Could pharmacist-prescribing reduce chemotherapy errors?
Shannon Nally is a pharmacist with a strong background in aseptic pharmacy work and oncology. Whilst studying for a master’s degree at University College Cork (UCC) she undertook a project at University Hospital Limerick which compared prescribing of chemotherapy by doctors and pharmacists. In this series of short videos, she explains the design of the study and the potential clinical and economic impact of chemotherapy prescribing by pharmacists.
Investigating chemotherapy prescribing errors
The workload in oncology clinics is growing but there is a paucity of doctors and a high prevalence of prescribing errors and these were all factors that prompted researchers at University College Cork to ask whether prescribing of chemotherapy by pharmacists might have beneficial clinical and economic impacts.
In this prospective, comparative study 82 percent of errors were from doctor-prescribed chemotherapy and 23 (18% percent) were from pharmacist-prescribed chemotherapy. In addition, 17.6 percent of doctors’ prescribing errors were classified as having a high probability of causing an ADE compared with zero percent for pharmacists’ prescribing errors.
An economic analysis suggested that the implementation of a pharmacist prescribing service for chemotherapy could be associated with a saving of more than 1.2 million Euro annually.
How investment could help reduce chemotherapy prescribing errors
Chemotherapy prescribing is an “error-prone process”, Ms Nally explains and all chemotherapy prescribing errors have an economic impact. Errors that are intercepted before they reach the patient incur the costs of ‘reworking’ – in this case re-prescribing, re-checking etc. Errors that are not intercepted could damage patients either by under- or over-treating patients. Ms Nally cites examples of some of the errors classed as ‘severe’ in this study.
She concludes that pharmacist-prescribing results in significantly fewer chemotherapy prescribing errors. It also reduces the risk of adverse drug reactions and patient harm and it has the potential for substantial cost savings. Most importantly, it improves patient safety and should therefore be considered for implementation in cancer care services on a much wider scale, Ms Nally says.
Shannon Nally is now Aseptic and Cancer Services Pharmacist at Imperial College Healthcare NHS Trust.
The poster: Evaluating the potential clinical and economic impact of chemotherapy prescribing by pharmacists at a university teaching hospital was selected as Best Poster at the EAHP Congress held in Lisbon, Portugal 22-24th March 2023.