Background Patients with cancer are managed across the whole healthcare spectrum. This complex system of interdependencies has high potential for errors to occur. This is a focus area for pharmacists, who possess the skillset to optimise cancer care across the health care system, identifying errors and other medication‐related problems (MRP). Aim The aim of this study was to identify and describe the impact of the pharmacist’s contribution in reducing cancer therapy‐related errors. Methods A search of English‐language publications in Embase, Medline and CINAHL was conducted. Databases were searched from 1 January 2010 until 29 September 2020 to identify all quantitative studies of a descriptive, observational or experimental design. Articles describing pharmacist‐led interventions in adults receiving one or more cancer therapies including oral chemotherapy, intravenous chemotherapy or immunotherapy compared to no intervention, usual care or a service delivered by another healthcare professional were included. Researchers screened articles to identify eligible studies, and then data were extracted using a standardised data collection sheet. Quality assessment was undertaken using the modified Cochrane and the Newcastle Ottawa risk of bias tools. Data were reported as number or percentage. Results Of 2292 papers identified, nine studies were eligible for inclusion in this review. Pharmacist interventions consistently showed an increased identification of medication errors and medication‐related problems. Pharmacist contributions in many of the included studies comprised medication reviews and monitoring, laboratory monitoring, adverse drug reaction and drug–drug interaction management, adherence monitoring and medication counselling. All studies showed pharmacist intervention in cancer care resulted in fewer errors compared to control arms. Error minimisation was described for parenteral and oral cancer therapies and also for supportive medications such as antiemetics. Conclusion Pharmacists reduce errors and potential patient harm in practice settings where cancer patients are treated. Pharmacists are an integral component of cancer care teams.

No abstract

Background The frequency and significance of cytomegalovirus (CMV) infection in seropositive (R+) heart transplant recipients (HTR) is unclear, with preventative recommendations mostly extrapolated from other groups. We evaluated the incidence and severity of CMV infection in R+ HTR, to identify risk factors and describe outcomes. Methods R+ HTR from 2010 to 2019 were included. Antiviral prophylaxis was not routinely used, with clinically guided monitoring the local standard of care. The primary outcome was CMV infection within one‐year post‐transplant; secondary outcomes included other herpesvirus infections and mortality. Results CMV infection occurred in 27/155 (17%) R+ HTR. Patients with CMV had a longer hospitalization (27 vs. 20 days, unadjusted HR 1.02, 95% CI 1.00–1.02, p = .01), higher rate of intensive care readmission (26% vs. 9%, unadjusted HR 3.46, 1.46–8.20, p = .005), and increased mortality (33% vs. 8%, unadjusted HR 10.60, 4.52–24.88, p < .001). The association between CMV and death persisted after adjusting for multiple confounders (HR 24.19, 95% CI 7.47–78.30, p < .001). Valganciclovir prophylaxis was used in 35/155 (23%) and was protective against CMV (infection rate 4% vs. 27%, adjusted HR .07, .01–.72, p = .025), even though those receiving it were more likely to have received thymoglobulin (adjusted OR 10.5, 95% CI 2.01–55.0, p = .005). Conclusions CMV infection is common in R+ HTR and is associated with a high burden of disease and increased mortality. Patients who received valganciclovir prophylaxis were less likely to develop CMV infection, despite being at higher risk. These findings support the routine use of antiviral prophylaxis following heart transplantation in all CMV R+ patients.

Background: Dispensing errors have the potential to cause significant patient harm. Strategies shown to improve the safety of medication dispensing have been widely published, however, there is an absence of literature comprehensively assessing the outcomes of these strategies. Aim: To evaluate the effectiveness of interventions designed to decrease the rate of dispensing errors in hospital pharmacy dispensaries. Methods: A systematic review and meta-analysis of the peer reviewed literature were conducted. Medline, Embase, CENTRAL and CINAHL were searched to identify comparative studies that evaluated interventions designed to reduce the rate of dispensing errors in hospital pharmacy dispensaries. Data were extracted from eligible studies using a standardised data collection tool. Quality assessment was conducted using the Scottish Intercollegiate Guidelines Network Checklist-3. Meta-analysis was performed using a random effects model and presented as risk ratios (RR), with corresponding 95% confidence intervals (CI). Results: Eleven studies were eligible for inclusion. Interventions included implementation of dispensing technologies, accredited technicians performing prescription verification, and addressing look-alike medications. Five studies detected dispensing errors during final verification (prevented or near-miss dispensing errors); five studies identified unprevented dispensing errors; one study evaluated both. There was a statistically significant reduction in the pooled rate of dispensing errors from 0.080% in the control group to 0.043% in the intervention group (rate difference 0.037%, 95% CI 0.033-0.042%). Meta-analysis demonstrated a 34% reduction in the risk of prevented dispensing errors (RR 0.66, 95% CI 0.46-0.93) and 68% reduction in the risk of unprevented dispensing errors (RR 0.32, 95% CI 0.24-0.43). Conclusion: This is the first systematic review and meta-analysis of the impact of dispensing errors interventions. The results indicate that the implementation of the most effective interventions, such as appropriately trained staff and using technology, results in reductions in dispensing error rates.

Aim To investigate physical health outcomes associated with medications prescribed to manage chronic physical conditions in people living with dementia; and determine whether a dementia diagnosis altered drug utilisation patterns for physical health conditions. Data sources Medline, Embase, Central and Scopus were searched 01/2011 to 12/2020. Study selection Experimental and observational studies, where participants with dementia using medications prescribed by doctors to prevent or treat one or more chronic comorbid physical condition, were compared to no intervention, usual care, or a non‐dementia comparison group. The outcomes of interest were clinically meaningful physical outcomes, and medication utilisation patterns. Results Ten studies met the inclusion criteria. All were of medium to high quality relative to their study design. Mixed findings were reported for ischemic stroke (n = 3), all‐cause mortality (n = 3) and bleeding‐related outcomes (n = 2). This is likely due to the heterogeneity in exposures reported. One study found that people with dementia, receiving antidiabetic management, had a higher rate of severe hypoglycaemia compared to people without dementia. Medication utilisation pattern outcomes included oral anticoagulant use before stroke‐related hospitalisation (n = 1), antithrombotic medication use before stroke‐related hospitalisation (n = 1), cardiovascular medication use for secondary prevention of ischemic heart disease (n = 1), antidepressant medication discontinuation (n = 1), osteoporosis treatment (n = 1), diabetic medication use (n = 2), and antihypertensive medication discontinuation (n = 1). Conclusion This systematic review showed there is currently insufficient evidence to conclude that medication management in people with dementia should differ substantially to people without dementia. Comprehensive and high‐quality evidence is needed to improve confidence that medication prescribing achieves optimum clinical outcomes, quality of life, and benefit‐to‐risk determination in this vulnerable population.