Building an outpatient cancer center pharmacy program across a tristate region.

PURPOSE: The transition to a hybrid model of oncology pharmacy services including remote order verification across a regional network of cancer centers is described. SUMMARY: Five years ago the University of Pittsburgh Medical Center (UPMC) began a major expansion of its cancer care services, gradually integrating 19 community-based physician practice sites into its tristate oncology network as affiliated hospital-based clinics (HBCs). The network expansion was achieved through a stepwise process including (1) development of oncology medication protocols, (2) interdisciplinary efforts to modify oncology care workflows, (3) implementation of a hybrid practice model to optimize the use of clinical pharmacy resources, and (4) focused staff training programs. Under the hybrid practice model, first checks of antineoplastic medication orders, premedication orders, and laboratory values are performed by either onsite or remote pharmacists, with all second checks performed remotely. In 2013, network pharmacists implemented large numbers of medication therapy interventions to improve chemotherapy and biological response modifier dosing (n = 641) and nonchemotherapy medication use (n = 1082); other documented interventions included patient counseling to help optimize the use of erythropoietin-stimulating agents and other medications (n = 441) and anticoagulation-related dosing adjustments and patient education (n = 102). CONCLUSION: Nineteen ambulatory care centers were successfully integrated into the UPMC oncology network as affiliated HBCs through a stepwise process that included workflow modifications, staff training, and a hybrid pharmacy services model that ensures a two-pharmacist check of antineoplastic orders in accordance with regulatory and quality standards.

Educational program for pharmacists at a multifacility academic medical center.

PURPOSE: An educational program for pharmacists in a multifacility health care setting is described. SUMMARY: The expansion of pharmacy services at a university medical center from a centralized to a decentralized, unit-based model created the need for enhanced education of staff pharmacists. A steering committee with pharmacy department and school of pharmacy representation surveyed educational and professional needs related to the expanded services. Pharmacists indicated that they needed an educational program that was comprehensive, interactive, and accessible to all shifts. Pharmacy school clinical faculty members provided most of the initial educational sessions, which combined didactic presentations and case-based discussion. The needs survey was used in selecting topics that were most relevant to the pharmacists' expanded practice. Each major topic was covered in a series of one-hour sessions held at two-week intervals and scheduled at a time convenient for afternoon-shift pharmacists. Incentives were offered to encourage participation. The live presentations were recorded with video-streaming technology and made available via the Internet to pharmacists on all shifts in all facilities of the health system as well as to faculty members. Since program implementation in 2005, attendance at the live sessions has averaged 25. In postimplementation surveys, pharmacists indicated that the program was meeting their needs and improving patient care. Since 2008, pharmacists have been able to earn continuing-education (CE) credit for the sessions. CONCLUSION: A collaborative educational series with online access, clinical content, and CE credit has been effective in meeting pharmacists' needs in a multifacility health care setting.

Nationwide survey of hospital practices when compounding parenteral nutrition solutions in latex-allergic patients.

We surveyed 100 institutions in 50 states, varying in size from 50 to 1,000 beds. The purpose of this survey was to examine the policies and techniques hospitals used in confirming latex allergy (LA) in patients and preparing parenteral nutrition (PN) for LA patients. Our survey indicated that within the institutions in our study, many inpatient pharmacists do not use any defined method for confirming LA other than what is documented in the patient profile upon admission. Most inpatient pharmacies are not aware of any institutional policy concerning parenteral medications in LA patients, and some do not identify the importance of LA in preparing PN. It is apparent from the results of this survey that uniform guidelines or practice standards for this important issue should be developed. Although the publications on LA are numerous, they mostly deal with the exposure to latex gloves or latex devices. Knowledge of preparing parenteral medications for LA patients in the literature is minimal. It is also clear that awareness and knowledge of pharmacy personnel should be enhanced. Finally, we are hoping that this survey will send a clear message to pharmacy organizations to develop guidelines or pharmacy practice standards for this issue, and for health institutions to develop policies and make them available to their personnel.