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Kefale B, Engidaw MT, Tesfa D, Molla M, Tegegne GT. Medication-related problems among patients with cervical cancers at oncology centers of University of Gondar comprehensive specialized hospital: A hospital-based retrospective study. J Oncol Pharm Pract 2024; 30:270-277. [PMID: 37151053 DOI: 10.1177/10781552231174589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
INTRODUCTION Though drugs play indispensable role in the treatment of cervical cancer, they are associated with medication-related problems (MRPs). Hence, the present study was aimed to investigate MRPs among patients with cervical cancer. METHODS A hospital-based retrospective study was employed at the oncology center of University of Gondar Comprehensive Specialized Hospital. All patients with cervical cancer diagnosis from January 1, 2016 to December 31, 2020, were included. Stata version 16/MP for Windows was used for description and analysis. Logistic regression analysis was employed. RESULTS A total of 124 patients with cervical cancer were included. Paclitaxel and cisplatin (69.4%) combination were the most widely used treatment regimen. MRPs were found in 59.7% patients, with a mean of 2.22 ± 1.13. Subtherapeutic dose (24.4%), the need for additional drug therapy (22.6%), and adverse drug reactions (22%) were the most prevalent MRPs. Being >50 years (adjusted odds ratio (AOR) = 15.37, 95% confidence interval (CI) = 2.25-105.09, p = 0.005), treated with ≥5 medications (AOR = 7.00, 95% CI = 2.65-18.49, p < 0.001), and being stage III (AOR = 15.43, 95% CI = 2.92-81.47, p = 0.001) and stage IV (AOR = 8.41, 95% CI = 1.35-52.44, p = 0.023) were independent predictors of MRPs. CONCLUSION More than half of patients with cervical cancer had one or more MRPs. Being older, patients taking polypharmacy, stage III and IV patients were significantly associated with the development of MRPs. As most of the cervical patients experienced one or more MRPs, clinical pharmacy service should be strengthened to optimize drug therapy to reduce unwanted adverse events.
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Affiliation(s)
- Belayneh Kefale
- Clinical Pharmacy Unit and Research Team, Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Amhara, Ethiopia
| | - Melaku Tadege Engidaw
- Department of Social and Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara, Ethiopia
| | - Desalegn Tesfa
- Department of Social and Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara, Ethiopia
| | - Mulugeta Molla
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara, Ethiopia
| | - Gobezie T Tegegne
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Lattard C, Baudouin A, Larbre V, Herledan C, Cerutti A, Cerfon MA, Kimbidima R, Caffin AG, Vantard N, Schwiertz V, Ranchon F, Rioufol C. Clinical and economic impact of clinical oncology pharmacy in cancer patients receiving injectable anticancer treatments: a systematic review. J Cancer Res Clin Oncol 2023; 149:7905-7924. [PMID: 36853384 DOI: 10.1007/s00432-023-04630-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/01/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Clinical pharmacy can reduce drug-related iatrogenesis by improving the management of adverse effects of drugs, limiting drug-drug interactions, and improving patient adherence. Given the vulnerability of cancer patients and the toxicity of injectable anticancer drugs, clinical pharmacy service (CPS) could provide a significant clinical benefit in cancer care. This review aims to synthesize existing evidence on clinical pharmacy's impact on patients treated with intravenous anticancer drugs. METHODS A comprehensive search was performed in the PubMed/Medline database from January 2000 to December 2021, associating the keywords: clinical pharmacy, pharmaceutical care, pharmacist, oncology, and chemotherapy. To be eligible for inclusion, studies have to report clinical pharmaceutical services for patients treated with intravenous chemotherapy with a clinical and/or economic impact. RESULTS Forty-one studies met the selection criteria. Various CPS were reported: medication reconciliation, medication review, and pharmaceutical interview with patient. There was a lack of randomized study (n = 3; 7.3%). In one randomized controlled trial, pharmaceutical intervention significantly improved quality of life of patients receiving pharmaceutical care during injectable anticancer drugs courses. Economical results appear to show positive impact of clinical pharmacy with cost savings reported from 3112.87$ to 249 844€. Although most studies were non-comparative, they highlighted that clinical pharmacy tend to limit chemotherapy side effects and drug-related problems, improve quality of life and satisfaction of patients and healthcare professional, and a positive economic impact. CONCLUSION Clinical pharmacy can reduce adverse drug events in cancer patients. More robust and economic evaluations are still required to support its development in everyday practice.
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Affiliation(s)
- Claire Lattard
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Amandine Baudouin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Virginie Larbre
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1- EA 3738, CICLY Centre Pour l'Innovation en Cancérologie de Lyon, 69921, Lyon, Oullins Cedex, France
| | - Chloé Herledan
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1- EA 3738, CICLY Centre Pour l'Innovation en Cancérologie de Lyon, 69921, Lyon, Oullins Cedex, France
| | - Ariane Cerutti
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Marie-Anne Cerfon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Reine Kimbidima
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Anne-Gaelle Caffin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Nicolas Vantard
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Vérane Schwiertz
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Florence Ranchon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1- EA 3738, CICLY Centre Pour l'Innovation en Cancérologie de Lyon, 69921, Lyon, Oullins Cedex, France
| | - Catherine Rioufol
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France.
- Université Lyon 1- EA 3738, CICLY Centre Pour l'Innovation en Cancérologie de Lyon, 69921, Lyon, Oullins Cedex, France.
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Abstract
INTRODUCTION Telepharmacy has the potential to enhance pharmacy services in oncology care, especially in remote areas. This scoping review explored the range, critical benefits and barriers of using telepharmacy services in oncology care. METHODS The scoping review followed the Arksey and O'Malley's five-stage framework to identify available evidence. PubMed, CINAHL, Embase, PsycINFO, Ovid MEDLINE and Scopus databases were searched for original research published between 2010 and 2020. The five dimensions of the Alberta Quality Matrix for Health were used to analyse reported outcomes. RESULTS Eligible articles (n = 21) were analysed. Telepharmacy in oncology care was used for follow-up, monitoring and counselling, intravenous chemotherapy and sterile compounding, expanding availability of pharmacy services, and remote education. Telepharmacy obtained high acceptability among cancer patients (n = 5) and healthcare professionals (n = 5), and increased accessibility of pharmaceutical services to underserved cancer populations (n = 2). Commonly cited effectiveness and safety outcomes were improved patient adherence (n = 5), increased pharmacy services (n = 3) and early identification of medication-related problems (n = 5). Telepharmacy improved efficiency in staffing and workload (n = 3), and increased cost savings (n = 3). A shortage of resources (n = 5), technical problems (n = 4) and prolonged turnaround time (n = 4), safety concerns (n = 2) and patient willingness to pay (n = 1) were identified barriers to implementing telepharmacy in oncology care. DISCUSSION Despite evidence pointing to the advantages and opportunities for expanding oncology pharmacy services through telepharmacy, certain challenges remain. Further research is needed to investigate safety concerns and patient willingness to pay for telepharmacy services.
