pharmacist clinical service trial period summary january 31, 2013

Engle AL*, Lombardi TP
St. Peter’s Hospital Department of Pharmacy, 315 South Manning Blvd, Albany, NY 12208
Expand pharmacy services to include direct patient care in a community hospital outpatient cancer care center infusion
and clinic setting.
St. Peter’s Hospital Cancer Care Center provides care for Medical Oncology patients. The pharmacist attended
Medical/Radiation Oncology and Medical Oncology Chart Rounds to identify candidates for counseling service. Criteria
for counseling service were: scheduled for a chemo teaching session, scheduled to receive first or second chemotherapy
infusion, complex home medication list, high degree of anxiety, or recommended by nurse During the counseling
session the pharmacist reviewed the chemotherapy course, side effects and management, home medications, and
answered questions. The pharmacist provided highlighted handouts on chemotherapy and a home medication list. The
pharmacist contacted the physician with any drug or disease related problems identified and documents the visit in
progress note and adds a home medication list attached. Additionally, the pharmacist served as drug information
resource for all staff. Success of the pilot program was assessed with ongoing feedback, patient satisfaction survey, and
formal staff evaluation.
In the month of January 2013, 38 patients cases were reviewed and 23 patients were seen by the pharmacist. Thirty
three counseling sessions were performed with eight patients receiving more than one session. Eleven problems
requiring physician contact were identified. The average time spent on individual patient counseling was 30 minutes
(range 10 minutes to 90 minutes). Six drug information questions were answered for nursing staff. Fifteen survey
responses were received.
This service facilitated the development of new pharmacist roles in this community outpatient oncology center as a
patient educator, drug information resource, and process improvement team member. Counseling services included
educating on the correct use of home medications, answering medication-related questions, and preparing patients for
what to expect with their chemotherapy and how to manage side effects and toxicities. On the qualitative satisfaction
survey given to 15 patients who received pharmacist counseling, 100% indicated they felt more comfortable with their
treatment afterwards and would recommend the service to others. Drug-related problems identified included
under/overdose of narcotics, drug toxicity/adverse effects, untreated indications, drug interactions, and drug
diversion/abuse. Drug information questions were asked regarding drug compatibility, interactions, dosing, safety,
efficacy, and adverse effects. The clinical pharmacist also became an integral member of process improvement
initiatives, assuming roles in design and implementation of processes to track missed chemotherapy doses and
carboplatin dose calculation standardization.