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Villegas E, Arruñada M, Casado MÁ, González S, Moreno-Martínez ME, Peñuelas MÁ, Torres AM, Sierra Y, Seguí MA. National expert consensus on home-administered oncologic therapies in Spain. Front Oncol 2024; 14:1335344. [PMID: 38434688 PMCID: PMC10905380 DOI: 10.3389/fonc.2024.1335344] [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: 12/11/2023] [Accepted: 01/12/2024] [Indexed: 03/05/2024] Open
Abstract
The diagnosis and treatment of cancer impose a significant emotional and psychological burden on patients, families, and caregivers. Patients undergo several interventions in a hospital setting, and the increasing number of patients requiring extended care and follow-up is driving the demand for additional clinical resources to address their needs. Hospital at Home (HaH) teams have introduced home-administered oncologic therapies that represent a new model of patient-centered cancer care. This approach can be integrated with traditional models and offers benefits to both patients and healthcare professionals (HCPs). Home-administered treatment programs have been successfully piloted globally, demonstrated as a preferred option for most patients and a safe alternative that could reduce costs and hospital burden. The document aims to establish the minimum recommendations for the home administration of oncologic therapies (ODAH) based on a national expert agreement. The expert panel comprised seven leading members from diverse Spanish societies and three working areas: clinical and healthcare issues, logistical and administrative issues, and economic, social, and legal issues. The recommendations outlined in this article were obtained after a comprehensive literature review and thorough discussions. This document may serve as a basis for the future development of home-administered oncologic therapy programs in Spain. .
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Affiliation(s)
| | - María Arruñada
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
| | | | - Sonia González
- Innovation in Clinical Pharmacy Research Group (i-FARMA-Vigo), Vigo, Spain
- Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain
- University Hospital Complex of Vigo (SERGAS-UVIGO), Vigo, Spain
| | | | | | | | | | - Miguel Angel Seguí
- Parc Taulí Foundation, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
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Ueki D, Suzuki S, Ohta T, Shinohara A, Ohashi Y, Konuma D, Ryushima Y, Udagawa R, Motoshige H, Ieoka M, Taji A, Kogure Y, Hiraike M, Uoi M, Ino K, Kawasaki T, Yamaguchi M. Cancer-Chemotherapy-Related Regimen Checks Performed by Pharmacists of General Hospitals Other than Cancer Treatment Collaborative Base Hospitals: A Multicenter, Prospective Survey. PHARMACY 2023; 12:1. [PMID: 38392922 PMCID: PMC10891652 DOI: 10.3390/pharmacy12010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/14/2023] [Accepted: 12/17/2023] [Indexed: 02/25/2024] Open
Abstract
Although prescription review is an important role for pharmacists in anticancer drug therapy, there are no guidelines in Japan that specify what pharmacists should check for in chemotherapy regimens. This prospective multicenter survey aimed to investigate the implementation of chemotherapy regimen checks by pharmacists in general hospitals by focusing on 19 recommended confirmation items designed to enhance chemotherapy safety. This study involved 14 hospitals within the National Hospital Organization in different regions of Japan. The top five cancers in Japan (gastric, colorectal, lung, breast, and gynecological) were targeted and specific chemotherapy regimens were analyzed. This study assessed the amount of time required for regimen checks, the number of confirmation items completed, the number and the content of inquiries raised regarding prescriptions, and the pharmacists' opinions using a questionnaire that had a maximum score of 10 points. Pharmacists checked 345 and 375 chemotherapies of patients in the control group (CG) and recommended items group (RIG), respectively. The mean time periods required for completing a chemotherapy regimen check were 4 min and 14 s (SD ±1 min and 50 s) and 6 min and 18 s (SD, ±1 min and 7 s) in the CG and RIG, respectively. The mean of the recommended items for the CG = 12.4 and for the RIG = 18.6. The items that the pharmacists did not confirm included urine protein (sixty-nine cases, 18.4%), allergy history (four cases, 1%), previous history (two cases, 0.5%), and a previous history of hepatitis B virus (sixty-nine cases, 18.4%). The number of inquiries for a doctor's prescription order was higher in the RIG than in the CG (41 vs. 27 cases). This multicenter survey demonstrated the potential effectiveness of implementing 19 recommended confirmation items in the regimen checks by pharmacists in general hospitals other than cancer treatment collaborative base hospitals.
