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评估现代抗癌治疗中药剂师双重核查的影响。

Evaluating the Impact of Pharmacist Dual Verification of Anticancer Therapy in the Modern Era.

作者信息

Stonerock Devon S, Clark Kaylee, Shah Vishal, Irvine Clayton C, Draper Evan, Soefje Scott A

机构信息

Department of Pharmacy, Corewell Health, Grand Rapids, MI, USA.

Department of Pharmacy, Mayo Clinic, Rochester, MN, USA.

出版信息

J Pharm Technol. 2023 Dec;39(6):281-285. doi: 10.1177/87551225231197346. Epub 2023 Sep 29.

DOI:10.1177/87551225231197346
PMID:37974597
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10640867/
Abstract

Pharmacist order verification is a critical step in ensuring medication safety for patients. While the second pharmacist verification (SPV) before dispensing anticancer therapies has been a longstanding practice, its continued necessity in the context of modern electronic health systems lacks robust evidence. This study aimed to assess the frequency of interventions performed by a second pharmacist to determine the ongoing effectiveness of the SPV process. This retrospective chart review was conducted at the Mayo Clinic, encompassing all anticancer therapy orders that necessitated an SPV. The study period extended from January 1, 2019, to June 30, 2021, and included inpatient and outpatient anticancer orders. The quantification and reporting of alterations made to discrete order fields subsequent to initial pharmacist verification of clinical significance were performed, utilizing the total number of anticancer therapy orders as the denominator. Approximately 300 000 anticancer therapy orders were screened for inclusion criteria and 2.6% (N = 7634) of orders were modified on the SPV. Most changes were in the categories of rate (N = 1962), order start time (N = 1219), and pharmacy communication note (N = 777). Dosing changes greater than 10% accounted for 0.03% (N = 99) of the orders, with 10 anticancer therapies responsible for more than 50% of these changes. This study represents the largest report on the impact of SPV in a modern era. Our results suggest the SPV may be valuable for a small proportion of chemotherapy orders but raises questions about the necessity for broad application of this practice.

摘要

药剂师医嘱核查是确保患者用药安全的关键步骤。虽然在调配抗癌治疗药物前进行二次药剂师核查(SPV)一直是一种长期做法,但在现代电子健康系统背景下其持续必要性缺乏有力证据。本研究旨在评估第二位药剂师进行干预的频率,以确定SPV流程的持续有效性。这项回顾性病历审查在梅奥诊所进行,涵盖所有需要SPV的抗癌治疗医嘱。研究期间从2019年1月1日至2021年6月30日,包括住院和门诊抗癌医嘱。对初始药剂师核查后对离散医嘱字段进行的具有临床意义的更改进行量化和报告,以抗癌治疗医嘱总数作为分母。共筛查了约300000份抗癌治疗医嘱的纳入标准,2.6%(N = 7634)的医嘱在SPV时被修改。大多数更改属于速率(N = 1962)、医嘱开始时间(N = 1219)和药房沟通记录(N = 777)类别。剂量更改大于10%的医嘱占0.03%(N = 99),其中10种抗癌治疗药物导致了超过50%的此类更改。本研究是现代关于SPV影响的最大规模报告。我们的结果表明,SPV可能对一小部分化疗医嘱有价值,但引发了关于广泛应用这种做法必要性的质疑。

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本文引用的文献

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Decreasing drug waste, reducing drug costs, and improving workflow efficiency through the implementation of automated chemotherapy dose rounding rules in the electronic health record system.通过在电子健康记录系统中实施自动化化疗剂量四舍五入规则,减少药物浪费,降低药物成本,并提高工作流程效率。
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J Oncol Pharm Pract. 2022 Mar;28(2):381-386. doi: 10.1177/1078155221994319. Epub 2021 Feb 20.
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J Am Med Inform Assoc. 2020 Feb 1;27(2):284-293. doi: 10.1093/jamia/ocz188.
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Cancer. 2019 May 1;125(9):1547-1557. doi: 10.1002/cncr.31950. Epub 2019 Jan 29.
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Dose Rounding of Biologic and Cytotoxic Anticancer Agents: A Position Statement of the Hematology/Oncology Pharmacy Association.生物制剂和细胞毒性抗癌药物的剂量调整:血液学/肿瘤学药学协会的立场声明。
J Oncol Pract. 2018 Mar;14(3):e130-e136. doi: 10.1200/JOP.2017.025411. Epub 2018 Feb 5.
9
Safe Implementation of Computerized Provider Order Entry for Adult Oncology.成人肿瘤学计算机化医嘱录入的安全实施
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ASHP guidelines on preventing medication errors with chemotherapy and biotherapy.美国卫生系统药师协会关于预防化疗和生物治疗用药错误的指南。
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