Abstract Objectives: This retrospective study was conducted to evaluate the impact of a service in which clinical pharmacists collaborated with oncologists at an outpatient clinic on chemotherapy order prescriptions and adverse drug reaction management in outpatient cancer chemotherapy. Methods: This was a single-center retrospective cohort study. Subjects were patients who received pharmacist services at an outpatient clinic in 6 treatment divisions at the National Cancer Center Hospital East from June to September 2016. Pharmacist interventions were categorized and assessed for impact by 2 pharmacists according to previously published methods. Results: The 6 pharmacists worked a total of 1396 hours, providing 1645 pharmacy interventions to 3419 patients. Of the 1645 interventions, 459 interventions (27.9%) involved chemotherapy order prescriptions. The 459 interventions for chemotherapy prescriptions were categorized according to the previously reported categories “drug therapy safety” (n = 330, 71.9%), “other” (n = 91, 19.8%), “drug therapy efficacy” (n = 28, 6.1%), and “drug therapy indication” (n = 10, 2.2%). Of the 91 interventions categorized as “other,” the 2 most frequent types of interventions were “confirmation from pharmacists to oncologists about laboratory test order” (n = 54, 11.7%) and “consultation from oncologists to pharmacists about chemotherapy regimen” (n = 23, 5.0%). Most interventions were identified as having “no error” (n = 369, 80.4%), while 8 interventions (1.8%) were identified as being “potentially lethal” or “serious.” Moreover, 92.8% of interventions were identified as being “extremely significant,” “very significant” or “significant.” Conclusions: This study clarified the benefits of outpatient pharmacy services in which pharmacists collaborate with oncologists at an outpatient clinic on outpatient chemotherapy prescription orders.

We conducted a nationwide survey of 583 community pharmacists in Japan and demonstrated a need for additional education and training in oral chemotherapy from a multivariate analysis.A recent study of community pharmacists in Canada reported that they required additional education. We conducted a survey of community pharmacists to evaluate the adequacy of education and training in oral anticancer agents in Japan.Between May and June 2014, community pharmacists were asked to complete a questionnaire by using two different survey strategies, one online and one via postal mail.Three hundred community pharmacists responded to an online survey and 283 community pharmacists responded to a mailed survey. Only 6-10% of respondents felt that they had received adequate education in oncology or oral chemotherapy. Although 81% of Japanese pharmacists had attended at least one continuing education event related to oncology in the past 2 years, only 54% felt comfortable dispensing oral anticancer agents and only 40% felt comfortable educating patients about oral chemotherapy. In a multivariate analysis, confidence in educating patients about oral chemotherapy was associated with an understanding of chemotherapy cycles and doses (odds ratio = 4.89, 95% confidence interval [2.53-9.45]) and the number of continuing education events they had attended (odds ratio = 1.67, 95% confidence interval [1.35-2.08]).This is the first report to evaluate whether community pharmacists are equipped to ensure the safe use of oral anticancer agents in Japan. The results are similar to those previously reported for Canadian pharmacists, namely a low rate of positive responses for education in oncology and oral chemotherapy, demonstrating a similar need for additional education and training in oral chemotherapy.

Background Computerized provider order entry (CPOE) has been developed and implemented within cancer center hospitals nationwide in Japan. To ensure that high-quality services are routinely provided by oncology pharmacists, this study was designed to evaluate the interventions through reviewing the orders that are generated by CPOE. Methods The objective of this retrospective chart review was to evaluate how pharmacists contributed to safe cancer treatment using paper-based pharmacy records. Data were collected from a total of 35,062 chemotherapy regimens for 18,515 outpatients between January and December 2013. Results Of these 35,062 chemotherapy regimens, the rate of pharmacists’ interventions was 1.1% ( n = 408). Among them, 53.1% (217/408) of the chemotherapy prescriptions were modified due to pharmacist interventions. The reasons for interventions included “changes in the chemotherapy regimen were unclear” in 49.5%, “physicians’ prescription errors” (22.0%), “pharmacist suggestions to improve chemotherapy” (15.1%), and “finding differences between physicians’ chemotherapy records and their chemotherapy prescriptions” (13.2%). The top three reasons for the 217 prescription modifications due to pharmacist interventions were “finding prescription errors” (34.5%), “reasons for change in the chemotherapy regimen were unclear” (32.7%), and “finding differences between physicians’ chemotherapy records and their chemotherapy prescriptions” (28.5%). Conclusion The computer could not evaluate chemotherapy protocols or adjust doses of anticancer medicines according to patients’ conditions. Therefore, oncology pharmacists should continue to ensure safe and appropriate administration of cancer chemotherapy.