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Affiliation(s)
- Daisuke Ueki
- Department of Pharmacy, National Hospital Organization Tokyo National Hospital, Tokyo 204-8585, Japan
| | - Shinya Suzuki
- Department of Pharmacy, National Cancer Center Hospital East, Chiba 277-8577, Japan
| | - Takahiro Ohta
- Department of Pharmacy, National Hospital Organization Tokyo Medical Center, Tokyo 152-8902, Japan
| | - Akira Shinohara
- Department of Pharmacy, National Cancer Center Hospital East, Chiba 277-8577, Japan
| | - Yasukata Ohashi
- Department of Pharmacy, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Daisuke Konuma
- Department of Pharmacy, National Hospital Organization Chiba Medical Center, Chiba 260-8606, Japan
| | - Yasuaki Ryushima
- Department of Pharmacy, National Hospital Organization Saitama Hospital, Saitama 351-0102, Japan
| | - Ryoko Udagawa
- Department of Pharmacy, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Hironori Motoshige
- Department of Pharmacy, National Hospital Organization Hokkaido Medical Center, 5-7 Yamanote, Nishi-ku, Sapporo 063-0005, Japan
| | - Masahiro Ieoka
- Department of Pharmacy, National Hospital Organization Hamada Medical Center, Matsue 697-8511, Japan
| | - Akihiro Taji
- Department of Pharmacy, National Hospital Organization Osaka Minami Medical Center, Osaka 586-8521, Japan
| | - Yuuki Kogure
- Department of Pharmacy, National Hospital Organization Higashihiroshima Medical Center, Hiroshima 739-0041, Japan
| | - Mikako Hiraike
- Department of Pharmacy, National Hospital Organization Kumamoto Medical Center, Kumamoto 860-0008, Japan
| | - Miyuki Uoi
- Department of Pharmacy, National Hospital Organization Kyusyu Cancer Center, Fukuoka 811-1395, Japan
| | - Kazuhiko Ino
- Department of Pharmacy, National Hospital Organization Tokyo National Hospital, Tokyo 204-8585, Japan
| | - Toshikatsu Kawasaki
- Department of Pharmacy, National Cancer Center Hospital East, Chiba 277-8577, Japan
| | - Masakazu Yamaguchi
- Department of Pharmacy, Cancer Institute Hospital, Tokyo 135-8550, Japan
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Algethami AA, Alshamrani MA, AlHarbi AM, AlAzmi AA, Khan MA, AlHadidi RA. Evaluation of handling, storage, and disposal practices of oral anticancer medications among cancer patients and their caregivers at home setting in the Princess Noorah Oncology Center. J Oncol Pharm Pract 2020; 27:20-25. [PMID: 32151186 DOI: 10.1177/1078155220908937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUD Oral medications are commonly prescribed for many cancer patients. Unfortunately, most of them are dispensed without proper counseling about handling practices. We aimed to evaluate the handling, storage, and disposal practices of oral anticancer medications among cancer patients and their caregivers at home. METHODS A cross-sectional questionnaire was filled in by adult cancer patients or caregivers who received oral anticancers and/or visited an outpatient pharmacy over two months. RESULTS A total of 201 participants were interviewed, 67% were female, and nearly 44% were between 40 and 60 years of age. The majority of participants were educated (78%). The top five medications involved were: tamoxifen, capecitabine, letrozole, dasatinib, and imatinib. More than 95% of participants reported that medications were kept away from children and pets in the original container and stored away from extreme heat, cold, and humidity. Hand washing and wearing gloves were not consistently practiced. Only 5% reported "Always" wearing gloves, while 24% reported "Always" washing hands after handling anticancer medications. The participants reported that they had been informed about safe handling and storage by their physician (39%) and pharmacist (25%), while 34% had not been informed. In terms of disposal practices, 66% of patients have not had any unused or expired medications, 29% disposed them in the trash, and 27% returned them. CONCLUSIONS Our findings suggest that patients and caregivers' handling practices of oral anticancer medications are inconsistent with the published recommendations. Hence, appropriate and comprehensive education is needed to mitigate the risk of exposure to these agents in the home setting.
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Affiliation(s)
- Ashwag A Algethami
- Department of Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Majed A Alshamrani
- Department of Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Atika M AlHarbi
- Department of Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Aeshah A AlAzmi
- Department of Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Mansoor A Khan
- Department of Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Rawad A AlHadidi
- Department of Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
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Mononen N, Airaksinen MSA, Hämeen-Anttila K, Helakorpi S, Pohjanoksa-Mäntylä M. Trends in the receipt of medicines information among Finnish adults in 1999-2014: a nationwide repeated cross-sectional survey. BMJ Open 2019; 9:e026377. [PMID: 31203239 PMCID: PMC6588993 DOI: 10.1136/bmjopen-2018-026377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine long-term trends in the receipt of medicines information (MI) among adult medicine users from 1999 to 2014. DESIGN Repeated cross-sectional postal survey from the years 1999, 2002, 2005 and 2008-2014. SETTING Each study year, a new nationally representative sample of 5000 Finns aged 15-64 years was drawn from the Population Register Centre of Finland. PARTICIPANTS The range of annual respondents varied from 2545 to 3371 and response rates from 53% to 67%. Of the total responses (n=29 465), 64% were from medicine users (n=18 862, ranging by year from 58% to 68%). OUTCOME MEASURES Receipt of information on medicines in use within 12 months prior to the survey from a given list of consumer MI sources available in Finland. RESULTS Physicians, community pharmacists and package leaflets were the most common MI sources throughout the study period. Receipt of MI increased most from the Internet (from 1% in 1999 to 16% in 2014), while decreased most from physicians (62% to 47%) and package leaflets (44% to 34%), and remained stable from community pharmacists (46% to 45%) and nurses (14% to 14%). In 1999, of the medicine users 4% did not report receipt of MI from any of the sources listed in the survey, while this proportion had remarkably increased to 28% in 2014. CONCLUSIONS Healthcare professionals and package leaflets had still a dominating importance in 2014 despite the growing number of MI sources over time, but still a minority of adult medicine users reported receiving MI via the Internet in 2014. Worrying is that the proportion of adult medicine users who did not receive MI from any of the sources became seven fold during the study period.
