Chemotherapy order second check and error rates
Abstract:
Background: The American Society of Health-System Pharmacists suggests that pharmacy practice models allow pharmacists to be readily available as organizational leaders. This project aimed to identify potential process improvements to increase pharmacist availability to perform more clinical activities.
Objective: We evaluated the effectiveness of pharmacy technicians performing chemotherapy second checks at an outpatient infusion clinic.
Practice description: Intermountain Medical Center is a Level 1 Trauma Center. The infusion clinic treats a variety of oncology indications, with solid organ tumors being most prevalent. At Intermountain Healthcare, a second pharmacist reverifies all chemotherapy orders for accuracy of drug, dose, preparation, and administration instructions.
Practice innovation: Pharmacy technicians are in a unique position to assist with chemotherapy second checks because they are already knowledgeable in compounding and reviewing chemotherapy. This would be particularly useful in rural settings where staffing is sparse.
Evaluation methods: This was a single-center prospective analysis of chemotherapy second-check processes at an outpatient infusion clinic. Once chemotherapy orders were sent to the infusion clinic, first and second checks were completed to verify the correct patient, medication(s), dose calculations, diluents, administration rates, volumes, and other instructions. The chemotherapy first checks were completed by a pharmacist. The second checks were completed by a second pharmacist and a chemotherapy-trained certified pharmacy technician. The second checks by the pharmacist and technician were compared to determine if they were in agreement regarding error identification. Any disagreements found between the 2 second checks or between the first check and either of the second checks were discussed before compounding. We evaluated whether a chemotherapy-trained pharmacy technician could identify the same errors as a pharmacist.
Results: The Cohen kappa test was used to determine rater agreement between the pharmacist and technician second checks. The kappa value measure of inter-rater reliability between pharmacist and chemotherapy-trained pharmacy technician was excellent (kappa = 0.88, P < 0.001). They agreed 96.8% of the time, with technicians correctly identifying more errors.
Conclusion: This project illustrates that chemotherapy-trained pharmacy technicians may be capable of performing chemotherapy second checks as accurately as pharmacists.
Reference:
Gundrum D, Brown K, Collingridge DS. Chemotherapy order second check and error discovery rates by pharmacists and technicians. J Am Pharm Assoc (2003). 2021 Apr 30:S1544-3191(21)00167-9. doi: 10.1016/j.japh.2021.04.012. Epub ahead of print. PMID: 34023280.