scholarly journals P007 Improving paediatric chemotherapy prescribing through use of an electronic prescribing system

2019 ◽  
Vol 104 (7) ◽  
pp. e2.9-e2
Author(s):  
Charlotte Summerfield ◽  
Susan Kafka ◽  
Michelle Lewis ◽  
Guy Makin ◽  
Joseph Williams ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Malignant Disease ◽  
Electronic Prescribing ◽  
List Type ◽  
Prescribing Errors ◽  
Exact Test ◽  
Anti Cancer ◽  
Treatment Data ◽  
Cost Implications ◽  
Electronic Prescriptions

AimPaediatric prescriptions are almost 50% more likely to contain an error than adult orders. The risk of prescription error is further increased when prescribing for malignant disease.1 In 2017 the Trust introduced ChemoCare, an electronic prescribing system for paediatric chemotherapy. The primary aim of this study was to investigate whether implementing ChemoCare has affected the incidence and type of errors made in paediatric chemotherapy prescriptions, compared with written prescriptions. A secondary aim was to explore possible reasons why these prescribing errors may occur. Since 2014 it has been mandatory for all NHS England specialist trusts to send monthly submissions to the Systemic Anti-Cancer Therapy (SACT) Database, regarding the treatment of malignant disease in secondary care.2 Therefore, the study also analysed Trust compliance with communicating treatment data to SACT.MethodsData collection took place over a four-week period in Spring 2018. Prescriptions were reviewed by pharmacists and categorised as written or electronic. Prescriptions were then checked for 7 different error types; calculation error, drug prescribed on wrong day, incorrect drug prescribed for cycle, incorrect dose of concomitant medications, incorrect surface area used, not adjusted dose for previous age or weight related toxicities, no drug prescribed. The Fisher’s Exact test was employed to detect significance between chemotherapy prescription type and error incidence. A written questionnaire was designed to obtain the views of consultants, pharmacists and specialist trainees, and explore possible reasons why prescription errors occur. ChemoCare treatment data was retrospectively reviewed in order to determine how many prescribed cycles had been marked as ‘completed’.Results143 prescriptions were analysed. 34.4%(n=21) of written prescriptions contained errors, compared with 11.4% (n=5) of electronic orders. Two of the error types measured‘wrong calculation’ and ‘wrong drug prescribed for cycle’occurred significantly more frequently in written than electronic prescriptions.The Fisher’s Exact test produced p values of 0.017 and 0.008 respectively. Of the 409 treatment cycles prescribed and administered on the electronic system, 56.5% (n=231) had not been marked as ‘completed’, so would not be returned to SACT as administered chemotherapy. Failure to communicate accurate chemotherapy data to SACT not only limits research opportunities to progress safety aspects of delivering chemotherapy, but also has significant cost implications for the Trust, as chemotherapy treatment costs are not recovered.ConclusionThis study supports the use of an electronic prescribing system for ordering paediatric chemotherapy, given the significant reduction in errors compared with written prescriptions. The introduction of a chemotherapy-specific safe prescribing poster is suggested in order to improve compliance with ChemoCare. Further studies analysing national compliance with data return to SACT, are required to identify cost implications for the NHS and subsequent areas for quality improvement.ReferencesAvery AJ, Ghaleb M, Barber N, et al. Investigating the prevalence and causes of prescribing errors in general practice: The practice study. Pharmacoepidemiol Drug Saf 2012;21:4.NCRAS. Systemic Anti-Cancer Therapy Dataset [Internet]. [cited 2018 June 26]. Available from: http://www.ncin.org.uk/collecting_and_using_data/data_collection/chemotherapy