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Affiliation(s)
- Niina Mononen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Marja S A Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Katri Hämeen-Anttila
- Assessment of Pharmacotherapies, Finnish Medicines Agency FIMEA, Kuopio, Finland
| | - Satu Helakorpi
- Department of Welfare, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Marika Pohjanoksa-Mäntylä
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
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Valencia FS, Ruiz R, Neciosup SP, Mas LA, Aliaga KM, Huaman F, Ruiz J, Vasquez E, Llacctahuaman N, Pedraza R, Paz M, Aguirre W, Gomez HL. Implementation of Computerized Physician Order Entry for Chemotherapy: A Latin American Experience. JCO Clin Cancer Inform 2019; 2:1-12. [PMID: 30652618 DOI: 10.1200/cci.18.00041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We describe the implementation process of a computerized physician order entry (CPOE) for outpatient chemotherapy at a Latin American hospital, with the intent of providing other institutions with general guidance and insight through our experience. METHODS In 2012, under the direction of the Department of Medicine of the Instituto Nacional de Enfermedades Neoplásicas, a multidisciplinary team composed of oncologists, nurses, pharmacists, and informatics engineers was formed to develop software for a CPOE for chemotherapy within a preexistent homegrown electronic medical record system in various phases. This included mapping and redesigning processes in an entirely electronic format, integrating the needs of the user for the development of electronic order sets, developing a checkpoint and a warning system to minimize prescription errors, and finally, training all the staff in implementation of the system. RESULTS A CPOE for outpatient chemotherapy was successfully implemented in 2016. We have successfully standardized 266 chemotherapy orders, including for both solid tumors and hematologic malignancies, on the basis of appropriate guidelines. The software is linked to laboratory results and allows entry of important details for the patient's safety, such as anthropometric information for an automatic dose calculation and ranges for safe prescription. In addition, it is linked to the nursing plan sheets. Finally, it is possible to assess and continuously monitor the complex process of chemotherapy prescription. CONCLUSION This is the first report of implementation of a CPOE for chemotherapy in our region. The system was designed by a multidisciplinary team with its own resources. Our experience demonstrates the feasibility of computerizing the chemotherapy prescription process, constituting a tangible example for other institutions with potential impact on patient care.
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Affiliation(s)
- Fernando S Valencia
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
| | - Rossana Ruiz
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
| | - Silvia P Neciosup
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
| | - Luis A Mas
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
| | - Karina M Aliaga
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
| | - Flor Huaman
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
| | - Jenny Ruiz
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
| | - Edinson Vasquez
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
| | - Noel Llacctahuaman
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
| | - Robert Pedraza
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
| | - Missael Paz
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
| | - Willam Aguirre
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
| | - Henry L Gomez
- All authors: Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima, Peru
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Vera R, Otero MJ, Ayala de la Peña F, González-Pérez C, Peñuelas Á, Sepúlveda JM, Quer N, Doménech-Climent N, Virizuela JA, Beorlegui P, Gorgas MQ. Recommendations by the Spanish Society of Hospital Pharmacy, the Spanish Society of Oncology Nursing and the Spanish Society of Medical Oncology for the safe management of antineoplastic medication in cancer patients. Clin Transl Oncol 2018; 21:467-478. [DOI: 10.1007/s12094-018-1945-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
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Belderson KM, Billett AL. Chemotherapy safety standards: A pediatric perspective. Pediatr Blood Cancer 2017; 64. [PMID: 28306217 DOI: 10.1002/pbc.26484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/06/2017] [Accepted: 01/10/2017] [Indexed: 11/06/2022]
Affiliation(s)
| | - Amy L Billett
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
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8
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Belderson KM, Billett AL. Chemotherapy Safety Standards: A Pediatric Perspective. J Pediatr Oncol Nurs 2017; 34:156-159. [PMID: 28415960 DOI: 10.1177/1043454217697670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Amy L Billett
- 2 Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
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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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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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Suzuki S, Chan A, Nomura H, Johnson PE, Endo K, Saito S. Chemotherapy regimen checks performed by pharmacists contribute to safe administration of chemotherapy. J Oncol Pharm Pract 2016; 23:18-25. [DOI: 10.1177/1078155215614998] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Computerized provider order entry (CPOE) has been developed and implemented within cancer center hospitals nationwide in Japan. To ensure that high-quality services are routinely provided by oncology pharmacists, this study was designed to evaluate the interventions through reviewing the orders that are generated by CPOE. Methods The objective of this retrospective chart review was to evaluate how pharmacists contributed to safe cancer treatment using paper-based pharmacy records. Data were collected from a total of 35,062 chemotherapy regimens for 18,515 outpatients between January and December 2013. Results Of these 35,062 chemotherapy regimens, the rate of pharmacists’ interventions was 1.1% ( n = 408). Among them, 53.1% (217/408) of the chemotherapy prescriptions were modified due to pharmacist interventions. The reasons for interventions included “changes in the chemotherapy regimen were unclear” in 49.5%, “physicians’ prescription errors” (22.0%), “pharmacist suggestions to improve chemotherapy” (15.1%), and “finding differences between physicians’ chemotherapy records and their chemotherapy prescriptions” (13.2%). The top three reasons for the 217 prescription modifications due to pharmacist interventions were “finding prescription errors” (34.5%), “reasons for change in the chemotherapy regimen were unclear” (32.7%), and “finding differences between physicians’ chemotherapy records and their chemotherapy prescriptions” (28.5%). Conclusion The computer could not evaluate chemotherapy protocols or adjust doses of anticancer medicines according to patients’ conditions. Therefore, oncology pharmacists should continue to ensure safe and appropriate administration of cancer chemotherapy.
