Interventions to optimize the use of colony-stimulating factors

Presentation Notes

2014 ASCO Quality Care Symposium; General Poster Session B: Cost, Value, and Policy in Quality and Practice of Quality


Background: The Food and Drug Administration approved granulocyte colony-stimulating factors filgrastim (fil) and pegfilgrastim (peg) for use in the prevention of chemotherapy-induced neutropenia. The objective of this study was to characterize and optimize the current utilization of these costly colony-stimulating factors within a tertiary care health system.

Methods: Data parameters and improvement measures were defined based on the current literature, national guidelines and institutional standards. Data was collected retrospectively by chart review and analyzed to develop interventions that would optimize fil/peg utilization. Existing policies and procedures were updated, and feedback and approval was obtained through collaborative groups. Improvement measurements will be reassessed post implementation of the proposed interventions.

Results: Chart review yielded 156 fil/peg orders. The following observations and interventions were applied. All indications were determined appropriate per established oncology guidelines; however, 3 patients received an unwarranted fil/peg dose within a week of peg administration. An electronic alert was created to prevent administration of an additional fil dose if a recent peg dose had been administered. Of inpatient fil orders (n=38), 24% of weight-based dose rounding and 32% of predetermined discontinuation parameters were not compliant with the institutional standards. Fill electronic order entries were modified to automatically round doses based on patient weight. If an additional one-time absolute neutrophil count (ANC) discontinuation parameter was applied, it is anticipated that fil treatment duration could decrease in 30% of patients. The one-time ANC discontinuation parameter for fil was added.

Conclusions: Although our system’s utilization of colony-stimulating factors was in compliance with national guidelines and institutional standards, opportunities for optimization were identified and targeted for improvement.

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