Oral chemotherapy prescriptions

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With an increase in accessibility of oncologists and haematologists, it has become more common for prescriptions for oral chemotherapy as well as adjuvant medications to be presented to community pharmacies. Patients may be undergoing treatment in either public or private sectors as well as regional centres. While affiliated pharmacies for the treatment centres may dispense and supply all medications for a patient’s protocol, a patient may choose to get prescriptions for some of their treatment dispensed at a pharmacy closer to home. Any prescriptions for immunomodulators and chemotherapy agents that are ambiguous must be confirmed with the prescriber before dispensing.

Whilst the below communique is specific for the Central Adelaide Local Health Network (Royal Adelaide and Queen Elizabeth Hospitals), the potential risks and consequences can be applied to all patients undergoing treatment.

– Paula Kwan,
PDL Director for South Australia and the Northern Territory

Communique to Community Pharmacists

Central Adelaide Local Health Network (CALHN)
Royal Adelaide Hospital and Queen Elizabeth Hospital

  • Quality & Safety Memorandum
  • Date: 12/10/2020
  • From: SA Pharmacy, CALHN
  • To: Community Pharmacists
  • Subject: Oral chemotherapy prescriptions

Purpose: To describe prescription clarification pathways for community pharmacists dispensing oral chemotherapy prescriptions from the Royal Adelaide Hospital (RAH) or The  Queen Elizabeth Hospital (TQEH) in the Central Adelaide Local Health Network (CALHN).

Background: As part of our health service reporting function we recently identified an error in a prescription. This led to a review of the case as part of our continuous quality improvement philosophy.

Through this multidisciplinary review, we identified the need to improve communication processes between community dispensing pharmacists and hospital prescribers when queries arise relating to oral chemotherapy prescriptions.

Actions: Oral chemotherapy is high risk and protocol/patient-specific dosing is not easily confirmed using standard medicines resources. Ambiguous orders for oral chemotherapy must be clarified with the prescriber prior to dispensing.

CALHN is implementing a process that will increase the proportion of new oral chemotherapy prescriptions that are verified by a clinical pharmacist prior to dispensing. This process is expected to support dispensing pharmacies and enhance patient safety.

If you have any chemotherapy prescription queries, these should be directed to the prescriber as per the details on the prescription. If you have a query after-hours, or the prescriber is not contactable, please contact the on-call Oncologist via the main hospital switchboard. For RAH or TQEH prescriptions, please contact the RAH switchboard: (08) 7074 0000 (available 24 hours).

If you are unable to contact a prescriber, supply should be withheld until the order can be verified.

If you have any suggestions about how we can improve our communication with you to optimise patient safety, please contact us on 7074 0000.