Pharmacists who provide medication and pharmaceutical care to patients with cancer need to be equipped with the appropriate skills and competencies to ensure the safe use of these medicines. Maintaining the competency of healthcare professionals is a key principle of clinical governance and risk management.
Adequate training and skills assessments are necessary to ensure pharmacists attain and maintain these skills to deliver optimal and safe pharmaceutical care to patients with cancer.
Competency standards and assessment tools are available to describe and assess the skills, attitudes and attributes essential to a practicing pharmacist. Frameworks can also be used as a method to inform the development and provision of training, professional development for cancer pharmacists and the commissioning of pharmacy cancer services.
There is no Australian endorsed competency framework for specialist cancer pharmacists, however a key set of competencies for the pharmaceutical delivery of cancer care has been developed. Standards of practice and guidelines that define the appropriate training, knowledge and skills in cancer chemotherapy are also available.
There are established courses available that support the required skills and continuing professional education for cancer pharmacists. There is a need for more structured programs that link to competency frameworks and are flexible in their delivery.
Note: Section 1 of these guidelines (General Information, "Competency and Skills") provides additional recommendations on competency and skills relevant to cancer treatment.
All tasks involved in the provision of cancer therapy must only be undertaken by a cancer pharmacist who has undergone specialist training, demonstrated their appropriate competence and is locally authorised/accredited for the task (Goldspiel et al, 2015). This includes (but is not limited to) clinical verification of cancer therapy, monitoring of patients, dispensing of medications and education of patients.
All institutions and individual pharmacists must demonstrate competency in the domains of the National Competency Standards Framework for Pharmacists in Australia (Pharmaceutical Society of Australia, 2010) and in the Society of Hospital Pharmacists Clinical Competency Assessment Tool (Society of Hospital Pharmacists of Australia, 2013).
All institutions must ensure policies and procedures are in place for training, continuing education and assessment of competency of pharmacists responsible for tasks involved in the provision of cancer therapy including clinical verification of prescriptions, monitoring of patients and dispensing of medications for cancer treatment (Goldspiel et al, 2015; Carrington et al, 2011; Carrington et al, 2010; Neuss et al, 2017).
A pharmacist with a role in cancer should ensure that continuing professional education activities are relevant to the scope of role as a cancer pharmacist and meet the Pharmacy Board of Australia’s requirement for CPD credits (Pharmacy Board of Australia, 2015; Society of Hospital Pharmacists of Australia Committee of Specialty Practice in Oncology, 2002).
The pharmacist must demonstrate competence, knowledge and proficiency in techniques and procedures for safe handling and disposing of hazardous agents including cytotoxic therapies. These competencies should be reassessed at least annually (Goldspiel et al, 2015; Society of Hospital Pharmacists of Australia Committee of Specialty Practice in Cancer Services, 2007).
Pharmacists with insufficient knowledge or experience in cancer treatment should not be delegated to manage patients receiving chemotherapy and related treatment.
A pharmacist working in cancer care without the direct supervision of a more senior pharmacist should have a minimum of 2 years previous experience in cancer working under a senior cancer pharmacist (Carrington et al, 2011).
Competencies should be reassessed at least annually or sooner where a member of staff has been absent from the work area for a substantial period of time.
A pharmacist working independently as a cancer pharmacist should hold, or be working towards a postgraduate qualification in clinical pharmacy (Carrington et al, 2011).
Cancer pharmacists should be encouraged to obtain formalised accreditation through the US Board of Pharmaceutical Specialties. Institutes should provide relevant support to enable pharmacists to undertake credentialing.
A pharmacist with a role in cancer should attend specialist cancer conferences, seminars and educational meetings to maintain and update specialist knowledge and skills.
(Goldspiel et al, 2015) ;(Pharmaceutical Society of Australia, 2010) ;(Society of Hospital Pharmacists of Australia, 2013) ;(Carrington et al, 2011) ;(Carrington et al, 2010) ;(Neuss et al, 2017) ;(Pharmacy Board of Australia, 2015) ;(Society of Hospital Pharmacists of Australia, 2002) ;(Society of Hospital Pharmacists of Australia, 2007)
- Pharmaceutical Society of Australia. National Competency Standards Framework for Pharmacists in Australia.; 2010 [cited 2016 Sep] Available from: http://www.psa.org.au/download/standards/competency-standards-complete.pdf.
- Society of Hospital Pharmacists of Australia. Clinical Competency Assessment Tool (shpaclinCAT version 2). Journal of Pharmacy Practice and Research 2013 [cited 2016 Sep];43,s50-67.
- British Oncology Pharmacy Association (BOPA). Competency Framework for Specialist Oncology Pharmacists. [homepage on the internet]; 2004 [cited 2016 Sep]. Available from: www.bopawebsite.org (Members only section).
- Carrington C, Weir J, Smith P. The development of a competency framework for pharmacists providing cancer services. J Oncol Pharm Pract 2011 Sep;17(3):168-78 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20395350.
- Society of Hospital Pharmacists of Australia. Committee of Specialty Practice in Oncology. Standards of Practice for the Provision of Clinical Oncology Pharmacy Services. J Pharm Pract Res 2002;32,115-18.
- 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.
- 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.
- Clinical Oncology Society of Australia and Cancer Pharmacists Group. Foundation and Advanced Clinical Practice for Cancer Pharmacists. [homepage on the internet]; 2017 [cited 2017 Mar]. Available from: http://cosacpgcourses.org.au/cosa-and-the-cpg/.
- Society of Hospital Pharmacists of Australia. Cancer Services Seminars. [homepage on the internet]; [cited 2017 Mar]. Available from: http://cpd.shpa.org.au/Seminars-and-Symposiums/Cancer-Services.
- Neuss MN, Gilmore TR, Belderson KM, Billett AL, Conti-Kalchik T, Harvet BE, et al. 2016 Updated American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards, Including Standards for Pediatric Oncology. Oncol Nurs Forum 2017 Jan 6;44(1):31-43 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/28067033.
- Pharmacy Board of Australia. Continuing professional development registration standard. [homepage on the internet]; 2015 Dec [cited 2016 Sep]. Available from: http://www.pharmacyboard.gov.au/Registration-Standards.aspx.
- Society of Hospital Pharmacists of Australia. Committee of Specialty Practice in Cancer Services. Standards of Practice for the Transportation of Cytotoxic Drugs from Pharmacy Departments. J Pharm Pract Res 2007;37,234-5.