Utilization of a cardio-oncology clinic: A single center experience.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19192-e19192
Author(s):  
Peter Doukas ◽  
Sadiya S Khan ◽  
Nausheen Akhter
Keyword(s):  
Cancer Therapy ◽  
Systolic Function ◽  
Nyha Class ◽  
Tertiary Care ◽  
Cardiac Events ◽  
Exact Test ◽  
Cardiac Health ◽  
Academic Center ◽  
Anti Cancer ◽  
Referral Practices

e19192 Background: Many systemic anti-cancer therapies (chemotherapy, immunotherapy and radiation) have known cardiac toxicities. The field of cardio-oncology aims to optimize the cardiac health of cancer patients. Our goal was to evaluate baseline clinical characteristics, referral patterns and the rate of adverse cardiac outcomes in patients referred to a single cardio-oncology clinic at a tertiary care academic center. Methods: We performed a retrospective review of 100 consecutive patients who established care at a cardio-oncology clinic between 2011-2019. Baseline clinical data was collected from the initial presentation. Interventions and subsequent adverse cardiac events that occurred within a 6-24 month follow-up period were recorded. Fisher’s exact test was used to compare the measured variables. Results: Of the 100 patients, the median age was 63 years old and 69% were women. The most common reasons for referral were echocardiographic changes in systolic function or symptomatic congestive heart failure (HF) (54%; 54/100). Of patients who received anti-cancer therapy, only 18% (17/95) were referred for a pre-treatment cardiac evaluation. The rate of new HF diagnoses or worsening HF symptoms, defined by decreased NYHA class or HF-related hospitalizations, was 6% in the cancer treatment naïve group and 12% in the group that was not (p=0.68). Anti-cancer therapy was stopped or changed in 6 patients who were diagnosed with HF at any point. Conclusions: Our study provides insight into referral practices, interventions and outcomes at a single cardio-oncology clinic at a tertiary care academic center. Patients were often referred after the initiation of anti-cancer therapy, with the majority already experiencing a decline in systolic function. There was a higher rate of new HF events in patients who had already been treated with anti-cancer therapy before their first cardio-oncology visit. This may suggest the need for a change in referral practices to optimize cardiac health, specifically a shift in cardio-oncology evaluation prior to initiation of anti-cancer therapy. [Table: see text]

The impact of new cancer drug therapies on site specialised cancer treatment activity in a UK cancer network 2014–2018

2019 ◽  
Vol 26 (1) ◽  
pp. 93-98 ◽  
Author(s):  
Jenna Bhimani ◽  
Lara Philipps ◽  
Lawrence Simpson ◽  
Mark Lythgoe ◽  
Aspasia Soultati ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
New Drugs ◽  
Electronic Prescribing ◽  
Cancer Drug ◽  
Individual Treatment ◽  
Anti Cancer ◽  
Delivery Planning ◽  
The Uk ◽  
Cancer Network ◽  
The Impact

Introduction Drug treatment for cancer has changed dramatically over the past decade with many new drugs often with multiple applications. More recently, the detailed pathway for approval from the National Institute for Health and Care Excellence (NICE) in the UK has been simplified. To explore how these changes have impacted on systemic anti-cancer therapy tumour site-specific prescribing and workload activities, we have reviewed the prescribing records for 2014–2018 in a UK cancer network. Methods Information about the numbers of new systemic anti-cancer therapy drugs and NICE approvals were obtained from print editions of the British National Formulary (BNF) and the NICE website. Data on the numbers of new chemotherapy courses and individual treatment-related attendances were obtained from the cancer network Chemocare electronic prescribing system. Results During the five-year study period, there were 49 new systemic anti-cancer therapy drugs for all tumour types, and a total of 65 NICE technology approvals for solid tumour indications. Overall numbers of treatment courses increased by 40.7% and total treatment-related visits by 80.6%. There was a wide variation across tumour types with the highest number of increased visits seen for melanoma (349.3%) and prostate cancer (242.3%), but in contrast, no appreciable increases were seen for lower gastrointestinal cancers or small cell lung cancer. Conclusion The study confirms the major impact of the arrival of new drug technology and positive NICE appraisals on increasing systemic anti-cancer therapy prescribing and chemotherapy unit activity. The data in this study may be of help in planning for future service delivery planning and workforce configurations.

