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Following a review of a chemotherapy medication adverse event where the incorrect medication was prepared by a pharmacy, a number of steps were taken to review the literature and best practice information related to checking processes for the preparation of parenteral chemotherapy. Concepts such as identification of critical stop check points, independent double checks, and human factors principles were reviewed and incorporated into newly designed chemotherapy preparation worksheets with embedded checklists. Usability testing and staff feedback during implementation revealed a number of key learning points that resulted in additional work to further improve the chemotherapy worksheets with embedded checklists and highlighted the need for a culture of continuous quality improvement.

Objective. To continue with workplace contamination monitoring in the Alberta Cancer Board (ACB) pharmacy practice environment. Setting. The ACB in the Canadian province of Alberta which includes two public tertiary centers and 19 associated community satellite sites based around the province in existing hospitals. Methods. After the completion of a Phase 1 and Phase 11 study,1 which investigated the feasibility of routine monitoring of antineoplastic agent contamination in the pharmacy practice environment, it was decided to launch a Phase III study. The Phase III study would be done at the Cross Cancer Institute in the main pharmacy department as well as at a brand new satellite pharmacy within the CCI hospital. Samples would be taken in these areas as well as on the outer exterior of latex gloves worn to prepare cyclophosphamide and other antineoplastics. Results. The result determined that the area in front of the biological safety cabinet in the main CCI pharmacy department as well as the exterior of the latex gloves showed evidence of cyclophosphamide contamination. The results from the sample taken in the new satellite pharmacy showed no evidence of cyclophosphamide contamination. Conclusion. Results from this study prompted a decision to launch a Phase IV study to determine the feasibility within our network, for routine monitoring as well as sampling throughout the clean room beyond the BSC.

Study objective. To investigate the feasibility of routine monitoring for workplace antineoplastic agent contamination in the Alberta Cancer Board (ACB) pharmacy practice environment. Setting. The ACB in the Canadian province of Alberta, which includes two public tertiary centres and 17 associated community satellite sites based around the province in existing hospitals. Methods. Obtained organizational support and input prior to launching the feasibility study (Phase I). Samples were analysed for a common cytotoxic agent - cyclophosphamide. Surfaces chosen were within the biological safety cabinets, workplace counter tops and on external surfaces of vials provided by manufacturers. Blank samples and known contaminated controls were included in Phase I to reconfirm the methodology in a previously published study.1 Feasibility aspects of logistics and financial expenses were examined. A second phase (Phase II) was completed to test other areas of the pharmacy and vials, with blank samples included to reconfirm previously mentioned methodology. Results. The results determined that the samples tested were below acceptable detection limits with the exception of the known contaminated sample (Phase I) and exterior surfaces of vials (Phase II). Conclusion. This project has increased staff awareness of the sources for antineoplastic agent workplace contamination. Some practice changes were instituted during the project itself. Logistics and expenses were realistic for routine monitoring to be adopted.

Objective. The Alberta Cancer Board (ACB) Pharmacy recognized the importance of having a sound knowledge of drug interactions with anti-neoplastic agents. A pharmacy student was given the task of surveying ACB pharmacists for published literature and Internet sources used most often as sources of drug interaction information during medication order review and evaluation of patient profiles. The goal was to extract information from these sources and integrate it into a concise ACB drug interaction database, which lists the actual and potential antineoplastic drug-drug, drug-disease, drug-natural products and drug-food interactions. The antineoplastic agents identified and examined were part of the ACB Out-patient Cancer Drug Benefit Program (OCDBP) (August 2002). Equipped with this information and using their clinical expertise, pharmacists can play an important role in the medical management of patients with cancer. Data sources. The student collected information from literary and remote sources used most often by ACB pharmacists. Study selection. ACB pharmacists were surveyed for published literature and Internet sources that contained drug interaction information on antineoplastics used most often during medication order review, patient counselling sessions and when responding to drug information requests. The contributors of these information sources claim to have reviewed existing references and thus the student relied on the accurate reporting of their findings instead of collecting data from the original works. The drugs reviewed for the purpose of the study were taken from the ACB OCDBP. Data extraction. There was an extensive data collection process. Dorland’s definition of a drug interaction was adopted. The student determined a potential interaction based on the words `may’ or `risk’ found in the statement of the interaction. The student extracted the drug interaction information into tables and a sample of 10 of 87 drugs from the ACB OCDBP are presented in this paper. A complete guide of the ACB drug interaction index can be obtained from the ACB Pharmacy. Data synthesis. Actual and potential antineo-plastic drug-drug, drug-disease, drug-natural products and drug-food interactions are summarized in tables. The information collected was as current as the date that the data were extracted. The determination of clinical significance relies on the expertise of the pharmacist or other healthcare professional. Moreover, the data contained in the tables is representative of the information collected exclusively from sources used most often by ACB pharmacists and therefore is only one source of drug interaction information. Conclusion. An indepth knowledge of actual and potential interactions with antineoplastic agents is critical for pharmacists in the management of patients with cancer. The ACB drug interaction index is an attempt to promote awareness of interactions with antineoplastic drugs and to encourage clinicians to investigate drug interactions during their treatment and management protocols.

