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Fentie AM, Huluka SA, Gebremariam GT, Gebretekle GB, Abebe E, Fenta TG. Impact of pharmacist-led interventions on medication-related problems among patients treated for cancer: A systematic review and meta-analysis of randomized control trials. Res Social Adm Pharm 2024; 20:487-497. [PMID: 38368123 DOI: 10.1016/j.sapharm.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Medication-related problems (MRPs) continue to impose a voluminous health impact, particularly among patients on anti-cancer therapy, due to the nature and complexity of the care. Pharmacists have a pivotal role in ensuring the safe, effective, and rational use of medicines in this group of patients. OBJECTIVES To examine the impact of pharmacist-led interventions in resolving MRPs among patients treated for cancer. METHODS This systematic review and meta-analysis was conducted and reported following the PRISMA protocol and registered in PROSPERO (Registration number: CRD42022311535). Four database searches, PubMed, EMBASE, Cochrane, and International Pharmaceuticals Abstracts, were systematically searched from August 2022 to January 2023. Only randomized control trials (RCTs) were included. The Cochrane risk of bias assessment tool was used to check the quality of the included studies. The outcome measures were overall MRPs, adherence, medication errors, and adverse drug events (ADEs). Data for meta-analysis were analyzed used using STATA version 17 and standardized mean difference effect sizes were calculated for continuous outcomes and odds ratio for categorical outcomes. RESULTS Out of the 90 studies screened for eligibility, 20 RCT studies were included for the systematic review and 15 for the meta-analysis. Close to two-thirds of the studies were from Europe (n = 7) and Asia (n = 6). A combination of educational and behavioral intervention strategies were used for a period ranged from 8 days to 12 months. The pharmacist-led intervention improved adherence to treatment by 4.79 times (AOR = 4.79; 95%CI = 2.64, 8.68; p-value<0.0001), reduced the occurrence of ADEs by 1.28 (SMD = -1.28; 95%CI = -0.04-2.52; p-value = 0.04) and decreased the overall MRPs by 0.53 (SMD = -0.53; 95%CI = -0.79, -0.28; p-value<0.0001) compared to control groups. CONCLUSION This study found out that pharmacist-led interventions can significantly lower MRPs among patients treated for cancer. Hence, a global concerted effort has to be made to integrate pharmacists in a multidisciplinary direct cancer care.
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Affiliation(s)
- Atalay Mulu Fentie
- Addis Ababa University, College of Health Sciences, School of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Ethiopia.
| | - Solomon Assefa Huluka
- Addis Ababa University, College of Health Sciences, School of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Ethiopia
| | - Girma Tekle Gebremariam
- Addis Ababa University, College of Health Sciences, School of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Ethiopia
| | | | - Ephrem Abebe
- Purdue University, College of Pharmacy, West Lafayette, IN, USA; Indiana University, School of Medicine, Indianapolis, IN, USA
| | - Teferi Gedif Fenta
- Addis Ababa University, College of Health Sciences, School of Pharmacy, Department of Social Pharmacy and Pharmaceutics, Ethiopia
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Chadwick V, Kim M, Mills G, Tang C, Anazodo A, Dear R, Rodgers R, Lavee O, Milliken S, McCaughan G, Hamad N. A minority of women of childbearing potential are tested for pregnancy before chemoimmunotherapy: an Australian cancer centre experience. Intern Med J 2024; 54:750-754. [PMID: 37929784 DOI: 10.1111/imj.16287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Chemotherapy is potentially harmful to a developing foetus, and there are limited data on the foetal impact of chemoimmunotherapy (CIT). Therefore, determining pregnancy status prior to initiation of CIT should be standard of care. AIMS To determine how many women of childbearing age are tested for pregnancy prior to immunochemotherapy administration. METHODS A retrospective chart review at a large Australian metropolitan cancer referral centre, including 304 women aged 18-51 years with a diagnosis of cancer receiving outpatient-based CIT between 1 May 2015 and 12 June 2020. We assessed the uptake of pregnancy screening and contraception counselling prior to and during first-line CIT. RESULTS Only 17.3% of CIT cycles (n = 416) screened patients for pregnancy no more than 90 days prior to administration, and the median time between pregnancy screening and treatment was approximately 3 weeks. One patient with early breast cancer had a spontaneous miscarriage estimated at 3-4 weeks' gestation, and neither the patient nor the treating oncologist was aware of this event. This was also the only patient who had a pregnancy test beyond the first cycle of CIT during their treatment. CONCLUSIONS Our results highlight a concerningly low rate of pregnancy screening in women of childbearing age receiving CIT. The implication of missing a positive pregnancy test in this group of women could result in foetal complications, accidental miscarriage, potential bleeding risks and avoidable psychosocial stress. This highlights the urgent need for guidelines to mandate pregnancy testing in women of childbearing age receiving CIT and evidence-based implementation tools.
