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Al-Shamsi HO, Alwbari A, Azribi F, Calaud F, Thuruthel S, Tirmazy SHH, Kullab S, Ostomane S, Abulkhair O. BRCA testing and management of BRCA-mutated early-stage breast cancer: a comprehensive statement by expert group from GCC region. Front Oncol 2024; 14:1358982. [PMID: 38725624 PMCID: PMC11080009 DOI: 10.3389/fonc.2024.1358982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/28/2024] [Indexed: 05/12/2024] Open
Abstract
BReast CAncer (BRCA)1 and BRCA2 gene pathogenic variants account for most hereditary breast cancers (BC). Identification of BRCA mutations can significantly influence both prognosis and treatment outcomes. Furthermore, it enables the identification of individuals who are at heightened risk of developing BC due to inherited genetic mutations. Many developing countries rely on western guidelines for BRCA testing and BC management; however, there exist wide disparities in the prevalence of risk factors, availability of medical resources, and practice patterns. Guidelines tailored to specific regions can help mitigate healthcare variations, promote consistency in treatment, and aid healthcare providers in identifying effective therapies for improving patient outcomes. Hence, oncologists from the Gulf Cooperation Council (GCC) congregated virtually in March 2023 and reviewed existing data on the epidemiology of BC, BRCA mutations, practices and challenges associated with BRCA testing and management of BRCA mutated early-stage BC in the GCC region. They also provided insights on the real-world diagnostic and treatment practices and challenges in the GCC region in the BRCA-mutated early-stage BC domain and suggested some variations to international guidelines to aid their uptake in this region.
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Affiliation(s)
- Humaid O. Al-Shamsi
- Burjeel Medical City, Burjeel Holding, Abu Dhabi, United Arab Emirates
- Gulf Medical University, Ajman, United Arab Emirates
- Emirates Oncology Society, Dubai, United Arab Emirates
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Gulf Cancer Society, Alsafa, Kuwait
| | - Ahmed Alwbari
- Almoosa Specialist Hospital Cancer Center, Al Ahsa, Saudi Arabia
| | | | | | | | | | - Sharif Kullab
- King Khalid University Hospital, Riyadh, Saudi Arabia
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2
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Fyhr A, Persson J, Ek Å. Usage and Usability of a National e-Library for Chemotherapy Regimens: Mixed Methods Study. JMIR Hum Factors 2022; 9:e33651. [PMID: 35175199 PMCID: PMC8895277 DOI: 10.2196/33651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/09/2021] [Accepted: 12/19/2021] [Indexed: 12/02/2022] Open
Abstract
Background Accurate information about chemotherapy drugs and regimens is needed to reduce chemotherapy errors. A national e-library, as a common knowledge source with standardized chemotherapy nomenclature and content, was developed. Since the information in the library is both complex and extensive, it is central that the users can use the resource as intended. Objective The aim of this study was to evaluate the usage and usability of an extensive e-library for chemotherapy regimens developed to reduce medication errors, support the health care staff in their work, and increase patient safety. Methods To obtain a comprehensive evaluation, a mixed methods study was performed for a broad view of the usage, including a compilation of subjective views of the users (web survey, spontaneous user feedback, and qualitative interviews), analysis of statistics from the website, and an expert evaluation of the usability of the webpage. Results Statistics from the website show an average of just over 2500 visits and 870 unique visitors per month. Most visits took place Mondays to Fridays, but there were 5-10 visits per day on weekends. The web survey, with 292 answers, shows that the visitors were mainly physicians and nurses. Almost 80% (224/292) of respondents searched for regimens and 90% (264/292) found what they were looking for and were satisfied with their visit. The expert evaluation shows that the e-library follows many existing design principles, thus providing some useful improvement suggestions. A total of 86 emails were received in 2020 with user feedback, most of which were from nurses. The main part (78%, 67/86) contained a question, and the rest had discovered errors mainly in some regimen. The interviews reveal that most hospitals use a computerized physician order entry system, and they use the e-library in various ways, import XML files, transfer information, or use it as a reference. One hospital without a system uses the administration schedules from the library. Conclusions The user evaluation indicates that the e-library is used in the intended manner and that the users can interact without problems. Users have different needs depending on their profession and their workplace, and these can be supported. The combination of methods applied ensures that the design and content comply with the users’ needs and serves as feedback for continuous design and learning. With a broad national usage, the e-library can become a source for organizational and national learning and a source for continuous improvement of cancer care in Sweden.
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Affiliation(s)
- AnnSofie Fyhr
- Regional Cancer Centre South, Region Skåne, Lund, Sweden.,Ergonomics and Aerosol Technology, Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
| | - Johanna Persson
- Ergonomics and Aerosol Technology, Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
| | - Åsa Ek
- Ergonomics and Aerosol Technology, Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
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Weingart SN, Atoria CL, Pfister D, Classen D, Killen A, Fortier E, Epstein AS, Anderson C, Lipitz-Snyderman A. Risk Factors for Adverse Events in Patients With Breast, Colorectal, and Lung Cancer. J Patient Saf 2021; 17:e701-e707. [PMID: 29419566 PMCID: PMC6078829 DOI: 10.1097/pts.0000000000000474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to identify risk factors associated with medical errors and iatrogenic injuries during an initial course of cancer-directed treatment. METHODS In this retrospective cohort study of 400 patients 18 years or older undergoing an initial course of treatment for breast, colorectal, or lung cancer at a comprehensive cancer center, we abstracted patient, disease, and treatment-related variables from the electronic medical record. We examined adverse events (AEs) and preventable AEs by risk factor using the χ2 or Fisher exact tests. We estimated the association between risk factors and the relative risk of an additional AE or preventable AE in multivariable negative binomial regression models with backwards selection (P < 0.1). RESULTS There were 304 AEs affecting 136 patients (34%) and 97 preventable AEs affecting 53 patients (13%). In multivariable analyses, AEs were overrepresented in those with lung cancer compared with patients with breast cancer (incident rate ratio = 1.9, 95% confidence interval = 1.1-3.2). Nonwhite race (1.6, 1.0-2.6), Hispanic or Latino ethnicity (2.0, 0.9-4.1), advanced disease (1.7, 1.1-2.6), use of each additional class of high-risk nonchemotherapy medication (1.6, 1.3-1.9), and chemotherapy (2.1, 1.3-3.3) were all associated with risk of an additional AE. Preventable AEs were associated with lung cancer (7.4, 2.4-23.2), Hispanic or Latino ethnicity (5.5, 1.7-17.9), and high-risk nonchemotherapy medications (1.5, 1.2-2.0). CONCLUSIONS Risk factors for AEs among patients with cancer reflected patients' underlying disease, cancer-directed therapy, and high-risk noncancer medications. The association of AEs with ethnicity merits further research. Risk factor models could be used prospectively to identify patients with cancer at increased risk of harm.