P31 The effect of electronic prescribing on the incidence and nature of paediatric medication errors – an observational study

2018 ◽  
Vol 103 (2) ◽  
pp. e2.35-e2 ◽  
Author(s):  
Sattam Alenezi ◽  
Helen Sammons ◽  
Sharon Conroy
Keyword(s):  
Observational Study ◽  
General Medical Council ◽  
Clinical Work ◽  
Clinical Decision ◽  
Oral Route ◽  
Electronic Prescribing ◽  
Medical Council ◽  
List Type ◽  
Prescribing Errors ◽  
Significant Difference

BackgroundPrescribing errors may adversely affect the safety of patients of all ages and particularly paediatric patients due to the complexity of calculating individual patient doses and the common need to use medicines not designed for children.Electronic prescribing systems (EPS) are an intervention used to try reduce such errors. Few studies have evaluated their impact on prescribing errors in the UK particularly in neonatal/paediatric settings.AimsTo evaluate the nature and prevalence of prescribing errors in a UK children’s hospital which uses an EPS.To compare the results with those of a previous study1 conducted in the same hospital before the introduction of EPS.MethodsPharmacists were shadowed in their routine clinical work by the researcher who documented all prescribing errors identified. All electronic prescriptions checked for patients≤18 years in the paediatric wards were included in the data collection. Data was entered into a SPSS database for analysis.Types and severity of errors identified were categorised according to criteria used in a previous General Medical Council funded study (EQUIP).2Results were compared to a previous study from 2012/2013 in the same hospital (4204 prescriptions) using the same method before the introduction of EPS.ResultsObservation of 4035 prescriptions checked by pharmacists on their routine ward visits (754 patients) during September-December 2015 identified 208 prescribing errors, an error rate of 5.2% prescriptions.There was a statistically significant difference between the rate of errors identified in this study compared to that found in the written prescriptions (8.7%) in the previous study (p<0.001).Fifteen errors (7.2%) were classified as serious; 106 errors (51%) significant and minor errors represented the remaining errors (data unavailable for previous study).The most common types of error identified were omission of regular medications (1.7% total prescriptions vs 1.6% in previous study); under-doses (0.8% vs 0.7%), non-measurable doses (0.7% vs 1.5%) and overdoses (0.5% vs 0.7%). Illegible prescriptions were reduced from 2% total prescriptions in the first study to zero by the EPS. Errors involving incorrect/missing administration times were also reduced from 0.9% in the previous study to 0.2% in this study.Antibacterial, analgesics and bronchodilators were the most common groups of drugs associated with errors (28.8%, 10.6% and 10.6% of total errors respectively). The oral route was most commonly involved in errors (47.2% of total errors) followed by intravenous (30.3%) (data unavailable for previous study).ConclusionThe EPS was associated with a significant reduction in prescribing errors compared with written prescriptions. Illegible prescription errors were eliminated and incorrect/missing administration time errors greatly reduced. Errors involving non-measurable doses were more than halved. EPS however had a negligible effect on under- and over-dosing errors. Introduction of a more sophisticated clinical decision support system may help to reduce such errors.ReferenceConroy S, Alsenani A, Sammons H. An observational study of the role of the paediatric clinical pharmacist. Arch Dis Child2015;100(6):e1–e1.Dornan T, Ashcroft D, Heathfield H, et al. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education. EQUIP Study2009. http://www.gmc-uk.org/FINAL_Report_prevalence_and_causes_of_prescribing_errors.pdf_28935150.pdf [Accessed: 1 July 16.

scholarly journals P029 Audit of aciclovir prescribing to assess whether changing the order of drop down box options in an electronic prescribing system can reduce prescribing errors

2019 ◽  
Vol 104 (7) ◽  
pp. e2.33-e2
Author(s):  
Clarissa Gunning ◽  
Jennifer Gray
Keyword(s):  
Patient Safety ◽  
Intensive Care ◽  
Improve Patient Safety ◽  
Error Rates ◽  
Electronic Prescribing ◽  
Contributory Factor ◽  
List Type ◽  
Prescribing Errors ◽  
Prescribing Error ◽  
Dosing Error