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Affiliation(s)
- Anh Thu Vo
- Faculty of Medicine, Memorial University of Newfoundland, Canada
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Zerbit J, Kroemer M, Fuchs B, Detroit M, Decroocq J, Vignon M, Willems L, Deau‐Fischer B, Franchi P, Deschamps P, Contejean A, Grignano E, Fouquet G, Birsen R, Mondesir J, Rocquet M, Huon J, Batista R, Marty‐Reboul J, Bouscary D. Pharmaceutical cancer care for haematology patients on oral anticancer drugs: Findings from an economic, clinical and organisational analysis. Eur J Cancer Care (Engl) 2022; 31:e13753. [DOI: 10.1111/ecc.13753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/26/2022] [Accepted: 10/09/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Jeremie Zerbit
- Pharmacy Department, Hospital at Home University Hospitals of Paris (AP‐HP) Paris France
| | - Marie Kroemer
- Pharmacy Department University Hospital of Besançon Besançon France
| | - Basile Fuchs
- Medical Information, Cochin Hospital University Hospitals of Paris (AP‐HP) Paris France
| | - Marion Detroit
- Pharmacy Department University Hospital of Besançon Besançon France
| | - Justine Decroocq
- Clinical Hematology, Cochin Hospital University Hospitals of Paris (AP‐HP) Paris France
- Université de Paris, Institut Cochin, CNRS UMR8104, INSERM U1016 Paris France
- Équipe Labellisée Ligue Nationale Contre le Cancer (LNCC) Paris France
| | - Marguerite Vignon
- Clinical Hematology, Cochin Hospital University Hospitals of Paris (AP‐HP) Paris France
| | - Lise Willems
- Clinical Hematology, Cochin Hospital University Hospitals of Paris (AP‐HP) Paris France
| | | | - Patricia Franchi
- Clinical Hematology, Cochin Hospital University Hospitals of Paris (AP‐HP) Paris France
| | - Paul Deschamps
- Clinical Hematology, Cochin Hospital University Hospitals of Paris (AP‐HP) Paris France
- Université de Paris, Institut Cochin, CNRS UMR8104, INSERM U1016 Paris France
- Équipe Labellisée Ligue Nationale Contre le Cancer (LNCC) Paris France
| | | | - Eric Grignano
- Clinical Hematology, Cochin Hospital University Hospitals of Paris (AP‐HP) Paris France
- Université de Paris, Institut Cochin, CNRS UMR8104, INSERM U1016 Paris France
- Équipe Labellisée Ligue Nationale Contre le Cancer (LNCC) Paris France
| | - Guillemette Fouquet
- Hematology Department Centre Hospitalier Sud Francilien Corbeil‐Essonnes France
| | - Rudy Birsen
- Clinical Hematology, Cochin Hospital University Hospitals of Paris (AP‐HP) Paris France
- Université de Paris, Institut Cochin, CNRS UMR8104, INSERM U1016 Paris France
- Équipe Labellisée Ligue Nationale Contre le Cancer (LNCC) Paris France
| | - Johanna Mondesir
- Clinical Hematology, Cochin Hospital University Hospitals of Paris (AP‐HP) Paris France
- Université de Paris, Institut Cochin, CNRS UMR8104, INSERM U1016 Paris France
- Équipe Labellisée Ligue Nationale Contre le Cancer (LNCC) Paris France
| | - Mathieu Rocquet
- Hematology Department Necker Hospital, University Hospitals of Paris (AP‐HP) Paris France
| | - Jean‐François Huon
- INSERM, UMR 1246‐SPHERE, MethodS in Patients‐Centered Outcomes and HEalth ResEarch Nantes France
- Clinical Pharmacy Unit Nantes University Hospital Nantes France
| | - Rui Batista
- Clinical Pharmacy, Cochin Hospital University Hospitals of Paris (AP‐HP) Paris France
| | - Jeanne Marty‐Reboul
- Medical Information, Cochin Hospital University Hospitals of Paris (AP‐HP) Paris France
| | - Didier Bouscary
- Clinical Hematology, Cochin Hospital University Hospitals of Paris (AP‐HP) Paris France
- Université de Paris, Institut Cochin, CNRS UMR8104, INSERM U1016 Paris France
- Équipe Labellisée Ligue Nationale Contre le Cancer (LNCC) Paris France
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Kefale B, Engidaw MT, Tesfa D, Molla M, Yismaw MB. Management Practice and Drug Related Problems and Its Contributing Factors Among Cervical Cancer Patients at Oncologic Center in Ethiopia: A Hospital-Based Retrospective Study. Ther Clin Risk Manag 2022; 18:643-655. [PMID: 35711253 PMCID: PMC9196911 DOI: 10.2147/tcrm.s364923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/04/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction In cervical cancer therapy, there is a high prevalence of drug-related problems (DRPs) due to the high toxicity and complexity of most antineoplastic regimens. However, there is a paucity of data about DRPs among patients with cervical cancer in Ethiopia. Hence, the present study was aimed at investigating management practices and DRPs among patients diagnosed with cervical cancer. Methods A registry-based retrospective cohort study was employed among cervical cancer patients at the oncology center of Felege Hiwot Comprehensive Specialized Hospital (FHCSH). All patients with a histologically confirmed diagnosis of cervical cancer from January 2016 to December 2020 were included. Relevant information was recorded by reviewing medical records. The possibility of DRPs was evaluated by comparing with standard guidelines. Logistic regression analysis was employed. Results A total of 184 cervical cancer patients were included, with a mean age of 50.2±10.7 years. A total of 216 DRPs were identified from 93 cervical cancer patients, translating to a prevalence of 50.5% and a mean of 2.32±1.11 DRPs per patient. ADR (27.3%), DDI (25%), and the need for additional drug therapy (22.2%) were the most prevalent DRPs. DRPs were associated with the presence of co-morbidity (AOR = 4.23, 95% CI = 1.78–10.05, p = 0.001), complications (AOR = 2.99, 95% CI = 1.28–6.99, p = 0.011), being treated with ≥5 medications (AOR = 5.1, 95% CI = 2.38–10.95, p < 0.001), being stage II (AOR = 0.14, 95% CI = 0.02–0.90, p = 0.038), and stage III (AOR = 0.04, 95% CI = 0.01–0.32, p = 0.003). Conclusion Cisplatin-based chemotherapy was the frequently used therapeutic option. Co-morbidity and complication status, number of medication and stage of cancer were significantly associated with DRPs. The study highlights the need of clinical pharmacy services to optimize drug therapy and reduce DRPs.
