National chemotherapy eLibrary – Sweden

Challenge

As cancer treatment has seen rapid medical advances over recent decades, treatment protocols have become more complex and specific.^{1 2} Administering chemotherapy requires planning what medication to use, its dosage and the intervals between treatment sessions is a process, all of which which takes time and expertise.^{3 4} Any errors in the delivery of chemotherapy can risk the person’s safety.⁴ In Sweden, over 700 different chemotherapy regimens are approved for use.

The majority of cancer treatment in Sweden is delivered at autonomous cancer centres Historically, the centres would develop their own versions of each chemotherapy protocol and their own patient information sheets.^{3 5} Many people with cancer are diagnosed at a university hospital and will receive their first chemotherapy treatments there, before transferring to a smaller, local hospital for subsequent treatment. Even slight discrepancies in chemotherapy regimens between centres could cause confusion and distress to the person receiving treatment, as well as heightening their risk of harm. The fact that different centres produced their own versions of regimens and patient information sheets also meant that work was being duplicated where common resources could have been used.

Solution

In 2011, following a request from the directors of Swedish oncology clinics, a pharmacist-led team within the Regional Cancer Centres began developing an online library of chemotherapy regimens.³ They assembled a large reference group of potential users for the eLibrary from across Sweden, including specialist oncology nurses, doctors, pharmacists, software engineers and representatives from the shared IT systems used by Swedish healthcare facilities.^{3 5} The group made recommendations on how the eLibrary should be structured to make it as user friendly as possible. This included defining search terms and enabling individual dosage calculations.

The eLibrary became accessible to healthcare professionals in 2015. It contains over 700 standardised chemotherapy regimens as well as patient information sheets for each regimen in both Swedish and English.³ In many facilities, the standardised regimens have been integrated into the computerised prescribing systems used when planning a person’s cancer treatment.⁵

The reference group continues to meet regularly to ensure that the regimens are kept up to date, in line with the latest clinical guidelines. Whenever national clinical guidelines are updated, a representative from the guideline committee will liaise with the eLibrary team to ensure that any changes are reflected in the online chemotherapy regimens. Each regimen shows the date on which it was approved, as well as the signature of the guideline committee representative.

Healthcare professionals who use the eLibrary are encouraged to communicate with the development team and reference group by email or telephone, both to ask questions and to offer up any information that might be missing from the library.³

Next steps

The reference group will continue to ensure that the eLibrary remains up to date through regular liaison with guideline committees.³ They are also working to make patient information sheets available in Arabic, so that they are accessible to more people receiving cancer treatment across Sweden.