A recent study conducted at Memorial Cancer Institute in Pembroke Pines, Florida, and presented in a poster session at the 2023 ASCO Quality Care Symposium analyzed the cause of excessive alarm rates from ambulatory chemotherapy infusion pumps and evaluated the results of a quality improvement model designed to facilitate safe delivery of chemotherapy drugs. 

Computerized ambulatory infusion pumps are an important component of an outpatient cancer program and are necessary for delivering a therapeutic dose of chemotherapy for patients with cancer. Alarms generated from ambulatory pumps can result in interruptions in the delivery of doses, disruptions in clinical workflows, and patient dissatisfaction. Between April and July 2021, the center observed an excessive 60% ambulatory pump alarm rate as reported by the cancer center hotline. A team comprising frontline nurses, pharmacists, nurse leaders, and quality specialists was formed to address concerns over the safe and consistent delivery of chemotherapy to patients.

Implementing a plan-do-study-act model, the multidisciplinary team analyzed 6 months of alarm data and employed various quality tools to identify the root cause of the alarms. Their research found that 49% of alarms that could not be resolved, leading to interruptions in chemotherapy infusions as planned. There was also a high percentage of hotline calls resulting from the “No Disposable” alarm code, making up 70% of the cases.

In response to these findings, a collaborative effort between the research group and the vendor led to the recommendation and subsequent implementation of a more advanced replacement model in June/July 2022. The results of the improvement measure were encouraging: Between July 2022 and December 2022, the instances of medication variances related to “No Disposable” saw a 100% improvement, signifying a significant improvement in uninterrupted chemotherapy delivery. Additionally, the hotline nurse reported that out of a total of 34 calls received, 91% (31/34) were successfully resolved. Most notably, there were no reported instances of interruptions in chemotherapy drug delivery for ambulatory patients during the study period.

The authors of the study pointed to the multidisciplinary quality improvement program as being instrumental in improving the safety of chemotherapy drug delivery with ambulatory infusion pumps and in instilling a higher degree of confidence in the medical professionals involved, including infusion nurses, pharmacists, and medical providers.

Mackrell M, King K, Doliny P. Improving ambulatory infusion drug delivery through alarm management using a quality improvement model and team learning. Presented at: the 2023 ASCO Quality Care Symposium; October 27-28, 2023; Boston, MA, and virtual; Abstract 472)