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Affiliation(s)
- Belayneh Kefale
- Clinical Pharmacy Unit and Research Team, Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Amhara, Ethiopia
| | - Melaku Tadege Engidaw
- Department of Social and Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara, Ethiopia
| | - Desalegn Tesfa
- Department of Social and Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara, Ethiopia
| | - Mulugeta Molla
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara, Ethiopia
| | - Malede Berihun Yismaw
- Clinical Pharmacy Unit and Research Team, Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Amhara, Ethiopia
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Aguiar PM, Mori ALPM, Lima MGFD, Rossi MSPN, Nicoletti MA, Martins KOF, Lopes ALM, Coan TCM, Fugita OEH, Storpirtis S. The effects of pharmacist interventions on health outcomes in patients with advanced prostate cancer in Brazil. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902021000219273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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7
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da Rocha C, Carlotto J, Zanis Neto J. Analysis of the interventions in antineoplastic therapy by a clinical pharmacy service at a tertiary hospital in Brazil. J Oncol Pharm Pract 2021:10781552211017650. [PMID: 34000918 DOI: 10.1177/10781552211017650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Medication errors are avoidable occurrences that can assume clinically significant dimensions and impose relevant costs to the health system, especially in the context of antineoplastic therapy. OBJECTIVE Assess the clinical significance and economic impacts of a clinical pharmaceutical service. This retrospective study consists of an analysis of pharmacy interventions and drug-related problems found in a review of electronic prescriptions referring to antineoplastic therapy of a public teaching tertiary hospital in Brazil. METHOD Retrospective descriptive study obtained from electronic records of drug-related problems and pharmaceutical interventions related to antineoplastic therapy for oncological and hematological diseases, obtained through the pharmacotherapy review service. The accepted interventions were analyzed for the financial impact generated, evaluating your direct costs. The perception of clinical significance of a random sample of interventions was ascertained by the experts' opinion, using the Delphi method. RESULTS The most frequent problem was a "lack of information to professionals" (25.06%), "problems as to the frequency and interval of doses" (22.90%), and "medication underdosing" (16.20%). Dose adjustment (31.50%) and clarifications (30.90%) were the most frequent pharmaceutical interventions. In the second round of Delphi, experts rated 77.77% of interventions as extremely significant and very significant. The main drugs reported in the interventions were cyclophosphamide, carboplatin, methotrexate, folinic acid, and monoclonal antibodies. The savings amounted to US$1,193,970.18 and involved mainly bortezomib, dactinomycin, and monoclonal antibodies. CONCLUSION Clinical pharmacy services contributed to the rational use of medicines presenting clinical significance and avoiding waste of financial resources.
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Affiliation(s)
- Camile da Rocha
- Clinical Hospital of the Federal University of Paraná, Curitiba, Brazil
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8
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Karthikeyan K, Sunil VB, Alex SM, Cs M. A study to assess the impact of pharmaceutical care services to cancer patients in a tertiary care hospital. J Oncol Pharm Pract 2021; 28:588-597. [PMID: 33793356 DOI: 10.1177/10781552211005003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Clinical pharmacist can enthusiastically involve in oncology department through utilizing the skills and knowledge to support wide variety of functions in patient care. The impact of pharmaceutical care services in oncology department were analysed through various approaches including the analysis of knowledge level of patients towards the disease and its management through patient counselling, monitoring of performance status, observing of ADR and drug safety. Incidence of cancer was scrutinized during the study.Methodology: A Prospective interventional study was conducted from November 2019 to March 2020 with the support of institutional ethical approval at oncology department of Lourdes hospital, Ernakulam. 133 patients were included with all type of cancer. Data collected through Performa with KAP questionnaire and direct interview was conducted. Statistical significance was evaluated through p value of <0.001 Result: 123 patients were completed both questionnaire. Among this 69.91% were females and most of the patients belonged to 50 - 65yeras age group and carcinoma was frequently reported type. End of the study showed significant change in the knowledge level of patients after interaction with the clinical pharmacist. 26 ADRs were reported including solitary and multiple ADRs. Recommendations associated with drug reconstitution, administration were frequently given to the nurses. Most of the interventions to improve therapeutic outcome of the patients were accepted by the oncologist. CONCLUSION Clinical pharmacist can actively participate in all aspects of the oncology department in association with physician and other health care providers to improve the therapeutic outcome and quality of life of patients.
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Affiliation(s)
- Kavya Karthikeyan
- Department of Pharmacy Practice, St. Joseph's College of Pharmacy, Cherthala, India
| | - Vinayak B Sunil
- Department of Pharmacy Practice, St. Joseph's College of Pharmacy, Cherthala, India
| | - Soumya M Alex
- Department of Pharmacy Practice, St. Joseph's College of Pharmacy, Cherthala, India
| | - Madhu Cs
- Department of Oncology, Lourdes Hospital, Ernakulam, India
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Desmaris RP, Bermudez E, Annereau M, Lemare F, Slimano F. Organization of chemotherapeutic preparations in advance: Do we save or waste money? J Oncol Pharm Pract 2020; 27:1699-1703. [PMID: 33108989 DOI: 10.1177/1078155220967981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The development of oncology day-hospital activities contributes to increase quality of life of patients and consequently have changed their perception about waiting. The extemporaneous preparation of antineoplastic has become difficult to achieve given the increasing activity, and hospital pharmacists have taken up the challenge by the implementation of the antineoplastic preparation in anticipation. Because anticipation can lead to an important number of preparations to be discarded, we also develop a recycled process for other patients to limit these waste extra costs. We aim to demonstrate the positive balance of anticipated preparation in this 4-year study report.Data sources: This prospective study was conducted in a major European oncology day-hospital from January, 2012 to December, 2015. The data were extracted from our software WinSimbad™ and updated as needed. The number and cost-associated of preparation ungiven chemotherapy doses (recycled or discarded) were compared to the global drug budget of our hospital in order to not exceed 2%.Data summary: 303,100 antineoplastic have been prepared. Approximately 35% of them were anticipated with an average of 5,431±984 that were finally ungiven. Two-third was recycled and the cost of the ungiven preparations finally discarded represents 1.7±0.15% of the global drug budget. CONCLUSIONS This study assesses the drug wastage and its associated cost of this concept through a prospective study and discusses the cost of ungiven antineoplastic preparations. With prior consideration of the need to define the acceptable rate of discarded ungiven preparation, the hospitals with an high oncology day-hospital activity should implement this approach.