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Affiliation(s)
- Saul N. Weingart
- Department of Medicine, Tufts Medical Center and Tufts University School of Medicine
| | - Coral L. Atoria
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center
| | - David Pfister
- Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - David Classen
- Pascal Metrics and University of Utah School of Medicine
| | - Aileen Killen
- Department of Quality and Safety, Memorial Sloan Kettering Cancer Center (at time of this study); AIG (present)
| | - Elizabeth Fortier
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center
| | | | - Christopher Anderson
- Department of Surgery, Memorial Sloan Kettering Cancer Center (at time of this study); Department of Urology, Columbia University (present)
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Marzal-Alfaro MB, Escudero-Vilaplana V, Rodríguez-González CG, González-Haba E, Calvo A, Osorio S, Iglesias-Peinado I, Herranz A, Sanjurjo M. Error Detection and Cost Savings With an Image-Based Workflow Management System Connected to a Computerized Prescription Order Entry Program for Antineoplastic Compounding. J Patient Saf 2021; 17:e1589-e1594. [PMID: 30865164 DOI: 10.1097/pts.0000000000000591] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to analyze both the prevalence of errors with the implementation of an image-based workflow management system during the antineoplastic compounding process, and the estimated costs associated with the negative clinical outcome if the errors had not been intercepted. METHODS Three months after the implementation of Phocus Rx system at a hospital pharmacy department, the identification, classification (type, preparation stage, and cause), and potential severity degree (from negligible to catastrophic) of the errors intercepted were determined. The probability of an error causing an adverse event if it had reached the patient (from nil [0] to high [0.6]) and its consequences was estimated by a team of clinical pharmacists and physicians. Cost-effectiveness analysis from the hospital's perspective was performed. RESULTS Overall, 9872 antineoplastic medications were prepared using Phocus Rx. The total compounding error rate was 0.8% (n = 78, 56 [69.2%] were related to incorrect dose, 20 [28.2%] to incorrect drug preparation or conditioning technique, and 2 [2.6%] were wrong drugs). Approximately 70% of the detected errors were classified as undetectable via the previous verification practice, with 11.55% judged to be potentially severe (n = 9) and 51.3% moderate (n = 29). Likelihood of occurrence of an adverse event was medium (0.4) to high (0.6) for 37.2% of the errors. Estimated cost ratio and return on investment were €4.21 and 321%, respectively. CONCLUSIONS The implementation of Phocus Rx prevented antineoplastic preparation errors that would have reached the patient otherwise. In addition, acquisition of this technology was estimated to be cost-effective.
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Affiliation(s)
| | | | | | | | | | - Santiago Osorio
- Hematology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
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Dorothy A, Yadesa TM, Atukunda E. Prevalence of Medication Errors and the Associated Factors: A Prospective Observational Study Among Cancer Patients at Mbarara Regional Referral Hospital. Cancer Manag Res 2021; 13:3739-3748. [PMID: 34007209 PMCID: PMC8121619 DOI: 10.2147/cmar.s307001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/07/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Medication error is one of the most common medical errors in the practice of modern medicine. Among cancer patients receiving chemotherapy, medication errors can be potentially harmful given the narrow therapeutic index, complex dosing, and toxic nature of anti-cancer drugs. OBJECTIVE This study aimed to determine the incidence and factors associated with medication errors among cancer patients. METHODS The study was a prospective observational study carried out at the cancer unit of Mbarara Regional Referral Hospital, Southwestern Uganda. The study included 110 participants, both adults and children receiving chemotherapy. The study was carried out for a period of five months from January to May 2020. A checklist was used to collect patient, medication, and disease information to identify the prescription, transcription, dispensing, and administration errors. RESULTS Of the 110 participants, 52 (47.3%) experienced a total of 78 medication errors (MEs). Of these, 33 (42.31%) were prescription errors, 29 (37.18%) administration errors, 9 (11.54%) transcription errors, and 7 (8.97%) dispensing errors. In the adjusted logistic regression of factors associated with medication errors, urban residents (aOR, 4.59; 95% CI, 1.08, 19.53, p= 0.039) and educated participants (at secondary level) (aOR, 10.51; 95% CI, 1.43, 77.14, p= 0.021) had a significantly higher risk of experiencing medication errors. Participants treated with alkylating agents (aOR, 2.87; 95% CI, 1.07, 7.72, p= 0.036) had a greater risk of experiencing medication errors when compared to other classes of chemotherapy. CONCLUSION The incidence of medication errors among cancer patients was high in Mbarara Regional Referral Hospital. Prescription errors were the most common type of error followed by administration errors, and dispensing errors were the least common. Residence, education level, and alkylating agent chemotherapy were significantly associated with occurrence of medication errors.
