Assessing the impact of an electronic chemotherapy order verification checklist on pharmacist reported errors in oncology infusion centers of a health-system

PURPOSE

Chemotherapies are medications with narrow therapeutic indices and potential for severe adverse events that account for at least 1 to 3% of medication errors in all adult and pediatric oncology patients. The use of an electronic chemotherapy order verification (ECOV) checklist can standardize the steps of chemotherapy verification by pharmacists, which can potentially increase medication error detection at the point of dispensing. This study evaluated the implementation of a standardized chemotherapy order verification checklist on pharmacist error reporting, particularly good-catches or near-misses type errors.

METHODS

This retrospective, quasi-experimental, pre-/post-analysis of internal voluntary medication errors reported from 12 University Hospitals Seidman oncology infusion centers from June 2022 through December 2022. Error reports, categorized based on severity, were compared pre/post-implementation of the ECOV checklist.

RESULTS

A total of 62 and 71 cases of medication errors were reported in the pre-intervention and post-intervention periods, respectively. The rate of pharmacy reported medication errors was 2.4 times greater in the post-intervention period of the ECOV checklist (p < 0.006). Pharmacy reported errors increased among all error severities reported. However, the finding did not deduce a statistically significant difference (p < 0.244).

CONCLUSION

This study demonstrates the effectiveness of implementing the ECOV checklist in increasing the rate of pharmacy reported medication errors. The checklist was designed to complement existing pharmacist workflow and provide a source of documentation for steps of sequential pharmacist evaluation.

Biosimilar strategic implementation at a large health system

DISCLAIMER

In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

PURPOSE

This article highlights one health system's response to the market influx of biosimilars with the establishment of a process for formulary review and selection of preferred agents and support for therapeutic interchanges.

SUMMARY

Through assessment of available literature, insurance payor coverage, and manufacturer-anticipated approvals of biosimilars, a strategic stance was developed to guide biosimilar order preparation, review, adoption, and implementation. The electronic medical record (EMR) is prepared for biosimilar implementation at least 6 to 12 months ahead of anticipated formulary review. The review includes assessment of a class (reference product and available biosimilars) after at least 2 biosimilars become available. Key health-system departments and clinicians are enlisted to support review of clinical, safety, and economic implications. Implementation of a preferred product relies on standard education, formulary availability, and staff awareness to address any perceived patient safety concerns and gather provider support. The standard steps developed now apply to all future biosimilar reviews, adoption plans, and ongoing monitoring. Barriers evaluated include changes in payor coverage and challenges in preparation of the EMR for future biosimilars, meeting precertification team education needs, and providing operational support for pharmacy inventory.

CONCLUSION

To date, use of 5 preferred biosimilar products has led to significant cost savings to the institution, and the process has been endorsed by providers. The institution's successes can be attributed to clear communication with stakeholders and the development of a deliberate process, led by a multidisciplinary leadership team, for managing formulary, safety, and operational barriers in a thoughtful and systematic manner.

Assessment of adipokines, adenine nucleotides and uric acid in the dynamics of coronary intervention

Introduction: The association of vaspin and visfatin, with a myocardial infarction is still not fully understood. Reduced levels of adenine nucleotides are hallmarks of chronic heart failure. There is little data concerning the relationship between these markers and their changes over time. Material/Methods: The concentration of adenine nucleotides, vaspin and visfatinwere assessed in 41 consecutive patients with acute myocardial infarction one before (day I) and four days after (day IV) percutaneous coronary intervention (PCI) and a control group. Results: Visfatin concentrations were higher before and after PCI vs. control (visfatin I: median 25.55, 20.12 - 30.69 ng/ml; visfatin IV: median 20.79, 16.89 - 25.61 ng/ml vs. control: median 14.94, 10.66 - 25.25 ng/ml; p < 0.0001). Vaspin concentrations were lower before and after PCI vs. control (vaspin I: median 0.18, 0.11 - 0.44 ng/ml; vaspin IV: median 0.24, 0.15 - 0.58 ng/ml vs. control: median 1.303, 1.13 - 2.26 ng/ml, p < 0.00001). Concentrations of visfatin, day I, correlated well to vaspin concentrations (r