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Affiliation(s)
- Verity Chadwick
- Women's and Babies Service, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Michaela Kim
- School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Georgia Mills
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Catherine Tang
- Department of Haematology and Flow Cytometry, Laverty Pathology, Sydney, New South Wales, Australia
| | - Antoinette Anazodo
- School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
- Nelune Cancer Centre, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Rachel Dear
- School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Oncology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Rachael Rodgers
- School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Reproductive Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Orly Lavee
- School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Sam Milliken
- School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Georgia McCaughan
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
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Buja A, De Luca G, Ottolitri K, Marchi E, De Siena FP, Leone G, Maculan P, Bolzonella U, Caberlotto R, Cappella G, Grotto G, Lattavo G, Sforzi B, Venturato G, Saieva AM, Baldo V. Using Failure Mode, Effect and Criticality Analysis to improve safety in the cancer treatment prescription and administration process. J Pharm Policy Pract 2023; 16:9. [PMID: 36658618 PMCID: PMC9851104 DOI: 10.1186/s40545-023-00512-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Administering cancer drugs is a high-risk process, and mistakes can have fatal consequences. Failure Mode, Effect and Criticality Analysis (FMECA) is a widely recognized method for identifying and preventing potential risks, applied in various settings, including healthcare. The aim of this study was to recognize potential failures in cancer treatment prescription and administration, with a view to enabling the adoption of measures to prevent them. METHODS This study consists of a FMECA. A team of resident doctors in public health at the University of Padua examined the cancer chemotherapy process with the support of a multidisciplinary team from the Veneto Institute of Oncology (an acknowledged comprehensive cancer center), and two other provincial hospitals. A diagram was drafted to illustrate 9 different phases of chemotherapy, from the adoption of a treatment plan to its administration, and to identify all possible failure modes. Criticality was ascertained by rating severity, frequency and likelihood of a failure being detected, using adapted versions of already published scales. Safety strategies were identified and summarized. RESULTS Twenty-two failure modes came to light, distributed over the various phases of the cancer treatment process, and seven of them were classified as high risk. All phases of the cancer chemotherapy process were defined as potentially critical and at least one action was identified for a single high-risk failure mode. To reduce the likelihood of the cause, or to improve the chances of a failure mode being detected, a total of 10 recommendations have been identified. CONCLUSIONS FMECA can be useful for identifying potential failures in a process considered to be at high risk. Safety strategies were devised for each high-risk failure mode identified.
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Affiliation(s)
- Alessandra Buja
- grid.5608.b0000 0004 1757 3470Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Giuseppe De Luca
- grid.5608.b0000 0004 1757 3470Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Ketti Ottolitri
- grid.419546.b0000 0004 1808 1697Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Elena Marchi
- grid.419546.b0000 0004 1808 1697Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Francesco Paolo De Siena
- grid.5608.b0000 0004 1757 3470Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Giovanni Leone
- grid.5608.b0000 0004 1757 3470Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Pietro Maculan
- grid.5608.b0000 0004 1757 3470Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Umberto Bolzonella
- grid.5608.b0000 0004 1757 3470Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Riccardo Caberlotto
- grid.5608.b0000 0004 1757 3470Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Giovanni Cappella
- grid.5608.b0000 0004 1757 3470Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Giulia Grotto
- grid.5608.b0000 0004 1757 3470Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Gaia Lattavo
- grid.5608.b0000 0004 1757 3470Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Benedetta Sforzi
- grid.5608.b0000 0004 1757 3470Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Giovanni Venturato
- grid.5608.b0000 0004 1757 3470Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Anna Maria Saieva
- grid.419546.b0000 0004 1808 1697Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Vincenzo Baldo
- grid.5608.b0000 0004 1757 3470Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
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Bialik M, Kuras M, Sobczak M, Oledzka E. Achievements in Thermosensitive Gelling Systems for Rectal Administration. Int J Mol Sci 2021; 22:ijms22115500. [PMID: 34071110 PMCID: PMC8197127 DOI: 10.3390/ijms22115500] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 12/22/2022] Open
Abstract
Rectal drug delivery is an effective alternative to oral and parenteral treatments. This route allows for both local and systemic drug therapy. Traditional rectal dosage formulations have historically been used for localised treatments, including laxatives, hemorrhoid therapy and antipyretics. However, this form of drug dosage often feels alien and uncomfortable to a patient, encouraging refusal. The limitations of conventional solid suppositories can be overcome by creating a thermosensitive liquid suppository. Unfortunately, there are currently only a few studies describing their use in therapy. However, recent trends indicate an increase in the development of this modern therapeutic system. This review introduces a novel rectal drug delivery system with the goal of summarising recent developments in thermosensitive liquid suppositories for analgesic, anticancer, antiemetic, antihypertensive, psychiatric, antiallergic, anaesthetic, antimalarial drugs and insulin. The report also presents the impact of various types of components and their concentration on the properties of this rectal dosage form. Further research into such formulations is certainly needed in order to meet the high demand for modern, efficient rectal gelling systems. Continued research and development in this field would undoubtedly further reveal the hidden potential of rectal drug delivery systems.
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Holle LM, Bilse T, Alabelewe RM, Kintzel PE, Kandemir EA, Tan CJ, Weru I, Chambers CR, Dobish R, Handel E, Tewthanom K, Saeteaw M, Dewi LKM, Schwartz R, Bernhardt B, Garg M, Chatterjee A, Manyau P, Chan A, Bayraktar-Ekincioglu A, Aras-Atik E, Harvey RD, Goldspiel BR. International Society of Oncology Pharmacy Practitioners (ISOPP) position statement: Role of the oncology pharmacy team in cancer care. J Oncol Pharm Pract 2021; 27:785-801. [PMID: 34024179 DOI: 10.1177/10781552211017199] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The Oncology Pharmacy Team (OPT), consisting of specialty-trained pharmacists and/or pharmacy technicians, is an integral component of the multidisciplinary healthcare team (MHT) involved with all aspects of cancer patient care. The OPT fosters quality patient care, safety, and local regulatory compliance. The International Society of Oncology Pharmacy Practitioners (ISOPP) developed this position statement to provide guidance on five key areas: 1) oncology pharmacy practice as a pharmacy specialty; 2) contributions to patient care; 3) oncology pharmacy practice management; 4) education and training; and 5) contributions to oncology research and quality initiatives to involve the OPT. This position statement advocates that: 1) the OPT be fully incorporated into the MHT to optimize patient care; 2) educational and healthcare institutions develop programs to continually educate OPT members; and 3) regulatory authorities develop certification programs to recognize the unique contributions of the OPT in cancer patient care.
