Punke Alexandra P, Waddell J A
1 PGY1 Pharmacy Resident, Pharmacy Department, Blount Memorial Hospital, Maryville, USA.
2 Professor, College of Pharmacy, University of Tennessee Health Science Center, Knoxville, USA.
J Oncol Pharm Pract. 2019 Jan;25(1):25-43. doi: 10.1177/1078155217726162. Epub 2017 Aug 21.
The proper evaluation of cancer chemotherapy orders is necessary for patients to receive safe and effective treatment. The chemotherapy treatment setting is evolving resulting in hospital pharmacists without extensive oncology training or experience now being responsible for evaluation of chemotherapy orders. The primary objective was to create a step-by-step chemotherapy order evaluation guide with a detailed explanation for each step. The secondary objective was to evaluate non-oncology trained pharmacists' ability to accurately review simulated chemotherapy orders post-education using the guide. A two-page chemotherapy order evaluation guide was created based on an accepted method of chemotherapy order review consisting of the following eight steps: regimen verification, clinical trial protocol verification, body surface area calculation, dose calculation, laboratory values, emesis prophylaxis, adjunctive or supportive care measures, and pharmacy labels. A literature search was performed for each step. A detailed explanation for each step was written as a separate component from the guide to encompass the literature search information and current guidelines in a more comprehensive manner. Non-oncology trained community hospital pharmacists were educated on use of the guide for approximately 30 min. The guide was evaluated using timed simulated chemotherapy orders pre- and post-education consisting of a general chemotherapy order and a carboplatin dosing order. Nineteen pharmacists were tested with simulated chemotherapy orders. A significant difference was detected between the pre- and post-education for both the general chemotherapy (p = 0.00032) order and carboplatin dosing order (p = 0.031).
对癌症化疗医嘱进行恰当评估，对于患者接受安全有效的治疗而言是必要的。化疗治疗环境正在不断演变，这导致没有广泛肿瘤学培训或经验的医院药剂师现在要负责评估化疗医嘱。主要目标是创建一份循序渐进的化疗医嘱评估指南，并对每个步骤进行详细解释。次要目标是评估未接受肿瘤学培训的药剂师在接受教育后使用该指南准确审查模拟化疗医嘱的能力。基于一种公认的化疗医嘱审查方法，创建了一份两页的化疗医嘱评估指南，该指南包括以下八个步骤：方案验证、临床试验方案验证、体表面积计算、剂量计算、实验室值、呕吐预防、辅助或支持性护理措施以及药房标签。对每个步骤都进行了文献检索。对每个步骤的详细解释作为指南的一个单独部分来撰写，以便更全面地涵盖文献检索信息和当前指南。对未接受肿瘤学培训的社区医院药剂师进行了约30分钟的指南使用培训。使用教育前后的限时模拟化疗医嘱对该指南进行评估，这些医嘱包括一份普通化疗医嘱和一份卡铂给药医嘱。19名药剂师接受了模拟化疗医嘱测试。普通化疗医嘱（p = 0.00032）和卡铂给药医嘱（p = 0.031）在教育前后均检测到显著差异。
