Decreasing Inappropriate Use of Rasburicase to Promote Cost-Effective Care

Komal K. Patel, Timothy J. Brown, Arjun Gupta, Taylor Roberts, Eileen Marley, Hsiao C. Li, Navid Sadeghi

Research output: Contribution to journalArticle

Abstract

BACKGROUND:: Rasburicase is a recommended treatment of tumor lysis syndrome and patients at high-risk for developing tumor lysis syndrome. Unfortunately, it is expensive, and unnecessary use raises costs of care. METHODS:: Plan, Do, Study, Act methodology was used to decrease the inappropriate use of rasburicase. In the Plan phase, a multidisciplinary quality improvement team reviewed the rasburicase ordering process and its prescription patterns at Parkland Health and Hospital System between October 2015 and September 2017 to determine appropriate interventions for improvement. In the Do phase, interventions were deployed to improve rasburicase prescriptions. In the Study phase, the team reviewed the rasburicase orders and appropriateness from February 2018 to October 2018. During the Act phase, the interventions were found to be successful, and the process changes were solidified. RESULTS:: At baseline, 65 doses of rasburicase were administered during the 2-year baseline period, 21 of these (32.3%) were inappropriate. Review of the ordering process identified pitfalls: one-click ready-to-sign order, fixed default dose, no hard-stop alert requiring physicians to review and confirm appropriate indications, and lack of secondary pharmacy review. We aimed to reduce the percentage of inappropriate rasburicase orders from a baseline of 32.3% to 10% over 3 months. In February 2018, we implemented the interventions, which resulted in reduction in inappropriate rasburicase use, with only a single inappropriate order placed in 7 months postintervention. CONCLUSION:: A multidisciplinary approach and classic quality improvement methodology enabled us to reduce inappropriate rasburicase use. Straightforward electronic medical record interventions and secondary pharmacy review are effective in addressing overuse.

Original languageEnglish (US)
Pages (from-to)e178-e186
JournalJournal of oncology practice
Volume15
Issue number2
DOIs
StatePublished - Feb 1 2019

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Costs and Cost Analysis
Tumor Lysis Syndrome
Quality Improvement
Prescriptions
rasburicase
Electronic Health Records
Physicians
Health

ASJC Scopus subject areas

  • Oncology
  • Oncology(nursing)
  • Health Policy

Cite this

Decreasing Inappropriate Use of Rasburicase to Promote Cost-Effective Care. / Patel, Komal K.; Brown, Timothy J.; Gupta, Arjun; Roberts, Taylor; Marley, Eileen; Li, Hsiao C.; Sadeghi, Navid.

In: Journal of oncology practice, Vol. 15, No. 2, 01.02.2019, p. e178-e186.

Research output: Contribution to journalArticle

Patel, Komal K. ; Brown, Timothy J. ; Gupta, Arjun ; Roberts, Taylor ; Marley, Eileen ; Li, Hsiao C. ; Sadeghi, Navid. / Decreasing Inappropriate Use of Rasburicase to Promote Cost-Effective Care. In: Journal of oncology practice. 2019 ; Vol. 15, No. 2. pp. e178-e186.
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abstract = "BACKGROUND:: Rasburicase is a recommended treatment of tumor lysis syndrome and patients at high-risk for developing tumor lysis syndrome. Unfortunately, it is expensive, and unnecessary use raises costs of care. METHODS:: Plan, Do, Study, Act methodology was used to decrease the inappropriate use of rasburicase. In the Plan phase, a multidisciplinary quality improvement team reviewed the rasburicase ordering process and its prescription patterns at Parkland Health and Hospital System between October 2015 and September 2017 to determine appropriate interventions for improvement. In the Do phase, interventions were deployed to improve rasburicase prescriptions. In the Study phase, the team reviewed the rasburicase orders and appropriateness from February 2018 to October 2018. During the Act phase, the interventions were found to be successful, and the process changes were solidified. RESULTS:: At baseline, 65 doses of rasburicase were administered during the 2-year baseline period, 21 of these (32.3{\%}) were inappropriate. Review of the ordering process identified pitfalls: one-click ready-to-sign order, fixed default dose, no hard-stop alert requiring physicians to review and confirm appropriate indications, and lack of secondary pharmacy review. We aimed to reduce the percentage of inappropriate rasburicase orders from a baseline of 32.3{\%} to 10{\%} over 3 months. In February 2018, we implemented the interventions, which resulted in reduction in inappropriate rasburicase use, with only a single inappropriate order placed in 7 months postintervention. CONCLUSION:: A multidisciplinary approach and classic quality improvement methodology enabled us to reduce inappropriate rasburicase use. Straightforward electronic medical record interventions and secondary pharmacy review are effective in addressing overuse.",
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