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Annual Report - 2007-2008 - Cancer Care Cycle

Annual Report - Winter 2009

Momentum in Patient Care and Safety

Profile: Progress in Cancer Care at MD Anderson Is a Given
Profile: Nurse’s Dissertation Provides Scaffolding for Symptom Management
Ethics, Compliance Key in Clinical Trials
Critical Care Medicine — Automated Tools Help Understand Who Should Receive Intensive Care
Joint Commission Survey a Success
MD Anderson Nurses Make Good Catches
Gaining Ground with Tools and Tests – Infection Control

Progress in Cancer Care at MD Anderson Is a Given

Faculty Leader Addresses the 'How' of Patient Care


By Erika Hargrove
Thomas Feeley, M.D.

The foresight of our leaders, zeal of our researchers and compassion of our clinicians guarantees it.

The question for Thomas Feeley, M.D., is not “if” we will progress but “how.” How will we continue to deliver the quality of care our patients deserve in this changing world?

A man of many hats, Feeley wears them all in an effort to find the answer.

He holds two titles: vice president for medical operations and head of the Division of Anesthesiology and Critical Care. Since joining MD Anderson in 1997, he has led a series of efforts that focus on process improvement — the how of getting things done.

The Institute for Cancer Care Excellence is the latest process improvement project under his leadership. Its charge is to study how the cancer care cycle — prevention, intervention and survivorship — is impacted by tests and new treatments, patient safety, information technology, and the need for improved efficiency and reduced cost. It also promises to have the most far-reaching effect of any program he has worked on.

Feeley says that the institute is an additional imperative effort. “If we don’t work on the ‘how’ of cancer care, there is the potential that disparities will worsen, and there will not be equal access to optimal cancer treatment.”

“When it comes to cancer care the predominant focus has been on working toward the cure. The motivation behind the institute is to evaluate all the ways we are addressing the delivery of cancer care in its broadest sense. It should be safe, timely, efficient, effective, equitable and patient-centered,” he says.

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Nurse’s Dissertation Provides Scaffolding for Symptom Management

By Julie Penne

Anecita Fadol, Ph.D.

When it comes to patient care and safety, MD Anderson takes a multidisciplinary approach — from considering the ethical and compliance issues of clinical trials to encouraging nurses to identify and correct potential patient safety errors; from careful consideration of who most benefits from critical care to innovative discoveries for infection control.

As an advanced practice nurse in the Department of Cardiology, Anecita Fadol, Ph.D., considers herself a bridge, caring for patients who are diagnosed with both cancer and heart disease.

But as a nurse researcher, she also is a bridge builder, having helped design the first symptom assessment tool that provides a stronger scaffolding for decision making in the prevention and treatment of heart failure in cancer patients.

Fadol’s tool, which originated as the topic of her doctoral dissertation, is being adapted for study with an interactive telephone response system so patients can directly, frequently and conveniently report their experiences with the most common symptoms of cancer and heart failure.

The automated system will phone about 144 study patients every other day, prompting them to gauge their experiences with fatigue, nausea, shortness of breath, numbness or tingling, pain, drowsiness and other symptoms. In addition, the survey asks questions regarding conditions related directly to heart failure, such as ankle swelling, palpitations, nighttime cough and weight gain. With each prompt, patients rate their recent experience by pressing their telephone keypad from home.

Though the survey is automated, Fadol says it is only the day-to-day data that is gathered through electronic means. If a patient presses a number for a symptom that surpasses a set threshold, a cardiology nurse is alerted for immediate personal followup.

“When the system alerts us about a patient’s response, we call those patients immediately and provide not just a clinical consultation, but also the comfort they often need,” says Fadol. “With this followup call, we can make a more accurate determination of how to best care for patients, whether bringing them to the Emergency Center or monitoring them at home.” 

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Ethics, Compliance Key in Clinical Trials

To enhance the understanding of federal regulations related to clinical cancer research and to better protect patients who participate in clinical trials, MD Anderson hosted the Ethics and Compliance in Oncology Research conference in April 2008. This first-of-its-kind event focused primarily on cancer research to explore complex issues faced when conducting clinical trials of potential new therapies involving cancer patients. Topics discussed included conducting ethical Phase I studies; issues in oncology research design; clinical trial contracts; conflict-of-interest management; tissue and data repositories; and expanded access programs.

“On a national level, we felt it was very important to bring together academics, ethicists, industry sponsors, institutional review board professionals and government regulators to discuss how we can optimize safety for patients in a rapidly changing environment,” says Maurie Markman, M.D., vice president for clinical research, who co-chaired the conference.

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Critical Care Medicine — Automated Tools Help Understand Who Should Receive Intensive Care

MD Anderson researchers have created and validated an automated tool that could help evaluate the severity of patients’ illnesses in the intensive care unit and determine which ones will benefit from continued intensive care. To accomplish this, they have modified the Sequential Organ Failure Assessment (SOFA), which is a good indicator of the severity of illness in the critically ill and shows a significant correlation with mortality.

The modified SOFA score performs satisfactorily, can be calculated electronically at the bedside of the patient and has the potential to save time and resources. “This and similar scores could be used outside the intensive care environment and in particular for critical care outreach programs such as rapid response teams (RRT). Smart alerts generated by the scores could be used to trigger a visit by an RRT or to call the responsible physician,” says Joseph Nates, M.D., lead author and professor in the Department of Critical Care.

Reported in the December 2007 supplement to Critical Care Medicine.

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Joint Commission Survey a Success

Continuing a long tradition of focusing on safe, comprehensive care for patients, MD Anderson again received accreditation from the Joint Commission, following a five-day visit by a team of surveyors. Since 1951, MD Anderson has been consistently accredited by this independent, not-for-profit organization that accredits and certifies more than 15,000 health care institutions and programs in the United States. Held every three years, the survey includes close observation of a range of quality, safety, patient care and support practices.

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M. D. Anderson Nurses Make Good Catches

Through its Good Catch Program, the Division of Nursing encourages inpatient unit nurses to report potential patient safety errors that they identify and correct as part of their daily practice. Reporting such instances allows for analysis of systems and factors that may contribute to errors. The program — which is becoming a national model for development of similar systems — shifts emphasis from the negative implication of “near miss” or “close call” to focus positively on nurses’ actions to identify and prevent potential errors with medications, equipment and patient care. “We’re trying to create a fair and supportive culture in which nursing staff feel empowered to identify opportunities to improve patient safety and eliminate any fear of reporting,” says Barbara Summers, Ph.D., vice president and chief nursing officer.

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Infection Control – Beyond Vascular Catheters

An antiseptic dye combination developed by MD Anderson investigators and already proven effective as a coating for medical devices, such as vascular catheters and other implants, has been shown to be useful in preventing the adherence of bacteria and fungi to medical gloves. In addition, anti-infective urinary catheters coated with these antiseptic dyes were found superior to other U.S. Food and Drug Administration-approved antimicrobial urinary catheters in both in vitro and rabbit models.

Reported at the 2008 annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy/Infectious Disease Society of America.

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© 2014 The University of Texas MD Anderson Cancer Center