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In-house specialty pharmacy reduces medical errors, wait time
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The addition of an in-house specialty pharmacy at a cancer center in Connecticut reduced the amount of time patients waited for oral cancer medications; prevented errors associated with filling, dispensing and taking oral chemotherapy; and improved overall quality of care, according to a study being presented at the Quality Care Symposium.
“An in-house pharmacy is integrated into the clinical team where pharmacists, nurses and oncologists manage patients collaboratively,” Kerin Adelson, MD, chief officer at Smilow Cancer Center Hospital at Yale School of Medicine, told HemOnc Today. “At Smilow, having our own specialty pharmacy has led to tremendous improvements in quality of care for patients on oral oncologics.”
Prior to the launching of Smilow Cancer Hospital’s specialty pharmacy in 2011, Adelson and colleagues noted patients often reported anecdotally that they would wait 2 to 3 weeks to receive medications. Further, more than 400 prescription errors were reported, including patients taking improper doses or refilling prescriptions after their treatment regimen ended.
Smilow Cancer Hospital extended its reach to patients by integrating a group of private oncology practices with offices throughout the state of Connecticut. The goal was to provide first-rate cancer treatment to patients near their homes.
Under Smilow’s model of a specialty pharmacy, a physician writes a chemotherapy prescription, which is entered into an electronic medical records system. A nurse reviews the script for accuracy and sends it to a pharmacist, who reviews it against the patient’s labs for accuracy and appropriateness. The order goes to a pharmacy technician at the location where the patient receives therapy. The technician in that location mixes the prescription’s drugs, using menu-driven software that requires a step-by-step procedure. The software requires the name of the drug, the lot number and the expiration date, all of which get photographed.
A second level of safety comes from bar coding. The pharmacy technician is required to scan every drug before mixing it into a prescription. If the drug is incorrect, the software halts the process, eliminating errors due to drugs with similar appearances or spellings. Once the prescription is filled, a second pharmacist reviews the photos to make sure the prescription was mixed correctly. Once the prescription is approved, a second label is applied and ready for pickup.
Pharmacists are required to call patients 1, 5 and 21 days after filling an oral prescription to evaluate for toxicity.
“Medication documentation and reconciliation is one aspect of clinical care that has greatly improved with electronic health records,” Adelson said. “When a prescription is made electronically, all providers caring for the patient can see when it was prescribed, what the dosage is and how many refills there are. However, high-cost oncologic drugs often have to be filled by remote specialty pharmacies. This process occurs outside of health systems electronic health records and prescriptions are faxed on paper forms.
“Because of this, there is often no electronic health record of when the drug was prescribed, what the correct dosage is, or instructions on how the patient should take the medication,” Adelson added. “When we interviewed patients and providers, we heard many stories of problems with the offsite specialty pharmacy process.”
These problems included:
- delays in getting drug;
- patients not being able to afford the copay, which could be as high has several thousand dollars a month;
- no documentation of when the drug was received or when the patient started treatment;
- patients taking the drug incorrectly; and
- patients continuing to receive and take refills after the oncologist had stopped the treatment.
Following the opening of the specialty pharmacy, researchers found that 80% of patients received oral treatments within 72 hours of prescribing.
“Patients prescribed oral chemotherapy and other cancer treatments should be supported and monitored with the same vigilance as those patients who receive chemotherapy intravenously in our clinics or in our hospital,” Howard Cohen, BSPharm, MS, FASHP, associate director of oncology pharmacy services at Yale New Haven Hospital, said in a press release. “With our protocol, we are able to better address medication adherence and side effects, all of which translates to a higher quality of care for our patients.”
Researchers noted the addition of a specialty pharmacy also yielded additional revenue, allowing the not-for-profit cancer center to provide additional services to patients, including the expansion of its medication assistance program, which provided 140 patients more than $1.5 million per month in drug replacements and copays in 2016.
“This project transferred revenue from for-profit, third-party pharmacies to our nonprofit health system, and revenue is used to provide enhanced education, monitoring and patient assistance,” Adelson said. – by Chuck Gormley
Reference:
Adelson KB, et al. Abstract 108. Presented at: Quality Care Symposium; March 3-4, 2017; Orlando, Fla.
Disclosure: Researchers report no relevant financial disclosures.