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Affiliation(s)
- Shinya Suzuki
- Division of Pharmacy, National Cancer Center Hospital East, National Research and Development Agency, Kashiwa, Japan
| | - Alexandre Chan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
- Oncology Pharmacy, National Cancer Centre Singapore, Singapore
| | - Hisanaga Nomura
- Division of Pharmacy, National Cancer Center Hospital East, National Research and Development Agency, Kashiwa, Japan
| | - Philip E Johnson
- Director of Pharmacy (Retired), Moffitt Cancer Center, Tampa, FL, USA
| | - Kazushi Endo
- Japanese Society of Hospital Pharmacists, Tokyo, Japan
- Department of Drug Safety Management, Meiji Pharmaceutical University, Tokyo, Japan
| | - Shinichiro Saito
- Division of Pharmacy, National Cancer Center Hospital East, National Research and Development Agency, Kashiwa, Japan
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12
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Baldwin A, Rodriguez ES. Improving Patient Safety With Error Identification in Chemotherapy Orders by Verification Nurses. Clin J Oncol Nurs 2016; 20:59-65. [PMID: 26800407 DOI: 10.1188/16.cjon.59-65] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The prevalence of medication errors associated with chemotherapy administration is not precisely known. Little evidence exists concerning the extent or nature of errors; however, some evidence demonstrates that errors are related to prescribing. This article demonstrates how the review of chemotherapy orders by a designated nurse known as a verification nurse (VN) at a National Cancer Institute-designated comprehensive cancer center helps to identify prescribing errors that may prevent chemotherapy administration mistakes and improve patient safety in outpatient infusion units. OBJECTIVES This article will describe the role of the VN and details of the verification process. METHODS To identify benefits of the VN role, a retrospective review and analysis of chemotherapy near-miss events from 2009-2014 was performed. FINDINGS A total of 4,282 events related to chemotherapy were entered into the Reporting to Improve Safety and Quality system. A majority of the events were categorized as near-miss events, or those that, because of chance, did not result in patient injury, and were identified at the point of prescribing.
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13
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Tuna R, Baykal U, Turkmen E, Yildirim A. Planning for the Size of the Nursing Staff at an Outpatient Chemotherapy Unit. Clin J Oncol Nurs 2015; 19:E115-20. [PMID: 26583645 DOI: 10.1188/15.cjon.e115-e120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Griffin MC, Gilbert RE, Broadfield LH, Easty AE, Trbovich PL, Griffin MC, Gilbert RE, Broadfield LH, Easty AE, Trbovich PL. ReCAP: Comparison of Independent Error Checks for Oral Versus Intravenous Chemotherapy. J Oncol Pract 2015; 12:168-9; e180-7. [PMID: 26420888 DOI: 10.1200/jop.2015.005892] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Intravenous (IV) chemotherapy is routinely delivered to patients in hospital settings, where safeguards such as independent checks and guidelines govern their administration. In contrast, oral chemotherapy, which is typically ordered in a cancer center but dispensed and administered in the community and home, respectively, is subject to fewer controls. Research in the United States has found that few safeguards in routine use for IV chemotherapy have been adopted for oral chemotherapy; however, less is known about the Canadian context. The objective of this study was to determine whether similar safeguards, in the form of independent checks, existed to identify potential errors related to both formulations. METHODS Human factors specialists conducted observations and interviews in cancer center clinics, a cancer center pharmacy, and four community pharmacies across Nova Scotia. Processes were analyzed to determine if an independent check was performed, which qualified provider completed the check, and at what point of the process the check occurred. RESULTS A total of 57 systematic checks were identified for IV chemotherapy, whereas only six systematic checks were identified for oral chemotherapy. Community pharmacists were the only qualified professionals involved in independent systematic checking of oral chemotherapy, which occurred during ordering and dispensing. CONCLUSION There is an enormous opportunity for pharmacists and other qualified professionals to take on an expanded role in improving patient safety for oral chemotherapy. Greater involvement of pharmacists, in both the clinic environment and the community, would facilitate increased systematic checking, which could improve patient safety related to oral chemotherapy.