Background In 2012, the Institute for Safe Medication Practices (ISMP) and the Institute for Safe Medication Practices Canada (ISMP Canada) collaborated with an international panel of oncology practitioners to develop the ISMP International Medication Safety Self Assessment® for Oncology. This self-assessment was designed to assist oncology practitioners in hospitals, ambulatory care centers, and office practice settings throughout the world to evaluate safe practices related to medication use in the oncology setting and to identify opportunities for improvement. Instrument Design The self-assessment consists of 175 items organized into 10 key elements subdivided into 18 core characteristics of safe medication use. Assessment results were submitted via a secure online portal. The online program allows participants to print and graph their results and to compare their findings with those of similar organizations both nationally and internationally. Methods Complimentary access to the self-assessment was made available for a seven-month “snapshot” period in 2012. Results A total of 352 organizations from 13 countries submitted assessment results. Key opportunities for improvement were identified in five areas: implementation of the World Health Organization recommendations for management of vinCRIStine and other vinca alkaloids, safe management of oral chemotherapy, labeling of distal ends of intravenous tubing, implementation of technology-based safeguards, and patient education. Conclusions This international snapshot provides important data about the level of implementation of system-based safeguards in oncology practice, key improvement opportunities, and represents a baseline for future improvement efforts. A collaborative approach to identifying vulnerabilities and developing solutions for safe medication use in oncology will enhance the care of patients with cancer internationally.

Journal Article Drug shortages in oncology Get access Ali McBride, Pharm.D., M.S., Ali McBride, Pharm.D., M.S. Specialty Practice Pharmacist, Stem Cell Transplantation Department of Pharmacy Arthur G. James Cancer Hospital The Ohio State University 216 South Kingshighway Boulevard Room 368 Doan Hall Columbus, OH 43228 alimcbride@gmail.com Search for other works by this author on: Oxford Academic Google Scholar Philip E. Johnson, B.S.Pharm., M.S., FASHP Philip E. Johnson, B.S.Pharm., M.S., FASHP Oncology Director Premier Tampa, FL Search for other works by this author on: Oxford Academic Google Scholar American Journal of Health-System Pharmacy, Volume 69, Issue 14, 15 July 2012, Page 1190, https://doi.org/10.2146/ajhp120136 Published: 15 July 2012

