A multidisciplinary approach to ensure safety in the prescribing and administration of chemotherapy

Abstract

Contemporary cancer treatment requires a multidisciplinary approach in order to ensure the safe prescribing and administration of chemotherapy. The increasing complexity of drug regimens and the introduction of new cytotoxic agents, combined with the inexperience of medical staff in this area, highlighted the need for a comprehensive educational reference tool. Our experience highlighted inconsistencies in prescribing anti-emetics and hydration regimens and the need for ongoing education.1 A multidisciplinary team was established to address these issues and develop a Chemotherapy Practice Manual which consists of chemotherapy protocols, administration guidelines including cost-effective premedication recommendations and supportive therapy such as hydration regimens. It also includes patient monitoring parameters for before, during and after treatment and protocol specific patient education. Preprinted prescription charts were designed to aid the medical officer in prescribing the chemotherapy and include discharge medication to ensure appropriate post treatment therapy. These have been incorporated into a computer-generated prescribing program. The introduction of the manual to the oncology unit has proved beneficial: prescriptions are legible and include all supportive treatment and follow up medication. The nursing staff now have guidelines regarding chemotherapy administration and patient education. By working together and combining our knowledge we have provided a complete package that ensures safety in prescribing and administration of chemotherapy as well as an educational reference tool. Other benefits include both time and cost savings.

Comparison of state requirements for preprinted prescriptions

“…5 There are numerous potential advantages to using preprinted prescriptions, including (1) fewer medication errors (attributable to increased legibility), [6][7][8][9] (2) improved compliance with Joint Commission requirements, 5 (3) improved speed and efficiency of dispensing, (4) cost savings in conjunction with the creation of a subformulary, 10 and (5) increased prescription completeness and error reduction. 11,12 Despite these advantages, several disadvantages to preprinted prescriptions exist, including (1) the possibility of drug diversion if preprinted prescription blanks are lost or stolen, (2) the risk of medication errors when preprinted prescriptions contain multiple check-off boxes, 12 (3) practitioners may encounter ethical problems or display a bias for a particular drug product, 9,13 (4) errors resulting from prescriber alterations to preprinted prescriptions, 14 and (5) the risk of medical personnel becoming less vigilant about or assuming prescription accuracy. 15 These opportunities and obstacles should be considered before implementing the use of preprinted prescriptions at any site.…”