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Affiliation(s)
- Melissa C Griffin
- HumanEra, University Health Network; Institute of Biomaterials and Biomedical Engineering, University of Toronto; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario; Cancer Care Nova Scotia; Capital District Health Authority; and School of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rachel E Gilbert
- HumanEra, University Health Network; Institute of Biomaterials and Biomedical Engineering, University of Toronto; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario; Cancer Care Nova Scotia; Capital District Health Authority; and School of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Larry H Broadfield
- HumanEra, University Health Network; Institute of Biomaterials and Biomedical Engineering, University of Toronto; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario; Cancer Care Nova Scotia; Capital District Health Authority; and School of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anthony E Easty
- HumanEra, University Health Network; Institute of Biomaterials and Biomedical Engineering, University of Toronto; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario; Cancer Care Nova Scotia; Capital District Health Authority; and School of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Patricia L Trbovich
- HumanEra, University Health Network; Institute of Biomaterials and Biomedical Engineering, University of Toronto; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario; Cancer Care Nova Scotia; Capital District Health Authority; and School of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Melissa C Griffin
- HumanEra, University Health Network; Institute of Biomaterials and Biomedical Engineering, University of Toronto; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario; Cancer Care Nova Scotia; Capital District Health Authority; and School of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rachel E Gilbert
- HumanEra, University Health Network; Institute of Biomaterials and Biomedical Engineering, University of Toronto; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario; Cancer Care Nova Scotia; Capital District Health Authority; and School of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Larry H Broadfield
- HumanEra, University Health Network; Institute of Biomaterials and Biomedical Engineering, University of Toronto; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario; Cancer Care Nova Scotia; Capital District Health Authority; and School of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anthony E Easty
- HumanEra, University Health Network; Institute of Biomaterials and Biomedical Engineering, University of Toronto; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario; Cancer Care Nova Scotia; Capital District Health Authority; and School of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Patricia L Trbovich
- HumanEra, University Health Network; Institute of Biomaterials and Biomedical Engineering, University of Toronto; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario; Cancer Care Nova Scotia; Capital District Health Authority; and School of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
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15
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Krzyzanowska MK, Powis M. Extending the Quality and Safety Agenda From Parenteral to Oral Chemotherapy. J Oncol Pract 2015; 11:198-201. [DOI: 10.1200/jop.2015.004002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This article describes some of the steps that can be taken across the entire oral chemotherapy journey to improve quality and safety by leveraging existing and emerging tools.
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Affiliation(s)
- Monika K. Krzyzanowska
- Princess Margaret Cancer Centre; University of Toronto; and Cancer Care Ontario, Toronto, Ontario, Canada
| | - Melanie Powis
- Princess Margaret Cancer Centre; University of Toronto; and Cancer Care Ontario, Toronto, Ontario, Canada
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16
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Kintzel PE, VanDyke TH, Athmann PW, Mills LB, Bonter MP, Bremer MW, Dougherty ML, Foster RW, Knight SK, Slot MG, Steinmetz-Malato LL. Improved pharmacy department workflow with new method of order entry for single-agent, high-dose methotrexate. Hosp Pharm 2014; 49:1039-43. [PMID: 25673893 PMCID: PMC4319804 DOI: 10.1310/hpj4911-1039] [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: 03/23/2024]
Abstract
PURPOSE To determine whether a process change impacted the proportion of orders for single-agent, high-dose methotrexate entered by chemotherapy pharmacists instead of general pharmacy staff. Coordination of antiemetic premedication and leucovorin rescue with the new method of order entry was evaluated. METHODS Adults treated with single-agent, high-dose methotrexate were identified retrospectively. Order entry of methotrexate and ancillary medications was examined to determine whether the old or new method was used and whether it was performed by a chemotherapy pharmacist. The fundamental difference between the old and new methods for order entry is use of the "unscheduled" frequency of medication administration to replace the administration frequency of "once" with a specified date and time. Timing of antiemetic premedication and leucovorin rescue relative to methotrexate administration were tallied for the new method. Chi-square analysis was performed for the primary objective. Observational statistics were performed otherwise. RESULTS The number of evaluable encounters identified was 158. A chemotherapy pharmacist entered a greater proportion of orders when the new method was utilized (P < .0001). The proportion of orders entered by a chemotherapy pharmacist increased during the hours of 0700 and 2259 with the new method. Appropriate coordination of antiemetic and leucovorin administration was documented for 96% and 100% of cases with the new method of order entry. CONCLUSION The proportion of orders for single-agent, high-dose methotrexate entered by a chemotherapy pharmacist was significantly greater with the use of the new method. Administration of antiemetic premedication and leucovorin rescue were appropriately coordinated with the use of the new method for order entry of single-agent, high-dose methotrexate.
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Affiliation(s)
- Polly E. Kintzel
- Department of Pharmacy, Spectrum Health Hospitals, Grand Rapids, Michigan
| | - Thomas H. VanDyke
- Department of Pharmacy, Spectrum Health Hospitals, Grand Rapids, Michigan
| | - Paul W. Athmann
- Department of Pharmacy, Spectrum Health Hospitals, Grand Rapids, Michigan
| | - Lisa B. Mills
- Department of Pharmacy, Coram Healthcare, Oklahoma City, Oklahoma
| | | | | | - Mary L. Dougherty
- Department of Pharmacy, Spectrum Health Hospitals, Grand Rapids, Michigan
| | - Ryan W. Foster
- Department of Pharmacy, Spectrum Health Hospitals, Grand Rapids, Michigan
| | - Sandra K. Knight
- Department of Pharmacy, Spectrum Health Hospitals, Grand Rapids, Michigan
| | - Martha G. Slot
- Department of Pharmacy, Spectrum Health Hospitals, Grand Rapids, Michigan
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17
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Gilmore TR, Schulmeister L, Jacobson JO. Quality Oncology Practice Initiative Certification Program: measuring implementation of chemotherapy administration safety standards in the outpatient oncology setting. J Oncol Pract 2014; 9:14s-8s. [PMID: 23914147 DOI: 10.1200/jop.2013.000886] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The Quality Oncology Practice Initiative (QOPI) Certification Program (QCP) evaluates individual outpatient oncology practice performance in areas that affect patient care and safety and builds on the American Society of Clinical Oncology (ASCO) QOPI by assessing the compliance of a practice with certification standards based on the ASCO/Oncology Nursing Society standards for safe chemotherapy administration. To become certified, a practice must attain a benchmark quality score on certification measures in QOPI and attest that it complies with 17 QCP standards. Structured on-site reviews, initially performed in randomly selected practices, became mandatory beginning in September 2011. Of 111 practices that have undergone on-site review, only two were fully concordant with all of the standards (median, 11; range, seven to 17). Most practices were subsequently able to modify practice to become QOPI certified. The QCP addresses the call from the Institute of Medicine to close the quality gap by aligning evidence-based guidelines and consensus-driven standards with requirements for oncology practices to develop and maintain structural safety components, such as policies and procedures that ensure practice performance. On-site practice evaluation is a high-impact component of the program.
