Hollywood, FL—Results from a survey of oncology pharmacists from across the country indicate that the verification process for chemotherapy orders is not uniformly electronic. In fact, >25% of responders are still using paper orders, said Carly Duncan, PharmD candidate, of the Cleveland Clinic Florida, Weston. She presented findings from her and her colleagues’ survey at the 2016 annual conference of the National Comprehensive Cancer Network.
“I’m no expert, but I would think all systems would be electronic by now. For the most part, I wouldn’t expect 26% to still be using paper orders,” said Ms Duncan. The study aimed to identify the key points within the verification process that allow for optimum functionality and efficacy for oncology pharmacies. “We were looking at our computer system capabilities against others,” she explained. Her staff wanted to make a case to management for modifying their systems toward more efficiency.
The investigators sent a 10-question survey to members of the American College of Clinical Pharmacy Hematology/Oncology group and other oncology professionals, asking how their pharmacies were processing orders. “We expected 25 responses, and we heard from 73 all across the country,” Ms Duncan said.
Key Questions & Answers
Q. Which software does your institution currently use to process chemotherapy orders?
Beacon, 47%
Paper orders, 26%
Other, 28%
Q. What is the workflow of chemotherapy order processing at your institution?
Physician→Nursing→Pharmacy, 49%
Physician→Pharmacy→Nursing, 44%
Other, 7%
Q. If a drug requires a screening before processing, does the system alert the physician when inputting the order and/or the pharmacist of this requirement during the verification process?
No, 81%
Yes, 19%
Q. Does your system link its protocols to any of the national guidelines?
No, 68%
Yes, 32%
Q. Does your system alert you in the event that the patient does not meet the treatment parameters?
No, 84%
Yes, 16%
Q. When a protocol is created, does it contain specific premedications for a regimen based on the national guidelines, or is a generic protocol applied to all regimens?
Specific, 74%
Generic, 26%
Q. When a protocol is created, does it contain pertinent lab values to monitor for a particular regimen or is a generic protocol applied to all regimens?
Specific, 65%
Generic, 35%.
Verification Processes, Wish List
Pharmacists were asked what their institutions required for verifying medications in a protocol. A total of 52% of respondents said their institutions require double verification of the chemotherapy medications only, and single verification of nonchemotherapy medications; 29% of institutions require double verification of all medications; and 19% require a single verification for all medications.
The pharmacists were also asked which elements of their system they would like to keep or add most. Respondents “overwhelmingly” (65%) cited that they wanted an automatic alert for patients who fall outside of treatment parameters. Elaborating on this point, Ms Duncan explained that the researchers wanted to know whether a system was capable of indicating an alert if a patient had a marker, such as platelet count, that fell outside of the acceptable range. They asked, “Does your system alert you, or do you have to manually check for that?”
“We found that 84% of systems do not have these alerts, so each time the pharmacist, nurse, or physician has to manually check that. These alerts would catch patients who fall through the cracks. It would prevent errors,” Ms Duncan said.
The researchers also thought that it was important to be alerted when a drug requires prescreening (eg, testing for hepatitis B before rituximab is given). Overall, 81% of those surveyed did not have this system. Although her institution also lacks these pop-up alert systems, her department is making it a priority to obtain them, Ms Duncan said.