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Affiliation(s)
- Abigaba Dorothy
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
- World Bank, ACE II, Pharmacy Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Tadele Mekuriya Yadesa
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
- World Bank, ACE II, Pharmacy Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Esther Atukunda
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
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Tsai CH, Hsieh HF, Lai TW, Kung PT, Kuo WY, Tsai WC. Effect of multidisciplinary team care on the risk of recurrence in breast cancer patients: A national matched cohort study. Breast 2020; 53:68-76. [PMID: 32652461 PMCID: PMC7375674 DOI: 10.1016/j.breast.2020.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 07/01/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cancer has been the leading cause of death in the past decade in Taiwan, with breast cancer being the most common type of cancer in females. Very few studies looked at the risk of recurrence in patients who received multidisciplinary team (MDT) care. We analyzed the influence of MDT on the risk of recurrence and death in breast cancer patients. METHOD In this retrospective study, we included newly diagnosed patients from 2004 to 2010. The study included 9,266 breast cancer patients who were enrolled in MDT care and 9,266 patients who were not. The study used log-rank test to analyze patients' characteristics, hospital characteristics, cancer staging, and treatment methods to compare the recurrence rates in MDT care and non-MDT care participants. We used Cox proportional hazards model to examine the effect of MDT and associated factors on the risk of recurrence and mortality of breast cancer patients. RESULTS Relative risk of recurrence was lower for patients who received MDT care than for patients who did not (HR, 0.84; 95%CI: 0.70-0.99) after matching. The mortality risk for breast cancer patients with relapse was 8.48 times (95%CI: 7.53-9.54) than that for patients without relapse. CONCLUSIONS The relative risk of recurrence and death was significantly lower for breast cancer patients who received MDT care than for those who did not. We suggest that MDT care be implanted in the National Health Policy settings of breast cancer patients.
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Affiliation(s)
- Chang-Hung Tsai
- Miao-Li General Hospital, Ministry of Health and Welfare, Taiwan, ROC; Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC; Department of Public Health, China Medical University, Taichung, Taiwan, ROC
| | | | - Ting-Wei Lai
- Management Center, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan, ROC; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan, ROC
| | - Wei-Yin Kuo
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC.
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7
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Marzal-Alfaro MB, Rodriguez-Gonzalez CG, Escudero-Vilaplana V, Revuelta-Herrero JL, González-Haba E, Ibáñez-Garcia S, Iglesias-Peinado I, Herranz-Alonso A, Sanjurjo Saez M. Risks and medication errors analysis to evaluate the impact of a chemotherapy compounding workflow management system on cancer patients' safety. Health Informatics J 2020; 26:1995-2010. [PMID: 31912756 DOI: 10.1177/1460458219895434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A failure modes, effects and criticality analysis was supported by an observational medication error rate study to analyze the impact of Phocus Rx®, a new image-based workflow software system, on chemotherapy compounding error rates. Residual risks that should be a target for additional action were identified and prioritized and pharmacy staff satisfaction with the new system was evaluated. In total, 16 potential failure modes were recognized in the pre-implementation phase and 21 after Phocus Rx® implementation. The total reduction of the criticality index was 67 percent, with a reduction of 46 percent in material preparation, 76 percent in drug production and 48 percent in quality control subprocesses. The relative risk reduction of compounding error rate was 63 percent after the implementation of Phocus Rx®, from 0.045 to 0.017 percent. The high-priority recommendations defined were identification of the product with batch and expiration date from scanned bidimensional barcodes on drug vials and process improvements in image-based quality control. Overall satisfaction index was 8.30 (SD 1.06) for technicians and 8.56 (SD 1.42) for pharmacists (p = 0.655). The introduction of a new workflow management software system was an effective approach to increasing safety in the compounding procedures in the pharmacy department, according to the failure modes, effects and criticality analysis method.
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Affiliation(s)
| | | | | | | | | | - Sara Ibáñez-Garcia
- Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Spain
| | | | - Ana Herranz-Alonso
- Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Spain
| | - Maria Sanjurjo Saez
- Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Spain
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8
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Kurgat EK, Weru I, Wata D, Godman B, Kurdi A, Guantai AN. Proactive risk assessment of vincristine use process in a teaching and referral hospital in Kenya and the implications. J Oncol Pharm Pract 2019; 26:666-679. [PMID: 31475881 DOI: 10.1177/1078155219869439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The chemotherapy use process is potentially risky for cancer patients. Vincristine, a "High Alert" medicine, has been associated with fatal but preventable medication errors. Consequently, there is a need to improve the use of vincristine especially in lower- and middle-income countries where there are constraints with resources and often a lack of trained personnel to administer cancer medicines. However, where there is a rising prevalence of cancer cases. These concerns can be addressed by performing proactive risk assessments using Healthcare Failure Mode Effect Analysis (HFMEA) and implementing the findings. METHODS A multidisciplinary health team driven by pharmacists identified and evaluated potential failure modes based on a vincristine use process flow diagram using a hazard scoring matrix in a leading referral hospital in Kenya. RESULTS The processes evaluated were: prescribing, preparation and dispensing, transportation and storage, administration and monitoring of the use of vincristine. Seventy-seven failure modes were identified over the three-month study period, of which 25 were classified as high risk. Thirteen were adequately covered by existing control measures while 12 including one combined mode required new strategies. Two of the failure modes were single-point weaknesses. Recommendations were subsequently made for improving the administration of vincristine. CONCLUSIONS HFMEA is a useful tool to identify improvements to medication safety and reduction of patient harm. The HFMEA process brings together the multidisciplinary team involved in patient care in actively identifying potential failure modes and owning the recommendations made, which are now being actively followed up in this hospital. Pharmacists are a key part of this process.
