Table 3.
Selected Recommendations to Address High-Risk Failure Modes Affecting Five Oral Chemotherapies
| Recommendation | Source |
|---|---|
| Prescribing | |
| Create checklists to guide and remind clinicians about key elements required for patient education | Capecitabine/imatinib/temozolomide |
| Provide patients and families members with educational material about research protocol and call-in number for questions | Investigational agent |
| Provide patients and families with abbreviated protocol guide or roadmap | Investigational agent |
| Require study nurse to call patients and families shortly after starting protocol to review protocol and consent and ensure understanding | Investigational agent |
| Dedicate follow-up appointment specifically to medication education | 6-mercaptopurine |
| Dispensing | |
| Implement barcode scanning for dispensed medications | Capecitabine/imatinib/temozolomide |
| Provide patients with images of pills | Capecitabine/imatinib/temozolomide/investigational agent |
| Standardize clinician documentation of dose modifications to facilitate pharmacy verification | Capecitabine/imatinib/temozolomide/investigational agent |
| Standardize data entry in ambulatory pharmacy to avoid data entry errors | 6-mercaptopurine |
| Minimize number of dose forms and concentrations available in pharmacy | 6-mercaptopurine |
| Institute triple-check system for dispensing oral chemotherapies | Investigational agent/6-mercaptopurine |
| Administration, monitoring, and follow-up | |
| Provide patients with dosing calendars similar to those provided in clinical trials | Capecitabine/imatinib/temozolomide/6-mercaptopurine |
| Encourage use of automated reminder systems and prefilled pill boxes | Capecitabine/imatinib/temozolomide |
| Offer online educational and management tools for addressing adverse effects | Capecitabine/imatinib/temozolomide |
| Support safe home administration by reaching out to patients and families through nurse practitioner follow-up calls | Temozolomide |
| Encourage patients to bring in medication bottles to monitor adherence | 6-mercaptopurine |
| Identify specific clinic staff responsible for patient and family education about medications | 6-mercaptopurine |
| Provide oral chemotherapy travel kits to children whose parents are separated | 6-mercaptopurine |