Patient safety and the value of pharmaceutical intervention in a cancer hospital.

Objective To demonstrate economic impact of pharmaceutical evaluation in detection and prevention of errors in antineoplastic prescriptions. Methods This was an observational and retrospective study performed in a cancer hospital. From July to August 2016 pharmacists checked prescriptions of antineoplastic and adjuvant drugs. Drug-related problems observed were classified and analyzed concerning drug, pharmaceutical intervention, acceptability and characteristic of the error. In case of problem related to dose, we calculated a deviation percentage related with correct dose and value spent or saved. Data were analyzed using descriptive statistics with frequency and percentage. Results A total of 6,104 prescriptions and 12,128 medications were evaluated. Drug-related problems were identified in 274 (4.5%) prescriptions. Most of them was due to lack of information (n=117; 36.1%). Problems associated with dose accounted for 32.1% (n=98) of the total. In 13 cases (13.3%) ranging of prescribed dose was 50% greater than the correct dose. Intercepted drug-related problems provided savings of R$54.081,01 and expenses of R$20.863,36, therefore resulting in a positive balance of R$33.217,65. Each intervention promoted saving of R$126,78 with an acceptance rate of 98%. Main pharmaceutical interventions were information inclusion (n=117; 36.1%) and dose change (n=97; 29.9%). All errors were classified as error with no harm. Conclusion Simple actions such as prescription checking are able to identify and prevent drug-related problems, avoid financial losses and add immeasurable value to patient safety.

Patient safety and the value of pharmaceutical intervention in a cancer hospital / Segurança do paciente e o valor da intervenção farmacêutica em um hospital oncológico

ABSTRACT Objective To demonstrate economic impact of pharmaceutical evaluation in detection and prevention of errors in antineoplastic prescriptions. Methods This was an observational and retrospective study performed in a cancer hospital. From July to August 2016 pharmacists checked prescriptions of antineoplastic and adjuvant drugs. Drug-related problems observed were classified and analyzed concerning drug, pharmaceutical intervention, acceptability and characteristic of the error. In case of problem related to dose, we calculated a deviation percentage related with correct dose and value spent or saved. Data were analyzed using descriptive statistics with frequency and percentage. Results A total of 6,104 prescriptions and 12,128 medications were evaluated. Drug-related problems were identified in 274 (4.5%) prescriptions. Most of them was due to lack of information (n=117; 36.1%). Problems associated with dose accounted for 32.1% (n=98) of the total. In 13 cases (13.3%) ranging of prescribed dose was 50% greater than the correct dose. Intercepted drug-related problems provided savings of R$54.081,01 and expenses of R$20.863,36, therefore resulting in a positive balance of R$33.217,65. Each intervention promoted saving of R$126,78 with an acceptance rate of 98%. Main pharmaceutical interventions were information inclusion (n=117; 36.1%) and dose change (n=97; 29.9%). All errors were classified as error with no harm. Conclusion Simple actions such as prescription checking are able to identify and prevent drug-related problems, avoid financial losses and add immeasurable value to patient safety.

RESUMO Objetivo Demonstrar o impacto econômico da avaliação farmacêutica na detecção e na prevenção de erros em prescrições de antineoplásicos. Métodos Estudo observacional e retrospectivo realizado em um hospital oncológico. De julho a agosto de 2016, prescrições contendo antineoplásicos e fármacos adjuvantes ao tratamento foram avaliadas por farmacêuticos. Os problemas detectados relacionados a medicamentos foram classificados e analisados quanto ao medicamento, à intervenção farmacêutica, à aceitabilidade e à caracterização do erro. Quando o problema envolveu dose, calcularam-se a percentagem de desvio em relação à dose correta e o valor gasto ou economizado. Os dados foram analisados por estatística descritiva com aplicação de frequência e percentual. Resultados Foram avaliadas 6.104 prescrições e 12.128 medicamentos. Identificaram-se problemas relacionados a medicamentos em 274 (4,5%) prescrições, sendo a maioria causado por falta de informações (n=117; 36,1%). Quando reunidos, os problemas envolvendo dose representaram 32,1% (n=98) do total. Em 13 casos (13,3%), a variação da dose prescrita em relação à correta foi maior do que 50%. Os problemas relacionados a medicamentos interceptados representaram economia de R$54.081,01 e gastos de R$20.863,36, resultando em saldo positivo de R$33.217,65. Cada intervenção promoveu economia de R$126,78 com aceitabilidade de 98%. As principais intervenções foram inclusão de informações (n=117; 36,1%) e alteração de dose (n=97; 29,9%). Todos os erros foram considerados sem dano. Conclusão Ações simples de serem implantadas, como análise de prescrições, são capazes de identificar e prevenir problemas relacionados a medicamentos, evitar perdas financeiras e agregar imensurável valor na segurança do paciente.