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Affiliation(s)
- Emmanuel K Kurgat
- School of Pharmacy, University of Nairobi, Nairobi, Kenya.,Pharmacy Department, Kakamega County General Hospital, Kakamega, Kenya
| | - Irene Weru
- School of Pharmacy, University of Nairobi, Nairobi, Kenya.,Pharmacy Department, Kakamega County General Hospital, Kakamega, Kenya
| | - David Wata
- School of Pharmacy, University of Nairobi, Nairobi, Kenya.,Division of Pharmacy, Kenyatta National Hospital, Nairobi, Kenya
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK.,Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden.,School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
| | - Amanj Kurdi
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
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9
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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: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [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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Rahimi R, Moghaddasi H, Rafsanjani KA, Bahoush G, Kazemi A. Effects of chemotherapy prescription clinical decision-support systems on the chemotherapy process: A systematic review. Int J Med Inform 2019; 122:20-26. [DOI: 10.1016/j.ijmedinf.2018.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 10/09/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
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Reinhardt H, Otte P, Eggleton AG, Ruch M, Wöhrl S, Ajayi S, Duyster J, Jung M, Hug MJ, Engelhardt M. Avoiding chemotherapy prescribing errors: Analysis and innovative strategies. Cancer 2019; 125:1547-1557. [DOI: 10.1002/cncr.31950] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/17/2018] [Accepted: 11/02/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Heike Reinhardt
- Department of Hematology, Oncology, and Stem Cell Transplantation, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Petra Otte
- Department of Hematology, Oncology, and Stem Cell Transplantation, Faculty of Medicine University of Freiburg Freiburg Germany
- Comprehensive Cancer Center Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Alison G. Eggleton
- Pharmacy Department Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust Cambridge United Kingdom
| | | | - Stefan Wöhrl
- Pharmacy Department Freiburg University Medical Center Freiburg Germany
| | - Stefanie Ajayi
- Department of Hematology, Oncology, and Stem Cell Transplantation, Faculty of Medicine University of Freiburg Freiburg Germany
- Comprehensive Cancer Center Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Justus Duyster
- Department of Hematology, Oncology, and Stem Cell Transplantation, Faculty of Medicine University of Freiburg Freiburg Germany
- Comprehensive Cancer Center Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Manfred Jung
- Institute of Pharmaceutical Sciences University of Freiburg Freiburg Germany
- German Cancer Consortium (DKTK) Freiburg Germany
| | - Martin J. Hug
- Pharmacy Department Freiburg University Medical Center Freiburg Germany
| | - Monika Engelhardt
- Department of Hematology, Oncology, and Stem Cell Transplantation, Faculty of Medicine University of Freiburg Freiburg Germany
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12
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Cotteret C, Marry S, Loeuillet R, Videau M, Cisternino S, Schlatter J. A virtual centralized cytotoxic preparation unit simulation to evaluate the pharmacy staff knowledge. J Oncol Pharm Pract 2019; 25:1187-1194. [PMID: 30626271 DOI: 10.1177/1078155218821426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The risk of medication errors related to drug preparation unit cannot be totally avoided because of human interference. The aim of this study is to investigate the background and knowledge of the pharmacy staff by replicating the cytotoxic preparation unit with potential errors. METHODS A 10-m2 room was provided to duplicate the centralized chemotherapy unit with three areas reproducing virtually the equipment preparation bench, the isolator, and the dispensing bench. The 14 situations selected by experts were integrated to each corresponded area. For each participant, a form was given and answers were analyzed by two independent experts. Statistical processing data were performed using GraphPad Prism® software. RESULTS A total of 19 professionals participated in error simulation workshop over a one-month period. The overall rate of correct responses was 58 ± 19%. In five situations, correct responses rate was lower than 50%: wrong drug batch related to the preparation sheet (40%), inappropriate sterilizing conditions (15%), the time on the preparation sheet provides an expired expiry date for melphalan preparation (45%), a maximum drug dose exceeded (25%), the dispensing form not corresponds to the preparation sheet and final product label (30%). The rate of correct responses was 45 ± 25% for professionals not specifically dedicated to chemotherapy preparation. The overall satisfaction workshop rate was 8.7 ± 1.0 out of 10. CONCLUSION This study showed the importance of training programs to sensitize personal staff to the risks of chemotherapy preparation and prevent errors.
