Development of a tool to allocate inpatient specialized pharmacy resources at a comprehensive cancer center

PURPOSE

Develop an objective tool to align the needs of inpatient services at a Comprehensive Cancer Center with the available resources of hematology/oncology clinical specialist pharmacists.

SUMMARY

The shift of the pharmacy profession from product-centered to patient-centered care has expanded the scope of practice of the clinical pharmacist and their ability to specialize in a therapeutic area. However, these specialized resources are limited. The pharmacy department at The James Comprehensive Cancer Center at The Ohio State University Wexner Medical Center developed a tool to objectively determine which inpatient services would receive the most benefit from having a hematology/oncology clinical specialist pharmacist on their healthcare team. A Steering Committee was created to determine the necessary metrics needed across the 29 inpatient services at The James, and data was collected from the electronic medical record. The metrics evaluated were: patient acuity, inpatient intravenous anticancer administrations, inpatient oral anticancer administrations, presence of an outpatient anticancer treatment plan for patients admitted for an inpatient stay, and the use of high-risk hematology/oncology therapies.

CONCLUSION

A novel and data-driven tool was created to allocate hematology/oncology clinical specialist pharmacists across a Comprehensive Cancer Center. Annual use of this objective tool can aid institutions in appropriate distribution of limited hematology/oncology specialized pharmacy resources.

The pharmacist's role in chimeric antigen receptor T cell therapy

The emergence and efficacy of chimeric antigen receptor (CAR) T cell therapy in previously incurable malignancies represents a promising paradigm shift in cancer care. However, it is not without significant clinical, operational, and financial considerations. Pharmacists should be prepared to fulfill the various roles in CAR T cell therapy provision including: policy development; electronic medical record build; patient and staff education; patient selection; procurement, storage, and handling; medication administration and supportive care; management of adverse reactions; and quality tracking. Our commentary provides an overview of the opportunities for pharmacy involvement in the implementation and maintenance of a CAR T cell therapy program with an emphasis on the importance of pharmacy involvement as part of a multidisciplinary approach to care. Although some institutions have dedicated a CAR T cell pharmacist to meet the demands of emerging CAR T cell therapy, we believe that clinical pharmacists practicing in hematopoietic stem cell transplant and hematology/oncology have the skills and training to fulfill the pharmacist's role in CAR T cell therapy.

Describing the role of the hematology/oncology clinical pharmacist in health information technology

PURPOSE

To describe the role of hematology/oncology clinical pharmacists in health information technology as well as their perceptions of the impact of technology expansion on patient care.

METHODS

A single-center, web-based survey was distributed to 30 hematology/oncology clinical pharmacists by email over the two-week-period of 24 September 2018 to 8 October 2018. The anonymous survey was composed of 19 questions, with varying formats including multiple choice, fill-in-the-blank, and rank order. Primary endpoints were quantification of time spent in the electronic health record and perceptions on how technology expansion has impacted the safety, quality, and efficiency of patient care.

RESULTS

Twenty-seven hematology/oncology clinical pharmacists (90% response rate) completed the survey in its entirety. Respondents reported that they spend an average of 84.1% of their work day in the electronic health record. Based on a 40-h work week, clinical pharmacists indicated that they spend approximately 32.2 h each week performing direct patient care tasks in the electronic health record compared to 3.7 h on indirect patient care tasks. All respondents reported a greater utilization of technology over the last five years, and most respondents felt that patient care is safer, of better quality, and more efficient with technology expansion. The majority of respondents (81.5%) indicated that clinical pharmacists have the best understanding of the health information technology system, followed by generalist pharmacists and informatics pharmacists.

CONCLUSION

The hematology/oncology clinical pharmacist is well positioned to serve as a health information technology leader on the interdisciplinary healthcare team.