Background

After the oncology unit at Sunnyside Medical Center in the Northwest had problems with incorrect chemotherapy dosages, the department's unit-based team decided something needed to change. Using the plan, do, study, act method, the UBT cooked up new procedures that appear to have corrected the problem.

To arrive at the correct dosage, the nursing staff must calculate the patient's body surface area using a complicated formula that involves converting kilograms to pounds and centimeters to feet and inches. The dosage is then dispensed over several sessions. In some instances, the team found that inaccurate measurements were resulting in initial doses that were under or over the correct amount—although in all cases, patients received the appropriate total dosage.

To eliminate the risk that the dosing per chemotherapy session might not be corrected, the new procedure has two members of the nursing staff independently measuring and weighing the patients. They compare the calculations, sign off on the results and double-check with the patient that the measurements are accurate.

Biggest challenge

"Communication," said Parmenter. "It's hard to find a communication system that really works when almost everybody in the unit is doing direct patient care."

Side benefit

The UBT also came up with a policy for dealing with inaccurate dosages. At the advice of a physician liaison, they've decided to proactively alert the patient. The nurses have found that patients appreciate the information. In one instance, "Our nurse explained the situation and the whole process we are using to correct the errors," Parmenter said. "It went really, really well. It was nice step to take."