Clinical and economic impact of pharmacists’ intervention in a large volume chemotherapy preparation unit

Abstract

Background Even though pharmacists have devoted considerable time to ensuring patient safety during the process of preparing and dispensing chemotherapy, only a few studies have evaluated their efforts. Objective To evaluate the clinical and economic impact of pharmacists' interventions in a large volume chemotherapy preparation unit. Setting A 1600-bed tertiary hospital in Seoul, Korea. Method Pharmacist intervention records from May 2012 to April 2013 were retrospectively reviewed. The clinical significance of interventions was rated by one physician and one pharmacist. A cost-benefit analysis was conducted. The benefit from interventions was estimated through both cost avoidance based on the potential to avoid an adverse drug event (ADE) and cost savings related to reducing discarded products. Cost was estimated from the pharmacists' salary corresponding to the time spent in reviewing chemotherapy prescriptions. Main outcome measure Acceptance rate, clinical significance, net cost-benefit, and cost-benefit ratio of pharmacist interventions. Results Among 39,649 cancer chemotherapy prescriptions in 6364 patients, 631 interventions were performed for 435 patients. The acceptance rate was 72.1 %. Most cases of declined interventions were related to dosage adjustment within the range of <10 % of the prescribed dosage. More than half of the interventions were considered as clinically more than "significant" (50.4 %). The cost-benefit analysis showed a clear cost benefit with a net cost-benefit of $116,493 and a cost-benefit ratio of 3.64:1. Conclusion Pharmacists' interventions in a large volume ambulatory-based chemotherapy preparation unit provided a positive economic impact on health care budget and were effective in preventing clinically significant ADEs.

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

“…A large proportion of prescriptions established by residents in medicine and the lack of update of creatinine values in the CPOE system may explain this finding. Our results confirm those of previous studies which showed that overdosages and under-dosages are the most frequently encountered problems [20,21,24]. Consequently, in more than half of cases, PIs requested a dose adjustment.…”

“…In our study, PIs were accepted by senior physicians and medicine residents in 75.5% of the cases. This acceptance rate is close to that usually observed in cancerology and in others areas of clinical pharmacy [21,25].…”

“…A DRP rate of 3.0% was found in an establishment in which prescriptions were based on standardized pre-printed prescriptions and a listing of protocols [22]. Recent studies in settings with CPOE found a PI rate lower than 2% [20,21]. In our study, the PI rate of 10.1% was quite high despite computerized prescriptions and use of protocols.…”

“…In our study, no PI was considered to have avoided a potentially lethal effect for the patient, while some other studies have reported PIs performed by pharmacists in a CPU that potentially avoided patient death [21,23,26]. In these studies, PIs with life-saving impact were essentially related to overdose prescription problems of 3-to 50-fold the theoretical doses or cases of co-prescription.…”

“…Previous studies have reported PIs as being needed for 1.5 to 27.6% of injectable antineoplastic prescriptions [20][21][22][23][24]. This wide range can be explained by organizational differences: in a center without computerized prescriptions, 27.6% of prescriptions required a PI [24].…”