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MODES OF PREVENTION OF COMPUTERIZED CHEMOTHERAPY PRESCRIBING ERORRS BY CLINICAL PHARMACIST

European Statement

Patient Safety and Quality Assurance

Why was it done?

Chemotherapy prescribing errors could arise even when computerized systems are used. Additional evaluation of prescribed chemotherapy is needed, to prevent any harm to the patient and rise the level of patent’s safety.

What was done?

Preparation of written standard operating procedure that could help recognize the errors between the electronic chemotherapy record of prescribing and actual drug delivery.
Chemotherapy prescribing is a complex process encompassing prescription of cytotoxic medicines, infusion fluids and supportive care. Cytotoxic medicines have a narrow therapeutic range and actual dosage is usually adjusted according to the body surface area, weight or creatinine clearance. Minor alterations can have a significant effects on cytotoxicity, therefore the computerized prescribing is preferred. The dose is automatically calculated from the pre-inserted chemotherapy protocols and patient data.

How was it done?

Each computerized chemotherapy prescription should be closely reviewed by standard operating procedure, step by step, to complete the validation of chemotherapy accordingly.
Detected error should be noted by the pharmacist and corrected by the referring oncologist.

What has been achieved?

During the period from 1st January to 30st September 2021, approximatly. 13.400 chemotherapy prescription have been received at our pharmacy department. In 848 cases of prescribed chemotherapy, intervention of a pharmacist has been required because of inappropriate prescription. Among that, in 100 cases, computerized prescribing errors were identified. These errors identified were: wrong patient (2), incorrect dose prescribed (38), incorrect chemotherapy protocol chosen (30), incorrect day of chemotherapy administration prescribed (3), erroneous height or weight (1), incorrect glomerular filtration rate calculation for carboplatin (1), dual chemotherapy (9), change of the drug in pre-entered protocol (5), incomplete prescription (missing validation) (11).
Good cooperation with oncologist and oncology nurses, who are aware of clinical pharmacists pivotal role in
error avoidance, is needed.

What next?

Written standard operating procedure should be useful to detect common errors and to guide corrective actions, which can help
experienced clinical pharmacist and should be used as a tool for pharmacist trainees and student to learn
how to work accordingly to the protocols in use.

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