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Affiliation(s)
| | - Tegan Bilse
- Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | | | | | | | - Chia Jie Tan
- National University of Singapore, Singapore, Singapore
| | - Irene Weru
- Kenyatta National Hospital, Nairobi, Kenya
| | | | | | - Evelyn Handel
- National Comprehensive Cancer Network, Plymouth Meeting, PA, USA
| | | | - Manit Saeteaw
- Faculty of Pharmaceutical Sciences, Ubon Ratchathani University, Warin Chamrap District, Thailand
| | | | | | | | - Manju Garg
- Alberta Health Services, Calgary, AB, Canada
| | | | | | - Alexandre Chan
- University of California Irvine, Irvine, School of Pharmacy & Pharmaceutical Sciences, Irvine, CA, USA
| | | | - Elif Aras-Atik
- Hacettepe University, Faculty of Pharmacy, Ankara, Turkey
| | | | - Barry R Goldspiel
- National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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6
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Wu Y, Li W, Stephenson M, Cong W, Zhou C. Pre-treatment assessment for patients with breast cancer undergoing chemotherapy: a best practice implementation project. JBI Evid Synth 2021; 18:212-223. [PMID: 31972683 DOI: 10.11124/jbisrir-d-19-00163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES This project aimed to conduct an audit of pre-treatment assessment for patients with breast cancer undergoing chemotherapy and to assess the impact of these changes in improving the compliance with evidence-based best practice criteria in a large tertiary hospital. INTRODUCTION Pre-treatment assessment before cancer chemotherapy is paramount in order for patients to receive effective and safe treatment. Numerous guidelines and consensus-based standards for safe chemotherapy administration have been developed, which state that nurses should conduct and document comprehensive health assessments for patients prior to administration of chemotherapy. METHODS The project was conducted in the Breast Surgery Department of a nearly 3000-bed tertiary hospital in China. Evidence-based audit criteria were developed based on a JBI evidence summary. The JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) audit tool were used to promote changes in practice. Sample sizes of 13 clinical nurses and 30 breast cancer patients undergoing chemotherapy were included in baseline and follow-up audits. RESULTS The baseline audit indicated significant deficits in pre-treatment assessment nursing practice in the unit, with eight of the 12 criteria recording 0% compliance and one criterion recording only 3% compliance. Barriers to compliance were identified by the project team, and a series of strategies were adopted to address the barriers. There was improvement in compliance with all the best practice criteria in the follow-up audit compared with the baseline audit, with each one achieving a minimum of 90% compliance. CONCLUSIONS The project showed that regular and focused education and ongoing audits on pre-treatment assessment can help to optimize safe and effective chemotherapy treatment. Further strategies are planned to sustain the implementation of evidence.
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Affiliation(s)
- Yanni Wu
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China.,PR China Nanfang Nursing Centre for Evidence-based Practice: a Joanna Briggs Institute Affiliated Group
| | - Wenji Li
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Matthew Stephenson
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Weilian Cong
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Chunlan Zhou
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China.,PR China Nanfang Nursing Centre for Evidence-based Practice: a Joanna Briggs Institute Affiliated Group
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7
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Pavlakis N. As cancer therapy becomes more complex, we must enhance our professional standards. J Pharm Pract Res 2020. [DOI: 10.1002/jppr.1700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Nick Pavlakis
- Department of Medical Oncology Royal North Shore Hospital St Leonards Australia
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8
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Abstract
PURPOSE Take-home cancer drugs (THCDs) have become a standard treatment of many cancers. Robust guidelines have been developed for intravenous chemotherapy drugs, but few exist for THCDs with a focus on decentralized models. Hence, Ontario Health (Cancer Care Ontario) established the Oncology Pharmacy Task Force (OPTF) to develop consensus-based recommendations on best practices for THCDs to ensure that patients receive safe, consistent, high-quality care in the community once they leave the cancer center/practice with a prescription. METHODS The OPTF included 34 members with comprehensive representation. Guidance from leading authorities was extracted through literature review, thematically analyzed, and synthesized to develop 29 recommendations. The consensus process (> 70% agreement) included a three-step modified Delphi method followed by an extensive review process. RESULTS Sixteen recommendations were developed: training and education for providers (2), drug access (1), prescribing (4), patient and family/caregiver education (3), communication (1), dispensing (3), monitoring for patient adherence and adverse effects (1), and incident reporting (1). CONCLUSION Through a rigorous methodology, the OPTF derived a robust set of recommendations similar to the ASCO/Oncology Nursing Society and ASCO/National Community Oncology Dispensing Association guidelines, further validating and strengthening the applicability across multiple jurisdictions, including those with decentralized models. Unique aspects in a decentralized model include the need for two pharmacy professionals, with one doing cognitive verification of the script and the other dispensing the medication; moreover, they optimize interprofessional communication between community providers and the cancer center/practice health care team.
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Affiliation(s)
- Aliya Pardhan
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Kathy Vu
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Daniela Gallo-Hershberg
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Leta Forbes
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Lakeridge Health, Oshawa, Ontario, Canada
| | - Scott Gavura
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Vishal Kukreti
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Lichtner V, Franklin BD, Dalla-Pozza L, Westbrook JI. Electronic ordering and the management of treatment interdependencies: a qualitative study of paediatric chemotherapy. BMC Med Inform Decis Mak 2020; 20:193. [PMID: 32795356 PMCID: PMC7427723 DOI: 10.1186/s12911-020-01212-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are serious safety risks associated with chemotherapy, often associated with interdependencies in regimens administered over months or years. Various strategies are used to manage these risks. Computerized provider order entry (CPOE) systems are also implemented to improve medication safety. Little is known regarding the effect of CPOE on how clinicians manage chemotherapy interdependencies and their associated safety strategies. METHODS We conducted a multi-method qualitative study in a paediatric hospital. We analysed 827 oncology incidents reported following CPOE implementation and carried out semi-structured interviews with doctors (n = 10), nurses (n = 6), a pharmacist, and oncology CPOE team members (n = 2). Results were interpreted according to safety models (ultra-safe, high-reliability organisations [HROs], or ultra-adaptive). RESULTS Incident reports highlighted two interrelated types of interdependencies: those within organisation of clinical activities and those inherent in chemotherapy regimens. Clinicians reported strategies to address chemotherapy risks and interdependencies. These included rigid rules and 'no go' contexts for treatment to proceed, typical of the ultra-safe model; use of time (e.g. planning only so far ahead) and sensitivity to operations, typical of HROs. We identified three different time horizons in CPOE use in relation to patients' treatments: life-long, the whole regimen, and the 'here and now'. CPOE supported ultra-safe strategies through automation and access to rules/standardisation, but also created difficulties and contributed to incidents. It supported the 'here and now' better than a life-long or whole regimen view of a patient treatment. Sensitivity to operations was essential to anticipate and resolve uncertainties, hazards, CPOE limitations, and mismatches between CPOE processes and workflow in practice. CONCLUSIONS Within oncology, CPOE appears to move the 'mix' of risk strategies towards ultra-safe models of safety and protocol-mandated care. However, in order to operate ultra-safe strategies embedded in CPOE and stay on protocol it is essential for clinicians to be thoughtful and show sensitivity to operations in CPOE use. CPOE design can be advanced by better consideration of mechanisms to support interdependencies.
