Implementing Quality Initiatives for Myeloproliferative Neoplasms (MPNs)

Hello, I’m Neal Dave, PharmD. I’m an Area Manager, Texas Oncology. I also work with NCODA’s Positive Quality Initiatives, and serve on the US Oncology Collaborative Care Committee and the US Oncology Supportive Care Task Force.

I’d like to discuss the importance of implementing Quality Interventions, known as PQIs, in your practice. In addition, NCODA offers suggestions for PQIs available on their website.

First, it’s important to understand why patients with polycythemia vera or PV may benefit from a quality initiative. We implemented a PV Quality Initiative that allowed us to identify these patients, with the goal of improving patient outcomes.

First, it’s essential to incorporate a multidisciplinary approach from the start. We worked with our pharmacy staff, technicians, physicians, our Nursing Director, and our Director of Quality. The first step is to identify patients with a PV diagnosis and who may be treated with hydroxyurea.

Next, we counsel patients about hydroxyurea and how we’ll monitor red and white blood cells, and how they may need dosage adjustments. We tell them PV is a long-term disease. We can work with them to help manage the disease.

We identify patients who are coming in for treatment when they are due for refills. We check the EMR for lab values at that point and to see if everything is stable. When we see a hematocrit of 45% or higher, or an elevated white blood cell count, we’ll make a note to monitor that patient and alert the physician.

We also continue to monitor trends in lab values over subsequent refill visits, so if, for example, we see a patient with a persistently high hematocrit, we’ll also mention that to the physician.

We realized that because we had been routinely checking lab values already, implementing our Quality Initiative was simple. And our staff likes it because anyone who’s filling in at the pharmacy can also follow our Quality Initiative and it can be consistently recreated.

We’ve generally found that physicians really appreciate that we are another touchpoint on the labs, as we call them to their attention.

In fact, this Quality Initiative enhances the pharmacy relationship with physicians and nurses. It helps to get the pharmacy more involved in patient care, which is our common focus.

I recommend you first understand the goal of the Quality Initiative, which is to improve patient outcomes. Get buy-in from physicians, pharmacists, clinical staff, and management. And, document the steps of your Quality Initiative.

Our Quality Initiative streamlines our process for checking lab values to ensure quality clinical care for PV patients. This Quality Initiative can be simple and have a big impact, because in the end you're delivering better care more efficiently and can help patients achieve better outcomes.

Thank you.