An Audit of the Implementation of an Oral Anti-Cancer Medicines Prescription Verification Tool for Use by Haematology/Oncology Pharmacists in St. Vincent's University Hospital

Introduction: Oral anti-cancer medicine (OAM) prescription verification by Haematology/Oncology pharmacists is recommended to identify and address drug-related problems (DRPs), contributing to the safe use of these medicines.1-3 However, there are currently no OAM-specific prescription verification standards in Ireland.

Aims: The aim of this audit was to structure and standardise OAM prescription verification by Haematology/Oncology pharmacists in St Vincent's University Hospital (SVUH).

Methods: An OAM prescription verification tool was developed based on Irish and international prescription verification standards.1,4-7 An audit of the implementation of the tool against these standards took place between 26th March and 26th July 2024. OAM prescriptions were verified by Haematology/Oncology pharmacists in SVUH. DRPs identified were classified using the Pharmaceutical Care Network Europe (PCNE) tool.3 Actions taken to resolve DRPs and outcomes of OAM prescription verification were recorded.

Results: In total, 53 prescriptions were collected. Issue(s) were identified with 73.58% (n = 39) of prescriptions, while 26.42% (n = 14) of prescriptions had no issues. Overall, 65 issues were identified. Dose selection (29.23%, n = 19) and dispensing issues (29.23%, n = 19) were the most common DRPs.

Pharmacists reported taking 45 actions to address the issues identified, including contacting Clinical Nurse Specialists (31.11%, n = 14), and review of healthcare records (22.22%, n = 10) and clinic letters (17.78%, n = 8).

Verification was completed for 41 prescriptions (77.36%). Verification could not be completed for 12 prescriptions (22.64%). The most common barrier to completing prescription verification was unknown reasons for dose reductions (n = 6).

Conclusion: This audit highlights the role of Haematology/Oncology pharmacists in identifying and addressing issues relating to OAM prescriptions. The verification tool provided a framework for pharmacist OAM verification, based on national and international standards.

References

1. British Oncology Pharmacy Association. Standards for the Pharmacy Verification of Prescriptions for Cancer Medicines. Version 4.2. [Internet]. UK: British Oncology Pharmacy Association; 2023. Available from: https://www.bopa.org.uk/resources/bopa-standards-for-clinicalpharmacy-verification-of-cancer-medicine-prescriptions/.Accessed 15/08/2024.

2. National Cancer Control Programme (NCCP). OAM Model of Care Recommendations. [Internet]. Ireland: Health Service Executive; 2018. Available from: https://www.hse.ie/eng/services/list/5/cancer/profinfo/medonc/safetyreview/oam-model-of-care.pdf.

3. Pharmaceutical Care Network Europe Association. PCNE Classification for drug-related problems. Version 9.1. [Internet]. Pharmaceutical Care Network Europe Association; 2020. Available from: https://www.pcne.org/upload/files/417_PCNE_classification_V9-1_final.pdf.

4. NCCP. Oncology Medication Safety Review Report. [Internet]. Ireland: Health Service Executive; 2014. Available from: https://www.hse.ie/eng/services/list/5/cancer/profinfo/medonc/safetyreview/oncreview.pdf.

5. BC Cancer. Clinical Cancer Drug Order Review Checklist: Take home drugs. [Internet]. Canada: BC Cancer; 2022. Available from: http://www.bccancer.bc.ca/pharmacy-site/Documents/Clinical_Pharmacy_Guide/cpgx-a-clinical-checklist-take-home.pdf.

6. Cancer Care Ontario. Clinical Verification of Cancer Drug Prescriptions Checklist: Cancer Centres and Specialty Pharmacies. [Internet]. Canada: Cancer Care Ontario; 2015. Available from: https://www.cancercareontario.ca/en/guidelines-advice/types-of-cancer/38556.

7. Clinical Oncological Society of Australia. Guidelines for the Safe Prescribing, Dispensing and Administration of Cancer Chemotherapy. [Internet]. Australia: Clinical Oncological Society of Australia; 2008. Available from: https://www.cosa.org.au/media/1093/cosa_guidelines_safeprescribingchemo2008.pdf. Accessed 15/08/2024.