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Affiliation(s)
- Valentina Lichtner
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia. .,Department of Practice and Policy, UCL School of Pharmacy, University College London, BMA House, Entrance A, Tavistock Square, Bloomsbury, London, WC1H 9JP, UK.
| | - Bryony Dean Franklin
- Department of Practice and Policy, UCL School of Pharmacy, University College London, BMA House, Entrance A, Tavistock Square, Bloomsbury, London, WC1H 9JP, UK.,Centre for Medication Safety and Service Quality, Pharmacy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Luciano Dalla-Pozza
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, Australia
| | - Johanna I Westbrook
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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10
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Dillmon MS, Kennedy EB, Anderson MK, Brodersen M, Cohen H, D′Amato SL, Davis P, Doshi G, Genschaw S, Makhoul I, Ormsby W, Panikkar R, Peng E, Raez LE, Ronnen EA, Wimbiscus B, Reff M. Patient-Centered Standards for Medically Integrated Dispensing: ASCO/NCODA Standards. J Clin Oncol 2020; 38:633-644. [DOI: 10.1200/jco.19.02297] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To provide standards for medically integrated dispensing of oral anticancer drugs and supportive care medications. METHODS An Expert Panel was formed, and a systematic review of the literature on patient-centered best practices for the delivery of oral anticancer and supportive care drugs was performed to April 2019 using PubMed and Google Scholar. Available patient-centered standards, including one previously developed by the National Community Oncology Dispensing Association (NCODA), were considered for endorsement. Public comments were solicited and considered in preparation of the final manuscript. RESULTS A high-quality systematic review that was current to May 2016 was adopted into the evidence base. Five additional primary studies of multifaceted interventions met the inclusion criteria. These studies generally included a multicomponent intervention, often led by an oncology pharmacist, and also included patient education and regular follow-up and monitoring. These interventions resulted in significant improvements to patient quality and safety and demonstrated improvements in adherence and other patient outcomes. CONCLUSION The findings of the systematic review were consistent with the NCODA patient-centered standards for patient relationships and education, adherence, safety, collection of data, documentation, and other areas. NCODA standards were adopted and used as basis for these American Society of Clinical Oncology/NCODA standards. Additional information is available at www.asco.org/mid-standards .
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Affiliation(s)
| | | | | | | | | | | | - Patty Davis
- Oncology Hematology Associates, Springfield, MO
| | | | - Stuart Genschaw
- Cancer & Hematology Centers of Western Michigan, Grand Rapids, MI
| | - Issam Makhoul
- University of Arkansas for Medical Sciences, Little Rock, AK
| | | | | | - Eileen Peng
- Regional Cancer Care Associates, East Brunswick, NJ
| | - Luis E. Raez
- Memorial Healthcare System/Florida International University, Pembroke Pines, FL
| | | | - Bill Wimbiscus
- National Community Oncology Dispensing Association, Cazenovia, NY
| | - Michael Reff
- National Community Oncology Dispensing Association, Cazenovia, NY
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11
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Weingart SN, Zhang L, Sweeney M, Hassett M. Chemotherapy medication errors. Lancet Oncol 2019; 19:e191-e199. [PMID: 29611527 DOI: 10.1016/s1470-2045(18)30094-9] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 12/07/2017] [Accepted: 12/14/2017] [Indexed: 11/26/2022]
Abstract
Although chemotherapy is a well established treatment modality, chemotherapy errors represent a potentially serious risk of patient harm. We reviewed published research from 1980 to 2017 to understand the extent and nature of medication errors in cancer chemotherapy, and to identify effective interventions to help prevent mistakes. Chemotherapy errors occur at a rate of about one to four per 1000 orders, affect at least 1-3% of adult and paediatric oncology patients, and occur at all stages of the medication use process. Oral chemotherapy use is a particular area of growing risk. Our knowledge of chemotherapy errors is drawn primarily from single-institution studies at university hospitals and referral centres, with a particular focus on prescription orders and pharmacy practices. Although the heterogeneity of research methods and measures used in these studies limits our understanding of this issue, the rate of chemotherapy error-related injuries is generally lower than those seen in comparable studies of general medical patients. Although many interventions show promise in reducing chemotherapy errors, most have little empirical support. Additional research is needed to understand and to mitigate the risk of chemotherapy medication errors.
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Affiliation(s)
- Saul N Weingart
- Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA.
| | - Lulu Zhang
- Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Megan Sweeney
- Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Michael Hassett
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Valencia FS, Ruiz R, Neciosup SP, Mas LA, Aliaga KM, Huaman F, Ruiz J, Vasquez E, Llacctahuaman N, Pedraza R, Paz M, Aguirre W, Gomez HL. Implementation of Computerized Physician Order Entry for Chemotherapy: A Latin American Experience. JCO Clin Cancer Inform 2019; 2:1-12. [PMID: 30652618 DOI: 10.1200/cci.18.00041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We describe the implementation process of a computerized physician order entry (CPOE) for outpatient chemotherapy at a Latin American hospital, with the intent of providing other institutions with general guidance and insight through our experience. METHODS In 2012, under the direction of the Department of Medicine of the Instituto Nacional de Enfermedades Neoplásicas, a multidisciplinary team composed of oncologists, nurses, pharmacists, and informatics engineers was formed to develop software for a CPOE for chemotherapy within a preexistent homegrown electronic medical record system in various phases. This included mapping and redesigning processes in an entirely electronic format, integrating the needs of the user for the development of electronic order sets, developing a checkpoint and a warning system to minimize prescription errors, and finally, training all the staff in implementation of the system. RESULTS A CPOE for outpatient chemotherapy was successfully implemented in 2016. We have successfully standardized 266 chemotherapy orders, including for both solid tumors and hematologic malignancies, on the basis of appropriate guidelines. The software is linked to laboratory results and allows entry of important details for the patient's safety, such as anthropometric information for an automatic dose calculation and ranges for safe prescription. In addition, it is linked to the nursing plan sheets. Finally, it is possible to assess and continuously monitor the complex process of chemotherapy prescription. CONCLUSION This is the first report of implementation of a CPOE for chemotherapy in our region. The system was designed by a multidisciplinary team with its own resources. Our experience demonstrates the feasibility of computerizing the chemotherapy prescription process, constituting a tangible example for other institutions with potential impact on patient care.