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Affiliation(s)
| | - Elisabeth Bermudez
- Department of Clinical Pharmacy, Gustave Roussy Hospital, Rue Edouard Vaillant, France
| | - Maxime Annereau
- Department of Clinical Pharmacy, Gustave Roussy Hospital, Rue Edouard Vaillant, France
| | - François Lemare
- Department of Clinical Pharmacy, Gustave Roussy Hospital, Rue Edouard Vaillant, France
| | - Florian Slimano
- Department of Clinical Pharmacy, Gustave Roussy Hospital, Rue Edouard Vaillant, France
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10
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Bowles H, Tawfik B, Abernathy J, Lauer R, Hashemi N, Dayao Z. Pharmacist-Driven Oral Oncolytic Medication Education and Consent. JCO Oncol Pract 2020; 16:e1209-e1215. [DOI: 10.1200/jop.19.00418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: The numbers and types of oral oncolytics in oncology are expanding rapidly. Oral oncolytics have serious adverse effects, and pharmacist-driven patient education has the potential to reduce adverse events. The University of New Mexico Comprehensive Cancer Center (UNM CCC) initiated a patient education and consent process for oral oncolytics in our minority, rural, and economically disadvantaged population. PATIENTS AND METHODS: The UNM CCC initiated a pharmacist-driven education and consent process from August 2016 to October 2018. The process metric measured via statistical process control charts was the percentage of patients receiving oral oncolytic therapy who were educated and consented. The balancing metric was time for benefit investigation. The intervention was pharmacy team members providing standardized education for and obtaining consent from each patient, supported by electronic medical record orders, physician education, pharmacy notifications, and hospital discharge planning. RESULTS: The initial monthly education and consent rate was 17.9%, followed by 45.5% the subsequent month. This quickly grew to an average of 87.0% (95% CI, 81.5% to 92.4%) for the subsequent 15 months in which control was achieved. Additional changes increased the education rate to 95.7% (95% CI, 93.4% to 98.1%). These 2 periods were statistically different ( P = .0025). There was no change in time for benefit investigation (5.60 v 5.52 days; P = .75). CONCLUSION: A pharmacist-driven program for education and consent upon initiation of oral oncolytics is possible and can successfully educate a majority of patients. Future directions will include ensuring patient adherence and educating patients who fill oral oncolytic prescriptions outside UNM CCC.
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Affiliation(s)
- Harmony Bowles
- Section of Hematology and Oncology, Division of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Bernard Tawfik
- Section of Hematology and Oncology, Division of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Janet Abernathy
- Section of Hematology and Oncology, Division of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Richard Lauer
- Section of Hematology and Oncology, Division of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Neda Hashemi
- Section of Hematology and Oncology, Division of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Zoneddy Dayao
- Section of Hematology and Oncology, Division of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
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11
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Zecchini C, Vo TH, Chanoine S, Lepelley M, Laramas M, Lemoigne A, Allenet B, Federspiel I, Bedouch P. Clinical, economic and organizational impact of pharmacist interventions on injectable antineoplastic prescriptions: a prospective observational study. BMC Health Serv Res 2020; 20:113. [PMID: 32050957 PMCID: PMC7017539 DOI: 10.1186/s12913-020-4963-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 02/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background Pharmacists play a key role in ensuring the safe use of injectable antineoplastics, which are considered as high-alert medications. Pharmaceutical analysis of injectable antineoplastic prescriptions aims to detect and prevent drug related problems by proposing pharmacist interventions (PI). The impact of this activity for patients, healthcare facilities and other health professionals is not completely known. This study aimed at describing the clinical, economic, and organizational impacts of PIs performed by pharmacists in a chemotherapy preparation unit. Methods A prospective 10-week study was conducted on PIs involving injectable antineoplastic prescriptions. Each PI was assessed by one of the four multidisciplinary expert committees using a multidimensional tool with three independent dimensions: clinical, economic and organizational. An ancillary quantitative evaluation of drug cost savings was conducted. Results Overall, 185 patients were included (mean age: 63.5 ± 13.7 years; 54.1% were male) and 237 PIs concerning 10.1% prescriptions were recorded. Twenty one PIs (8.9%) had major clinical impact (ie: prevented hospitalization or permanent disability), 49 PIs (20.7%) had moderate clinical impact (ie: prevented harm that would have required further monitoring/treatment), 62 PIs (26.2%) had minor clinical impact, 95 PIs (40.0%) had no clinical impact, and 9 PIs (3.8%) had a negative clinical impact. For one PI (0.4%) the clinical impact was not determined due to insufficient information. Regarding organizational impact, 67.5% PIs had a positive impact on patient management from the healthcare providers’ perspective. A positive economic impact was observed for 105 PIs (44.3%), leading to a saving in direct drug costs of 15,096 €; 38 PIs (16.0%) had a negative economic impact, increasing the direct drug cost by 11,878 €. Overall cost saving was 3218€. Conclusions PIs are associated with positive clinical, economic and organizational impacts. This study confirms the benefit of pharmacist analysis of injectable antineoplastic prescriptions for patient safety with an overall benefit to the healthcare system.
