Source: www.nccn.org
Author: Megan Martin, Communications Manager

Recent media coverage surrounding treatment errors that have occurred in radiation therapy has only intensified discussions about the need to improve safety for patients with cancer.

Joseph Herman, MD, a radiation oncologist at The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins and a featured panelist at the upcoming NCCN 2010 Patient Safety Summit, recently spoke with NCCN about policies Hopkins has implemented to ensure the safety of their radiation therapy patients.

Radiation safety, an issue that has always received great attention at Hopkins, came to the forefront a few years ago as Hopkins was looking to develop a new program for high dose rate intraoperative radiation therapy (IORT) – delivered through brachytherapy – and discovered that there were no clear standard guidelines or quality indicators for how to develop such a program.

“Safety is of particular concern in this type of treatment because due to the high dose of radiation being emitted, clinicians cannot remain in the same room as the patient, a specific cause of anxiety for anesthesiologists,” said Dr. Herman.

Using a patient simulator, the team walked through a variety of practice scenarios, identified areas for concern, and developed strategies to address potential safety issues. For example, Hopkins now uses cameras to monitor patient vital signs in the room and also has pre-measured medications available that can be delivered via a pole from another room – basically a “long-distance” method of treatment.

Furthering their aim to identify points in the process where potential errors may arise, Hopkins constructed a map listing each person who is currently in contact the patient, from consultation to treatment to follow-up, and created nodes pinpointing where an error may occur. Each node was then assigned a score based on Failure Mode and Effect Analysis (FMEA). FMEA ranks any weak points using a calculation that is based on the frequency of the occurrence, the detectability, and the severity. Utilizing these scores, Stephanie Terezakis, MD, Eric Ford, PhD, and Peter Pronovost, MD, at Johns Hopkins Department of Radiation Oncology created a list of top-ranked failure modes and strategies to address issues within each node.

Another relatively simple, yet effective, tactic designed to eliminate giving radiation to the wrong part of a person’s body was also initiated several years ago. “Before treatment can commence, we circulate a diagram of the human body with the area receiving treatment clearly marked. This diagram must be acknowledged and signed off-on by each member of the treatment team,” Dr. Herman stated.

According to Dr. Herman, there have been no cases of the misadministration of therapy since Hopkins implemented this approach.

To reduce the risk of bringing up the incorrect treatment plan for a patient, perhaps due to the confusion of a common name, Hopkins instituted a card reading system. The system does not allow a treatment plan to be accessed until the team scans the patient’s individual barcode on his or her ID bracelet.

Although great strides have been made at Hopkins, Dr. Herman stressed that patient quality and safety is a continuous process.

For example, Dr. Herman recently conducted an informal poll of his staff to determine what they thought could be improved upon and what might have a significant impact on quality and patient safety. The overwhelming response was related to tumor contouring for radiation therapy planning. The staff felt that it was imperative that contours be as accurate as possible in order to avoid a ripple effect of erroneous decisions being made by physicists and other clinicians who use the contour as a point of reference. To address this issue, the Hopkins Radiation Oncology Department is developing formal checklists to further improve the quality of tumor contouring.

Dr. Herman emphasized the importance of forums such as the NCCN 2010 Patient Safety Summit for allowing his colleagues to gain a more in-depth understanding of the role of radiation oncologists and the complexity of the treatments.

“Sometimes there is the perception that radiation oncologists simply ‘press the button’ to deliver treatment, which certainly is not the case,” said Dr. Herman. “We often want to slow down the implementation process of treatment to ensure the safety of the treatment and utilize the best technology available. It’s vitally important that oncologists learn about radiation therapy and how to work with their colleagues to guarantee the safety of their patients.”

The NCCN 2010 Patient Safety Summit is being held on October 14, 2010 in Bethesda, MD and will address issues such as radiation safety, infection control, oral chemotherapeutics, and safety and accountability. Peter J. Pronovost, MD, PhD, ScD, will provide the keynote address.