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Open house: Ramathibodi hospital cancer care


 International Conference on Health Promotion and Quality in Health Services (IHPQS)
" Global Sharing : People and Integration as Key to Success"
19 - 21 November 2008
At Centara Grand and Bangkok Convention Center Bangkok, Thailand

Open house: Ramathibodi hospital cancer care
Surgical oncology service

          Most cancer patients were diagnosed and staging at this facility. Surgical oncology service consists of variety of surgery subspecialties such as general surgery, thoracic surgery, neurosurgery, urology, plastic surgery, pediatrics surgery, gynecologic oncology and ENT etc. We performed various minimally invasive procedures such as laparoscopic surgery, breast conservative surgery, sentinel lymph nodes biopsy and video-assisted thoracoscopy etc. Our pathology department has up-to-date technology for accurate histological/ cytological and molecular diagnosis for example fluorescence in situ hybridization (FISH) and cytogenetic studies. 
          To achieve maximal local control of cancer, radiotherapy is one of the most important facilities. Our radiotherapy unit is a referral center for many cancer centers around the country especially the radio surgery center. In addition, we also performed 3D conformal radiotherapy, intraoperative radiotherapy (IORT) and brachytherapy. In the future we plan to perform CyberKnife radiosurgery which is image guided radiotherapy (IGRT) and intensive modulated radiotherapy (IMRT).
            Online chemotherapy ordering system
          Online chemotherapy order software has been developed by hospital IT unit. Hematologists and Oncologists can make and review orders at outpatients departments. Using the preorder forms of any regimens minimizes prescription errors and saves time for physicians. The doses of chemotherapy and targeted therapy are automatically calculated according to patients’ body surface areas. The orders are rechecked by oncology nurses and pharmacists to prevent prescription errors. Then the orders are sent electronically to chemotherapy pharmacy service center and short stay service for preparations and administrations respectively. The order forms are also documented in both medical records and electronic files for reference.  
Chemotherapy pharmacy service center
          Since Ramathibodi has provided chemotherapy service for cancer patients, chemotherapy preparation by physicians or nurses leads to the human and environmental contamination and the loss of unused drug disposing. Chemotherapy pharmacy service center was implemented, in 2002, in order to provide patient safety and cost management for the hospital. All chemotherapy and targeted therapy preparations are prepared by trained pharmacist for outpatients (short stay) services, inpatients and other 2 collaborated nearby hospitals, where our patients were referred for chemotherapy administrations. The preparations are performed in the negative pressure clean room equipped with 2 biosafety cabinets. The team consists of 4 pharmacists and 2 pharmacist assistances. The patient safety is granted by quality assurance, premedical verification, clean room system validation and maintenance, personnel health monitoring, risk management and appropriate cytotoxic discard management. At the present, there are 40 items of cytotoxic agents. During 2007, the total preparations were 38,915 doses and we were able to save more than 6 millions baht.  
 Short stay service
          Due to the shortage of available beds for admission in Ramathibodi hospital, many patients have to receive chemotherapy at outpatient service. Short stay service, initiated in 1998, are chemotherapy administration unit for cancer patients receiving short infusion chemotherapy. Chemotherapy and targeted therapy prepared by chemotherapy pharmacy service center is sent directly to short stay service. Our nurses experienced for chemotherapy administration recheck online order and chemotherapy before treatment starts. Patients’ safety is of highest concern. On call physicians, resuscitation equipments and medications are ready in case that hypersensivity reaction and other emergency adverse events occur. We improve the service process to be one stop service that is more convenience and save the patients’ time.
Ambulatory care service
          Almost all cancer patients have performance status declined during their terminal periods. The sufferings from their symptoms make their caregivers difficulty to handle and transfer them to the hospital. Our ambulatory care service provides the patients and their caregivers the medical assistance and consultation by nurses at their homes. The nurses visit the patients regularly and coordinate with the physician to solve their problems. Therefore the patients do not need to follow up at the hospital frequently.