AimIn December 2016 it was identified that there had been multiple reports of prescribing errors with intravenous aciclovir on the paediatric intensive care unit (PICU). After investigation it was concluded that prescribers choosing incorrectly from a drop down menu of drug and dosing options on the electronic prescribing (EP) system was the main contributory factor. From 01/02/17 the aciclovir drop down options were prioritised, with the most frequently used option appearing first, to encourage prescribers to pick the correct regimen.MethodsThe trust has been using the Phillips ICCA EP system across all intensive care units since 2016. Picking errors when prescribing are known to be a potential risk within EP systems, however tailoring these systems to guide choice also has the potential to improve patient safety by reducing the risk of prescribing errors.1 Aciclovir has a complex range of dosing recommendations, especially in paediatrics, and incorrect prescribing increases the likelihood of subtherapeutic treatment or adverse effects. The aim of this audit is to assess whether changing the order of prescription choices on the drop down menu in the EP system reduced prescribing error rates for intravenous aciclovir. All prescriptions for aciclovir on PICU were identified during the 6 months before and after implementing the change, from 01/08/16 to 31/07/17. 65 prescriptions were included in the audit and were reviewed retrospectively using the EP system and electronic medical notes to assess whether the prescribed aciclovir dose and route was correct for the patient’s age, weight and indication as well as whether the appropriate drop down option had been selected by the prescriber. Dosing was assessed against recommendations in the British National Formulary for children and trust empirical antibiotic guidelines.ResultsDosing errors were found in 22% (14/65) of prescriptions overall during the review period. Before the change was implemented 26% (9/35) of aciclovir prescription doses were incorrect, reducing to 17% (5/30) after the change. The overall dosing error rate was 14% (7/50) in prescriptions where the correct drop down option was chosen, in comparison to 47% (7/15) in cases where the wrong option had been selected, suggesting the importance of choosing the correct pre-set option to minimise prescribing error rates. In cases where doses were incorrect, the prescriber had chosen the incorrect pre-set drop down option for the patient’s age and indication in 78% (7/9) of prescriptions before the order change compared to 0% (0/5) afterwards.ConclusionThese results suggest that prescribing error rates were reduced after making alterations to the order of prescription choices on the drop down menu in the EP system and that prioritising the order of these options may positively influence prescribing. Errors were not completely eliminated suggesting more work is required to further minimise risk.ReferenceAhmed Z, Garfield S, Jani Y, et al. Impact of electronic prescribing on patient safety in hospitals: implications for the UK. Pharm J 2016;8:1–11.

P04 Exploring the competency assessment required for pharmacists to undertake systemic anti-cancer therapy verification in paediatric haematology oncology

2018 ◽  
Vol 103 (2) ◽  
pp. e1.7-e1
Author(s):  
Guerin Claire ◽  
Richardson Neil ◽  
Mullen Alex ◽  
Kinnear Moira ◽  
Souter Caroline
Keyword(s):  
High Risk ◽  
Cancer Therapy ◽  
Clinical Application ◽  
Cancer Biology ◽  
Vena Cava ◽  
Theoretical Domains Framework ◽  
Competency Assessment ◽  
List Type ◽  
Paediatric Haematology ◽  
Anti Cancer