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Affiliation(s)
- Fernando S Valencia
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
| | - Rossana Ruiz
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
| | - Silvia P Neciosup
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
| | - Luis A Mas
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
| | - Karina M Aliaga
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
| | - Flor Huaman
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
| | - Jenny Ruiz
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
| | - Edinson Vasquez
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
| | - Noel Llacctahuaman
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
| | - Robert Pedraza
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
| | - Missael Paz
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
| | - Willam Aguirre
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
| | - Henry L Gomez
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
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Oliveira PPD, Santos VEP, Bezerril MDS, Andrade FBD, Paiva RDM, Silveira EAAD. PATIENT SAFETY IN THE ADMINISTRATION OF ANTINEOPLASTIC CHEMOTHERAPY AND OF IMMUNOTHERAPICS FOR ONCOLOGICAL TREATMENT: SCOPING REVIEW. Texto contexto - enferm 2019. [DOI: 10.1590/1980-265x-tce-2018-0312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to identify and synthesize the scientific evidence on cancer patient safety in the administration of antineoplastic and immunotherapeutic chemotherapeutic agents. Method: a scoping review, according to the Joanna Briggs Institute and to the recommendations of the PRISMA-ScR international guide. The research was conducted in five electronic databases, the Cochrane Library and eight catalogs of theses and dissertations. The inclusion criteria were the following: studies related to patient safety in the administration of antineoplastic and immunotherapeutic chemotherapy by nurses in places where cancer care occurs, published entirely in Portuguese, Spanish and/or English, with no time limit. The extracted data were analyzed and synthesized in narrative form. Results: a total of 14,444 records were retrieved and 47 studies were kept for review. Most publications (44.7%) had a qualitative approach, while 40.4% were quantitative and 14.9%, mixed. When summarizing the findings, the following themes emerged: Safety standards in parenteral administration of antineoplastic chemotherapy; Good practices for patient safety using oral antineoplastic therapy; Administration and safe handling of immunotherapies; Prevention and management of errors related to the administration of antineoplastic and immunotherapeutic chemotherapeutic agents. Conclusion: patients safety with cancer in the administration of antineoplastic therapy occurs when there is implementation of evidence-based protocols, continuing education of nurses and implementation of safety standards and processes, as a strategy to prevent errors in drug administration.
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Vera R, Otero MJ, Ayala de la Peña F, González-Pérez C, Peñuelas Á, Sepúlveda JM, Quer N, Doménech-Climent N, Virizuela JA, Beorlegui P, Gorgas MQ. Recommendations by the Spanish Society of Hospital Pharmacy, the Spanish Society of Oncology Nursing and the Spanish Society of Medical Oncology for the safe management of antineoplastic medication in cancer patients. Clin Transl Oncol 2018; 21:467-478. [DOI: 10.1007/s12094-018-1945-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
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Al Khawaldeh TA, Wazaify M. Intravenous cancer chemotherapy administration errors: An observational study at referral hospital in Jordan. Eur J Cancer Care (Engl) 2018; 27:e12863. [PMID: 29873424 DOI: 10.1111/ecc.12863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 03/31/2018] [Accepted: 04/17/2018] [Indexed: 10/14/2022]
Abstract
This study aimed to describe types, frequencies and stages of errors which occurred during administration of commonly used intravenous (IV) cancer chemotherapy medications inclusive of "aseptic technique." A disguised direct observational cross-sectional prospective study was performed. A checklist consisting of appropriate process of administration of injectable chemotherapy agents along with the "aseptic technique" was developed and used. The study was conducted at the haematology and oncology wards at King Hussein Medical Centre/Jordanian Royal Medical Services (KHMC/JRMS). In all, 10 nurses who administrated IV chemotherapy in both inpatient and outpatient settings were observed. Overall, administration processes of 654 cases, consisting of 15,042 error opportunities, were observed of which 4112 (27.3%) errors were detected. A total of 19.9% (2217/11,118) and 48.3% (1895/3924) of the errors were in the administration process and "aseptic techniques," respectively. Nurses who had finished a cancer chemotherapy medication preparation and administration training course committed significantly (p > 0.05) more medication administration errors compared to those who had not completed such course. This study highlighted a significant incidence of medication errors during administration of injectable chemotherapy agents. Educational programmes are required for safe administration of IV chemotherapy agents in some settings in Jordan.
