Implementing a clinical pharmacy service in hematology

Farias, Tatiane; Aguiar, Karina da Silva; Rotta, Inajara; Belletti, Klezia Morais da Silva; Carlotto, Juliane

doi:10.1590/s1679-45082016ao3667

Cited by 18 publications

(28 citation statements)

References 19 publications

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“…In a Brazilian study regarding inpatients and outpatients with hematologic diseases, the rate of interventions in medication orders by clinical pharmacists was similar to that in our study (1.97% vs. 1.87%). 13 The main medication-related problems detected by the specialized clinical pharmacist in the Brazilian study included issues of dose, day of cycle, duration, and dilution/concentration. 13 In our study, the prescription errors were mostly related to duration or quantity, unnecessary as-needed medication orders, dosage or frequency, and drug-drug interactions.…”

Section: Discussionmentioning

confidence: 99%

“…13 The main medication-related problems detected by the specialized clinical pharmacist in the Brazilian study included issues of dose, day of cycle, duration, and dilution/concentration. 13 In our study, the prescription errors were mostly related to duration or quantity, unnecessary as-needed medication orders, dosage or frequency, and drug-drug interactions. The discrepancies may be attributed to differences in the type of medication analyzed (antineoplastic drugs vs. all drugs), patient population (all patients vs. inpatients only), and the classification of medication-related problems in different institutions.…”

Section: Discussionmentioning

confidence: 99%

“…First, because this interventional study was performed in the inpatient setting of the Hematology Department, it may not be generalizable to other clinical settings. According to Farias et al, more drug-related problems were found in outpatients than in inpatients with hematological diseases; 13 therefore, higher total saving by CPS can be expected for the outpatient department. Furthermore, the clinical and economic benefit of CPS has been reported in various specialties, such as intensive care unit, 3 nephrology ward, 9 and surgery department.…”

Section: Discussionmentioning

confidence: 99%

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Clinical and economic impact of clinical pharmacist intervention in a hematology unit

Chen

Huang

2019

J Oncol Pharm Pract

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Background Medication errors can lead to preventable adverse drug events and associated hospitalization and healthcare cost to patients. Pharmacotherapy in patients with hematologic malignancies is more complex than that in general medicine patients. This study evaluated the clinical and economic impact of clinical pharmacist intervention in a hematology unit. Methods This retrospective study compared the number of pharmacist interventions and the economic impact for one year before and after a clinical pharmacist was deployed in a hematology unit. The clinical pharmacist joined the ward rounds and gave patient counseling and recommendations on medication use. For pharmacist intervention analysis, we compared the number and type of interventions. For cost analysis, we calculated the cost savings, estimated the cost avoidance, and compared the benefit–cost ratio between the two periods. Results The average length of hospitalization reduced from 19.27 days to 16.69 days after clinical pharmacist deployment. The rate of pharmacist interventions in medication orders increased from 143 out of 42,501 prescriptions (0.34%) to 826 out of 44,175 prescriptions (1.87%) (P < 0.00001). The calculated cost savings (NT$37,080 and NT$252,280), cost avoidance (NT$582,100 and NT$2,304,600), and benefit–cost ratio (0.77 and 3.19) increased after clinical pharmacist deployment. Conclusion This study demonstrated that the number of interventions significantly increased after clinical pharmacist deployment. This service could reduce medication errors, preventable adverse drug events, and costs of both medications and potential adverse drug events.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical and economic impact of clinical pharmacist intervention in a hematology unit

Chen

Huang

2019

J Oncol Pharm Pract

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“…They reported 106.5% increase in detection of MRPs after implementation of clinical pharmacy services. 24 A study conducted by Wong and Gray provided patient medication counselling (30.8%), therapeutic recommendations (30.3%) to improve existing drug therapy and identified prescribing errors (2.4%) after implementation of clinical pharmacy services. However, this study was conducted at ambulatory oncology clinics and for shorter duration.…”

Section: Discussionmentioning

confidence: 99%

Implementation of clinical pharmacy services in an academic oncology practice in India