AimTo gain consensus on the content required to develop a training plan and competency assessment tool for pharmacists to undertake systemic anti-cancer therapy (SACT) verification for paediatric haematology oncology patients; a high risk clinical pharmacy area.1MethodA two-stage Delphi style questionnaire, using a five point Likert scale, was distributed to pharmacists in the UK and Ireland.2 The extent to which they agreed or disagreed with a series of statements was rated. These statements covered seven key elements3:essential requirements for pharmacists working in cancer care areas;governance and patient safety;cancer biology and SACT;initiation of treatment;toxicity and oncological emergencies;prescription verification; andclinical application and assessment.Consensus of opinion with each statement was set at ≥70% agreement.4 Where there was failure of agreement in round one, this was reassessed in round two.ResultsThe majority of respondents operated in principal treatment centres and had >5 years work experience. Consensus was reached in 80.3% of the statements asked in round one.Consensus was not reached on whether a pharmacist would be required to be aware of the Lanksy and Karnofsky performance scales, whether they would be required to explain how to manage some oncological emergencies and how it was best to assess competence for the pharmacist’s clinical application of knowledge. These areas were further explored in round two and consensus was reached in 66.7% of the statements. Consensus was reached on how best to assess the competence of a pharmacist new to this high-risk area and advanced level pharmacist would need to demonstrate awareness of the Lanksy and Karnosfky performance scales. However, consensus was not reached on whether they would be able to explain and how to manage superior vena cava obstruction and increased intracranial pressure.ConclusionA strong consensus was reached on the competency assessment required for pharmacists to undertake SACT verification in paediatric haematology oncology, and how best to conduct this assessment. These findings will be used to develop a training framework and evidence pack to traininexperienced pharmacists entering this high-risk clinical area. It will be distributed to the Children’s Cancer and Leukaemia Group principal treatment centres and members of Neonatal Paediatric Pharmacy Group – Paediatric Oncology Pharmacists sub-group.ReferencesCane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci2012;7:37.Carrington C, Weir J, Smith P. The development of a competency framework for pharmacists providing cancer services. J Oncol Pharm Pract2011;17(3):168–78.Meyers RS, Costello-Curtin J. Implementing a paediatric pharmacy educational program for health-system pharmacists. Am J Pharm Educ2011;75(10):205.Powell C. The Delphi technique: Myths and realities. J Adv Nurs2003;41(4):376–82.

P32 Rate of paediatric inpatient and discharge medication prescribing errors

2018 ◽  
Vol 103 (2) ◽  
pp. e1.37-e1
Author(s):  
Rahman Tasnim ◽  
Crook Joanne
Keyword(s):  
Patient Safety ◽  
Drug Interaction ◽  
Drug Dose ◽  
Electronic Prescribing ◽  
List Type ◽  
Prescribing Errors ◽  
Dose Frequency ◽  
Common Error ◽  
Feeding Tubes ◽  
Complex Patients

AimTo assess the documentation of allergies and quantify the rate of prescribing errors (PEs) for inpatient and discharge medications in paediatrics.MethodA data collection form was produced and data was collected prospectively by pharmacists for all paediatric patients’ prescribed inpatient and discharge medicines for 1 week during 9 am–5 pm. Electronic charts and allergy status for patients was checked, and all prescribed medicines were screened. If an error was identified, the drug name, type of error and category (wrong drug, dose, route, frequency, duplication etc.) were documented.Medications were screened against the British National Formulary for Children (BNFc), paediatric formularies and trust guidelines. Parenteral nutrition, IV fluids, outpatient and ambulatory medicines were excluded.ResultsData was collected for 152 patients with a total of 601 drugs screened. 151 patients (99%) had their allergies with nature of reaction documented as per the trust’s medicines policy. 89 PEs were identified (15% error rate). 89.9% of medicines were prescribed correctly in relation to the drug, dose, frequency, route and formulation. The most common error was wrong dose with 24 (27%) errors; 15 medicines (17%) were prescribed at doses too high. 7 errors occurred with high paracetamol dosing. This potentially occurred due to the dose banding in the BNFc which does not take into consideration dosing for small-for-age children.Wrong route (19 (21%) errors) was the 2nd common error identified. All of these errors related to administration of medicines via enteral feeding tubes. This highlights that careful consideration needs to be given when prescribing medicines for complex patients with feeding tubes.The incidence of drug interaction and contraindication PEs was low. This could be a result of electronic prescribing providing drug interaction alerts.ConclusionPEs can be defined as ‘an unintentional significant reduction in the probability of treatment being timely and effective or increase in the risk of harm when compared with generally accepted practice’.1PEs in the paediatric population can potentially have a serious impact on patient safety and lead to significant morbidity and mortality. In children, the risk of PEs is three times more likely to occur than in adults.1 One of the key improvements NHS England wants to achieve for 2017/2018 is reducing medication errors across the NHS.2 The trust paediatric clinical quality group have set an objective to have a 40% reduction in PEs by the end of 2017/2018.This audit demonstrates the most prevalent PEs which occurs at the trust and helps to identify the key actions that are needed to maintain patient safety. A paracetamol guideline will be introduced to highlight the difference between dosing-banding and weight-based dosing. Doctor’s training package will be updated to highlight common errors including the importance of thorough medicines reconciliation especially for complex patients with feeding tubes.ReferencesBannan DF, Tully MP. Bundle interventions used to reduce prescribing and administration errors in hospitalised children: A systematic review. Journal of Clinical Pharmacy and Therapeutics2016;41(3):246–255.NHS England. Next steps on the NHS five year forward view [Internet]Mar 2017. https://www.england.nhs.uk/wp-content/uploads/2017/03/NEXT-STEPS-ON-THE-NHS-FIVE-YEAR-FORWARD-VIEW.pdf [Accessed: 4th August 2017].