Implementing a clinical pharmacy service in hematology.

OBJECTIVE:: To implement a clinical pharmacy service focused on the comprehensive review of antineoplastic drugs used in therapy of hematological diseases. METHODS:: An interventional study was conducted in a Brazilian tertiary teaching hospital in two different periods, with and without a clinical pharmacy service, respectively. This service consisted of an antineoplastic prescription validation (analysis of patients' characteristics, laboratory tests, compliance with the therapeutic protocol and with pharmacotechnical parameters). When problems were detected, the pharmacist intervened with the physician or another health professional responsible for the patient. Inpatients and outpatients with hematological diseases were included. RESULTS:: We found an increased detection of drug-related problem by 106.5% after implementing the service. Comparing the two periods, an increase in patients' age (26.7 years versus 17.6 years), a predominance of outpatients (54% versus 38%), and an increase in multiple myeloma (13% versus 4%) and non-Hodgkin lymphoma (16% versus 3%) was noted. The most commonly found problems were related to dose (33% versus 25%) and cycle day (14% versus 30%). With regard to clinical impact, the majority had a significant impact (71% versus 58%), and in one patient from the second period could have been fatal. The main pharmaceutical interventions were dose adjustment (35% versus 25%) and drug withdrawal (33% versus 40%). CONCLUSION:: The pharmacy service contributed to increase the detection and resolution of drug-related problems, and it was an effective method to promote the safe and rational use of antineoplastic drugs. OBJETIVO:: Implementar um serviço farmacêutico clínico centrado na revisão completa dos antineoplásicos utilizados no tratamento de doenças hematológicas. MÉTODOS:: Estudo intervencional conduzido em um hospital universitário terciário brasileiro em dois períodos distintos, com base na ausência e na presença do serviço farmacêutico clínico, respectivamente. O referido serviço consistiu na validação farmacêutica de prescrição de medicamentos antineoplásicos (análise de características do paciente, exames laboratoriais, conformidade com o protocolo terapêutico e parâmetros farmacotécnicos). Após a detecção dos problemas, o farmacêutico interveio junto ao médico ou outro profissional de saúde responsável pelo paciente. Foram incluídos pacientes internados e ambulatoriais com doenças hematológicas. RESULTADOS:: Observou-se um aumento de 106,5% na detecção de problemas relacionados com medicamentos após a implementação do serviço. Comparando-se os dois períodos, verificou-se aumento na idade dos pacientes (26,7 anos versus 17,6 anos), predomínio de pacientes ambulatoriais (54% versus 38%) e aumento de mieloma múltiplo (13% versus 4%) e linfoma não Hodgkin (16% versus 3%). Os problemas mais comumente encontrados foram relacionados à dose (33% versus 25%) e ao dia do ciclo (14% versus 30%). Quanto ao impacto clínico, a maioria apresentou impacto significante (71% versus 58%) e um poderia ter sido fatal no segundo período. As principais intervenções farmacêuticas realizadas foram ajuste de dose (35% versus 25%) e suspensão de medicamento (33% versus 40%). CONCLUSÃO:: O serviço farmacêutico contribuiu para o aumento da detecção e resolução de problemas relacionados com medicamentos, tratando-se de um método efetivo para promover o uso seguro e racional de medicamentos antineoplásicos.

Implementing a clinical pharmacy service in hematology / Implementação de um serviço farmacêutico clínico em hematologia

ABSTRACT Objective: To implement a clinical pharmacy service focused on the comprehensive review of antineoplastic drugs used in therapy of hematological diseases. Methods: An interventional study was conducted in a Brazilian tertiary teaching hospital in two different periods, with and without a clinical pharmacy service, respectively. This service consisted of an antineoplastic prescription validation (analysis of patients' characteristics, laboratory tests, compliance with the therapeutic protocol and with pharmacotechnical parameters). When problems were detected, the pharmacist intervened with the physician or another health professional responsible for the patient. Inpatients and outpatients with hematological diseases were included. Results: We found an increased detection of drug-related problem by 106.5% after implementing the service. Comparing the two periods, an increase in patients' age (26.7 years versus 17.6 years), a predominance of outpatients (54% versus 38%), and an increase in multiple myeloma (13% versus 4%) and non-Hodgkin lymphoma (16% versus 3%) was noted. The most commonly found problems were related to dose (33% versus 25%) and cycle day (14% versus 30%). With regard to clinical impact, the majority had a significant impact (71% versus 58%), and in one patient from the second period could have been fatal. The main pharmaceutical interventions were dose adjustment (35% versus 25%) and drug withdrawal (33% versus 40%). Conclusion: The pharmacy service contributed to increase the detection and resolution of drug-related problems, and it was an effective method to promote the safe and rational use of antineoplastic drugs.

