Medication discrepancies and drug-related problems in the ambulatory oncology setting

Objectives:

Primary: to determine the number of medication discrepancies in new ambulatory chemotherapy patients.

Secondary: to determine the types of medication discrepancies and the numbers and types of drug-related problems identified and resolved in new ambulatory chemotherapy patients; to determine the costs and resources associated with maintaining the program.

Methods:

Prospective, non-randomized, open-label, multi-centre study. 

Data from new ambulatory chemotherapy patients is collected prospectively by pharmacists conducting medication histories and performing chart reviews.  The numbers and types of medication discrepancies and drug-related problems are determined using each centre's current processes for chart-checking and/or verification of medication orders and histories.  Data sources include the patient's Pharmacy Treatment Record, Health Assessment Form, PharmaNet profile, computerized information systems, physician's dictation, and the paper chart to check for allergies, correct doses of chemotherapy drugs, required lab work, and all other relevant medication-related information, as applicable to both intravenous and oral chemotherapy drugs.

Results:

One hundred and fifty medication discrepancies were identified among 861 new ambulatory chemotherapy patients, of which 147 (98%) were resolved.  One hundred twenty nine (86%) of the discrepancies were unintentional, while twenty one (14%) were undocumented intentional discrepancies.  Four hundred ninety four drug-related problems, excluding discrepancies, were also identified, of which 477 (97%) were resolved.  The most common drug-related problems identified and resolved included the need for the provision of drug information and patient counseling, missing pertinent laboratory measures, drug interactions, medication allergies, and incorrect medication doses.  On average, 26 minutes were spent per patient assessment, resulting in $18,334 pharmacy resources expenditure.

Conclusion:

Clinically important medication discrepancies and drug-related problems were identified and resolved in new ambulatory chemotherapy patients.  The next phase of the study will evaluate the impact of medication reconciliation on the numbers and types of medication discrepancies and drug-related problems identified and resolved in ambulatory medical oncology patients.