Establishment of an efficient workflow for the administration of radium-223 dichloride

Objectives Radium 223 dichloride was approved by the FDA in May, 2013 for the treatment of patients with castration-resistant prostate cancer with metastasis to the bone. This treatment is administered in 6 cycles, 4 weeks apart and requires complete blood count(CBC)labs before each cycle. A workflow to easily schedule, track treatment cycles and CBC labs is necessary for successful administration of this radiotherapy. The objective is how we dealt with obstacles specific to this treatment that were rarely encountered in a nuclear medicine department.

Methods First, physician authorized users determined that CBC labs should be drawn within 7 days of each therapy. A contact person was designated to coordinate efforts between the hematology/radiation oncology staff who order the treatments and nuclear medicine. Communication between departments is vital to insure CBC labs are drawn in sync with treatment dates. The contact person is also responsible for contacting patients to schedule treatments, submitting intake forms to Xofigo Access Services and ordering doses on a weekly basis. We developed a spreadsheet to assist in tracking patient treatment cycles which is updated and shared weekly with our treatment team. Appointment and CBC lab reminder cards, QMP, written directive, CBC criteria checklist and patient instruction forms were created for this treatment. Subsequent treatment dates are scheduled with the patient the day of their therapy administration and they are given their reminder cards.

Results In the 6 months since ra-223 dichloride received FDA approval for treatment, we've enrolled 31 patients into this therapeutic process. In this timeframe we've scheduled 95 treatments and administered 91 of them on time following our workflow. That's a success rate of 96%.

Conclusions Coordinating between departments, patients and dosage delivery to assure efficient use of this radiotherapy can be challenging to a large institution. Appointing a contact person, treatment cycle spreadsheet, reminder cards and communication with patients are vital to successfully treating patients with radium-223 dichloride.