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Affiliation(s)
- Camille Cotteret
- 1 Service Pharmacie, Hôpital Universitaire Necker-Enfants Malades - APHP, Paris, France
| | - Stéphanie Marry
- 1 Service Pharmacie, Hôpital Universitaire Necker-Enfants Malades - APHP, Paris, France
| | - Richard Loeuillet
- 1 Service Pharmacie, Hôpital Universitaire Necker-Enfants Malades - APHP, Paris, France
| | - Margaux Videau
- 1 Service Pharmacie, Hôpital Universitaire Necker-Enfants Malades - APHP, Paris, France
| | - Salvatore Cisternino
- 1 Service Pharmacie, Hôpital Universitaire Necker-Enfants Malades - APHP, Paris, France.,2 Inserm UMR-S 1144, Team "Blood-brain barrier in brain pathophysiology and therapy", Université Paris Descartes, Paris, France
| | - Joël Schlatter
- 1 Service Pharmacie, Hôpital Universitaire Necker-Enfants Malades - APHP, Paris, France
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13
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Role and impact of pharmacists in Spain: a scoping review. Int J Clin Pharm 2018; 40:1430-1442. [PMID: 30367376 DOI: 10.1007/s11096-018-0740-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 10/13/2018] [Indexed: 10/28/2022]
Abstract
Background The role of the pharmacist has evolved greatly over the last decades, expanding to patient-oriented activities, administrative tasks and public health functions. However, considerable differences emerge across regions. Aim of the review To gather evidence in order to describe and highlight the different characteristics of the pharmacists' role and the impact of their activities in Spain. Method A review of the existing literature was conducted. The literature search was undertaken in PubMed between 01/01/2006 and 15/08/2017. Results were screened and reviewed to extract previously established criteria such as author(s), publication year, language, study design, setting, pharmaceutical activity, patient care programs, targeted diseases and intervention description using DEPICT2 tool. Pharmaceutical intervention were classified into eight outcome measures and categorized by types of outcomes reported: descriptive or impact evaluation regarding the effect of the service (positive, neutral or negative). Results The search strategy resulted in 473 articles and 108 articles met the inclusion criteria. The most common design was observational (n = 76, 70%). Most articles were published after 2011 (75%), in English (69%). Studies were conducted in hospitals (60%) and community pharmacies (30%). Of the 24 pharmaceutical activities identified, medication review was the activity most frequently studied (n = 42), followed by patient education (n = 29), risk and prevention (n = 27) and medication reconciliation (n = 19). Only 39 articles (36%) had outcome measures with impact evaluation. Of the 223 impact outcome measures, 48% (107/223) had a positive effect. Conclusion This review shows the substantial scientific production focusing on pharmacy practice in Spain over the last years. The evidence reviewed reflects the pharmacist role at various professional settings, providing a wide variety of activities on diverse targeted diseases and patient care programs, in line with the increasing specialization of clinical pharmacists over the last years.
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Unluturk MS, Tamer O, Utku S. A robotic system to prepare IV solutions. Int J Med Inform 2018; 119:61-69. [PMID: 30342687 DOI: 10.1016/j.ijmedinf.2018.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/01/2018] [Accepted: 09/09/2018] [Indexed: 11/17/2022]
Abstract
Drugs need to be used regularly and correctly in order to be effective. When medicines are used correctly, negativities that threaten human health and life can be avoided, but they can cause unwanted situations that can occur until the end of life when they are used incorrectly. The most common drug administration errors in hospitals are: The wrong dosage of the drug given to the patient, the timing and / or the method of administration, the wrong drug given to the patient, the drug given to the wrong patient, or even not given. Furthermore, the information about the drug that is administered to the patient may not be registered at all. In this research, a robotic drug preparation system and a communication server accepting prescription orders have been developed. Component engineering methodology is further utilized in the design of the Drug Preparation System to maximize reuse, increase product reliability, reduce design, code and test efforts. The IV Robotic Drug Preparation Robot is composed of a robotic work station and a Cartesian carrier to carry the work station to the desired location. The robotic work station has several grippers to handle syringes, to pull the piston of the syringe and to lock the closed system connector to the vial. The IV Robotic Drug Preparation System and communication server are developed and being used in the hospitals. Due to this system, medicines left unused in vials can be used and a great amount of savings is obtained from the drug purchases.
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Affiliation(s)
- Mehmet S Unluturk
- Yasar University, Department of Software Engineering, 35100, Izmir, Turkey.
| | - Ozgur Tamer
- Dokuz Eylul University, Department of Electrical and Electronics Engineering, Izmir, Turkey
| | - Semih Utku
- Dokuz Eylul University, Department of Computer Engineering, Izmir, Turkey
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Macias M, Bernabeu-Andreu F, Arribas I, Navarro F, Baldominos G. Impact of a Barcode Medication Administration System on Patient Safety. Oncol Nurs Forum 2018; 45:E1-E13. [DOI: 10.1188/18.onf.e1-e13] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Saad A, Der-Nigoghossian CA, Njeim R, Sakr R, Salameh P, Massoud M. Prescription Errors with Chemotherapy: Quality Improvement through Standardized Order Templates. Asian Pac J Cancer Prev 2017; 17:2329-36. [PMID: 27221940 DOI: 10.7314/apjcp.2016.17.4.2329] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the existence of established guidelines advocating the use and value of chemotherapy order templates, chemotherapy orders are still handwritten in many hospitals in Lebanon. This manuscript describes the implementation of standardized chemotherapy order templates (COT) in a Lebanese tertiary teaching hospital through multiple steps. INITIAL ASSESSMENT An initial assessment was conducted through a retrospective appraisal of completeness of handwritten chemotherapy orders for 100 adult patients to serve as a baseline for the project and identify parameters that might afford improvement. CHOICE OF SOLUTION Development of over 300 standardized pre-printed COTs based on the National Comprehensive Cancer Network templates and adapted to the practice culture and patient population. IMPLEMENTATION The COTs were implemented, using Kotter's 8-step model for leading change, by engaging health care providers, and identifying and removing barriers. EVALUATION Assessment of physicians' compliance with the new practice (122 orders assessed) was completed through two phases and allowed for the identification of areas of improvement. LESSONS LEARNED Overall, COT implementation showed an average improvement in order completion from 49.5% (handwritten orders) to 77.6% (phase 1-COT) to 87.6% (phase 2-COT) reflecting an increase of 38.1% between baseline and phase 2 and demonstrating that chemotherapy orders completeness was improved by pre-printed COT. As many of the hospitals in Lebanon are moving towards standardized COTs and computerized physician order entry (CPOE) in the next few years, this study provides a prototype for the successful implementation of COT and demonstrates their role in promoting quality improvement of cancer care.
