SAFE Chemo App : Highly Automated Prescription Programme
The SAFE Chemo HACPP App We Are TLM is building, will transform the delivery of protocol based treatments in resource limited settings across Sub-Saharan Africa, and potentially, the developing world. A prototype of the tool being developed, has been successfully used on the Upendo & Tumaini Children’s Cancer Wards at MNH for over a year. It was rapidly adopted and reduced prescription errors by more than 90% almost over night.
Previously all chemotherapy prescriptions were handwritten with all protocol decisions, calculations and modifications, the prescribing doctors responsibility. These decisions are complex and error prone with significant (sometimes life-threatening) consequences to the patient. The process was also very time consuming.
The programme we have developed requires the prescribing doctor to input minimal and simple patient and treatment-response related data. The programme then automatically makes the required calculations and adjustments clearly outlined in each treatment protocol. These automations include simple dose calculations, plus complex dose reductions for malnutrition and a variety of side effects and vital treatment modifications driven by the results of protocol timed response-to-treatment assessments. We plan to move the current prototype which exists as an Excel based programme to a web-based App.
There is no programme like this anywhere in the world, as all available chemotherapy prescribing programmes assume senior specialists are present at treatment centres. Another difference is that the available tools are expensive and designed for use in Europe and North America. Our programme will be free to centres who need it and built with resource limited centres in mind. This programme truly has the potential to change to way children’s (and adults) cancer services are delivered across the world.
Clinical Data Management through We Are TLM’s EMRS
Until now, Dr Jane Kaijage and her incredible memory and recall was the only Paediatric Oncology Database in Tanzania. Not only can Dr Jane remember all of her patients, their diagnosis, their home town and their families, she can remember their hopes for the future, their favourite games and their stories. For this, and many other of Dr Jane's contributions to the field of Paediatric Oncology in Tanzania, our Electronic Medical Record System is called Janey.
In order to have a reliable, accurate and nationwide data source both to understand the impact of our efforts and identify areas of urgent Paediatric Oncology need, an Electronic Medical Records System has been designed and awaits beta testing before planned roll out to all partner centres as they join.
Within its comprehensive data fields, it has been designed to automatically capture the limited data required by the government in the Cancer Registries Initiative (CANREG5) initiative. This avoids the double entry of information problem.
The availability of an accurate data source for Paediatric Oncology Nationwide will be an invaluable tool in identifying areas requiring strengthening, the design and implementation of our targeted childhood cancer awareness campaigns, the procurement of appropriate supplies of drugs and consumables per region and the ongoing and future expansion of our support and services. It will be a vital tool in the pursuit of a reliable, easily accessible and update-able database for all aspects of Paediatric Oncology.
Our EMRS aims that:
All children attending a Paediatric Oncology service in Tanzania will be included and reports generated will be
studied and audited for future plans.
This system will be managed at the Hub but each centre will be provided with the necessary tools, training and staffing to maintain local records. Elements of this database will be linked to the National Cancer Statistics gathered by the Ministry of Health.
We believe that this database will be instrumental in the development of Paediatric Oncology Provision across other East African countries and indeed, the global south more generally. It is the first of its kind in the region and we look forward to collaborating with institutions across the continent and world of medical technology in the pursuit of a reliable, easily accessible and update-able accurate source of data for all aspects of Paediatric Oncology.
Most children are not deemed successfully cured until they have reached 3-5 years post treatment. (Burkitts Lymphoma is one of the only exceptions. These children are considered cured if they remain disease free 12 months from completing chemotherapy).
This will be kept up to date daily with a data management team and an effort to input the data of historical cases from the last 2-5 years will be made (understanding that charts may be incomplete or missing). It will help enormously to identify all areas of care that need to be strengthened including those children lost to follow-up.