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Affiliation(s)
- Céline Zecchini
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France.
| | - Thi-Ha Vo
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France.,CNRS, TIMC-IMAG, UMR5525, F-38000, Grenoble, France.,Pham Ngoc Thạch University of Medicine, Hochiminh, V-70000, Vietnam
| | - Sébastien Chanoine
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France.,CNRS, TIMC-IMAG, UMR5525, F-38000, Grenoble, France.,University Grenoble Alpes, F-38000, Grenoble, France
| | - Marion Lepelley
- Centre Régional de Pharmacovigilance, F-38000, Grenoble, France
| | - Mathieu Laramas
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Cancer et maladies du sang, F-38000, Grenoble, France
| | - Aude Lemoigne
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France
| | - Benoît Allenet
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France.,CNRS, TIMC-IMAG, UMR5525, F-38000, Grenoble, France.,University Grenoble Alpes, F-38000, Grenoble, France
| | - Isabelle Federspiel
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France
| | - Pierrick Bedouch
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France.,CNRS, TIMC-IMAG, UMR5525, F-38000, Grenoble, France.,University Grenoble Alpes, F-38000, Grenoble, France
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12
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Kucuk E, Bayraktar-Ekincioglu A, Erman M, Kilickap S. Drug-related problems with targeted/immunotherapies at an oncology outpatient clinic. J Oncol Pharm Pract 2019; 26:595-602. [DOI: 10.1177/1078155219861679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Some studies in the literature describe drug-related problems in patients with cancer, although few studies focused on patients receiving targeted chemotherapy and/or immunotherapy. To identify the incidence of drug-related problems in patients receiving targeted chemotherapy and/or immunotherapy, and demonstrate the impact of a clinical pharmacist in an outpatient oncology care setting. Methods Prospective study was conducted in a hospital outpatient oncology clinic between October 2015 and March 2016. Patients greater than 18 years old receiving cetuximab, nivolumab, ipilimumab, or pembrolizumab were included in the study and monitored over a three-month period by a clinical pharmacist. Drug-related problems were analyzed using the Pharmaceutical Care Network Europe classification system. The main outcome measures were the frequency and causes of drug-related problems and the degree of resolution achieved through the involvement of a clinical pharmacist. Results A total of 54 patients (mean age: 57 ± 12 years) were included. There were 105 drug-related problems and 159 associated causes. Among the planned interventions (n = 149), 92 interventions were at the patient-level with 88 (96%) being accepted by the doctors. This resulted in 68 (65%) drug-related problems being completely resolved and 9 (8.6%) being partially resolved. The most common drug-related problem identified was “adverse drug event” (n = 38, 36%). Of the 105 drug-related problems, 63 (60%) related to targeted chemotherapy and/or immunotherapy with 34 (54%) classified as an “adverse drug event.” Conclusion Adverse drug events were the most common drug-related problems in patients with cancer. The involvement of a clinical pharmacist improved the identification of drug-related problems and helped optimize treatment outcomes in patients receiving targeted chemotherapy/immunotherapy.
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Affiliation(s)
- Esra Kucuk
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | | | - Mustafa Erman
- Department of Medical Oncology, Hacettepe University, Hacettepe Cancer Institute, Ankara, Turkey
| | - Saadettin Kilickap
- Department of Medical Oncology, Hacettepe University, Hacettepe Cancer Institute, Ankara, Turkey
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13
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Moon JY, Lee Y, Han JM, Lee MH, Yee J, Song MK, Kim YJ, Gwak HS. Effects of pharmacist interventions on reducing prescribing errors of investigational drugs in oncology clinical trials. J Oncol Pharm Pract 2019; 26:29-35. [DOI: 10.1177/1078155219834723] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
ObjectivesThis study aimed to investigate the effectiveness of pharmacist intervention in reducing and preventing prescribing errors of investigational drugs for cancer patients.Materials and methodsA retrospective study was conducted during two periods: a baseline period from December 2015 to June 2016 and an intervention period from July 2016 to February 2017. The investigational drug service (IDS) pharmacists performed active interventions during the intervention period.ResultsAmong 12,387 investigational drug orders, 395 (6.1%) prescribing errors were detected in 6477 orders at the baseline period, and 278 errors (4.7%) were detected in 5,910 orders at the intervention period. To identify factors that affect prescribing errors, three models were constructed for the multivariate analysis. Among factors affecting prescribing errors, sponsor initiated trial (SIT) was the strongest factor (AOR: 4.16, 95% CI: 3.31–5.23). Pharmacist intervention reduced prescribing errors by at least 25% in all constructed models after adjusting for confounding variables. Prescribing errors were 1.3 times higher when dealing with intravenous medications than when dealing with oral medications. There were 60% fewer prescribing errors in the blinded study than in the open study. SIT and multi-center/multi-nation studies had 4.2 and 2.4 times more frequent prescribing errors than in investigator-initiated trials (IIT) and single-center/single-nation studies, respectively. Fewer errors occurred in phase 2 and trials covering both phase 1 and phase 2 (phase 1/2) than in phase 3 trials.ConclusionsThe IDS pharmacist intervention in cancer clinical trials was associated with significant reductions in prescribing errors and may lead to increased medication safety.
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Affiliation(s)
- Jin Young Moon
- College of Pharmacy and Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
- Department of Pharmacy, National Cancer Center, Goyang-si, Republic of Korea
| | - Yeonhong Lee
- Department of Pharmacy, National Cancer Center, Goyang-si, Republic of Korea
| | - Ji Min Han
- College of Pharmacy and Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
| | - Mi Hyung Lee
- Department of Pharmacy, National Cancer Center, Goyang-si, Republic of Korea
- Graduate School of Converging Clinical & Public Health, Ewha Womans University, Seoul, Republic of Korea
| | - Jeong Yee
- College of Pharmacy and Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
| | - Mi Kyung Song
- Biometrics Research Branch, Research Institute, National Cancer Center, Goyang-si, Republic of Korea
| | - Young Ju Kim
- Department of Pharmacy, National Cancer Center, Goyang-si, Republic of Korea
| | - Hye Sun Gwak
- College of Pharmacy and Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
- Graduate School of Converging Clinical & Public Health, Ewha Womans University, Seoul, Republic of Korea
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14
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Daupin J, Perrin G, Lhermitte-Pastor C, Loustalot MC, Pernot S, Savoldelli V, Thibault C, Landi B, Sabatier B, Caudron E. Pharmaceutical interventions to improve safety of chemotherapy-treated cancer patients: A cross-sectional study. J Oncol Pharm Pract 2019; 25:1195-1203. [DOI: 10.1177/1078155219826344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Johanne Daupin
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
| | - Germain Perrin
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
- INSERM UMR 1138, Equipe 22, Centre de recherche des Cordeliers, Paris, France
| | | | | | - Simon Pernot
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, Paris, France
| | - Virginie Savoldelli
