013 American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Safety Standards (Neuss. J Oncol Pract. 2013).
Purpose: This initiative will be an ASPHO sponsored, multi-institutional, quality improvement project to increase home medication education compliance for Key Medications at hospital discharge. The home medication education will be for all hematology, oncology, and bone marrow transplant discharged from the hospital on Key Medications.
Global Aim: To improve the safety of pediatric patients being treated for pediatric hematology, oncology, and bone marrow transplant conditions.
Project AIM: To increase the percentage of patients that receive adequate home Key Medication instruction to > 90% in a 3 month period of time.
Patient Population: All pediatric hematology, oncology, and bone marrow transplant patients discharged from the hospital on Key Medications.
Outcome Definition: The outcome measurement for adequate home medication education upon discharge is based on the 2013 American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Safety Standards. Adequate home medication education must include instruction on:
- The storage, handling, preparation, administration, and disposal of Key Medication.
- Concurrent treatment and supportive care medications (when applicable)
- Possible drug/drug and drug/food interactions 4. Plan for missed doses.
Measurement: One must deliver all education components to receive credit for compliance (all-or-none measurement).
Sampling strategy: Compliance will be collected and analyzed on a weekly basis through run charts.
Baseline data: Baseline data of the compliance with the four components of the Key Medication education bundle, noted above within Outcomes Definition.
Process mapping: Individual institutions will map out their current process of delivering the components of the education bundle.
Identification of barriers: Barriers will be evaluated and addressed on at each local center. Failure mode effect analysis procedures will be utilized. We expect variability between centers, and that these barriers will be addressed in the initial PDSA testing.
Interventions: Interventions will be determined at each institution after thorough analysis of their education delivery system.
Key Driver Diagrams: Individual centers will utilize Key Driver Diagrams to describe the various interventions they utilize to build and sustain improvement.
Quality Improvement Education: Education on the Model of Improvement will be given to all participants. Training includes the use of Key Driver Diagrams, PDSA cycles, project charts, and the use of run charts and control charts. The Project Leader for this initiative has advanced training in quality improvement, and will help guide the local leaders in understanding the steps in the Model of Improvement.
We are interested in piloting a multi-centered, ASPHO sponsored, MOC-4 QI project. This pilot study would include 6 institutions: two small (1-3 attendings), two medium (4-10 attendings), and two large (>10 attendings) institutions that are interested in participating. Institutions for this pilot study will be selected based on:
- Previous quality improvement experience
- Divisional leadership approval
- Acceptance of the time commitment that will be required
- Existing framework of quality improvement team
During the pilot phase, the Physician Local Leaders will:
- The collection, attestation, and reporting mechanisms will be done in collaboration with ASPHO and shared during the Training phase
- Create a process map to understand the current microsystem processes
- Obtain baseline data
- Create a Key Driver Diagram o If you do not have access to a Key Driver Diagram template, one will be provided to you
- dentify barriers to care
- Complete of a Failure Mode and Effect Analysis (or other in depth evaluation of the current process)
- Perform Plan-Do-Study-Act testing on the process
- Create run charts o If you do not have access to a run chart, a template will be provided to you
- Oversee project implementation
- Sign off on pediatrician attestations for MOC-4 credit
- Submit a completed key driver diagram and monthly QI charts to the QI Project Leader which will be submitted to ASPHO.
During the pilot study, we will collect data on the time commitment and responsibilities of the local physician leaders, QI project leader, and the ASPHO staff. This step will require additional time each week. These data will be used to further develop ASPHO’s MOC-4/Quality Improvement work. We will conduct weekly phone conference calls for the first month and biweekly thereafter to identify and address unforeseen barriers.
Benefits to Site
- Improve compliance with home medication education
- Receive additional training in quality improvement
- Maintenance of Certification 4 credit for physicians participating in the project
Program Eligibility Requirements
- Local project leaders must have some quality improvement which includes use of control/run charts and key driver diagrams
- Must have approval from the institute division head
- As this is a pilot study, there will be additional measurements obtained from the local team leaders. Measurements will include measurements of time and resource utilization for the project
- Local Weekly telephone conference calls through the first month of the project, then biweekly for the second two weeks
ASPHO Support Services
- Conference call organizer and host
- Training facilitator
- Distributor of education materials
- Data collection repository
- Selected sites will be notified beginning of November
- This pilot project will run approximately 3 – 4 months
- Please complete the “Home Medication Adherence Pilot Study Application” online form.
- This pilot is limited to 6 sites
Application is now closed.