Background/objectives Several centres (Children’s Hospital Philadelphia, Sick Kids Toronto) and organisations (COG) have developed chemotherapy standardisation programmes to reduce risk, increase efficiency and decrease cost associated with the presciption, preparation and administration of chemotherapy in paediatric patients.
Most European paediatric chemotherapy protocols use different doses, infusion times, hydration protocols and supportive medicine doses for the same drugs. There is huge variety in how individual patients receive the same drugs. This introduces significant, unnecessary, potential risks and complexity.
By 2016 our aim is that all children at our institution should have chemotherapy prescribed, prepared and administered according to a standard institutional protocol.
Design/methods We set up a multi-disciplinary chemotherapy standardisation group within our department. The project was developed in association with a hospital quality initiative. We reviewed all treatment protocols in use at the current time at OLCH and assessed the variety in chemotherapy administration. We performed staff and parental questionnaires regarding their perceptions of the variety in administration, supportive medicines and discharge times.
We held a meeting of all senior departmental management to review and critique the project and multiple staff education sessions to implement the recommended changes.
Results There is huge variation in how European protocols mandate that chemotherapy be administered, particularly in protocols using doxorubicin, cisplatin, ifosfamide and cyclophosphamide.
We have developed a standard, institutional document which determines how chemotherapy and supportive medicines are administered, limiting variation and risk, increasing staff efficiency and decreasing lengths of hospital admissions.
Conclusion There is unnecessary variation in the way chemotherapy is administered to paediatric patients in Europe. Doses should not be changed, but length of chemotherapy infusion and associated hydration/supportive medicines are extremely varied and there is little evidence to say this is beneficial in terms of patient outcomes. Chemotherapy protocols can be standardised, limiting variation, reducing potential risk and increasing staff and ward efficiencies.
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