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
- Clinical Pharmacy Department, Faculty of Pharmacy, U-Psud University Paris-Saclay, Châtenay-Malabry, France
| | - Constance Thibault
- Department of Medical Oncology, Georges Pompidou European Hospital, Paris, France
| | - Bruno Landi
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, Paris, France
| | - Brigitte Sabatier
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
- INSERM UMR 1138, Equipe 22, Centre de recherche des Cordeliers, Paris, France
| | - Eric Caudron
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
- Lip(Sys)2 Laboratory of analytical chemistry, EA7357, U-Psud University Paris-Saclay, Châtenay-Malabry, France
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15
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Duarte NC, Barbosa CR, Tavares MGR, Dias LP, Souza RN, Moriel P. Clinical oncology pharmacist: Effective contribution to patient safety. J Oncol Pharm Pract 2018; 25:1665-1674. [DOI: 10.1177/1078155218807748] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Management and prevention of problems related to oncology drugs are particularly important due to the excessive cost, high toxicity, and narrow therapeutic index of the antineoplastic drugs, in addition to the patients' state of health. Therefore, the presence of the pharmacist as a member of the multidisciplinary team is essential to contribute to patient safety. In this work, the interventions performed were identified, quantified, and classified to characterize the work of the clinical oncology pharmacist. This is a prospective and quantitative study, conducted over a period of six months in the outpatient oncology and chemotherapy clinic of the University Hospital of the University of Campinas, Brazil. A total of 3526 medical prescriptions were evaluated for the 780 patients seen and, among these prescriptions, 220 (6.24%) contained errors, representing 6.24% of the total number. The most common error was dose-related with 79 (22.83%) cases of overdosing. Wrong-patient medication error was the least reported (0.29%). Thirty drugs were involved in the pharmaceutical interventions, Carboplatin and Ondansetron being the most frequent. Thirteen types of potential errors were evaluated according to the method proposed by Cardinal and Fernandes. Two (15.38%) included interventions of indication, contraindication, and therapeutic efficacy of a drug. Five of them (38.46%) are related to the treatment regimen, and two (15.38%) were related to prevention of potential adverse events. Four interventions (30.77%) concerned technical interventions in injectable drugs such as dilution, compatibility, and administration time. Of the 346 interventions performed, 1 (0.29%) was classified as potentially lethal, 114 as serious (32.95%), 140 as significant (40.46%), and 91 as minor (26.30%).
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Affiliation(s)
| | - Cristina R Barbosa
- Hospital das Clínicas of University of Campinas (HC-UNICAMP), Campinas, Brazil
| | - Mariane GR Tavares
- Hospital das Clínicas of University of Campinas (HC-UNICAMP), Campinas, Brazil
| | - Lara P Dias
- Hospital das Clínicas of University of Campinas (HC-UNICAMP), Campinas, Brazil
| | - Rafael N Souza
- Faculty of Pharmaceutical Sciences (FCF-UNICAMP), Campinas, Brazil
| | - Patricia Moriel
- Faculty of Pharmaceutical Sciences (FCF-UNICAMP), Campinas, Brazil
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16
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Bao Z, Ji C, Hu J, Luo C, Fang W. Clinical and economic impact of pharmacist interventions on sampled outpatient prescriptions in a Chinese teaching hospital. BMC Health Serv Res 2018; 18:519. [PMID: 29973200 PMCID: PMC6031100 DOI: 10.1186/s12913-018-3306-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limited studies have evaluated the effectiveness of pharmacist interventions on outpatient prescription. The goal of this study was to evaluate the clinical and economic impacts of pharmacist interventions on randomly sampled outpatient prescriptions. METHOD Outpatient prescriptions of our hospital were sampled automatically and reviewed by pharmacists since 2011. Pharmacists intervened in inappropriate prescriptions (IPs) real-timely, and summarized and analyzed the information monthly. Cost-benefit analysis was performed to estimate the economic benefit of the pharmacist intervention. RESULTS From 2011 to 2016, pharmacists reviewed 101,271 prescriptions and intervened in 5155 prescriptions. With the interventions of pharmacists, the number of IPs decreased from 1845 to 238, while the inappropriate percentage decreased from 12.60 to 1.22%. The inappropriate rates of different departments and the types decreased annually. IPs were mainly from the Department of Medicine and Department of Surgery and category 1 (Non-indicated medications) in all years. The benefit-to-cost ratios of pharmacist interventions were always more than 1. In the same years, the benefit-to-cost ratios in public payments were higher than those with insurance and self-payment. CONCLUSION This form of pharmacist intervention constitutes a method that showed positive clinical and economic benefits and is worth expanding in large hospitals. Pharmacists should pay more attention on prescriptions in department of surgery or prescriptions with public payments.
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Affiliation(s)
- Zhiwei Bao
- Department of Pharmacy, Jiangsu Jianhu People’s Hospital, Yancheng, 224700 China
| | - Chunmei Ji
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province 210029 People’s Republic of China
| | - Jing Hu
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province 210029 People’s Republic of China
| | - Can Luo
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province 210029 People’s Republic of China
| | - Wentong Fang
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province 210029 People’s Republic of China
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17
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Aguiar KDS, Santos JMD, Cambrussi MC, Picolotto S, Carneiro MB. Patient safety and the value of pharmaceutical intervention in a cancer hospital. ACTA ACUST UNITED AC 2018; 16:eAO4122. [PMID: 29694617 PMCID: PMC6063746 DOI: 10.1590/s1679-45082018ao4122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/18/2017] [Indexed: 11/27/2022]
Abstract
Objective To demonstrate economic impact of pharmaceutical evaluation in detection and prevention of errors in antineoplastic prescriptions. Methods This was an observational and retrospective study performed in a cancer hospital. From July to August 2016 pharmacists checked prescriptions of antineoplastic and adjuvant drugs. Drug-related problems observed were classified and analyzed concerning drug, pharmaceutical intervention, acceptability and characteristic of the error. In case of problem related to dose, we calculated a deviation percentage related with correct dose and value spent or saved. Data were analyzed using descriptive statistics with frequency and percentage. Results A total of 6,104 prescriptions and 12,128 medications were evaluated. Drug-related problems were identified in 274 (4.5%) prescriptions. Most of them was due to lack of information (n=117; 36.1%). Problems associated with dose accounted for 32.1% (n=98) of the total. In 13 cases (13.3%) ranging of prescribed dose was 50% greater than the correct dose. Intercepted drug-related problems provided savings of R$54.081,01 and expenses of R$20.863,36, therefore resulting in a positive balance of R$33.217,65. Each intervention promoted saving of R$126,78 with an acceptance rate of 98%. Main pharmaceutical interventions were information inclusion (n=117; 36.1%) and dose change (n=97; 29.9%). All errors were classified as error with no harm. Conclusion Simple actions such as prescription checking are able to identify and prevent drug-related problems, avoid financial losses and add immeasurable value to patient safety.
