Capecitabine and Temozolomide: Design, Implementation, and Preliminary Outcomes From a Pilot Project to Ensure Safe Prescribing of Oral Chemotherapy

Jatoi, Aminah; Smith, Emily L.; Gunderson, Heidi D; Hartgers, Mindy L.; Looker, Sherry; Santana-Dávila, Rafael; McWilliams, Robert R.

doi:10.1200/jop.200031

Cited by 4 publications

(11 citation statements)

References 10 publications

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“…Pharmacy oversight is crucial for improving patient safety and providing optimal patient care, and previously published data have shown that pharmacist review of oral chemotherapy can improve error rates as well as increase the accuracy of oral chemotherapy orders. 5 As demonstrated in this study, clinical pharmacists provide valuable interventions by ensuring appropriate therapy, catching and correcting dosing errors before they reach the patient, coordinating patient care, and providing comprehensive chemotherapy education.…”

Section: Discussionmentioning

confidence: 92%

“…To date, few descriptions of other pharmacist-managed oral chemotherapy programs exist in the literature. 1,4,5 Furthermore, the programs that do exist describe limited use of EMRs. 1 Implementation of a pharmacist-managed oral chemotherapy program can improve both clinical and economic outcomes when caring for patients on these complicated medications, 1 and it is hypothesized that an electronic system for implementing such a program will provide an improved and more streamlined workflow that can translate into more meaningful pharmacy interventions.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of electronic health record implementation on pharmacist interventions related to oral chemotherapy management

Finn

Bondarenka

Edwards

et al. 2016

J Oncol Pharm Pract

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Background With the ever growing arsenal of oral chemotherapy agents now available, cancer treatment is being increasingly managed in the outpatient setting. However, oral chemotherapy use is often associated with several potential obstacles and complications. In order to provide optimal patient safety and oral chemotherapy monitoring, our institution implemented an oral chemotherapy program managed by clinical pharmacists electronically through Epic Beacon. Objective To describe implementation of a novel pharmacist-managed oral chemotherapy program and evaluate pharmacist interventions before and after implementation of an oral chemotherapy program. Methods This was a single-center retrospective chart review of documented pharmacy interventions for oral chemotherapy prescriptions during three months prior to as well as three months following Epic Beacon implementation. Time periods for data inclusion were October-December 2013 (pre-Beacon) and October-December 2014 (post-Beacon). Patients included in the study had one or more oral chemotherapy orders during the pre-Beacon period, the post-Beacon period, or both pre- and post-Beacon. Our analysis did not include oral chemotherapy orders that were placed outside of a treatment plan in the post-Beacon period. Results A total of 240 patients with 450 total oral chemotherapy orders were assessed over the duration of the study. Beacon implementation allowed a greater number of oral chemotherapy orders to be reviewed, with 134 oral chemotherapy orders reviewed in the study period prior to Beacon implementation and 316 orders reviewed in the post-Beacon period. Additionally, there were 660% more pharmacist interventions (89 interventions pre-Beacon versus 681 interventions post-Beacon), with an increased focus on coordination of care, chemotherapy calendar coordination, and assistance with treatment plans. Furthermore, implementation of Epic Beacon allowed identification of over 500% more chemotherapy order errors (41 total errors identified pre-Beacon versus 250 total errors identified post-Beacon). Pharmacists were also able to identify more significant, serious, or potentially lethal errors following implementation. The time associated with oral chemotherapy review and intervention also increased accordingly with number of orders reviewed. Conclusion Implementation of an electronic workflow for oral chemotherapy dramatically increased pharmacist review of orders, resulting in improved documentation of interventions and errors, decreased need for clarification of orders, as well as increased volume of prescriptions at our on-site pharmacy. This study demonstrates a comprehensive approach to maximize safety when oral chemotherapy is utilized as a component of the treatment regimen.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Evaluation of electronic health record implementation on pharmacist interventions related to oral chemotherapy management

Finn

Bondarenka

Edwards

et al. 2016

J Oncol Pharm Pract

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“…24 Guidelines developed for physician practices or cancer center ambulatory facilities may not reach community pharmacies that are not affiliated with these practice sites, thus prescriptions must be double checked before they are dispensed to patients. 25 In addition, communication with community pharmacies that dispense TMZ should be enhanced. We encourage clinicians to report all errors that occur to accurately identify the true incidence.…”