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Affiliation(s)
- Terry R Gilmore
- American Society of Clinical Oncology, Alexandria, VA; Oncology Nursing Consultant, New Orleans, LA; and Dana-Farber Cancer Institute, Boston, MA
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18
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Abstract
With the increasing use of oral chemotherapy, there has been heightened appreciation of the unique challenges associated, especially in relation to prescribing, dispensing, reimbursement, adherence, and patient and family education.
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19
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Neuss MN, Polovich M, McNiff K, Esper P, Gilmore TR, LeFebvre KB, Schulmeister L, Jacobson JO. 2013 updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy. J Oncol Pract 2014; 9:5s-13s. [PMID: 23914148 DOI: 10.1200/jop.2013.000874] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In 2009, ASCO and the Oncology Nursing Society (ONS) published standards for the safe use of parenteral chemotherapy in the outpatient setting, including issues of practitioner orders, preparation, and administration of medication. In 2011, these were updated to include inpatient facilities. In December 2011, a multistakeholder workgroup met to address the issues associated with orally administered antineoplastics, under the leadership of ASCO and ONS. The workgroup participants developed recommended standards, which were presented for public comment. Public comments informed final edits, and the final standards were reviewed and approved by the ASCO and ONS Boards of Directors. Significant newly identified recommendations include those associated with drug prescription and the necessity of ascertaining that prescriptions are filled. In addition, the importance of patient and family education regarding administration schedules, exception procedures, disposal of unused oral medication, and aspects of continuity of care across settings were identified. This article presents the newly developed standards.
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Affiliation(s)
- Michael N Neuss
- Vanderbilt Ingram Cancer Center, Nashville TN; Duke Oncology Network, Durham, NC; University of Michigan Comprehensive Cancer Center, Ann Arbor MI; American Society of Clinical Oncology, Alexandria, VA; Oncology Nursing Society, Pittsburgh, PA; Oncology Nursing Consultant, New Orleans, LA; and Dana Farber Cancer Institute, Boston, MA
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20
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Bourmaud A, Pacaut C, Melis A, Tinquaut F, Magné N, Merrouche Y, Chauvin F. Is oral chemotherapy prescription safe for patients? A cross-sectional survey. Ann Oncol 2014; 25:500-4. [PMID: 24406423 DOI: 10.1093/annonc/mdt553] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Oral chemotherapies are increasingly prescribed. Yet wide variations in prescription practices and in monitoring of toxicity have been underlined despite existing guidelines. There is little recent information available as regard to these practices. We aimed to obtain exhaustive information on oral chemotherapy prescription practices and safety monitoring in French hospitals. METHODS A cross-sectional multicentre survey was carried out to collect information on drug prescription, administration and surveillance: prescribing practices, coordination and monitoring of adherence, safety monitoring and side-effects occurrence prevention. Participants were a large sample of the French oncologists prescribing oral chemotherapy (20%). RESULTS One hundred and fifty-seven oncologists from 112 hospitals (public, comprehensive cancer centres and private) replied (23.7% of cancer hospitals). The majority (56.1%) of the prescriptions were hand-written on a blank sheet. Eighty-four physicians (53.5%) included dose information and 36 (23%) declared having no monitoring procedures for adherence. Only 84 responders (54%) provided education material at first prescription of oral chemotherapy in way to limit avoidable side-effects. Sixty-one (39%) responders stated that they recalled at least one serious adverse event in the previous year declared in their centre. CONCLUSIONS In this 2012 study, the majority of prescribers followed no standards in prescription writing, safety monitoring and toxicity prevention. The implementation of the international recommendations for oral chemotherapy administration should be considered as a top priority-for both prescribers and health authorities-as regards to the dynamic of development of these molecules and their potential side-effects.
