Background and Importance Chemotherapy prescribing errors represent a potentially serious risk of causing patient harm. Whilst pharmacist prescribing has a well-established role in many clinical settings worldwide and has been shown to be effective, there is a paucity of research on pharmacist prescribing chemotherapy.
Aim and Objectives Assess the potential clinical and economic impact of pharmacist prescribing versus medical prescribing of chemotherapy (including supportive medicines) at a university teaching hospital.
Quantify the error rate in pharmacist- and doctor-prescribed chemotherapy prescriptions.
Classify prescribing errors according to the Pharmaceutical Care Network Europe (PCNE) classification framework for drug-related problems (DRPs).
Assess the potential severity of prescribing errors made by the pharmacists and doctors using a validated tool and peer review panel.
Evaluate the time taken for the chemotherapy prescribing process by doctors and pharmacists and assign costs to these times. Estimate the cost of the provision of a pharmacist prescribing service in comparison to the doctor prescribing practice.
Material and Methods This was a comparative, prospective study that examined the same set of 155 prescriptions prepared by both doctors and pharmacists for the same set of patients. The potential severity and adverse drug event (ADE) probability associated with the prescribing errors was assessed using a validated tool and peer review panel. The cost avoidance associated with the provision of pharmacist prescribing was also determined.
Results In the comparative sample of 155 prescriptions, doctors made significantly more errors (105 in 40.6% of prescriptions) than pharmacists (23 in 14.8% of prescriptions); p<0.05. None of the pharmacists’ errors were classified as 'severe', whilst 16.7% of doctors’ errors were 'severe' (n=17). Regarding cost avoidance, a potential yearly net cost benefit of €1,254,347.72 and a cost-benefit ratio of €41.82 was calculated for the provision of a pharmacist chemotherapy prescribing service.
Conclusion and Relevance This study has shown that having pharmacists prescribing – and better using their expert skillset – results in fewer chemotherapy prescribing errors. While this minimises healthcare professionals’ workload as well as any potential delays for patients to receive chemotherapy, pharmacist prescribing most importantly improves patient safety, and therefore this is ultimately why this initiative should be considered for implementation in cancer care services on a much wider scale in future.
Conflict of Interest No conflict of interest
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