Pharmaceutical interventions to improve safety of chemotherapy-treated cancer patients: A cross-sectional study

Abstract

Cancer chemotherapy is a high-risk process. To improve patient safety, a systematic pharmaceutical analysis of chemotherapy prescriptions is performed in our institution. The aim of this study was to assess the impact of pharmaceutical interventions (PIs) on the safety of patient chemotherapy prescriptions. Methods: This prospective cross-sectional study was conducted in an 800-bed university hospital with oncology departments. All chemotherapy prescriptions were included and PIs were collected prospectively during one month. The clinical impact of PIs was scored by an expert panel of oncologists and pharmacists, using the Hatoum scale. Univariate and multivariate analysis were conducted to identify factors associated with a higher frequency of PIs. Results: Of 1346 prescriptions included, 129 required a PI (9.6% (95% CI: 8.1-11.4)). Most PIs were scored as having at least a significant impact for patient safety (69.8% (95% CI: 60.4-76.9)). The frequency of PIs was significantly associated with tumour site (p ¼ 0.04) and weekday of prescription (p ¼ 0.005). Multivariate analysis identified factors independently associated with PI performance, including pancreas and biliary tract cancers (odds ratio ¼ 2.8 (95% CI: 1.4-5.3)), ovary cancers (odds ratio ¼ 2.4 (95% CI: 1.2-4.8)) and head and neck cancers (odds ratio ¼ 2.4 (95% CI: 1.1-5.1)) and the day 1 of the protocol with a cytotoxic agent (odds ratio ¼ 3.7 (95% CI: 1.1-11.1)). Conclusions: Oncology pharmacists have a critical role in the safety of chemotherapy prescriptions. The coordination between healthcare professionals and access to patient data seem essential to improve the PIs' relevance and their clinical impact on patient safety.

Clinical pharmacy in onco-hematology and bone marrow transplant: A valuable contribution to improving patient safety

“…In this prospective study, the clinical pharmacist identified prescribing errors in 9% of the prescriptions of inpatients in onco-hematology and bone marrow transplant units. Previous studies in oncology and hematology showed a similar incidence rate: 6.24%, 8 9.6%, 11 11.5%, 12 and 12.6%. 4 The occurrence of medication errors, among them prescribing errors, are expected in clinical practice; however, there are several ways to avoid them and to minimize risks.…”

Impact of clinical pharmacists in an inpatient medical oncology service: A prospective study at a comprehensive cancer center in Jordan

“…Daupin et al. reported that 69.8% of interventions were scored as having at least a significant impact for patient safety, 26 and Han et al. found that 50.4% of their interventions were considered clinically more than significant.…”

“…Clinical pharmacists filled in special data collection forms, recording patient demographics, medical and medications history, primary cancer, admission diagnosis, length of hospital stay, number and types of interventions during the study, the name of the medication associated with CPIs, the significance of the intervention and physicians’ acceptance of those interventions. The significance of the interventions was assessed on the Hatoum scale, 25,26 a scoring system used to evaluate the potential clinical significance of CPIs on a scale of 1, “adverse significance,” indicating that the recommendations were inappropriate and could lead to adverse outcomes; 2, “no significance,” indicating that the recommendation was informational; 3, “somewhat significant,” indicating that the benefit of the recommendation for the patient could be neutral; 4, “significant,” whereby the recommendation would bring care to a more appropriate level; 5, “very significant,” indicating avoidance of potential major organ dysfunction; and 6, “extremely significant,” indicating that the intervention avoided death.…”

Atuação do farmacêutico em ambulatório de oncologia: uma experiência no cuidado ao paciente/ Pharmaceutical performance in oncology ambulatory: an experience in patient care

“…(12,13) A sua atuação pode ocorrer de várias formas, dentre elas a identificação dos problemas envolvidos à adesão ao tratamento, a conciliação medicamentosa, além do esclarecimento das dúvidas a respeito da medicação e os efeitos adversos que a mesma pode causar. (14) Através de ações de educação em saúde, pacientes podem receber informações que irão contribuir para questões relacionadas a quimioterapia antineoplásica referente aos medicamentos usados e o cuidado em saúde de forma geral. Sendo assim, o farmacêutico torna-se um dos corresponsável pela qualidade de vida do paciente.…”