Impact of Haematology Clinical Pharmacy Service in Princess Margaret Hospital

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Authors (including presenting author) :
Chan KH(1), Ng V(1), Yip YTE(1)
Affiliation :
(1)Pharmacy Department, Princess Margaret Hospital
Introduction :
Cancer chemotherapy in haematology are often complex. The variety of medications poses a high risk of drug interactions leading to numerous adverse effects and increased toxicity. Pharmacists have a crucial role to enhance medication safety. Furthermore, drug education is of significant importance to optimize the use of supportive medications, antibiotics and antifungal prophylactic therapies.
Objectives :
A haematology clinical pharmacy service was started in October 2015 at Princess Margaret Hospital. The aim was to enhance medication safety through provide patient drug counselling and clinical screening of chemotherapy prescriptions for these patients.
Methodology :
Patients were referred to the clinical pharmacist by haematologists at the out-patient haematology clinic. Drug counselling on the prescribed chemotherapy & other supportive medications was provided for each patient. Pharmacist also attended weekly in-patient ward round with haematologists. Clinical prescription screening was performed. Chemotherapy dosages were verified against body surface area, renal and hepatic status. Drug interaction, compatibility, concentration, infusion time, supportive medications, antibiotics & antifungal prophylaxis were also checked against the chemotherapy protocols to ensure optimal dosages were prescribed and minimize adverse effects.
Result & Outcome :
There were 429 sessions of haematology pharmacist out-patient clinic and 135 sessions of ward round from Oct 15 to Sep 18. A total of 1029 patient counselling sessions were performed and 2085 chemotherapy prescriptions were screened. There were 394 interventions and 288 drug information enquiries. One hundred and forty (35.5%) interventions were related to chemotherapy (e.g. incorrect dosages, concentrations, durations) and 99 (25.1%) were on medications for infection (e.g. incorrect dosages, unintentional omissions). Other interventions consisted mostly of supportive medications (e.g. therapeutic duplications, unintentional omissions). Immediate concurrent feedback was provided and the clinician acceptance rate was 100%. In conclusion, haematology clinical pharmacists enhanced medication safety and prevented medication errors. Through drug counselling on chemotherapy and on the use of medications, pharmacist can enhance quality and medication safety in high risk haematology cases.

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