A comprehensive survey of compliance to oncology medication safe practice standards was conducted in 2008 with results published (J. Oncology Pharm Practice 2008, 14: 169–180). Responses from 377 participants representing 34 countries demonstrated a wide variance in adherence to established standards and best practices (22.3– 98.3%). Since then, new standards have been published by several organizations, and new ‘best practices’ have been promoted through publications and presentations. There are currently multiple standards, and it is clear from medication error reports that many important standards are not fully understood and compliance is not optimal. The Institute for Safe Medication Practices (ISMP), ISMP Canada, and the International Society of Oncology Pharmacy Practitioners (ISOPP) will be launching the 2012 ISMP International Medication Safety Self Assessment for Oncology, a self-assessment tool designed to help hospitals and ambulatory cancer centers throughout the world evaluate oncology medication safety. This tool will establish an international baseline for safe medication practices related to oncology practice and will identify areas for improvement. A multidisciplinary team of 29 international experts evaluated published world standards which resulted in a consensus opinion on current best practices. This was the basis for the development of the oncology self assessment tool. The assessment items are divided into the key elements (domains) that most significantly influence a safe medication use process. The key elements include: (1) Patient information, (2) Drug information, (3) Communication of drug orders and other drug information, (4) Drug labeling, packaging and nomenclature, (5) Drug standardization, storage and distribution, (6) Medication device acquisition, use and monitoring, (7) Environmental factors, workflow and staffing patterns, (8) Staff competency and education, (9) Patient education, and (10) Quality processes and risk management. As with ISMP’s previous self-assessments, healthcare organizations will be asked to convene multidisciplinary teams to complete the self assessment tool and submit data confidentially through a secure web-based form. Respondents will then be able to compare their results with aggregate data from other demographically similar organizations. The assessment will be available on the websites of ISMP (www.ismp.org), ISMP Canada (www.ismp-canada.org), ISOPP (www.isopp.org), as well as other organizations that will help support its use. The development of the oncology medication safety self assessment is being supported through a grant from ISOPP to ISMP and ISMP Canada. The Clinical Excellence Commission and the Cancer Institute of New South Wales have also provided grant support and their expertise to this project. Private sector support was received from Baxter Corporation, ICU Medical, Inc., Pfizer Oncology, and Roche. We encourage you to complete the self assessment as soon as it is available to you. Please watch for announcements and encourage your colleagues to also complete this important evaluation.

The use of specialty pharmacies is expanding in oncology pharmacy practice. Specialty pharmacies provide a channel for distributing drugs that, from the payor perspective, creates economies of scale and streamlines the delivery of expensive drugs. Proposed goals of specialty pharmacy include optimization of pharmaceutical care outcomes through ensuring appropriate medication use and maximizing adherence, and optimization of economic outcomes through avoiding unwarranted drug expenditure. In oncology practice, specialty pharmacies have become a distribution channel for various agents. The use of a specialty pharmacy, and the addition of the pharmacist from the specialty pharmacy to the health care team, may not only provide benefits for care but also present challenges in oncology practice. The NCCN Specialty Pharmacy Task Force met to identify and examine the impact of specialty pharmacy practice on the care of people with cancer, and to provide recommendations regarding issues discussed. This report provides recommendations within the following categories: education and training of specialty pharmacy practitioners who care for individuals with cancer, coordination of care, and patient safety. Areas for further evaluation are also identified.

Background. The safe use of medications is a major concern in oncology practice. Three organizations collaborated on a survey to determine if practitioners had implemented current recommended safe practices for IV vincristine administration, general oncology safe practices, and safe practices for oral chemotherapy. Methods. A survey was distributed to members of the Hematology Oncology Pharmacy Association (HOPA) and the International Society of Pharmacy Practitioners (ISOPP) using Survey Monkey TM. The Institute of Safe Medication Practices (ISMP) also solicited readers of its Medication Safety Alert! ® to respond to the survey. A comparison to results from a survey conducted by ISMP in 2006 on safe practices for IV vincristine was also conducted. Results. The majority of respondents were aware of the WHO recommendations for IV vincristine, although the rate of implementation of the guidelines ranged from 24.1 to 53.6%. When compared to the ISMP 2006 survey there was a 25.8—37.4% improvement in following many of the safe practice guidelines. Administering IV vincristine via a minibag showed the lowest rate of adoption (less than 40%). Of the 35 survey items on general chemotherapy safety strategies, 80% of respondents had implemented at least 21 items in the survey. Overall 32.4% of respondents did not consider oral chemotherapy as requiring the same safety concerns as parenteral therapy. Conclusions. The results of this survey will provide a new baseline for the adoption rate of safe medication practice recommendations related to oncology. Further work on addressing barriers in adopting identified safe practice recommendations needs to be conducted.