Clinical audit to assess delays in chemotherapy administration at daycare oncology center at a tertiary care hospital in Karachi, Pakistan

Aim: There were delays reported by patients in chemotherapy administration in daycare oncology. Therefore, we decided to audit all processes which are involved in chemotherapy administration. The objective was to improve our service by decreasing the time between admission and initiation of chemotherapy and identify the reasons for delays. Materials and Methods: The audit was conducted in three parts. In Review I, audit tool was developed and information documented of 109 patients receiving chemotherapy at daycare center from April 14 to May 13, 2015. Five processes were assessed out of which delay in initial assessment by the nurse was the only factor identified leading to delay in chemotherapy. Review II was done from March 1 to 31, 2016 of 208 patients after increasing the number of nurses and Review III from June 7 to August 25, 2016 of 287 patients by dividing the initial assessment process at two different areas to decrease delay in initial assessment. Results: Seventy-two percent of patients had their initial assessment done within 15 min of arrival in daycare in the first audit. In the second part of audit this percentage decreased to 55%, and finally, in the third part of the audit, percentage was improved and increased to 75% after separating initial assessment process into two areas (P \u3c 0.001, Kruskal-Wallis test). Conclusion: After separating initial assessment process into two different areas, delays in chemotherapy administration were reduced

Diagnostic Value of Gauze Filtration Technique: A Comparison with Conventional Methods in a Diagnostic Laboratory in Pakistan

Background: Intestinal parasites cause significant morbidity and impact human development with an enormous global burden. Diagnosis of intestinal parasites by conventional methods has several limitations. The gauze filtration technique is a relatively simple method that has been shown to identify intestinal parasites with a high sensitivity and specificity. The aim of this study was to determine the diagnostic value of this technique as compared to more conventional methods in a large acclaimed laboratory within Pakistan. Methods: A total of 50 stool samples collected for routine diagnostic workup from patients age between 2-70 years were collected from the parasitology section of the Aga Khan University Hospital Clinical Laboratory. A direct wet mount, sedimentation technique, and gauze filtration technique were performed on all of the stool samples, and the sensitivity, specificity, negative predictive value, and positive predictive value were analyzed. Results: It was observed that the number of organisms observed by gauze filtration as compared to direct wet mount and sedimentation technique was higher for B. hominis, G. lamblia cysts and trophozoites, and I. bütschlii. Also, the detection rate was significantly higher for B. hominis and G. lamblia cysts using the gauze filtration technique. The sensitivity and specificity of the gauze filtration technique were found to be 95.8% and 100%, respectively. Conclusion: There is a significantly better stool sample parasite detection rate using the gauze filtration technique as compared to the conventional sedimentation techniques. The utility of the gauze filtration technique seems economically and technically feasible for diagnostic laboratories in resource-limited settings

Audit on incidents and knowledge of nurses regarding chemotherapy extravasations at day care oncology of a tertiary care hospital in Karachi, Pakistan

Purpose: Extravasations of cytotoxic agents after intravenous administration results in serious damage to the tissues leading to local injury and tissue necrosis. Worldwide incidence of extravasation ranges from 0.1% – 6%. Patient education, early identification and management can reduce morbidity associated with chemotherapy extravasation.Method: This audit was conducted at day care oncology of Aga Khan University Hospital to assess the knowledge of nursing staff regarding identification, management and teaching to the patients about of chemotherapy extravasations before and after teaching (intervention) sessions. These sessions were conducted monthly, for a year (July 2016 till June 2017). We also recorded incidents of extravasation reported before (February till June 2016) and after (July till November 2017) intervention.Results: A total of twelve nurses were audited before and after the intervention. Their mean age was 36.08 years ±3.35 (range 32-42 years). They had median 5 years’ (range 1-13 years) experience at Daycare Oncology. Overall, 63% and 96% had demonstrated and answered the steps of identification and management correctly in audit before and after intervention respectively (P\u3c0.001). Incidence of chemotherapy extravasation was 0.128% (7/5461) and 0.054% (3/5546) before and after intervention. In total, vinorelbine was the most common drug associated with such incidence (50%). Most had grade II reaction (50%) and history of chemotherapy (70%) was the most common risk factor.Conclusion: Our hospital based incidence of chemotherapy extravasation is comparable to international data. This may be reduced further by improving knowledge of nurses regarding prevention, prompt identification, management and education of patients