Section: Resultsmentioning

confidence: 99%

Analyzing temozolomide medication errors: potentially fatal

et al. 2014

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Background The EORTC-NCIC regimen for glioblastoma requires different dosing of temozolomide (TMZ) during radiation and maintenance therapy. This complexity is exacerbated by the availability of multiple TMZ capsule strengths. TMZ is an alkylating agent and the major toxicity of this class is dose-related myelosuppression. Inadvertent overdose can be fatal. Methods The websites of the Institute for Safe Medication Practices (ISMP), and the Food and Drug Administration (FDA) MedWatch database were reviewed. We searched the MedWatch database for adverse events associated with TMZ and obtained all reports including hematologic toxicity submitted from November 1st 1997 to May 30th 2012. Results The ISMP describes errors with TMZ resulting from the positioning of information on the label of the commercial product. The strength and quantity of capsules on the label were in close proximity to each other, and this has been changed by the manufacturer. MedWatch identified 45 medication errors. Patient errors were the most common, accounting for 21 or 47% of errors, followed by dispensing errors, which accounted for 13 or 29%. Seven reports or 16% were errors in the prescribing of TMZ. Reported outcomes ranged from reversible hematological adverse events (13%), to hospitalization for other adverse events (13%) or death (18%). Four error reports lacked detail and could not be categorized. Conclusion Although the FDA issued a warning in 2003 regarding fatal medication errors and the product label warns of overdosing, errors in TMZ dosing occur for various reasons and involve both healthcare professionals and patients. Overdosing errors can be fatal.

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“…Innovation is together a procedure and a result. It includes "production or adoption, assimilation, and exploitation of value-added novelty" [28], to produce outcomes such as new or improved products and services, or to create or improve production or management methods in organizations [29]. The definition of innovation has been broadened beyond the outputs of research and development or technology, to include assets with a knowledge base, social and enterprise innovation and business models, as previously defined by [30].…”

Section: Innovationmentioning

confidence: 99%

“…We have adopted a general management contingency framework for our current research, but this also applies to project management. A survey on the categorization framework for the project is in line with the contingency selection method, underlining the principle that "organizational structure must contribute to the context" [15,[21][22][23][25][26][27][28][29][30][31][32][33][34][36][37][38][39][40][41][42][43][44][45].…”

Section: Theoretical Foundationmentioning

confidence: 99%

The Impact of Project Manager Soft Competences on Project Sustainability

et al. 2020

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The current study suggests a different and innovative view by testing a unique combination of variables, which are unproven in a single model for the purpose of increasing the ratio of sustainable projects. The project manager can use the model to look their projects and can compose necessary changes for better outcomes. The study objects to postulate the competence breach of project managers with regard to sustainability, and to deliver direction that how to fulfill the research gap. The given work is centered on the result of project supervisor soft capabilities on project sustainability mediated by innovation. To achieve this aim, deductive approach was adopted. The sample size of the study was 242 respondents, and data were collected from software houses. The collected data were then analyzed by doing the structural equation modeling in PLS-SEM in order to examine the relationships. The outcomes demonstrate positive impact of project manager soft competences on project sustainability and mediating impact of innovation among the relationship of project manager soft competences and project sustainability. Innovation is directly linked to project sustainable development, and was accepted, which aligns with the previous studies. This research reflects the role of project manager soft competences on innovation and project sustainability. The study is unique in its scope and implications as the focus is upon empirical investigation of the project manager soft competences and project sustainability in the context of Pakistan.

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Capecitabine and Temozolomide: Design, Implementation, and Preliminary Outcomes From a Pilot Project to Ensure Safe Prescribing of Oral Chemotherapy

Abstract: Without adequate safety measures, oral chemotherapy can lead to undetected dosing errors. The Mayo Clinic launched a project to ensure that all capecitabine and temozolomide prescriptions receive an independent double check.

Cited by 4 publications

References 10 publications

Evaluation of electronic health record implementation on pharmacist interventions related to oral chemotherapy management

Evaluation of electronic health record implementation on pharmacist interventions related to oral chemotherapy management

Analyzing temozolomide medication errors: potentially fatal

The Impact of Project Manager Soft Competences on Project Sustainability

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