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Date Available
8-5-2026
Year of Publication
2026
Document Type
DNP Project
Degree Name
Doctor of Nursing Practice
College
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Department/School/Program
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Faculty
Dr. Debra Hampton
Committee Member
Dr. Holly Chitwood
Faculty
Dr. Jodie Dunkelberger
Abstract
Background
Adult patients initiating systemic cancer therapy frequently present with pre-existing polypharmacy related to chronic comorbidities and cancer-related symptom management. The addition of anticancer therapies and supportive care medications further increases medication burden and the risk of medication-related harm. Although national organizations and institutional policies recommend comprehensive medication review before treatment initiation, implementation remains inconsistent in ambulatory oncology practice.
Purpose
To implement and evaluate a standardized Advanced Practice Provider (APP)-led multidisciplinary medication review and reconciliation process designed to identify medication medication-related safety risks before initiation of systemic cancer therapy in adult oncology patients receiving care in an ambulatory infusion center.
Methods
This quality improvement project implemented a standardized, APP-led multidisciplinary medication review and reconciliation process for adults with solid tumors initiating standard-of-care systemic therapy in an ambulatory infusion center. Guided by the Iowa Model Revised, the intervention was integrated into the existing Cycle 1, Day 1 infusion workflow. Outcome measures included medication burden, medication discrepancies, clinically significant drug–drug interactions, therapeutic duplication, medication nonadherence, untreated or inadequately managed comorbid conditions, and medication reconciliation needs.
Results
Twenty adult patients initiating standard-of-care systemic cancer therapy were included. All participants met the definition of baseline polypharmacy, with a mean baseline medication burden of 14.5 medications. Medication discrepancies were identified in 95% of patients, clinically significant potential drug-drug interactions in 45%, supportive medication confusion in 25%, and inappropriately treated comorbid conditions in 30%. Patients required a mean of 3.1 medication reconciliations and were prescribed a mean of 2.1 supportive care medications during treatment initiation.
Conclusions
Standardizing an APP-led multidisciplinary medication review and reconciliation process within the existing Cycle 1, Day 1 ambulatory infusion workflow was feasible and identified clinically significant medication-related safety risks before systemic therapy initiation. These findings support establishing clear role accountability and standardized implementation of comprehensive medication review and reconciliation in ambulatory oncology practice to enhance medication safety.
Recommended Citation
Hines, Sarah R., "Implementing a Standardized APP-Led Multidisciplinary Medication Review and Reconciliation to Improve Medication Safety Before Systemic Cancer Therapy: An Ambulatory Oncology Quality Improvement Initiative" (2026). DNP Projects. 523.
https://uknowledge.uky.edu/dnp_etds/523
Included in
Oncology Commons, Other Pharmacy and Pharmaceutical Sciences Commons, Patient Safety Commons
