Evaluation of clinical interventions made by pharmacists in chemotherapy preparation

Abstract

BackgroundCancer drugs are high risk drugs and medication errors in their prescribing, preparation and administration have serious consequences, including death. The importance of a multidisciplinary approach and the benefits of pharmacists’ contribution to cancer treatment to minimise risk have been established. However, the impact of services provided by pharmacists to cancer patient care is poorly studied. This study explored the clinical interventions made by pharmacists in dispensing of chemotherapy doses, and evaluated pharmacists’ contribution to patient care.MethodsPharmacists at the Chemotherapy Preparation Unit at a tertiary cancer centre in London were shadowed by two research pharmacists during the clinical screening of chemotherapy prescriptions and release of prepared drugs. An expert panel of pharmacy staff rated the clinical significance of the recorded interventions.ResultsTwenty-one pharmacists’ interventions were recorded during the screening or releasing of 130 prescriptions or drugs. “Drug and therapy” (38%), “clerical” (22%) and “dose, frequency and duration” (19%) related problems most often required an intervention, identifying areas in chemotherapy prescribing that need improvement. The proposed recommendations were implemented in 86% of the cases. Many recorded interventions (48%) were ranked to have had a “very significant” influence on patient care.ConclusionClinical interventions made by pharmacists had a significant impact on patient care. The integration of pharmacists’ technical and clinical roles into dispensing of chemotherapy doses is required for providing high-quality cancer services.

The impact of Medicines Information enquiry answering on patient care and outcomes

“…Improving medication safety therefore continues to be a priority. Pharmacists' interventions improve patient care and outcomes and reduce medication risk…”

“…[5,6] Improving medication safety therefore continues to be a priority. Pharmacists' interventions improve patient care and outcomes [7][8][9][10][11][12][13][14][15][16] and reduce medication risk. [17] Healthcare professionals constantly make decisions about patients' drug therapy but the volume and changing evidence presents challenges, [18][19][20][21][22] including: time; [23] access to and familiarity with resources; [23,24] literature searching and critical appraisal skills.…”

Implementing new clinical pharmacy services parallel to the introduction of centralized preparation of anti-cancer drugs

“…Informacijski listi so bili izdelani na podlagi povzetkov glavnih zna~ilnosti zdravil (6, 7), navodil za posamezno shemo kemoterapije svetovnih terciarnih centrov za zdravljenje onkolo{kih bolnikov in strokovnih zdru`enj (3,6,8,9) ter druge objavljene literature (20,2,22). Pregledane podatke so si zdravniki, medicinske sestre in farmacevti interpretirali na podlagi lastnih klini~nih izku{enj in jih v okviru zmo`nosti v ustanovi oblikovali v informacijske liste, ki povzemajo usklajene informacije o zdravljenju s posamezno shemo kemoterapije.…”

“…V literaturi objavljene {tudije o ukrepih farmacevta pri pregledu predpisa kemoterapije so potekale v bolni{nicah s {ir{o onkolo{ko dejavnostjo (9,3,4). Objavljene {tudije so zajele med 30 in ve~ kot 22.000 naro~il protitumorskih zdravil, kar uvr{~a na{o {tudijo med srednje velike.…”

“…Pri razlagi rezultatov na{e {tudije je potrebno upo{tevati tudi to, da je bil predpis podpornega zdravljenja v informacijskih listih zelo natan~en in ni omogo~al individualne obravnave bolnika, kar je tudi vodilo do velikega dele`a neskladij. K nizkemu dele`u ukrepov v {tudiji Markerta in sodelavcev je lahko pripomogla tudi uporaba elektronskega naro~anja kemoterapije (4), v {tudiji Knezove in sodelavcev pa uporaba receptnih obrazcev, ki vsebujejo informacije o predlaganem antiemeti~nem in drugem podpornem zdravljenju pri dolo~eni shemi kemoterapije (9). Seveda pa take re{itve ne omogo~ajo individualizacije podpornega zdravljenja, na pomembnost katerega se je za~elo opozarjati {ele v zadnjem ~asu (24).…”