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Affiliation(s)
- Thamer Ali Al Khawaldeh
- Clinical Pharmacist, Department of Pharmacy, Jordan Royal Medical Services (JRMS), Amman, Jordan
| | - Mayyada Wazaify
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
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Taghizadeh-Ghehi M, Amouei A, Mansouri A, Kohneloo AJ, Hadjibabaie M. Prescribing Pattern and Prescription-writing Quality of Antineoplastic Agents in the Capital City of a Middle-income Developing Country. J Res Pharm Pract 2018; 7:46-50. [PMID: 29755999 PMCID: PMC5934988 DOI: 10.4103/jrpp.jrpp_17_74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective Cancer is a global health concern with growing incidence worldwide. Chemotherapy is the main treatment modality in many malignancies. This study aimed at evaluation of antineoplastic prescribing pattern and prescription-writing quality in the capital city of Iran. Methods All dispensed chemotherapy prescriptions by four main authorized pharmacies in Tehran during 1 month were targeted. Prescriptions with no antineoplastic medications or written by specialties other than oncology-related fields were excluded from the study. From the total 10,944 eligible prescriptions, 2736 (25%) prescriptions were selected randomly for data extraction. Findings Total 5784 antineoplastic medications were written by 239 physicians; most of them were adult hematologist-oncologist (69.0%) and male (86.6%). Each prescription contained an average of 1.8 (±0.9) antineoplastic medications. The most widely prescribed antineoplastic agents were cyclophosphamide (16.2%), fluorouracil (15.2%), doxorubicin (12.8%), and oxaliplatin (11.0%). The quality of prescription writing was poor; diagnosis, drug dosing, treatment schedule, and instructions were mostly absent. Sixty percent of drugs were written in brand names. Conclusion The prescribing writing quality was poor and patients were at great risk of medication errors. Prompt action including policies and educational strategies should be taken to assure effective and safe patient treatment with antineoplastic medications.
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Affiliation(s)
| | - Asiyeh Amouei
- Department of Pharmaceutical Care, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ava Mansouri
- Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Molouk Hadjibabaie
- Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
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Bernabeu-Martínez MA, Ramos Merino M, Santos Gago JM, Álvarez Sabucedo LM, Wanden-Berghe C, Sanz-Valero J. Guidelines for safe handling of hazardous drugs: A systematic review. PLoS One 2018; 13:e0197172. [PMID: 29750798 PMCID: PMC5947890 DOI: 10.1371/journal.pone.0197172] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 04/27/2018] [Indexed: 12/12/2022] Open
Abstract
Objective To review the scientific literature related to the safe handling of hazardous drugs (HDs). Method Critical analysis of works retrieved from MEDLINE, the Cochrane Library, Scopus, CINHAL, Web of Science and LILACS using the terms "Hazardous Substances", "Antineoplastic Agents" and "Cytostatic Agents", applying "Humans" and "Guidelines" as filters. Date of search: January 2017. Results In total, 1100 references were retrieved, and from those, 61 documents were selected based on the inclusion and exclusion criteria: 24 (39.3%) documents related to recommendations about HDs; 27 (44.3%) about antineoplastic agents, and 10 (33.3%) about other types of substances (monoclonal antibodies, gene medicine and other chemical and biological agents). In 14 (23.3%) guides, all the stages in the manipulation process involving a risk due to exposure were considered. Only one guide addressed all stages of the handling process of HDs (including stages with and without the risk of exposure). The most described stages were drug preparation (41 guides, 67.2%), staff training and/or patient education (38 guides, 62.3%), and administration (37 guides, 60.7%). No standardized informatics system was found that ensured quality management, traceability and minimization of the risks associated with these drugs. Conclusions Most of the analysed guidelines limit their recommendations to the manipulation of antineoplastics. The most frequently described activities were preparation, training, and administration. It would be convenient to apply ICTs (Information and Communications Technologies) to manage processes involving HDs in a more complete and simpler fashion.
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Affiliation(s)
- Mari A. Bernabeu-Martínez
- Department of Public Health and History of Science, School of Medicine, Miguel Hernandez University, Elche, Spain
| | - Mateo Ramos Merino
- Department of Telematics Engineering, Telecommunication Engineering School of the University of Vigo, Vigo, Spain
| | - Juan M. Santos Gago
- Department of Telematics Engineering, Telecommunication Engineering School of the University of Vigo, Vigo, Spain
| | - Luis M. Álvarez Sabucedo
- Department of Telematics Engineering, Telecommunication Engineering School of the University of Vigo, Vigo, Spain
| | - Carmina Wanden-Berghe
- Health and Biomedical Research Institute of Alicante, University General Hospital of Alicante, Alicante, Spain
| | - Javier Sanz-Valero
- Department of Public Health and History of Science, School of Medicine, Miguel Hernandez University, Elche, Spain
- * E-mail:
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Hu L, Kichenadasse G, Martin H, Roy A, Sukumaran S, Vatandoust S, Koczwara B, Karapetis CS. Pregnancy screening prior to chemotherapy administration. Intern Med J 2016; 46:1222-1224. [PMID: 27734613 DOI: 10.1111/imj.13214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 07/12/2016] [Accepted: 08/04/2016] [Indexed: 11/29/2022]
Abstract
A retrospective case notes review was performed to determine compliance with screening for undetected pregnancy prior to commencement of chemotherapy at Flinders Medical Centre. All female patients aged 18-55 who commenced chemotherapy between January and December 2014 were included. During the first 12 months, for women identified as having childbearing potential, pre-chemotherapy pregnancy screening was performed only in 40% of patients under 40 years and in 20.5% of the entire age range.
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Affiliation(s)
- L Hu
- Flinders Centre for Innovation in Cancer, Flinders Medical Centre/Flinders University, Adelaide, South Australia, Australia
| | - G Kichenadasse
- Flinders Centre for Innovation in Cancer, Flinders Medical Centre/Flinders University, Adelaide, South Australia, Australia.
| | - H Martin
- Flinders Centre for Innovation in Cancer, Flinders Medical Centre/Flinders University, Adelaide, South Australia, Australia
| | - A Roy
- Flinders Centre for Innovation in Cancer, Flinders Medical Centre/Flinders University, Adelaide, South Australia, Australia
| | - S Sukumaran
- Flinders Centre for Innovation in Cancer, Flinders Medical Centre/Flinders University, Adelaide, South Australia, Australia
| | - S Vatandoust
- Flinders Centre for Innovation in Cancer, Flinders Medical Centre/Flinders University, Adelaide, South Australia, Australia
| | - B Koczwara
- Flinders Centre for Innovation in Cancer, Flinders Medical Centre/Flinders University, Adelaide, South Australia, Australia
| | - C S Karapetis
- Flinders Centre for Innovation in Cancer, Flinders Medical Centre/Flinders University, Adelaide, South Australia, Australia
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19
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Butt F, Ream E. Implementing oral chemotherapy services in community pharmacies: a qualitative study of chemotherapy nurses' and pharmacists' views. International Journal of Pharmacy Practice 2015; 24:149-59. [DOI: 10.1111/ijpp.12237] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 09/25/2015] [Indexed: 11/29/2022]
Abstract
Abstract
Objectives
Changes in health-care provision have led to cancer patients being offered oral chemotherapy in the community. Three levels of oral chemotherapy services have been proposed (levels 1, 2 and 3) with community pharmacies playing differing roles within them. This study aims to explore health-care professionals' views on oral chemotherapy services being delivered by community pharmacies and to gain insights into the barriers, facilitators and training/knowledge needs of community pharmacists with respect to providing them.
