Implementation of a pharmaceutical care model within haematology

Abstract

The complexity of haematological diseases together with complications that may arise during treatment, warrant the need for having a complete interdisciplinary team including the presence of a ward-based clinical pharmacist. The aim of this research was to develop and test the feasibility of a standardised pharmaceutical care model within the adult haematology ward at Sir Anthony Mamo Oncology Centre. The current practices within the ward were observed to develop a baseline against international standards of pharmacy practice care. The standards were used to devise an evidence based clinical pharmacy service at the ward. During ward rounds and whilst reviewing treatment charts and patient files, the pharmacist identified pharmaceutical care issues (PCIs) and drug-related problems (DRPs). These were recorded in the pharmacist patient profile developed. Discussions to resolve these PCIs and DRPs were held with the other healthcare professionals (HCPs). Ninety-three different patients were seen during 7 months of ward attendance. A total of 377 pharmaceutical care sessions were held, during which a total of 465 PCIs were identified. The DRPs were issues with drug selection (n=144) such as no indication for drug, monitoring needs (n=137), issues with dose selection (n=74) such as dose too low, the need for patient education (n=57), issues with treatment duration (n=24) such as duration of treatment too long, occurrence of side effects (n=13) and an issue related to the drug-use process (n=1). Eighty-seven percent of the interventions proposed for these PCIs were accepted by the other HCPs. The pharmacist also provided other pharmaceutical services to HCPs (n=398) including medicines information (n=180), administration advice (n=40), modifications on treatment charts (n=37), liaison with other pharmacy entities (n=37), dosage calculations (n=36), guiding doctors in filling the correct pharmacy-related forms (n=23), checking treatment against chemotherapy protocols (n=14), checking for drug interactions (n=13), provision of medication tables on discharge (n=7) and medicines reconciliation (n=3). This research demonstrated the feasibility of the developed standardised pharmacist intervention at ward level. The pharmacist interventions contributed to identifying PCIs occurring in patients which were, in the majority, accepted by the caring oncologists.