Anticancer Properties of Essential Oils: An Overview

2018 ◽  
Vol 18 (10) ◽  
pp. 957-966 ◽  
Author(s):  
Milene Aparecida Andrade ◽  
Mariana Aparecida Braga ◽  
Pedro Henrique Souza Cesar ◽  
Marcus Vinicius Cardoso Trento ◽  
Mariana Araújo Espósito ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Essential Oils ◽  
Public Health Problem ◽  
Mechanisms Of Action ◽  
Low Molecular Weight ◽  
Anticancer Properties ◽  
Anti Cancer ◽  
Different Types ◽  
Antitumor Properties ◽  
Pharmaceutical Properties

Background: Essential oils are complex mixtures of low molecular weight compounds extracted from plants. Their main constituents are terpenes and phenylpropanoids, which are responsible for their biological and pharmaceutical properties, such as insecticidal, parasiticidal, antimicrobial, antioxidant, anti-inflammatory, analgesic, antinociceptive, anticarcinogenic, and antitumor properties. Cancer is a complex genetic disease considered as a serious public health problem worldwide, accounting for more than 8 million deaths annually. Objective: The activities of prevention and treatment of different types of cancer and the medicinal potential of essential oils are addressed in this review. Conclusion: Several studies have demonstrated anti-carcinogenic and antitumor activity for many essential oils obtained from various plant species. They may be used as a substitution to or in addition to conventional anti-cancer therapy. Although many studies report possible mechanisms of action for essential oils compounds, more studies are necessary in order to apply them safely and appropriately in cancer therapy.

Exploring Nanoemulsion for Liver Cancer Therapy

2020 ◽  
Vol 16 (4) ◽  
pp. 260-268
Author(s):  
Tanmay Upadhyay ◽  
Vaseem A. Ansari ◽  
Usama Ahmad ◽  
Nazneen Sultana ◽  
Juber Akhtar
Keyword(s):  
Cancer Therapy ◽  
Liver Cancer ◽  
Treatment Plan ◽  
Chemotherapeutic Drugs ◽  
Drug Delivery Vehicles ◽  
Chronic Hepatitis B Virus ◽  
Anti Cancer ◽  
B Virus ◽  
Delivery Vehicles ◽  
Liquid Dosage Form

Cancer is a leading cause of mortality worldwide, accounting for 8.8 million deaths in 2015. Among these, at least 0.78 million people died of liver cancer alone. The recognized risk factors for liver cancer include chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, exposure to dietary aflatoxin, fatty liver disease, alcohol-induced cirrhosis, obesity, smoking, diabetes, and iron overload. The treatment plan for early diagnosed patients includes radiation therapy, tumour ablation, surgery, immunotherapy, and chemotherapy. Some sort of drug delivery vehicles has to be used when the treatment plan is targeted chemotherapy. Nanoemulsions are a class of biphasic liquid dosage form which are mixtures of oil and water stabilized by a surfactant. They are either transparent or bluish in hue and serve as a wonderful carrier system for chemotherapeutic drugs. These vehicles have a particle size in the range of 20-200 nm allowing them to be delivered successfully in the deepest of tissues. Recent publications on nanoemulsions reveal their acceptance and a popular choice for delivering both synthetic and herbal drugs to the liver. This work focuses on some anti-cancer agents that utilized the advantages of nanoemulsion for liver cancer therapy.

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