Introduction. A pilot project was established at the Cross Cancer Institute pharmacy to assess the feasibility of implementing a patient callback program to determine which patients would benefit from a callback and the impact a callback service would have on the workload of the pharmacy department. Program description/development/implementation/evaluation. A pharmacy student conducted the pilot project over a 14-week time period. Four categories of patients were selected for inclusion in the pilot. The student approached patients at the time of medication pick-up to receive verbal permission to be included in the callback program. A standardized callback form was utilized to record medication information and any recommendations made. Data were collected on the numbers of patients in each category with questions or concerns as this was felt to be indicative of patients who would most benefit from a callback. The total time spent making the telephone calls was recorded. Over the eight-week period, 530.5 minutes were spent making the telephone calls with the average length of call being 3.27 minutes. Discussion/conclusion. The student researcher proposed that three patient groups would benefit from receiving a callback: new patients or patients on new medications; elderly patients; and patients with specific disease-drug combinations. The project also provided an estimate of pharmacist time required to implement such a service and it was concluded that implementation could occur with minimal disruption to workflow.

Introduction/background information. In 1998, increasing patient volumes and workloads related to ambulatory chemotherapy began to result in delays in the outpatient clinics, laboratory, pharmacy and the chemotherapy administration areas. The various departments that were being impacted met to review the situation and propose a solution. Program description. The team proposed that a next-day chemotherapy schedule be implemented, whereby patients would have their laboratory and physician appointment on one day and their chemotherapy administered on the next day. Originally, this was turned down by senior management, however, a year later the same issues resurfaced and the next-day chemotherapy scheduling was once again proposed and approval received to implement. Program implementation. A timetable was created and chemotherapy administration appointments were scheduled based on the available timeslots. The goal was to have the majority of patients scheduled for chemotherapy administration on the day following their appointment with the physician. Patients who would be exceptions to the next-day scheduling system were identified and education of staff and patients regarding the change was completed. Resistance from patients and staff was encountered and managed through continued education and reinforcement regarding the reasons for the change. Pharmacy issues/evaluation. Pharmacy conducted a follow-up timing study and the results supported that the timetable change was successful in improving pharmacy’s ability to prepare the chemotherapy for the patient’s appointment time. Pharmacy operational issues had to be worked through, however, overall the change was found to be positive. Conclusion. The implementation of a next-day chemotherapy administration schedule has resulted in improved efficiencies for pharmacy and nursing and a decrease in waiting times for patients to receive their chemotherapy.

Objective. The Alberta Cancer Board (ACB) Pharmacy conducted a timing study to determine how electronic prescription ordering impacts the workload in pharmacy in comparison to the current paper system. The objective was to compare the mean time required to review orders generated by an electronic physician order entry system to the existing paper method, and to determine whether such an implementation would decrease pharmacist intervention rates. Methods. Self-reporting and measurement by stopwatch timing were used to record the timing data on the prescription order review process on all outpatient parenteral chemotherapy orders for adults handled within the ACB’s two main tertiary centres for the month of June. The primary endpoint measured was mean pharmacist order review time for manual and electronic orders. The secondary endpoint measured was pharmacist intervention rate for manual and electronic orders. Results. Among all 836 chemotherapy orders reviewed, the mean pharmacist order review time was increased by 5.15 min with the implementation of an electronic order entry system. A total of 62 pharmacist interventions were recorded in the study. The pharmacist intervention rate was 7.14% for the electronic orders and 7.47% for the manual paper orders. Conclusions. The study showed that the implementation of an electronic physician order entry system has significant impacts on pharmacy workload without providing significant reductions in pharmacist intervention rates.

Objective. To describe the numerous pharmacy ac tivities afforded by the seven pharmacy sites that provide various levels of pharmacy services to cancer patients in cities throughout Alberta, Canada. Methods. A questionnaire for measuring phar maceutical care (PC) was developed and applied to each site to benchmark the level of PC that was offered at each institution. The survey was con structed based on elements of the PC model of Hepler and Strand et al and grouped along the lines of Cal Knowlton's ABCs of PC. Responses were graded according to what degree the site had fully, partially, or not yet incorporated the element surveyed. Results. Overall, 44% of the PC elements were fully implemented, 33% were partially implemented, and 23% were not yet implemented in the newly formed Alberta Cancer Board Pharmacy Department. The traditional areas of bottling and counseling con tinue to be areas of strength, with 79% and 77% of the elements fully implemented, respectively. More em phasis is warranted in the areas of assessment and surveillance, with only 26% and 29% of the elements fully implemented, respectively. Conclusions. The results of the survey indicate the need for continued planning to incorporate some of the elements of cognitive pharmacy services in the Alberta Cancer Board Pharmacy Department strategic plan.