RESUMO Objetivo: Implementar um serviço farmacêutico clínico centrado na revisão completa dos antineoplásicos utilizados no tratamento de doenças hematológicas. Métodos: Estudo intervencional conduzido em um hospital universitário terciário brasileiro em dois períodos distintos, com base na ausência e na presença do serviço farmacêutico clínico, respectivamente. O referido serviço consistiu na validação farmacêutica de prescrição de medicamentos antineoplásicos (análise de características do paciente, exames laboratoriais, conformidade com o protocolo terapêutico e parâmetros farmacotécnicos). Após a detecção dos problemas, o farmacêutico interveio junto ao médico ou outro profissional de saúde responsável pelo paciente. Foram incluídos pacientes internados e ambulatoriais com doenças hematológicas. Resultados: Observou-se um aumento de 106,5% na detecção de problemas relacionados com medicamentos após a implementação do serviço. Comparando-se os dois períodos, verificou-se aumento na idade dos pacientes (26,7 anos versus 17,6 anos), predomínio de pacientes ambulatoriais (54% versus 38%) e aumento de mieloma múltiplo (13% versus 4%) e linfoma não Hodgkin (16% versus 3%). Os problemas mais comumente encontrados foram relacionados à dose (33% versus 25%) e ao dia do ciclo (14% versus 30%). Quanto ao impacto clínico, a maioria apresentou impacto significante (71% versus 58%) e um poderia ter sido fatal no segundo período. As principais intervenções farmacêuticas realizadas foram ajuste de dose (35% versus 25%) e suspensão de medicamento (33% versus 40%). Conclusão: O serviço farmacêutico contribuiu para o aumento da detecção e resolução de problemas relacionados com medicamentos, tratando-se de um método efetivo para promover o uso seguro e racional de medicamentos antineoplásicos.

Tyrosine kinase inhibitors in patients with chronic myelogeneous leukemia: defining the role of social risk factors and non-adherence to treatment / Inhibidores de la tirosin-kinasa en pacientes con leucemia mielógena crónica: definir el papel de los factores de riesgo sociales y la no adherencia al tratamiento

Objective: To assess the role of social risk factors on adherence to tyrosine kinase inhibitors (TKI) therapy in chronic myeloid leukemia (CML) patients. Methods: This is a retrospective study and eligible patients were adults with CML on TKI treatment. Cases of no adherence to treatment were confirmed during pharmacists’ consultation (patient-reported adherence). Baseline characteristics between groups were compared between cases and controls groups. Risk factors identified in bivariate analysis (p<0.2) were included in multivariate model. A qualitative investigation assessed whether such predictors of non-adherence had causal relationship. Results: Of 151 patients with CML consulted by pharmacists, 21% had adherence problems. Despite patients with secondary school (p=0.03), most of investigated social risk factors did not differ between groups. However, by using a qualitative approach, patients’ level of education could not explain low adherence rates behavior. Conclusions: Social determinants of health, herein investigated, were unlikely to predict adherence to treatment. Regression techniques may lead to untrue statements, so future researches should consider investigating the causes, not only the statistical estimates (AU)

Objetivo: Evaluar el papel de los factores de riesgo sociales sobre la adherencia a los inhibidores de la tirosin-kinasa (TKI) en pacientes con leucemia mieloide crónica (CML). Métodos: Este es un estudio retrospectivo y los pacientes elegibles eran adultos con CML a tratamiento con TKI. Los casos de no adherencia se confirmaron durante las consultas farmacéuticas (adherencia reportada por el paciente). Se compararon las características al inicio entre grupos casos y controles. Los factores de riesgos identificados en un análisis bivariado (p<0,2) se incluyeron en un modelo multivariado. La investigación cualitativa evaluó si esos predictores de no adherencia tenían una relación causal. Resultados: De los 151 pacientes con CML consultados por los farmacéuticos, el 21% tenía problemas de adherencia. Excepto los pacientes con educación secundaria (p=0,03), la mayoría de los factores de riesgo sociales no diferían entre grupos. Sin embargo, al usar un abordaje cualitativo, el nivel educacional de los pacientes no pudo explicar los comportamientos de bajas tasas de adherencia. Conclusiones: Los determinantes sociales de salud, aquí estudiados, no fueron capaces de predecir la adherencia al tratamiento. Las técnicas de regresión pueden llevar a afirmaciones irreales, así que la futura investigación debería considerar investigar las causas, y no solo los resultados estadísticos (AU)