Clinical verification of an order or prescription for cancer therapy by a pharmacist provides assurance that the prescribed treatment is accurate and appropriate for the patient and their specific cancer diagnosis. A step-wise, process-driven approach to clinical verification of cancer therapy is essential to minimise medication errors and optimise safety in the process of providing cancer therapy.
When verifying a prescription the pharmacist must ensure that the prescription is valid, the medicine is clinically appropriate for the patient and information is provided to the patient to ensure safe and appropriate use of the medicine.
A pharmacist must take reasonable steps to ensure that the dispensing of a medicine is consistent with the medical needs of the person for whom the prescription or order is intended. All health service organisations in Australia have mechanisms in place for the safe dispensing and supply of medicines. The prevention of medication errors is supported by standardised and systematic processes within the medication management pathway.
Evidence substantiates the need for clinical verification of all cancer medication orders prior to administration of these medications to patients. Over 1.5 million Australians are estimated to experience an adverse event from medicines every year which accounts for approximately 2-3% of all hospital admissions, with at least half of these admissions being avoidable.
For systemic cancer therapies the risks associated with incorrect prescribing, dispensing and administration are well described in the literature, and risk minimisation processes are essential to maximise patient safety. Clinical verification of cancer medication orders by pharmacists provides high levels of assurance that the prescribed treatment is accurate  and is consistent with guidelines issued by the Pharmacy Board of Australia.
All prescribed cancer therapy and associated supportive care medications (by any route of administration) must be clinically verified by a pharmacist prior to dispensing and administration to, or by, a patient. Verification must be performed according to the protocol and the patient’s treatment plan and individual parameters (Goldspiel et al, 2015; Carrington et al, 2010).
The five “P”s should be followed to successfully verify a cancer therapy medication order:
1. Patient details and dosing variables
2. Prescription/medication order
3. Protocol and scheduling
4. Prescribed medication, dose calculations and administration
5. Patient organ function and laboratory blood tests
Table 11 provides recommendations on details that must be verified by the pharmacist.
The pharmacy verification process must be documented in an up-to-date local procedure which outlines the individual systematic checks that pharmacists are required to undertake when verifying cancer medication orders prior to dispensing, supply and administration.
Any identified discrepancies, anomalies or errors must be clarified and resolved with the prescriber. All significant interventions should be documented in the patients’ healthcare record.
The pharmacist responsible for the verification must sign and date each cancer medication order to confirm verification has been completed. Where electronic medication management systems are in use the pharmacist must ensure that electronic verification is performed securely and in line with local procedures and state legislation.
A patient medication history must be taken from the patient and documented on first cycle of chemotherapy or when the protocol is changed (Australian Pharmaceutical Advisory Council, 2005; The Society of Hospital Pharmacists of Australia, 2013). The pharmacist must ensure regular review with the patient that captures any changes to the patients usual medications or commencement of new medications. The pharmacist must maintain an up-to-date treatment history relating to all chemotherapy medications, doses, variations and treatment dates (Carrington et al, 2010).
Physical and staffing resources should enable the pharmacist to verify all cancer medication orders and prescriptions away from distractions and interruptions to maximise safety.
An independent check should be performed by a second pharmacist with appropriate training and demonstrated competence in verifying cancer therapy when possible and supported by staffing resources. This should include a check of any manual dosage calculations.
When a patient is admitted to hospital and is already receiving cancer chemotherapy or targeted therapy (oral or parenteral) the original prescriber or an appropriate clinician with experience in haematology/oncology must be contacted to verify whether cancer therapy is to continue or whether dose adjustments or withholding of therapy is necessary.
Certain populations may be at increased risk of toxicities from chemotherapy (e.g. patients with chromosomal abnormalities including Down Syndrome, Ataxia Telangiectasia and Fanconi Anaemia etc). These patients require careful consideration for dosing, particularly chemotherapy. Documented guidelines should be followed for chemotherapy dosing in obese patients where there is limited guidance available within the patient’s protocol.
|The following information must be verified:|
|1. Patient details, patient parameters and body surface area (BSA)
|2. Prescription/medication order
|3. Protocol and scheduling
| 4. Prescribed medication, dose calculations
|5. Patient organ function and laboratory blood tests
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