Background and Importance Cytotoxic chemotherapeutic agents are classified as high alert medications according health accreditation standards. Detection and resolving of drug related problems (DRP) in chemotherapy prescriptions was associated with overall positive clinical and economic impact in international studies.
Aim and Objectives to describe the economic and clinical impact of interventions performed by pharmacists in the chemotherapy preparation unit at Sultan Qaboos University Hospital (SQUH).
Material and Methods This was a retrospective analysis of pharmacists’ interventions on injectable chemotherapy orders between January and December 2021. At SQUH, chemotherapy including biologicals/targeted therapies are centrally prepared within the pharmacy. SQUH is a tertiary care multi-speciality hospital in Oman. Chemotherapy prescriptions were routinely verified by trained pharmacists against set treatment protocols and in accordance to patients’ clinical and laboratory parameters prior to preparation/mixing. Consequently, a proportion of prescriptions was withheld on the day and differed to another subject to patients’ conditions. The direct cost reduction of unprepared doses was calculated.
The remaining prescriptions were screened for any DRP prior to mixing/preparation and PI were then documented on a specific form that was incorporated into the electronic patient record. Each intervention was then graded according to predefined criteria as death, major, moderate and minor according to the associated potential harm prevented.
Results A total of 9,515 orders were received in chemotherapy preparation unit including 18,408 individual injectable medications prescriptions, for 1,096 patients during 2021. A total of 4,440 interventions were performed on the individual medication prescriptions representing 24.1% of total orders. Prior to mixing, 4,069 orders (22.1%of total) were differed and the estimated potential direct cost reduction from the unprepared doses was around 1,000,000 OMR (2,000,000 €). A total of 303 PI were documented and 96% of them were accepted by the prescriber. The most common type of PI was dose adjustment (37.0%) followed by omission (17.2%) and wrong cycle (13.3%). PI prevented death in 1.6% while it prevented a major harm in 3.8%, moderate in 41.0%, minor in 3.0% and improved a suboptimal standard of care in 33.1% of cases.
Conclusion and Relevance Chemotherapy order verification and pharmacists’ interventions have minimised potential harm associated with cytotoxic chemotherapy regimens and resulted in considerable cost saving.
References and/or Acknowledgements https://www.ismp.org/recommendations/high-alert-medications-acute-list
Conflict of Interest No conflict of interest
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