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Affiliation(s)
- Aline Saad
- Department of Pharmacy Practice School of Pharmacy Lebanese American University Byblos, Lebanon E-mail :
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Neuss M, Gilmore T, Belderson K, Billett A, Conti-Kalchik T, Harvey B, Hendricks C, LeFebvre K, Mangu P, McNiff K, Olsen M, Schulmeister L, Von Gehr A, Polovich M. 2016 Updated American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards, Including Standards for Pediatric Oncology. Oncol Nurs Forum 2017; 44:31-43. [PMID: 28067033 DOI: 10.1188/17.onf.31-43] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To update the American Society of Clinical Oncology (ASCO)/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards and to highlight standards for pediatric oncology. Methods The ASCO/ONS Chemotherapy Administration Safety Standards were first published in 2009 and updated in 2011 to include inpatient settings. A subsequent 2013 revision expanded the standards to include the safe administration and management of oral chemotherapy. A joint ASCO/ONS workshop with stakeholder participation, including that of the Association of Pediatric Hematology Oncology Nurses and American Society of Pediatric Hematology/Oncology, was held on May 12, 2015, to review the 2013 standards. An extensive literature search was subsequently conducted, and public comments on the revised draft standards were solicited. Results The updated 2016 standards presented here include clarification and expansion of existing standards to include pediatric oncology and to introduce new standards: most notably, two-person verification of chemotherapy preparation processes, administration of vinca alkaloids via minibags in facilities in which intrathecal medications are administered, and labeling of medications dispensed from the health care setting to be taken by the patient at home. The standards were reordered and renumbered to align with the sequential processes of chemotherapy prescription, preparation, and administration. Several standards were separated into their respective components for clarity and to facilitate measurement of adherence to a standard. Conclusion As oncology practice has changed, so have chemotherapy administration safety standards. Advances in technology, cancer treatment, and education and training have prompted the need for periodic review and revision of the standards. Additional information is available at http://www.asco.org/chemo-standards.
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18
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Neuss MN, Gilmore TR, Belderson KM, Billett AL, Conti-Kalchik T, Harvey BE, Hendricks C, LeFebvre KB, Mangu PB, McNiff K, Olsen M, Schulmeister L, Von Gehr A, Polovich M. 2016 Updated American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards, Including Standards for Pediatric Oncology. J Oncol Pract 2016; 12:1262-1271. [DOI: 10.1200/jop.2016.017905] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To update the ASCO/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards and to highlight standards for pediatric oncology. Methods The ASCO/ONS Chemotherapy Administration Safety Standards were first published in 2009 and updated in 2011 to include inpatient settings. A subsequent 2013 revision expanded the standards to include the safe administration and management of oral chemotherapy. A joint ASCO/ONS workshop with stakeholder participation, including that of the Association of Pediatric Hematology Oncology Nurses and American Society of Pediatric Hematology/Oncology, was held on May 12, 2015, to review the 2013 standards. An extensive literature search was subsequently conducted, and public comments on the revised draft standards were solicited. Results The updated 2016 standards presented here include clarification and expansion of existing standards to include pediatric oncology and to introduce new standards: most notably, two-person verification of chemotherapy preparation processes, administration of vinca alkaloids via minibags in facilities in which intrathecal medications are administered, and labeling of medications dispensed from the health care setting to be taken by the patient at home. The standards were reordered and renumbered to align with the sequential processes of chemotherapy prescription, preparation, and administration. Several standards were separated into their respective components for clarity and to facilitate measurement of adherence to a standard. Conclusion As oncology practice has changed, so have chemotherapy administration safety standards. Advances in technology, cancer treatment, and education and training have prompted the need for periodic review and revision of the standards. Additional information is available at http://www.asco.org/chemo-standards .
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Affiliation(s)
- Michael N. Neuss
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - Terry R. Gilmore
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - Kristin M. Belderson
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - Amy L. Billett
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - Tara Conti-Kalchik
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - Brittany E. Harvey
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - Carolyn Hendricks
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - Kristine B. LeFebvre
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - Pamela B. Mangu
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - Kristen McNiff
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - MiKaela Olsen
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - Lisa Schulmeister
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - Ann Von Gehr
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - Martha Polovich
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
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Carrez L, Bouchoud L, Fleury-Souverain S, Combescure C, Falaschi L, Sadeghipour F, Bonnabry P. Reliability of chemotherapy preparation processes: Evaluating independent double-checking and computer-assisted gravimetric control. J Oncol Pharm Pract 2016; 23:83-92. [PMID: 26637408 DOI: 10.1177/1078155215620001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and objectives Centralized chemotherapy preparation units have established systematic strategies to avoid errors. Our work aimed to evaluate the accuracy of manual preparations associated with different control methods. Method A simulation study in an operational setting used phenylephrine and lidocaine as markers. Each operator prepared syringes that were controlled using a different method during each of three sessions (no control, visual double-checking, and gravimetric control). Eight reconstitutions and dilutions were prepared in each session, with variable doses and volumes, using different concentrations of stock solutions. Results were analyzed according to qualitative (choice of stock solution) and quantitative criteria (accurate, <5% deviation from the target concentration; weakly accurate, 5%-10%; inaccurate, 10%-30%; wrong, >30% deviation). Results Eleven operators carried out 19 sessions. No final preparation (n = 438) contained a wrong drug. The protocol involving no control failed to detect 1 of 3 dose errors made and double-checking failed to detect 3 of 7 dose errors. The gravimetric control method detected all 5 out of 5 dose errors. The accuracy of the doses measured was equivalent across the control methods ( p = 0.63 Kruskal-Wallis). The final preparations ranged from 58% to 60% accurate, 25% to 27% weakly accurate, 14% to 17% inaccurate and 0.9% wrong. A high variability was observed between operators. Discussion Gravimetric control was the only method able to detect all dose errors, but it did not improve dose accuracy. A dose accuracy with <5% deviation cannot always be guaranteed using manual production. Automation should be considered in the future.