Methods
Qualitative semi-structured interviews were conducted with a purposive sample of three chemotherapy nurses, five oncology pharmacists and five community pharmacists. Data were analysed thematically using Framework Analysis.
Key findings
Findings for level 1 and 2 services included uncertainty on community pharmacists' professional responsibilities, the expertise of GPs in prescribing oral chemotherapy and the training and competency of community pharmacists. The lack of patient information, care and support provision was emphasised for all the models. Although level 1 was achievable in current practice, level 2 was considered the safest option, while level 3 was ideal but risky option.
For all levels, training and education for community pharmacists and inter-professional issues were facilitators to oral chemotherapy services. The service environment, dispensing process-related constraints (access to blood test results and protocols) were significant barriers for levels 2 and 3.
Advanced communication skills, patient education and counselling were identified as key areas for education and training for community pharmacists.
Conclusion
The study suggests there are significant concerns and challenges associated with community pharmacies implementing any of the proposed levels of oral chemotherapy services. Educational and training opportunities for community pharmacists and the careful development of safe infrastructures will be essential in the future planning and implementation of any community pharmacy oral chemotherapy service.
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Affiliation(s)
- Farida Butt
- Pharmacy Department, Kingston University, Kingston upon Thames, UK
| | - Emma Ream
- Florence Nightingale Faculty of Nursing and Midwifery, Kings College London, London, UK
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Turner A, Stephenson M. Documentation of chemotherapy administration by nursing staff in inpatient and outpatient oncology/hematology settings: a best practice implementation project. ACTA ACUST UNITED AC 2015; 13:316-34. [DOI: 10.11124/jbisrir-2015-2157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
Oral targeted therapies are increasingly being used to treat cancer. They work by interfering with specific molecules or pathways involved in tumour growth. It is essential that health professionals managing patients taking these drugs have appropriate training and skills. They should be aware of potential adverse effects and drug interactions, and be able to manage toxicities when they occur. Despite the selectivity of these targeted therapies, they still have serious adverse effects including skin reactions, diarrhoea and altered organ function.
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Affiliation(s)
- Christine Carrington
- Assistant director of pharmacy, Senior consultant pharmacist - cancer services, Princess Alexandra Hospital, Brisbane
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22
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Abstract
Following a review of a chemotherapy medication adverse event where the incorrect medication was prepared by a pharmacy, a number of steps were taken to review the literature and best practice information related to checking processes for the preparation of parenteral chemotherapy. Concepts such as identification of critical stop check points, independent double checks, and human factors principles were reviewed and incorporated into newly designed chemotherapy preparation worksheets with embedded checklists. Usability testing and staff feedback during implementation revealed a number of key learning points that resulted in additional work to further improve the chemotherapy worksheets with embedded checklists and highlighted the need for a culture of continuous quality improvement.
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Affiliation(s)
- Roxanne Dobish
- Department of Cancer Services Pharmacy, Alberta Health Services, Canada
| | - Jonas Shultz
- Department of Human Factors, Alberta Health Services, Canada
| | - Sheena Neilson
- Department of Cancer Services Pharmacy, Alberta Health Services, Canada
| | - Amanda Raven
- Department of Human Factors, Alberta Health Services, Canada
| | - Carole R Chambers
- Department of Cancer Services Pharmacy, Alberta Health Services, Canada
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Conde-Estévez D, Salas E, Albanell J. Survey of oral chemotherapy safety and adherence practices of hospitals in Spain. Int J Clin Pharm 2013; 35:1236-44. [PMID: 24129581 DOI: 10.1007/s11096-013-9858-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 09/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Oral chemotherapy is increasingly used for cancer therapy but, without proper practices, creates safety and adherence issues. However, little is known on safety and adherence practices in wide clinical settings. OBJECTIVE To assess the implementation level of safety and adherence practices in oral chemotherapy in Spanish hospitals. SETTING All Pharmacy services from prescription, dispensation, patient education and monitoring hospitals that prescribe oral chemotherapy of Spain. MAIN OUTCOME MEASURE Level of safety practices regarding oral chemotherapy prescription, dispensation, patient education and adherence. METHOD An 11 multiple-choice-item questionnaire made in consensus with GEDEFO (Spanish Group of Oncology Pharmacists) was sent to all pharmacy services from hospitals that prescribe oral chemotherapy. This questionnaire comprised prescription, dispensation, education and monitoring. We arbitrarily defined three levels of practices: no sufficient specific practices were reported (we termed this as 'level I'); performance of an initial visit with a pharmacist providing written patient educational materials and monitoring adherence (termed as 'level II'); and level II requirements plus electronic chemotherapy ordering system and extra safety practices (termed as 'level III'). RESULTS Of the 169 targeted health-care settings, 86 (50.9 %) responded to the survey. The majority of responding hospitals were public, general, and teaching hospitals with more than 200 beds. Main discrepancies were in electronic prescription of oral chemotherapy and monitoring adherence. There were 32 hospitals (37.2 %) with level I of safety and adherence practices, 38 hospitals (44.2 %) accomplished level II, 16 (18.6 %) hospitals reached level III. No hospital variables were found to be correlated with each level of safety. CONCLUSIONS The majority of responding hospitals have safety and adherences practices for oral chemotherapy. However, the level of these practices varies. There are significant opportunities for improvement, particularly with regard to electronic prescription of oral chemotherapy and monitoring adherence.
