What are the responsibilities of the Pharmacist when dispensing and supplying cancer therapy?

From Cancer Guidelines Wiki

Introduction

The cancer pharmacist is responsible for the safe and appropriate preparation and dispensing of cancer therapy medications (chemotherapy, biological therapy, targeted therapy and associated supportive medications) in accordance with legislative requirements, national standards and local policy.


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Evidence Summary

Guidelines and standards of practice define the role and scope of the pharmacist when providing cancer chemotherapy, targeted therapy and supportive medications for patients with cancer.[1][2][3][4][5]

The roles and responsibilities of each multidisciplinary team member should be defined and expectations should be clarified about how each discipline will communicate and work collaboratively to provide cancer therapy, particularly regarding the chemotherapy medication use process.[4]


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Recommendations

Consensus-based recommendationQuestion mark transparent.png

The pharmacist is responsible for ensuring:

  • The clinical verification of the treatment prescription/order including chemotherapy (both parenteral and oral) and supportive medications is performed according to the protocol, the patient’s treatment plan and patient parameters.
  • The treatment protocol used has been through the multidisciplinary review and approval processes.
  • The cancer therapy is prescribed on a designated medication chart specifically designed for prescribing the cancer therapy.
  • Identified discrepancies in the prescription/order of the cancer treatment are clarified and resolved.
  • An up-to-date treatment history relating to all chemotherapy medications, doses and treatment dates is available in the patients’ healthcare record.
  • The accurate dispensing of both parenteral and oral cancer therapy and related treatment including supportive care therapies.
  • All components of the prescription are supplied in a timely and safe manner.
  • The preparation of parenteral cytotoxics is carried out using premises and equipment suitable for aseptic manipulation of the product according to risk and standards of practice.
  • The appropriate health and safety standards are applied when handling hazardous oral medications such as oral cytotoxics.
  • All professional and legal responsibilities are met with respect to dispensing of medication.
  • All materials used for patient education are comprehensive, suitable for the patient’s treatment and routinely updated.


Practice pointQuestion mark transparent.png

The pharmacist must be able to recognise situations where they need to seek advice and support from an appropriate source (e.g. senior colleague) and respond appropriately. In particular, where the complexity required exceeds their own personal level of competence, where the patient is from a specialised population the pharmacist is not familiar with (e.g. paediatrics) or where there is reason for concern about the patients suitability for the prescribed treatment (British Oncology Pharmacy Association, 2013).


The pharmacist should lead initiatives to standardise preparation procedures including reconstitution, dilution, and admixture methods for commonly used parenteral chemotherapy medications (Attilio, 1996).


The pharmacist should be an active member of the local governance committee and medication safety committee.


The pharmacist should regularly provide education to other cancer health professionals about medication safety and error reduction. Processes to report to the multidisciplinary team on near misses and trends should be in place.


The pharmacist should provide input and advice into the use of electronic information systems (including prescribing, dispensing and manufacturing) and liaise directly with software vendors on current and future needs.

(British Oncology Pharmacy Association, 2013)[3] ;(Attilio, 1996)[6]


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References

  1. Society of Hospital Pharmacists of Australia. Committee of Specialty Practice in Cancer Services. Standards of Practice for the Provision of Pharmaceutical Care of Patients Receiving Oral Chemotherapy for the Treatment of Cancer. J Pharm Pract Res 2007;37,147-150.
  2. Carrington C, Stone L, Koczwara B, Searle C, Siderov J, Stevenson B, et al. The Clinical Oncological Society of Australia (COSA) guidelines for the safe prescribing, dispensing and administration of cancer chemotherapy. Asia Pac J Clin Oncol 2010 Sep;6(3):220-37 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20887505.
  3. 3.0 3.1 British Oncology Pharmacy Association (BOPA). Standards for Pharmacy Verification of Prescriptions for Cancer Medicines. [homepage on the internet]; 2013 [cited 2016 Sep]. Available from: www.bopawebsite.org (Members only section).
  4. 4.0 4.1 Goldspiel B, Hoffman JM, Griffith NL, Goodin S, DeChristoforo R, Montello CM, et al. ASHP guidelines on preventing medication errors with chemotherapy and biotherapy. Am J Health Syst Pharm 2015 Apr 15;72(8):e6-e35 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25825193.
  5. Australian Commission on Safety and Quality in Health Care. National Quality Use of Medicines Indicators for Australian Hospitals.; 2014 [cited 2016 Sep] Available from: http://www.ciap.health.nsw.gov.au/nswtag/documents/publications/indicators/manual.pdf.
  6. Attilio, RM. Caring enough to understand: the road to oncology medication error prevention. Hosp Pharm 1996;31,17-26.

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