Lexa Walsh, MD, MSPH, a Pediatric Oncologist at Phoenix Children’s Hospital talks about the CINV Dashboard and how its making a difference in patients’ lives.
Interview conducted by Ivanhoe Broadcast News in September 2019.
The idea of creating the dashboard came from you. How did that come about?
WALSH: I joined the faculty about two and a half years ago and I started taking care of patients on the floor. I have an interest in supportive care in oncology and so I was trying to update our protocol for anti emetics or medications for the prevention of nausea and vomiting. I was working with this one patient and she was getting very highly emetogenic chemotherapy and was having a lot of problems with it. So I had adjusted her regimen and it really was working well for her and then she came in the next time for her second cycle of chemotherapy and I just happened to see the dad in the hallway and he was crying. He said “I’m so upset. The first cycle of the treatment you adjusted worked great, but nobody knew what worked and she vomited the whole cycle again”. And so then I went to IT. I had something really simple in mind of an alert or something to notify us of the regimen that worked, and it kind of mushroomed into this bigger project, looking at nausea and vomiting for all of our patients.
Just helping this one little girl launched a whole project.
WALSH: Yes.
What kind of difference is it making?
WALSH: Well I’ve noticed a huge difference since we’ve started the dashboard. And right now we’re collecting data to get more numbers of how it’s actually helping. But I really feel like our providers are all really tuned to giving the appropriate anti emetic regimen. It’s not something that providers always thought of, I think, because it’s just in addition to all the complicated things that they’re doing all day. But we kind of take that responsibility away from them and there’s a group of us who review the dashboard every day, and make sure that the right combination of drugs is ordered. And I’ve noticed huge differences, it’s much rarer now that patients are struggling with nausea and vomiting their whole admission.
The part I like about it is the multiple input. If you could talk a little bit about the benefits of that.
WALSH: It’s been a whole process to try and figure out the best way because nobody had really done something like this. And I think it’s an example of something I think that’s really interesting. We have all this data of what we should do but it doesn’t get to the patient very often. And so that gap – we’re trying to close using this project, but I think it’s a good example of how we might be able to do that with other things too because we spend millions and millions of dollars trying to figure out what’s the best thing to do and then we just don’t do it for a number of different reasons. And it’s not often what you think. It’s not that the providers don’t want to do it, it’s just that they’ve forgotten. It’s as easy as just prompting them to do the right thing and then it gets done a lot more frequently.
Is this system complicated or is it easy? I know it has a lot of information for providers.
WALSH: Yeah. And not all providers look at it. There’s a core group of us to make sure we look at it every day, but it’s available as a resource for all providers. The families don’t have access to it yet, but that may be something in the future. But one thing that we’ve added more recently is a nausea scale actually so that nurses are asking the patients, how are you feeling? Are you feeling nauseous? So we’re not just relying on vomiting. So the dashboard is now collecting vomiting and nausea, which is a unique thing to do.
It gives the kids a little bit of power too.
WALSH: Exactly. And then there’s a feedback so the nurse has to call the doctor if it’s above a certain level so that the patients can get medications if they need them instead of just feeling miserable all day, it’s more of a direct contact.
And I would think that because it’s stressful for everybody, I have to imagine providers too, when a child is throwing up and so sick and crying. This has to help with that too.
WALSH: Yeah, I think so. Something we know from the literature is the second most disturbing symptom from our families is nausea and vomiting, more than almost any other symptom. Families just really hate it. They hate seeing their children suffering. We have these great treatments. We also have to provide good supportive care so the patients aren’t miserable when we’re giving them the treatments.
What’s number one?
WALSH: I think it’s fatigue actually.
What haven’t I asked about the system that we should include in the story?
WALSH: It takes information from the nurses, from the medical record, from the pharmacy data and pulls it all together so you can look at it at one time. So it’s unique. It makes a more complicated system a little bit easier to understand.
You think this is something that will spread to other hospitals?
WALSH: We’re in talks with other hospitals. I think we might do that. I think there’s a lot of benefit in the data too. We have more numbers because a lot of the studies that have been done for these medications just use 20 or 30 patients. But we have hundreds of patients we can pull data from so that’s going to be really powerful too.
Right now you’re sharing data and sharing potentially ideas on how to strut the dashboard.
WALSH: We’ve presented it to national conferences and other places are interested, but we’re sort of in the preliminary stages of that right now.
And how long ago did it go in online?
WALSH: A year. We’ve been using it for about a year.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Elaina Steingard
602-933-0824
esteingard@phoenixchildrens.com
Sign up for a free weekly e-mail on Medical Breakthroughs called First to Know by clicking here
