Developing recommendations for the safe handling of oral anti-cancer drugs in community pharmacies: A pan-Canadian consensus approach.

PURPOSE: To create a set of consensus-based and evidence-informed recommendations to provide guidance around the safe dispensing and handling of oral anti-cancer drugs in low-volume settings unique to the community pharmacy setting. METHODS: A review of published and grey literature (published in non-commercial domains such as national organizations and associations) documents and nine key informant interviews were conducted and a modified Delphi approach was taken to achieve consensus. The final list of 47 candidate recommendations was reviewed by a task force and validated by multi-disciplinary stakeholders. A draft of the statements was circulated broadly within the community pharmacy community in an effort to assess relevance and implementation feasibility. RESULTS: The final report included 44 recommendations that addressed 11 key areas germane to the safe handling of oral anti-cancer drugs in community pharmacies. Mean agreement increased from 70% to 95%. Early feedback from community pharmacy leaders during the external review suggests that many of the proposed recommendations can be feasibly implemented within a reasonable timeframe when released with appropriate education and resource materials. CONCLUSIONS: A modified-Delphi approach supplemented by key informant interviews and a comprehensive external review resulted in a set of evidence-informed, community-driven recommendations for community pharmacies. The recommendations address a gap in existing literature to improve understanding of the risks associated with handling and dispensing oral anti-cancer drugs for both community pharmacy staff and management and offer mitigating strategies to reduce those risks. Incorporating feasibility assessment actions early (through the key informant interviews) and late (through the external review) ensures recommendations are grounded in practicality and support broad and early knowledge translation strategies.

The ADAPT online education program: A tool for practicing pharmacists delivering patient-centered care.

OBJECTIVES: The ADapting pharmacists' skills and Approaches to maximize Patient's drug Therapy effectiveness (ADAPT) e-learning program was developed by a consortium of Canadian pharmacy educators and researchers to prepare practicing pharmacists for patient-centered care. We selected this education program to provide training for pharmacists as the workforce transformation component of a Center for Medicare and Medicaid Innovation project. In this report we share our experiences with this educational program. SETTING: Online educational program. PRACTICE DESCRIPTION: ADAPT presents a standard approach to medication assessment, team collaboration, patient assessment, evidence-based decision making, and documentation. PRACTICE INNOVATIONS: ADAPT was used to prepare practicing pharmacists for new roles in direct patient care in patient-centered medical homes. EVALUATION: Participants were surveyed at the midpoint and end of the program to determine its impact on their confidence in providing patient-centered care and to elicit feedback about their perceptions of the program. Participants completed written action plans for each module that included their reflections on the course material and the skills they desired to implement in practice. Descriptive statistics were used to analyze Likert-type questions, and a content analysis was performed to analyze responses to open-ended questions and action plan responses. RESULTS: Two pharmacist cohorts completed the 20-week program from October 2012 to March 2013 (n = 13) and from August 2013 to January 2014 (n = 10). Pharmacists' perceived that their confidence in providing patient-centered care improved for all modules. Almost all pharmacists reported improved confidence in patient interviewing (89%), documentation (88%), and collaboration skills (83%). The content analysis identified the modules on interviewing and documentation as the most valuable and likely to result in changes to the pharmacists' practice. The opportunity to learn from colleagues was cited as a strength of the program. CONCLUSION: The ADAPT educational program provided pharmacists with the tools necessary to deliver patient-centered care in ambulatory care settings.