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Objective The aim of this study was to provide a pharmacy service to improve continuity of patient care across the primary‐secondary care interface. Setting The study involved patients discharged from two acute‐care tertiary teaching hospitals in Melbourne, Australia, returning to independent living. Methods Consecutive patients admitted to both hospitals who met the study criteria and provided consent were recruited. Recruited patients were randomised to receive either standard care (discharge counselling, provision of compliance aids and communication with primary healthcare providers when necessary) or the intervention (standard care and a home visit from a community liaison pharmacist (CLP) within 5 days of discharge). Participant medication was reviewed during the visit according to set protocols and compliance and medication understanding was measured. All participants were telephoned 8–12weeks after discharge to assess the impact of the intervention on adherence and medication knowledge. Key findings The CLP visited 142 patients with a mean time of 4.2 days following hospital discharge (range = 1–14 days). Consultations lasted 15–105 min (mean, 49 min; SD, ± 21 min). The CLPs retrospectively coded 766 activities and interventions that occurred during home visits, subsequently categorised into three groups: counselling and education, therapeutic interventions and other interventions. No statistical difference was detected in the number of medications patients reported taking at follow‐up: the mean value was 7.72 (SD, ± 3.27) for intervention patients and 7.55 (SD, ± 3.27) for standard‐care patients (P = 0.662). At follow‐up self‐perceived medication understanding was found to have improved in intervention patients (P < 0.001) and significant improvements from baseline in medication adherence were found in both standard‐care (P < 0.022) and intervention (P < 0.005) groups; however, adherence had improved more in intervention patients. Conclusion The community liaison pharmacy service provided critical and useful interventions and support to patients, minimising the risk of medication misadventure when patients were discharged from hospital to home.

Etoposide is commonly used in a variety of malignancies. A well known but rare toxicity are hypersensitivity reactions, usually manifested by chest discomfort, dyspnoea, bronchospasm and hypotension. We report the details of a patient who developed hypersensitivity reactions to intravenous etoposide, but subsequently tolerated the administration of intravenous etoposide phosphate with no sequalae. The podophyllotoxin etoposide has been used clinically for over 30 years. It is active in the treatment of a variety of malignant conditions and can be administered in either an i.v. or in an oral form. Intravenous etoposide is generally well tolerated. A well known but rare toxicity is a type I hypersensitivity reaction, manifested by dyspnoea, chest discomfort, hypotension, bronchospasm and/or skin flushing (Weiss, 1996;O'Brien and Souberbielle, 1992). It remains unclear whether this reaction is due to either the active drug or the solvent (Weiss, 1996).We report here the details of a patient who, despite experiencing a hypersensitivity reaction to intravenous etoposide, tolerated the subsequent administration of intravenous etoposide phosphate without any allergic sequalae. A test dose of etoposide phosphate was not administered, and premedication, which was administered initially, was discontinued. This case highlights three important aspects in patients experiencing hypersensitivity reaction to etoposide: (i) etoposide phosphate can be considered as an appropriate alternative; (ii) premedication may not be required; and (iii) the hypersensitivity reaction is more likely due to the solvent. CASE DESCRIPTIONA 19-year-old male with a newly diagnosed primary mediastinal non-seminomatous germ cell tumour was admitted for treatment with the standard BEP regimen. This consisted of weekly i.v. bleomycin 30 000 iu and 3-weekly cycles of i.v. etoposide 100 mg m 72 day 71 for 5 days and cisplatin 20 mg m 72 day 71 for 5 days (Williams et al, 1987). The patient had no known allergies. Following premedication with i.v. tropisetron (5 mg) and dexamethasone (8 mg) administration of etoposide was commenced (200 mg in 500 ml of sodium chloride 0.9%, over 60 min). Within minutes of commencement of the first dose of etoposide the patient complained of generalized discomfort and shortness of breath. He was found to be hypotensive (BP=95/60), tachycardic (PR=110) and had an oxygen saturation of 80% on room air.The infusion was immediately ceased. Treatment was begun with i.v. hydration, with bolus doses of hydrocortisone (100 mg) and promethazine (50 mg). Oxygen (6 l min 71 ) and nebulized salbutamol were also given. The patient improved rapidly with complete resolution of his symptoms, and was comfortable within 1 h. No bleomycin or cisplatin was administered.Germ cell tumours of the mediastinum are potentially curable, and etoposide is considered to be a critical component of an effective treatment schedule. Thus, it was felt that in this case continued use of etoposide was warranted. In light of this decision, cycle 1 of chemothera...

When used inside a CDSC, the closed system drug transfer device PhaSeal further reduces surface contamination, in some instances to undetectable levels.

The issue of medication safety is highly significant when anti-cancer therapy is used as a treatment modality due to the high potential for harm from these agents and the disease context in which they are being used. These guidelines provide recommendations on the safe prescribing, dispensing and administration of chemotherapy and related agents used in the treatment of cancer. The guidelines represent a multidisciplinary collaboration to standardise the complex process of providing chemotherapy for cancer and to enhance patient safety. These are consensus guidelines based on the best available evidence and expert opinion of professionals working in cancer care. The aim of these guidelines is to assist in the prevention of medication errors and to improve patient safety with respect to the treatment of cancer. This guidance is intended for a multi-disciplinary audience and will have most relevance for medical, nursing and pharmacy staff involved in the complex processes of delivering chemotherapy and associated treatment. The scope of the guidelines includes; all patients and age groups receiving chemotherapy and targeted therapy for the treatment of cancer and cancer therapy administered by any route in both the hospital and home setting. These guidelines should be seen as point of reference for practitioners providing cancer chemotherapy services.