Evaluation of electronic health record implementation on pharmacist interventions related to oral chemotherapy management

Abstract

Background With the ever growing arsenal of oral chemotherapy agents now available, cancer treatment is being increasingly managed in the outpatient setting. However, oral chemotherapy use is often associated with several potential obstacles and complications. In order to provide optimal patient safety and oral chemotherapy monitoring, our institution implemented an oral chemotherapy program managed by clinical pharmacists electronically through Epic Beacon. Objective To describe implementation of a novel pharmacist-managed oral chemotherapy program and evaluate pharmacist interventions before and after implementation of an oral chemotherapy program. Methods This was a single-center retrospective chart review of documented pharmacy interventions for oral chemotherapy prescriptions during three months prior to as well as three months following Epic Beacon implementation. Time periods for data inclusion were October-December 2013 (pre-Beacon) and October-December 2014 (post-Beacon). Patients included in the study had one or more oral chemotherapy orders during the pre-Beacon period, the post-Beacon period, or both pre- and post-Beacon. Our analysis did not include oral chemotherapy orders that were placed outside of a treatment plan in the post-Beacon period. Results A total of 240 patients with 450 total oral chemotherapy orders were assessed over the duration of the study. Beacon implementation allowed a greater number of oral chemotherapy orders to be reviewed, with 134 oral chemotherapy orders reviewed in the study period prior to Beacon implementation and 316 orders reviewed in the post-Beacon period. Additionally, there were 660% more pharmacist interventions (89 interventions pre-Beacon versus 681 interventions post-Beacon), with an increased focus on coordination of care, chemotherapy calendar coordination, and assistance with treatment plans. Furthermore, implementation of Epic Beacon allowed identification of over 500% more chemotherapy order errors (41 total errors identified pre-Beacon versus 250 total errors identified post-Beacon). Pharmacists were also able to identify more significant, serious, or potentially lethal errors following implementation. The time associated with oral chemotherapy review and intervention also increased accordingly with number of orders reviewed. Conclusion Implementation of an electronic workflow for oral chemotherapy dramatically increased pharmacist review of orders, resulting in improved documentation of interventions and errors, decreased need for clarification of orders, as well as increased volume of prescriptions at our on-site pharmacy. This study demonstrates a comprehensive approach to maximize safety when oral chemotherapy is utilized as a component of the treatment regimen.

Describing the role of the hematology/oncology clinical pharmacist in health information technology

“…Of existing evidence, the results of our study corroborate previous studies that report the significant amount of time clinical pharmacists spend using the EHR. 7,9 Specifically, hematology/oncology clinical pharmacists in our study reported spending the greatest amount of time on patient profile review, which is corroborated by Nelson and colleagues 7 finding that clinical pharmacists spend over 11 min working up each new patient prior to rounds. Compared to our study which relied on self-reported time spent in the EHR, previous studies measured time by assigning an allotted time to each type of intervention (with the opportunity to document a specific time) 9 or performing direct observation with eye-tracking camera and contextual inquiry.…”

“…7 Supporting the amount of time clinical pharmacists spend within the EHR is a standardized intervention capture template at the Veterans Health Administration, which documented a mean of 1.6 interventions per pharmacistpatient encounter. 8 A comparative study by Finn et al 9 which evaluated interventions before and after implementation of Epic Beacon showed a 560% increase in the number of pharmacist interventions, a 400% increase in the number of identified chemotherapy order errors, and an increase from 1.2 to 5.7 h spent daily on oral chemotherapy review. Taken together, the compilation of this evidence suggests that clinical pharmacists spend the majority of their time within the EHR.…”

What to expect from electronic patient record system implementation: lessons learned from published evidence

“…EPR-based handover between staff is associated with reduced clerical errors, greater satisfaction and improved efficiency, accuracy and safety; (around 400 work hours saved annually in one service) 105. There is an improved identification of significant prescribing errors, which improves patient safety,106 and in an ITU study, the medication error rate significantly decreased post-implementation, including ordering, dispensing and administration 107…”

The Expanding Role of the Oncology Pharmacist

“…The value of the oncology pharmacist in the care of patients with cancer and within the oncology care team has been documented in several studies [ 5 ]. Oncology pharmacists have demonstrated their value in providing clinical care that has directly impacted patient outcomes, supportive care management, laboratory monitoring, and increased documentation in the electronic medical record [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. Patient education, a common component of most oncology pharmacist positions, has been shown to be associated with high rates of patient satisfaction, improved learning outcomes, and leads to increased medication adherence and disease-based outcomes [ 6 , 17 , 19 , 25 , 26 , 27 , 28 , 29 , 30 ].…”

“…Patient education, a common component of most oncology pharmacist positions, has been shown to be associated with high rates of patient satisfaction, improved learning outcomes, and leads to increased medication adherence and disease-based outcomes [ 6 , 17 , 19 , 25 , 26 , 27 , 28 , 29 , 30 ]. Oncology pharmacists have become important members of informatics teams, and their integral role has been shown to be associated with increased rates of medication error identification [ 9 , 30 , 31 ]. Pharmacist-driven cost-savings have been reported in numerous studies, including those using pharmacists to manage oral anticancer therapies, by providing effective inpatient and ambulatory care and implementing quality improvement programs [ 18 , 29 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ].…”