Patel

Parthasarathi

2017

J Oncol Pharm Pract

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Objective This study was conducted to investigate medication-related problems after implementation of clinical pharmacy services at a speciality oncology care setting. Methods It was a prospective interventional study conducted for a period of three years at a private academic oncology care setting. Paper-based medical records and medication orders were reviewed and patients and care givers were interviewed to understand the treatment plan. All the medication-related problems were identified by clinical pharmacists by performing drug therapy review. Patients were also followed up at ambulatory care and in-patient units to ensure appropriate administration of anti-cancer drugs by nurses. All the medication-related problems were discussed with the concerned clinicians and then were resolved with the interventions of clinical pharmacists. Clinical significance of these interventions were assessed and classified as "Major", "Moderate "and "Minor". Educational, clinical and system-based interventions were developed and implemented to minimize medication-related problems at the study site. Results A total of 1359 medication-related problems were identified from 2120 medication orders reviewed of 1362 patients followed during the study period. The most common medication-related problems were lack of suboptimal supportive care (17.95%), inappropriate administration of medications (14.56%), untreated indication (14.20%), wrong dosing calculations (12.21%), drug-drug interactions (11.62%) and sub-therapeutic dose (11.11%). Clinical pharmacy interventions were made to resolve all the medication-related problems. Clinical significance of majority (n = 504, 37.08%) of medication-related problems was "Moderate" followed by "Major" (n = 434, 31.93%) and "Minor" (n = 421, 30.97%). Conclusion The study has demonstrated the importance of clinical pharmacy services in improving quality and safe use of medicines in oncology practice. Positive feedback of clinicians on clinical pharmacy services was a reflection of acceptance of clinical pharmacy interventions by clinicians.

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“…Such modifications may have clinical consequences for patients: in the most severe cases PIs can prevent hospitalization for chemotherapy toxicity, permanent disability such as renal failure, or paresthesia, especially by detecting dosage problems or contraindications [8][9][10]. In others cases PIs can improve quality of life, patient satisfaction and adherence with counseling [11].…”

Section: Introductionmentioning

confidence: 99%

Clinical, economic and organizational impact of pharmacist interventions on injectable antineoplastic prescriptions: a prospective observational study

Zecchini

Chanoine

et al. 2020

BMC Health Serv Res

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Background: Pharmacists play a key role in ensuring the safe use of injectable antineoplastics, which are considered as high-alert medications. Pharmaceutical analysis of injectable antineoplastic prescriptions aims to detect and prevent drug related problems by proposing pharmacist interventions (PI). The impact of this activity for patients, healthcare facilities and other health professionals is not completely known. This study aimed at describing the clinical, economic, and organizational impacts of PIs performed by pharmacists in a chemotherapy preparation unit.Methods: A prospective 10-week study was conducted on PIs involving injectable antineoplastic prescriptions. Each PI was assessed by one of the four multidisciplinary expert committees using a multidimensional tool with three independent dimensions: clinical, economic and organizational. An ancillary quantitative evaluation of drug cost savings was conducted. Results: Overall, 185 patients were included (mean age: 63.5 ± 13.7 years; 54.1% were male) and 237 PIs concerning 10.1% prescriptions were recorded. Twenty one PIs (8.9%) had major clinical impact (ie: prevented hospitalization or permanent disability), 49 PIs (20.7%) had moderate clinical impact (ie: prevented harm that would have required further monitoring/treatment), 62 PIs (26.2%) had minor clinical impact, 95 PIs (40.0%) had no clinical impact, and 9 PIs (3.8%) had a negative clinical impact. For one PI (0.4%) the clinical impact was not determined due to insufficient information. Regarding organizational impact, 67.5% PIs had a positive impact on patient management from the healthcare providers' perspective. A positive economic impact was observed for 105 PIs (44.3%), leading to a saving in direct drug costs of 15,096 €; 38 PIs (16.0%) had a negative economic impact, increasing the direct drug cost by 11,878 €. Overall cost saving was 3218€. Conclusions: PIs are associated with positive clinical, economic and organizational impacts. This study confirms the benefit of pharmacist analysis of injectable antineoplastic prescriptions for patient safety with an overall benefit to the healthcare system.

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Implementing a clinical pharmacy service in hematology

Cited by 18 publications

References 19 publications

Clinical and economic impact of clinical pharmacist intervention in a hematology unit

Clinical and economic impact of clinical pharmacist intervention in a hematology unit

Implementation of clinical pharmacy services in an academic oncology practice in India

Clinical, economic and organizational impact of pharmacist interventions on injectable antineoplastic prescriptions: a prospective observational study

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