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Affiliation(s)
- Laurent Carrez
- 1 Pharmacy Service, Geneva University Hospitals, Geneva, Switzerland.,2 School of Pharmaceutical Science, University of Geneva and University of Lausanne, Geneva, Switzerland
| | - Lucie Bouchoud
- 1 Pharmacy Service, Geneva University Hospitals, Geneva, Switzerland
| | | | - Christophe Combescure
- 3 Faculty of Medicine, Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
| | - Ludivine Falaschi
- 1 Pharmacy Service, Geneva University Hospitals, Geneva, Switzerland
| | - Farshid Sadeghipour
- 2 School of Pharmaceutical Science, University of Geneva and University of Lausanne, Geneva, Switzerland.,4 Pharmacy Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Pascal Bonnabry
- 1 Pharmacy Service, Geneva University Hospitals, Geneva, Switzerland.,2 School of Pharmaceutical Science, University of Geneva and University of Lausanne, Geneva, Switzerland
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20
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Le Guen R, Madelaine I, Tournamille JF, Bellanger A, Astier A, Braguer D, Ollivier C, Bardin C, Lemare F, Daouphars M, Pinguet F, Latour JF, Vigneron J, Tilleul P. [Study impacto: Descriptive analyzis of pharmacist's clinical practice in onco-hematology]. ANNALES PHARMACEUTIQUES FRANÇAISES 2015; 73:223-8. [PMID: 25934530 DOI: 10.1016/j.pharma.2014.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 10/10/2014] [Accepted: 10/10/2014] [Indexed: 11/29/2022]
Abstract
Pharmaceutical analyses of chemotherapy prescriptions by hospital pharmacists are activities codified by regulation and rules (bon usage). The involvement of the pharmacists in clinical pharmacy activities in the oncology setting is not clearly identified, justifying the development of a mapping of these activities from a questionnaire addressed to the professionals. One hundred and seven centers have participated to this study at the national level (overall participation rate of 32.4%). More than 95% of them used a computerized ordering system and three quarter of them submit the introduction of new compounds to an analysis by the drug therapeutic committee. Prescription analysis allowed detecting around 2% of errors from the current prescription. Clinical pharmacist participates to tumor boards of onco-hematology (RCP) at a level of 46% for senior pharmacist and 42% for junior pharmacist. This involvement in the RCP allowed anticipating protocol's modification and temporary used authorization. Ninety-two percent of the senior pharmacists estimate that they highlight the risk of no reimbursement for prescription out of the guideline during RCP, resulting to a modification of the prescription for 40% of them. This level of intervention is lower with respectively 64% and 10% for the juniors. This study underlines the expert value of the clinical pharmacist dedicated to oncology setting in pre and post analysis prescriptions. It could be targeted by a prospective analysis of both clinical and pharmacoeconomics impact of these interventions.
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Affiliation(s)
- R Le Guen
- Pharmacie Pitié-Salpêtrière, 47, boulevard de l'hôpital, 75013 Paris, France.
| | - I Madelaine
- Pharmacie St-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - J-F Tournamille
- Pharmacie Bretonneau, 2, boulevard Tonnelle, 37044 Tours, France
| | - A Bellanger
- Pharmacie Pitié-Salpêtrière, 47, boulevard de l'hôpital, 75013 Paris, France
| | - A Astier
- Pharmacie Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny 94100 Créteil, France
| | - D Braguer
- Université Aix-Marseille II, UMR 911-CRO2 faculté de médecine, 27, boulevard Jean-Moulin 13385 Marseille, France
| | - C Ollivier
- Pharmacie, CHU Caen, avenue de la Côte-de-Nacre, 14033 Caen, France
| | - C Bardin
- Pharmacie Cochin, 27, rue du Faubourg-St-Jacques, 75014 Paris, France
| | - F Lemare
- Pharmacie IGR, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Faculté de pharmacie, université Paris Descartes, 4, rue de l'Observatoire, 75006, Paris, France
| | - M Daouphars
- Pharmacie, CRLC Henri-Becquerel, rue d'Amiens, 76038 Rouen, France
| | - F Pinguet
- Pharmacie, CRLC Val-d'Aurelle-Parc Euromédecine 208, rue des Apothicaires, 34298 Montpellier, France
| | - J-F Latour
- Pharmacie, centre Léon-Bérard, 28, rue Laennec, 69373 Lyon, France
| | - J Vigneron
- Pharmacie, CHU Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
| | - P Tilleul
- Pharmacie Pitié-Salpêtrière, 47, boulevard de l'hôpital, 75013 Paris, France; Faculté de pharmacie, université Paris Descartes, 4, rue de l'Observatoire, 75006, Paris, France
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Diaz AH, Bubalo JS. Evaluation and implementation of chemotherapy regimen validation in an electronic health record. J Oncol Pharm Pract 2014; 20:461-8. [PMID: 24500809 DOI: 10.1177/1078155213520339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Computerized provider order entry of chemotherapy regimens is quickly becoming the standard for prescribing chemotherapy in both inpatient and ambulatory settings. One of the difficulties with implementation of chemotherapy regimen computerized provider order entry lies in verifying the accuracy and completeness of all regimens built in the system library. Our goal was to develop, implement, and evaluate a process for validating chemotherapy regimens in an electronic health record. METHODS We describe our experience developing and implementing a process for validating chemotherapy regimens in the setting of a standard, commercially available computerized provider order entry system. The pilot project focused on validating chemotherapy regimens in the adult inpatient oncology setting and adult ambulatory hematologic malignancy setting. RESULTS A chemotherapy regimen validation process was defined as a result of the pilot project. Over a 27-week pilot period, 32 chemotherapy regimens were validated using the process we developed. Results of the study suggest that by validating chemotherapy regimens, the amount of time spent by pharmacists in daily chemotherapy review was decreased. In addition, the number of pharmacist modifications required to make regimens complete and accurate were decreased. Both physician and pharmacy disciplines showed improved satisfaction and confidence levels with chemotherapy regimens after implementation of the validation system. CONCLUSION Chemotherapy regimen validation required a considerable amount of planning and time but resulted in increased pharmacist efficiency and improved provider confidence and satisfaction.