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Affiliation(s)
- A Bourmaud
- Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institut, Saint Priest en Jarez
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21
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Bubalo J, Warden BA, Wiegel JJ, Nishida T, Handel E, Svoboda LM, Nguyen L, Edillo PN. Does applying technology throughout the medication use process improve patient safety with antineoplastics? J Oncol Pharm Pract 2013; 20:445-60. [PMID: 24356802 DOI: 10.1177/1078155213514469] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Medical errors, in particular medication errors, continue to be a troublesome factor in the delivery of safe and effective patient care. Antineoplastic agents represent a group of medications highly susceptible to medication errors due to their complex regimens and narrow therapeutic indices. As the majority of these medication errors are frequently associated with breakdowns in poorly defined systems, developing technologies and evolving workflows seem to be a logical approach to provide added safeguards against medication errors. SUMMARY This article will review both the pros and cons of today's technologies and their ability to simplify the medication use process, reduce medication errors, improve documentation, improve healthcare costs and increase provider efficiency as relates to the use of antineoplastic therapy throughout the medication use process. Several technologies, mainly computerized provider order entry (CPOE), barcode medication administration (BCMA), smart pumps, electronic medication administration record (eMAR), and telepharmacy, have been well described and proven to reduce medication errors, improve adherence to quality metrics, and/or improve healthcare costs in a broad scope of patients. The utilization of these technologies during antineoplastic therapy is weak at best and lacking for most. Specific to the antineoplastic medication use system, the only technology with data to adequately support a claim of reduced medication errors is CPOE. In addition to the benefits these technologies can provide, it is also important to recognize their potential to induce new types of errors and inefficiencies which can negatively impact patient care. CONCLUSION The utilization of technology reduces but does not eliminate the potential for error. The evidence base to support technology in preventing medication errors is limited in general but even more deficient in the realm of antineoplastic therapy. Though CPOE has the best evidence to support its use in the antineoplastic population, benefit from many other technologies may have to be inferred based on data from other patient populations. As health systems begin to widely adopt and implement new technologies it is important to critically assess their effectiveness in improving patient safety.
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Affiliation(s)
- Joseph Bubalo
- Department of Pharmacy Services, Oregon Health & Science University, OR, USA
| | - Bruce A Warden
- Department of Pharmacy Services, Oregon Health & Science University, OR, USA
| | - Joshua J Wiegel
- Department of Pharmacy Services, Oregon Health & Science University, OR, USA
| | - Tess Nishida
- University of Washington Medical Center, WA, USA
| | - Evelyn Handel
- Department of Pharmacy Services, Roswell Park Cancer Institute, NY, USA
| | | | - Lam Nguyen
- Department of Pharmacy Services, Oregon Health & Science University, OR, USA
| | - P Neil Edillo
- Department of Pharmacy Services, Oregon Health & Science University, OR, USA
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22
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Neuss MN, Polovich M, McNiff K, Esper P, Gilmore TR, LeFebvre KB, Schulmeister L, Jacobson JO. 2013 updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy. Oncol Nurs Forum 2013; 40:225-33. [PMID: 23619103 DOI: 10.1188/13.onf.40-03ap2] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In 2009, the American Society of Clinical Oncology (ASCO) and the Oncology Nursing Society (ONS) published standards for the safe use of parenteral chemotherapy in the outpatient setting, including issues of practitioner orders, preparation, and administration of medication. In 2011, these were updated to include inpatient facilities. In December 2011, a multistakeholder workgroup met to address the issues associated with orally administered antineoplastics, under the leadership of ASCO and ONS. The workgroup participants developed recommended standards, which were presented for public comment. Public comments informed final edits, and the final standards were reviewed and approved by the ASCO and ONS Boards of Directors. Significant newly identified recommendations include those associated with drug prescription and the necessity of ascertaining that prescriptions are filled. In addition, the importance of patient and family education regarding administration schedules, exception procedures, disposal of unused oral medication, and aspects of continuity of care across settings were identified. This article presents the newly developed standards.
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23
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Frame JN, Jacobson JO, Vogel WH, Griffith N, Wariabharaj D, Garg R, Zon R, Stephens CL, Bialecki AM, Bruinooge SS, Allen SL. Assessment of risk evaluation and mitigation strategies in oncology: summary of the oncology risk evaluation and mitigation strategies workshop. J Oncol Pract 2013; 9:e24-39. [PMID: 23814522 DOI: 10.1200/jop.2012.000620] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To address oncology community stakeholder concerns regarding implementation of the Risk Evaluation and Mitigation Strategies (REMS) program, ASCO sponsored a workshop to gather REMS experiences from representatives of professional societies, patient organizations, pharmaceutical companies, and the US Food and Drug Administration (FDA). Stakeholder presentations and topical panel discussions addressed REMS program development, implementation processes, and practice experiences, as well as oncology drug safety processes. A draft REMS decision tool prepared by the ASCO REMS Steering Committee was presented for group discussion with facilitated, goal-oriented feedback. THE WORKSHOP IDENTIFIED SEVERAL UNINTENDED CONSEQUENCES RESULTING FROM CURRENT ONCOLOGY REMS: (1) the release of personal health information to drug sponsors as a condition for gaining access to a needed drug; (2) risk information that is not tailored-and therefore not accessible-to all literacy levels; (3) exclusive focus on drug risk, thereby affecting patient-provider treatment discussion; (4) REMS elements that do not consider existing, widely practiced oncology safety standards, professional training, and experience; and (5) administrative burdens that divert the health care team from direct patient care activities and, in some cases, could limit patient access to important therapies. Increased provider and professional society participation should form the basis of ongoing and future REMS standardization discussions with the FDA to work toward overall improvement of risk communication.
