Clinical, economic and organizational impact of pharmacist interventions on injectable antineoplastic prescriptions: a prospective observational study

Abstract

Background: Pharmacists play a key role in ensuring the safe use of injectable antineoplastics, which are considered as high-alert medications. Pharmaceutical analysis of injectable antineoplastic prescriptions aims to detect and prevent drug related problems by proposing pharmacist interventions (PI). The impact of this activity for patients, healthcare facilities and other health professionals is not completely known. This study aimed at describing the clinical, economic, and organizational impacts of PIs performed by pharmacists in a chemotherapy preparation unit.Methods: A prospective 10-week study was conducted on PIs involving injectable antineoplastic prescriptions. Each PI was assessed by one of the four multidisciplinary expert committees using a multidimensional tool with three independent dimensions: clinical, economic and organizational. An ancillary quantitative evaluation of drug cost savings was conducted. Results: Overall, 185 patients were included (mean age: 63.5 ± 13.7 years; 54.1% were male) and 237 PIs concerning 10.1% prescriptions were recorded. Twenty one PIs (8.9%) had major clinical impact (ie: prevented hospitalization or permanent disability), 49 PIs (20.7%) had moderate clinical impact (ie: prevented harm that would have required further monitoring/treatment), 62 PIs (26.2%) had minor clinical impact, 95 PIs (40.0%) had no clinical impact, and 9 PIs (3.8%) had a negative clinical impact. For one PI (0.4%) the clinical impact was not determined due to insufficient information. Regarding organizational impact, 67.5% PIs had a positive impact on patient management from the healthcare providers' perspective. A positive economic impact was observed for 105 PIs (44.3%), leading to a saving in direct drug costs of 15,096 €; 38 PIs (16.0%) had a negative economic impact, increasing the direct drug cost by 11,878 €. Overall cost saving was 3218€. Conclusions: PIs are associated with positive clinical, economic and organizational impacts. This study confirms the benefit of pharmacist analysis of injectable antineoplastic prescriptions for patient safety with an overall benefit to the healthcare system.

CLEO: a multidimensional tool to assess clinical, economic and organisational impacts of pharmacists’ interventions

“…17 This allows the CLEO tool to be used for screening to select PIs for economic studies. This approach was used by Zecchini et al 18 in the setting of a cancer department to select PIs that induced positive and negative cost savings as part of their estimation of the total amount of money saved as a result of PIs.…”

“…The independence of three dimensions helps to interpret the scoring results flexibly. Mongaret et al 21 and Duwez et al 22 used only the clinical dimension of the CLEO tool in their study to determine clinically significant PIs, while Zecchini et al 23 used only the clinical and economic dimensions. Another tool could take advantage of all three dimensions to demonstrate the whole effects of a PI.…”

“…User satisfaction and acceptability with the tool was high. Indeed, the CLEO tool was used easily in French hospital settings [21][22][23] and received good feedback from three Swiss hospitals. 24 However, pharmacists suggested that training with sample cases and regular discussion of real scenarios in daily practice is necessary to improve its reliability.…”

Clinical evaluation of pharmacists’ interventions on multidisciplinary lung transplant outpatients’ management: results of a 7-year observational study

“…19 The CLEO tool has been recently created according to different scales available in the literature 24 and provided suitable inter-rater and intrarater reliabilities. This CLEO tool was used to assess clinical impact of PIs on injectable antineoplastic prescriptions in a French Hospital Chemotherapy Preparation Unit 33 and was translated and validated in a German version. 34 We acknowledge that the use of a new tool adapted to clinical practice for assessing clinical impact of PIs does not allow any comparison with previous studies in several solid organ transplantation, 7 15 27 28 31 which mainly used Overhage and Lukes and Hatoum et al scales.…”

Economic Impact and Cost Benefit of the Inpatient Clinical Pharmacist Interventions in Cancer Care Units

“…These actions include but are not limited to identifying and managing DRPs, ensuring better utilization of medications, to eventually reduce the risk of unfavorable ADEs, which in turn reduces the healthcare costs [8]. Indeed, previous studies reporting pharmacists' participation in the cancer setting have demonstrated improved quality of care [9][10][11]. However, recruiting clinical pharmacists as well as implementing the interventions themselves can come with added costs that may offset any cost savings produced by the prevention of ADEs.…”