Clinical pharmacy services within an interdisciplinary model of care in adult oncology

Abstract

Identifying effective clinical pharmacist contributions within the provision of pharmaceutical services, enhances outcomes of therapy and supports interdisciplinary oncology patients’ management. The aim of this project was to develop, implement and evaluate a pharmaceutical care model within oncology, reflecting the relevant contribution of pharmacists through optimisation of patient care. The objectives were to undertake a gap analysis assessing current pharmaceutical service with established practice guidelines, to develop a standard operating procedure (SOP) for the service provision, and to implement a pharmaceutical care model and consolidate it. The research was divided into three phases. The first two phases included the evaluation of the existing policy framework, gap-finding and identification of weaknesses and opportunities. An SOP was completed and consequently, a pharmaceutical care model was constructed through adoption and adaptation of guidelines obtained from various international bodies and validated by an expert panel (n=4). Phase three of the research involved the implementation of the developed model, whereby the application of the developed SOP was undertaken across the compounding unit and oncology wards over a period of two months. This involved a thorough review of each individual patient medication record and identification of any pharmaceutical care issues. These issues were then classified using the PCNE (Pharmaceutical Care Network Europe) classification. Findings from the gap analysis (Phase 1) were that 29 of the 75 sub-sections of the gap-finding instrument, which pertain to the duties of a clinical pharmacist working in the ward, were not carried out fully, neither in the oncology ward nor at the compounding unit by any health care professional. The developed SOP (Phase 2), which consists of three dimensions, namely patient parameters, pharmacotherapeutic choice including dosing, and drug delivery systems, comprised three main components: the validation of the drug dosage and regimen in accordance with the indication, the validation of the prescribed drug delivery method, and the verification of the demographic information submitted by the doctor on the prescription. For each patient, in order to track cumulative doses and to note any changes from prior cycles, data from each prescription was entered into a synoptic patient medication record. For the implementation aspect (Phase 3), out of the 307 cases investigated, 72 drug related problems (DRPs) were identified. These DRPs were categorised into three sections: the occurrence of side effects (n=38, 53%), namely hypersensitivity reactions, incorrect dosage of pre-medication, and incorrect administration rate; issues with dose selection (n=28), the most common of which was the administration of a high dose; as well as issues with drug selection (n=6). These identified drug related problems were shared with the doctors, and the change or rationale for their decision was then reflected on the prescription. Expanding the pharmacist contribution to oversee a holistic patient approach within oncology pharmacotherapy management strengthens the interprofessional care model that streamlines patient needs within a personalised patient approach. This phased study design was intended to spearhead the transformation from a product-centric to a patient-centric approach within hospital oncology service in a controlled and solid manner, respecting principles of change management dynamics.