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Affiliation(s)
- Amber H Diaz
- Oregon Health and Science University Hospital, Portland, OR, USA
| | - Joseph S Bubalo
- Oregon Health and Science University Hospital, Portland, OR, USA
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Pharmaceutical follow-up for patients on rituximab therapy for non-Hodgkin lymphoma: what is the evidence? Int J Clin Pharm 2013; 35:513-9. [DOI: 10.1007/s11096-013-9780-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 04/23/2013] [Indexed: 10/26/2022]
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Jose J. Pharmacovigilance. Bioinformatics 2013. [DOI: 10.4018/978-1-4666-3604-0.ch075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Any substance that is capable of producing a therapeutic effect can also produce unwanted or adverse effects. It is important to understand the basic concepts related to Adverse Drug Reactions (ADRs): epidemiology, classification, predisposing factors, evaluation parameters, and surveillance methods. Pharmacovigilance is defined as the science and activities relating to the detection, evaluation, understanding, and prevention of ADRs or any other drug-related problems. It involves patients, medical professionals, the pharmaceutical industry, drug regulatory agencies, and academic scientists. Pharmacoinformatics, the application of information technology with regard to the drug design, development, and drug use has played a major role in the appropriate implementation of pharmacovigilance at industry, regulatory, and hospital levels. The functioning of international regulatory agencies and drug safety departments of pharmaceutical industries has been greatly influenced by pharmacoinformatics. Pharmacoinformatics has changed the way in which health care is practiced. Modern information technology can be used by health care professionals for various purposes and, thereby, make a substantial contribution to optimize the quality of medication use in institutions with due importance of safety. Pharmacoinformatics has a major influence in the development of pharmacogenetics and its individual applications including improving drug safety. Pharmacoinformatics will play a major role in the future development and practice of pharmacovigilance. The present chapter is aimed at providing the readers an insight into the importance and basic concepts of pharmacovigilance, and the process involved in it. Application of pharmacoinformatics in improving drug safety at various levels from an industry, regulatory and hospital perspective is discussed.
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Robot-assisted preparation of oncology drugs: The role of nurses. Int J Pharm 2012; 439:286-8. [DOI: 10.1016/j.ijpharm.2012.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 09/05/2012] [Accepted: 09/08/2012] [Indexed: 11/21/2022]
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25
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Nerich V, Borg C, Villanueva C, Thiery-Vuillemin A, Helias P, Rohrlich PS, Demarchi M, Pivot X, Limat S. Economic impact of prescribing error prevention with computerized physician order entry of injectable antineoplastic drugs. J Oncol Pharm Pract 2012; 19:8-17. [DOI: 10.1177/1078155212447974] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A cost–benefit analysis was carried out to determine the potential economic costs and benefits of pharmaceutical analysis in preventing prescribing errors for full standardized injectable antineoplastic drugs computerized physician order entry, in a pharmaceutical unit (University teaching hospital), compared with theoretical setting with no pharmaceutical analysis. The viewpoint is that of the payer or the French national Public Health Insurance system, and is limited to hospital cost (only direct medical costs related to net cost and net benefit. A decision analysis model was performed to compare two strategies: with pharmaceutical analysis (±pharmacy intervention) and without pharmaceutical analysis. Results are expressed in terms of benefit-to-cost ratio and total benefit. The robustness of the results was assessed through a series of one-way sensitivity analyses. Over 1 year, prescribing error incidence was estimated at 1.5% [1.3–1.7], i.e. 218 avoided prescribing errors. Potential avoidance of hospital stay was estimated at 419 days or 1.9 ± 0.3 days per prescribing error. Cost–benefit analysis could estimate a net benefit-to-cost ratio of 33.3 (€17.34/€0.52) and a total benefit at €16.82 per pharmaceutical analysis or €249,844 per year. The sensitivity analysis showed robustness of results. Our study shows a substantial economic benefit of pharmaceutical analysis and intervention in the prevention of prescribing errors. The clinical pharmacist adds both value and economic benefit, making it possible to avoid additional use of expensive antineoplastic drugs and hospitalization. Computerized physician order entry of antineoplastic drugs improves the relevance of clinical pharmacist interventions, expanding pharmaceutical analysis and also the role of the pharmacist.
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Affiliation(s)
- V Nerich
- Department of Pharmacy, University Teaching Hospital of Besançon, France; INSERM U645 EA-2284 IFR-133, Besançon, France
| | - C Borg
- Department of Medical Oncology, University Teaching Hospital of Besançon, France; INSERM U645 EA-2284 IFR-133, Besançon, France
| | - C Villanueva
- Department of Medical Oncology, University Teaching Hospital of Besançon, France
| | - A Thiery-Vuillemin
- Department of Medical Oncology, University Teaching Hospital of Besançon, France
| | - P Helias
- Department of Hematology, University Teaching Hospital of Besançon, France
| | - P-S Rohrlich
- Department of Hematology-Pediatrics, University Teaching Hospital of Besançon, France; INSERM U645 EA-2284 IFR-133, Besançon, France
| | - M Demarchi
- Department of Medical Oncology, University Teaching Hospital of Besançon, France
| | - X Pivot
- Department of Medical Oncology, University Teaching Hospital of Besançon, France; INSERM U645 EA-2284 IFR-133, Besançon, France
| | - S Limat
- Department of Pharmacy, University Teaching Hospital of Besançon, France; INSERM U645 EA-2284 IFR-133, Besançon, France
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