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Affiliation(s)
- James N Frame
- David Lee Cancer Center, Charleston Area Health Center Medical Systems, Charleston, WV, USA
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24
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Survey of oral chemotherapy safety and adherence practices of hospitals in Spain. Int J Clin Pharm 2013; 35:1236-44. [PMID: 24129581 DOI: 10.1007/s11096-013-9858-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 09/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Oral chemotherapy is increasingly used for cancer therapy but, without proper practices, creates safety and adherence issues. However, little is known on safety and adherence practices in wide clinical settings. OBJECTIVE To assess the implementation level of safety and adherence practices in oral chemotherapy in Spanish hospitals. SETTING All Pharmacy services from prescription, dispensation, patient education and monitoring hospitals that prescribe oral chemotherapy of Spain. MAIN OUTCOME MEASURE Level of safety practices regarding oral chemotherapy prescription, dispensation, patient education and adherence. METHOD An 11 multiple-choice-item questionnaire made in consensus with GEDEFO (Spanish Group of Oncology Pharmacists) was sent to all pharmacy services from hospitals that prescribe oral chemotherapy. This questionnaire comprised prescription, dispensation, education and monitoring. We arbitrarily defined three levels of practices: no sufficient specific practices were reported (we termed this as 'level I'); performance of an initial visit with a pharmacist providing written patient educational materials and monitoring adherence (termed as 'level II'); and level II requirements plus electronic chemotherapy ordering system and extra safety practices (termed as 'level III'). RESULTS Of the 169 targeted health-care settings, 86 (50.9 %) responded to the survey. The majority of responding hospitals were public, general, and teaching hospitals with more than 200 beds. Main discrepancies were in electronic prescription of oral chemotherapy and monitoring adherence. There were 32 hospitals (37.2 %) with level I of safety and adherence practices, 38 hospitals (44.2 %) accomplished level II, 16 (18.6 %) hospitals reached level III. No hospital variables were found to be correlated with each level of safety. CONCLUSIONS The majority of responding hospitals have safety and adherences practices for oral chemotherapy. However, the level of these practices varies. There are significant opportunities for improvement, particularly with regard to electronic prescription of oral chemotherapy and monitoring adherence.
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25
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Maloney KW, Denno M, Kider T, McClintock K, Moore A, Rutyna T, Wiley K, Sullivan MD. The Oncology Phone. Clin J Oncol Nurs 2013; 17:387-91. [DOI: 10.1188/13.cjon.17-04ap] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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26
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Johnson L. Achieving quality oncology practice initiative certification through quality improvement. Clin J Oncol Nurs 2013; 17:123-5. [PMID: 23538247 DOI: 10.1188/13.cjon.123-125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The public and healthcare payers are increasingly looking to specialty designations and certifications to determine the quality of cancer centers. The Quality Oncology Practice Initiative (QOPI®) Certification Program is one way for cancer centers to demonstrate commitment to high-quality patient care. Achieving QOPI certification for the author's cancer center was driven by a nurse-led quality improvement initiative. The result was an official designation that reflects the mission, vision, and philosophy of the organization.
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Affiliation(s)
- Lori Johnson
- University of California, San Diego Health System, USA.
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27
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Weingart SN, Mattsson T, Zhu J, Shulman LN, Hassett M. Improving electronic oral chemotherapy prescription: can we build a safer system? J Oncol Pract 2012; 8:e168-73. [PMID: 23598852 DOI: 10.1200/jop.2012.000677] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2012] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION To prevent oral chemotherapy prescription errors, we enhanced a prescription-writing module in an ambulatory electronic medical record. We sought to describe the enhancement, examine its performance to date, and identify opportunities for improvement. METHODS Enhancements to the oral chemotherapy writing module included weight- and body surface area-based dosing, fields for cancer diagnosis and intent of therapy (curative v palliative), and dose-limit warnings. We studied all prescriptions for 18 oral chemotherapies generated by oncology clinicians during the first 17 months after the safe prescribing enhancements were introduced, from May 1, 2010, to October 1, 2011. We examined the frequency with which clinicians used the new features, the number and type of alerts generated, and clinician actions in response to alerts. RESULTS Six hundred clinicians generated 6,673 prescriptions for 2,043 patients. Six drugs-temozolomide, capecitabine, lenalidomide, hydroxyurea, imatinib, and erlotinib-accounted for 5,512 of all oral chemotherapy prescriptions (83%). Prescribers indicated the intent of therapy 13% of the time and listed the patient's cancer diagnosis 46% of the time. Prescribers customized their instructions using a free-text field in 64% of prescriptions. Clinicians' 6,673 prescription attempts triggered 395 dose-limit warnings (5%), mostly for temozolomide. Clinicians ignored most (96%) warnings, because current dosing recommendations exceeded the dose-limit warnings for the alerted medications. CONCLUSION Oncology clinicians readily accepted features designed to enhance oral chemotherapy safety. Additional enhancements are needed to facilitate prescriptions with complex dosing regimens and to provide dose-limit warnings that reflect current clinical practice.
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Affiliation(s)
- Saul N Weingart
- Center for Patient Safety, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA.
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Jacobson JO, Mulvey TM. Time to Focus on Inpatient Safety: Revision of the American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards. J Clin Oncol 2012. [DOI: 10.1200/jco.2011.40.9409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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