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18
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Hamel C, Tortolano L, Bermudez E, Desmaris R, Klein S, Slimano F, Lemare F. Computerized pediatric oncology prescriptions review by pharmacist: A descriptive analysis and associated risk factors. Pediatr Blood Cancer 2018; 65. [PMID: 29251399 DOI: 10.1002/pbc.26897] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/23/2017] [Accepted: 10/23/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Systematic prescription analyses by clinical pharmacists result in pharmacist interventions (PIs) to reduce prescription errors and improve medication safety. PIs are particularly critical in oncology, because antineoplastic drugs are highly toxic with low therapeutic indexes especially in a pediatric population. The aim of this study is to describe PIs in a pediatric oncology department and to identify potential risk factors associated with prescription errors. PROCEDURE We conducted a 20-month observational study in a pediatric oncology department concerning electronic prescription of injectable chemotherapies was conducted. PIs were analyzed for drug-related problems (DRPs), type of intervention, population characteristics, involved drugs, and the potential risk factors. RESULTS Clinical pharmacists made 90 PIs for 10,214 antineoplastic prescriptions for a rate of 88 PIs per 10,000 prescriptions. The majority of DRPs were dosage errors (61.8%), imputable to measurements (weight and/or height) in 47.4% or unreported dose reduction. The most common patient ages were in the range 1-10 years and the most common time for medical double checks was 2-9 pm. There were statistically more prescription errors in standardized protocols (P < 0.001). CONCLUSIONS Not surprisingly, PIs were predominantly to correct dose errors, half of which related to height and weight measurements that were not updated. No significant risk factors for errors were identified for errors except in the standardized status of prescription, which appears to be linked in part to our software that did not automatically reflect dose reduction from one course to the next. Medical double-checking followed by a clinical pharmacist's double check were effective in order to prevent prescription errors.
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Affiliation(s)
- Claire Hamel
- Department of Clinical Pharmacy, Gustave Roussy Cancer Campus, Villejuif Cedex, 94805, France
| | - Lionel Tortolano
- Department of Clinical Pharmacy, Gustave Roussy Cancer Campus, Villejuif Cedex, 94805, France.,EA401, IFR141, Faculty of Pharmacy, Paris-sud, University, Chatenay-Malabry, 92296, France.,Assistance Publique-Höpitaux de Paris, Groupe hospitalier Henri Mondor, Department of Pharmacy, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, F-94010, France
| | - Elisabeth Bermudez
- Department of Clinical Pharmacy, Gustave Roussy Cancer Campus, Villejuif Cedex, 94805, France
| | - Romain Desmaris
- Department of Clinical Pharmacy, Gustave Roussy Cancer Campus, Villejuif Cedex, 94805, France
| | - Sébastien Klein
- Department of Pediatric Oncology, Gustave Roussy Cancer Campus, Villejuif Cedex, 94805, France
| | - Florian Slimano
- Department of Clinical Pharmacy, Gustave Roussy Cancer Campus, Villejuif Cedex, 94805, France.,MEDyC Research Unit, UMR CNRS/URCA no. 7369, Reims University, Reims, 51100, France.,Facuty of Pharmacy, Reims University, Reims, 51100, France
| | - François Lemare
- Department of Clinical Pharmacy, Gustave Roussy Cancer Campus, Villejuif Cedex, 94805, France.,Chair of Clinical Pharmacy, Faculty of Pharmacy of Paris, Sorbonne-Paris University, Paris, 75 270, France.,EA 7348 MOS, Ecole des Hautes Etudes en Santé Publique, Rennes, 35043, France
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19
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Farias TF, Aguiar KDS, Rotta I, Belletti KMDS, Carlotto J. Implementing a clinical pharmacy service in hematology. EINSTEIN-SAO PAULO 2017; 14:384-390. [PMID: 27759828 PMCID: PMC5234751 DOI: 10.1590/s1679-45082016ao3667] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/20/2016] [Indexed: 11/21/2022] Open
Abstract
Objective: To implement a clinical pharmacy service focused on the comprehensive review of antineoplastic drugs used in therapy of hematological diseases. Methods: An interventional study was conducted in a Brazilian tertiary teaching hospital in two different periods, with and without a clinical pharmacy service, respectively. This service consisted of an antineoplastic prescription validation (analysis of patients' characteristics, laboratory tests, compliance with the therapeutic protocol and with pharmacotechnical parameters). When problems were detected, the pharmacist intervened with the physician or another health professional responsible for the patient. Inpatients and outpatients with hematological diseases were included. Results: We found an increased detection of drug-related problem by 106.5% after implementing the service. Comparing the two periods, an increase in patients' age (26.7 years versus 17.6 years), a predominance of outpatients (54% versus 38%), and an increase in multiple myeloma (13% versus 4%) and non-Hodgkin lymphoma (16% versus 3%) was noted. The most commonly found problems were related to dose (33% versus 25%) and cycle day (14% versus 30%). With regard to clinical impact, the majority had a significant impact (71% versus 58%), and in one patient from the second period could have been fatal. The main pharmaceutical interventions were dose adjustment (35% versus 25%) and drug withdrawal (33% versus 40%). Conclusion: The pharmacy service contributed to increase the detection and resolution of drug-related problems, and it was an effective method to promote the safe and rational use of antineoplastic drugs.
