Due to excessive patient wait times for first chemotherapy

infusions, Patterson Clinic is looking to reengineer its first-day therapy

process for treating cancer. This process starts when the patient

arrives at the facility the morning of the first IV chemotherapy

administration. Next, the physician orders the IV chemotherapy for the

patient. If the physician is on-site, the physician handwrites the

chemotherapy order for the patient the morning of arrival; otherwise

the physician faxes the chemotherapy order from the office to the

clinic. Once the chemotherapy order from the physician arrives, the

patient’s nurse evaluates the order against the protocol, and then a

second nurse performs another check following the same process.

After the nurses check the order, it is scanned to the pharmacy to

continue the process. After the pharmacy has received the order, the

pharmacist completes the first check and prints labels. Prior to

chemotherapy administration, the pharmacy uses a check system that

takes place three times to make sure the order is correct. Completion

of the third check cannot be finished until the patient’s lab results are

completed and verified by the staff. The pharmacy technician

proceeds with compounding the chemotherapy after the third check,

the pharmacist verifies the admixture, and the technician places the

chemotherapy into the infusion cabinet in the oncology unit. At this

time, the premedication’s can be started and the IV chemotherapy can


. Prepare a flow chart depicting the process for first-day

chemotherapy at the clinic.


. What are some initial opportunities for improvement of the first-day

chemotherapy process?