Reducing defects in the medication use process for intravesicular chemotherapy in an academic ambulatory oncology infusion center.

425 Background: Procedural anti-cancer therapy presents unique operational and safety challenges, often deviating from national standard safety practices as most address systemic therapy. A common type is intravesicular medications for bladder cancer. We identified variation in how the medications were ordered, prepared, and administered at our site. The goal of this project was to reduce total defects per million opportunities (DPMO) in the anti-cancer intravesicular medication use process by % within a year. Methods: Bladder cancer installations at an academic oncology infusion center and urology department were compared pre- and post- quality improvement (QI) [Q1 2024 (n = 40) vs. Q1 2025 (n = 40)]. Lean Six Sigma methodology based of Define, Measure, Analyze, Improve, Control was utilized. Measurement was done per DPMO. A gap analysis found 12 potential defect opportunities per administration including compliance with internal policy/procedure, variability in catheter usage, medication safety administration, and hazardous drug safe handling practice. Interdisciplinary initiatives included: developing an oversight group for processes/guidelines and education, configuring bar code medication administration (BCMA), standardizing correct catheter use and administration/handling for Bacillus Calmette-Guérin. Results: DPMO decreased by 96.7% (197,916 to 6,520). Sigma level increased from 2.3 to 4. Yield increased from 080.2% to 99.4%. BCMA compliance increased from 0% to 92.5%. Conclusions: Improved quality and safety in intravesicular anti-cancer therapy can be achieved using a standardized QI approach as demonstrated by reduced DPMO and sigma. Future directions include spreading to all spaces performing bladder instillations and to other procedural chemotherapy administration.