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Affiliation(s)
| | | | - Inajara Rotta
- Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | - Juliane Carlotto
- Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
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20
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Colombo LRP, Aguiar PM, Lima TM, Storpirtis S. The effects of pharmacist interventions on adult outpatients with cancer: A systematic review. J Clin Pharm Ther 2017; 42:414-424. [DOI: 10.1111/jcpt.12562] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 04/24/2017] [Indexed: 12/29/2022]
Affiliation(s)
- L. R. P. Colombo
- Department of Pharmacy; University of São Paulo; São Paulo Brazil
| | - P. M. Aguiar
- Department of Pharmacy; University of São Paulo; São Paulo Brazil
| | - T. M. Lima
- Department of Pharmacy; University of São Paulo; São Paulo Brazil
| | - S. Storpirtis
- Department of Pharmacy; University of São Paulo; São Paulo Brazil
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21
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Han JM, Ah YM, Suh SY, Jung SH, Hahn HJ, Im SA, Lee JY. Clinical and economic impact of pharmacists’ intervention in a large volume chemotherapy preparation unit. Int J Clin Pharm 2016; 38:1124-32. [DOI: 10.1007/s11096-016-0339-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 06/17/2016] [Indexed: 11/30/2022]
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22
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Katoue MG, Al-Taweel D. Role of the pharmacist in parenteral nutrition therapy: challenges and opportunities to implement pharmaceutical care in Kuwait. Pharm Pract (Granada) 2016; 14:680. [PMID: 27382419 PMCID: PMC4930853 DOI: 10.18549/pharmpract.2016.02.680] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 05/12/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Pharmacists can provide beneficial pharmaceutical care services to patients receiving Parenteral Nutrition (PN) therapy by working within Nutrition Support Teams (NSTs). OBJECTIVE This study was designed to explore pharmacists' role in PN therapy in hospitals of Kuwait, sources of PN-related information, opinions on NSTs, perceptions about the barriers to pharmaceutical care implementation and views on how to enhance their practices. METHODS Data were collected via face-to-face semi-structured interviews with the senior Total Parenteral Nutrition (TPN) pharmacists at all the hospitals which provide TPN preparation services (six governmental hospitals and one private hospital) in Kuwait. Descriptive statistics were used to describe pharmacists' demographic details and practice site characteristics. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS The pharmacists mainly performed technical tasks such as TPN compounding with minimal role in providing direct patient care. They used multiple different sources of TPN-related information to guide their practice. They reported positive and negative experiences with physicians depending on their practice environment. None of the hospitals had a functional NST. However, pharmacists expressed preference to work within NSTs due to the potential benefits of enhanced communication and knowledge exchange among practitioners and to improve service. Pharmacists perceived several barriers to providing pharmaceutical care including lack of reliable sources of TPN-related information, lack of a standard operating procedure for TPN across hospitals, insufficient staff, time constraints and poor communication between TPN pharmacists. To overcome these barriers, they recommended fostering pharmacists' education on TPN, establishing national standards for TPN practices, provision of pharmacy staff, development of NSTs, enhancing TPN pharmacists' communication and conducting TPN-research research. CONCLUSION TPN pharmacists in Kuwait are confined to performing TPN manufacturing processes. There are promising avenues for future development of their role in patient care. This can be achieved by overcoming the barriers to pharmaceutical care practice and providing pharmacists with educational opportunities to equip them with the clinical competencies needed to practise as nutrition support pharmacists with patient-centred roles.
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Affiliation(s)
- Maram G Katoue
- Teaching Assistant, Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Kuwait University . Kuwait ( Kuwait ).
| | - Dalal Al-Taweel
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University . Kuwait ( Kuwait ).
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Liamis G, Filippatos TD, Elisaf MS. Electrolyte disorders associated with the use of anticancer drugs. Eur J Pharmacol 2016; 777:78-87. [PMID: 26939882 DOI: 10.1016/j.ejphar.2016.02.064] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/23/2016] [Accepted: 02/26/2016] [Indexed: 12/23/2022]
Abstract
The use of anticancer drugs is beneficial for patients with malignancies but is frequently associated with the occurrence of electrolyte disorders, which can be hazardous and in many cases fatal. The review presents the electrolyte abnormalities that can occur with the use of anticancer drugs and provides the related mechanisms. Platinum-containing anticancer drugs induce hypomagnesemia, hypokalemia and hypocalcemia. Moreover, platinum-containing drugs are associated with hyponatremia, especially when combined with large volumes of hypotonic fluids aiming to prevent nephrotoxicity. Alkylating agents have been linked with the occurrence of hyponatremia [due to syndrome of inappropriate antidiuretic hormone secretion (SIADH)] and Fanconi's syndrome (hypophosphatemia, aminoaciduria, hypouricemia and/or glucosuria). Vinca alkaloids are associated with hyponatremia due to SIADH. Epidermal growth factor receptor monoclonal antibody inhibitors induce hypomagnesemia, hypokalemia and hypocalcemia. Other, monoclonal antibodies, such as cixutumumab, cause hyponatremia due to SIADH. Tyrosine kinase inhibitors are linked to hyponatremia and hypophosphatemia. Mammalian target of rapamycin inhibitors induce hyponatremia (due to aldosterone resistance), hypokalemia and hypophosphatemia. Other drugs such as immunomodulators or methotrexate have been also associated with hyponatremia. The administration of estrogens at high doses, streptozocin, azacitidine and suramin may induce hypophosphatemia. Finally, the drug-related tumor lysis syndrome is associated with hyperphosphatemia, hyperkalemia and hypocalcemia. The prevention of electrolyte derangements may lead to reduction of adverse events during the administration of anticancer drugs.
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Affiliation(s)
- George Liamis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Theodosios D Filippatos
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Moses S Elisaf
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece.
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Impact of Clinical Pharmacy Services on KAP and QOL in Cancer Patients: A Single-Center Experience. BIOMED RESEARCH INTERNATIONAL 2015; 2015:502431. [PMID: 26697487 PMCID: PMC4677164 DOI: 10.1155/2015/502431] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/17/2015] [Accepted: 11/19/2015] [Indexed: 12/22/2022]
Abstract
This study was to evaluate the efficacy of pharmaceutical intervention (PI) on chemotherapy knowledge-attitude-practice (KAP) and quality of life (QOL) in cancer patients. A prospective, randomized, controlled study was carried out at Oncology Ward in a tertiary hospital affiliated to Southern Medical University, China. Eligible patient was randomly assigned to pharmaceutical intervention (PI) group or control group. Each patient in PI group was given information booklets and was given 30 min face-to-face medication education and psychological counseling by clinical pharmacists, 2 sessions per week for 2 months. Patients in control group only received conventional treatment. All participants were asked to complete a structured Chemotherapy KAP Questionnaire and QOL Questionnaire at pre- and poststudy time. A total of 149 cancer patients (77 in PI group and 72 in control group) completed the study. The baseline scores of KAP and QOL in 2 groups were similar. At the end of study, only knowledge score was significantly increased; meanwhile no difference existed for attitude, practice, and QOL scores in control group; both KAP scores and QOL score were significantly increased in PI group. As for the between-group comparison, both KAP scores and QOL score in PI group were significantly higher than those in control group. In conclusion, pharmaceutical intervention has a positive role in increasing chemotherapy-related knowledge, improving patients' positive emotions, dealing with chemotherapy adverse reactions, and improving the quality of life of patients.
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