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Strother RM, Rao KV, Gregory KM, Jakait B, Busakhala N, Schellhase E, Pastakia S, Krzyzanowska M, Loehrer PJ. The oncology pharmacy in cancer care delivery in a resource-constrained setting in western Kenya. J Oncol Pharm Pract 2012; 18:406-16. [DOI: 10.1177/1078155211434852] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The movement to deliver cancer care in resource-limited settings is gaining momentum, with particular emphasis on the creation of cost-effective, rational algorithms utilizing affordable chemotherapeutics to treat curable disease. The delivery of cancer care in resource-replete settings is a concerted effort by a team of multidisciplinary care providers. The oncology pharmacy, which is now considered integral to cancer care in resourced medical practice, developed over the last several decades in an effort to limit healthcare provider exposure to workplace hazards and to limit risk to patients. In developing cancer care services in resource-constrained settings, creation of oncology pharmacies can help to both mitigate the risks to practitioners and patients, and also limit the costs of cancer care and the environmental impact of chemotherapeutics. This article describes the experience and lessons learned in establishing a chemotherapy pharmacy in western Kenya.
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Affiliation(s)
- R Matthew Strother
- Indiana University School of Medicine, USA
- Indiana University School of Medicine, USA
| | - Kamakshi V Rao
- University of North Carolina, USA
- Indiana University School of Medicine, USA
| | - Kelly M Gregory
- Virginia Commonwealth Medical Center, USA
- Indiana University School of Medicine, USA
| | - Beatrice Jakait
- Moi Teaching and Referral Hospital, Kenya
- Indiana University School of Medicine, USA
| | - Naftali Busakhala
- Moi University School of Medicine, Kenya
- Indiana University School of Medicine, USA
| | - Ellen Schellhase
- Purdue University School of Pharmacy, USA
- Indiana University School of Medicine, USA
| | - Sonak Pastakia
- Purdue University School of Pharmacy, USA
- Indiana University School of Medicine, USA
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Malik M, Hassali MAA, Shafie AA, Hussain A, Sandhu G, Dionysopoulos D, Phillips CJ, Tomlin AC, Doherty P, Whitfield K, Polasek TM, Lin FPY, Doogue MP, Amir M, Ellis DP, Hassali MAA, Shafie AA, Palaian S. Letters to the Editor. Journal of Pharmacy Practice and Research 2011. [DOI: 10.1002/j.2055-2335.2011.tb00071.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Madeeha Malik
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical SciencesUniversity Sains Malaysia
| | - Mohamed AA Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical SciencesUniversity Sains Malaysia
| | - Asrul A Shafie
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical SciencesUniversity Sains Malaysia
| | - Azhar Hussain
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical SciencesUniversity Sains Malaysia Penang Malaysia
- Hamdard Institute of Pharmaceutical SciencesHamdard University Islamabad Pakistan
| | - Geeta Sandhu
- Specialist Pharmacist – Cancer Services Ambulatory Care, Princess Alexandra Hospital, The School of PharmacyUniversity of Queensland Woolloongabba Qld 4102
| | | | | | - Angela C Tomlin
- Surgical Preadmission ClinicFlinders Medical Centre Bedford Park Adelaide SA 5042
| | - Paula Doherty
- Drug Usage Evaluation, Medication Safety Project PharmacistJohn Hunter Hospital, Hunter New England Local Health Network New Lambton NSW 2305
| | - Karen Whitfield
- Quality Use of Medicines, School of PharmacyUniversity of Queensland Woolloongabba Qld 4102
| | - Thomas M Polasek
- Department of Clinical PharmacologyFlinders University and Flinders Medical Centre Adelaide SA 5042
| | - Frank PY Lin
- Centre of Health InformaticsUniversity of New South Wales Sydney NSW 2052
| | - Mathew P Doogue
- Clinical Pharmacologist and Endocrinologist, Department of Clinical PharmacologyFlinders University and Flinders Medical Centre Adelaide SA 5042
| | - Muhammad Amir
- Ziauddin College of PharmacyZiauddin University Clifton, Karachi 75600 Pakistan
| | - David P Ellis
- Women's and Children's HospitalChildren, Youth and Women's Health Service North Adelaide SA 5006
| | - Mohamed Azmi Ahmad Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical SciencesUniversiti Sains Malaysia Penang Malaysia
| | - Asrul Akmal Shafie
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical SciencesUniversiti Sains Malaysia Penang Malaysia
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Goodin S, Griffith N, Chen B, Chuk K, Daouphars M, Doreau C, Patel RA, Schwartz R, Tamés MJ, Terkola R, Vadnais B, Wright D, Meier K. Safe handling of oral chemotherapeutic agents in clinical practice: recommendations from an international pharmacy panel. J Oncol Pract 2011; 7:7-12. [PMID: 21532802 PMCID: PMC3014516 DOI: 10.1200/jop.2010.000068] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2010] [Indexed: 11/20/2022] Open
Abstract
Although there has been a significant increase in the availability and use of oral chemotherapeutic agents, the guidelines around their safe handling are still evolving. Although oral chemotherapy is associated with ease of administration, it has the same exposure risks to health care practitioners, patients, and their caregivers as intravenous formulations, and because it is administered in the home, to the families of patients. However, the general misconception appears to be that exposure risk is low and therefore oral chemotherapeutic agents present little risk and are safer to handle. In a series of three roundtable meetings, a team of international pharmacists from North America and Europe reviewed existing guidelines and identified gaps in recommendations that we believe are important for safe handling. The present article is a compilation of these gaps, especially applicable to manufacturers and distributors, storage and handling, and patient education regarding safe handling. These recommendations, on the basis of our experience and of best practices, provide an international perspective and can be adapted by institutions and practices for development of standardized procedures specific to their needs for the safe handling of oral chemotherapeutic agents.
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Affiliation(s)
- Susan Goodin
- Division of Pharmaceutical Sciences, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
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