Start using a checklist, PRONTO: Recommendation for a standard review process for chemotherapy orders.

Chemotherapy order review by pharmacists requires careful attention to many details, and serious consequences can occur if errors are made. Other high-risk industries have long used checklists to improve accuracy and reduce the risk of errors. Despite the recent expansion of checklist use in other areas of medicine, there is currently no published evidence that checklists are being widely used by pharmacists in the evaluation of chemotherapy orders. This article explains a flexible checklist called PRONTO (Patient, Regimen, Organ Function, Numbers, Toxicity, Order Verification) that has been successfully used by pharmacists in variety of practice settings in two academic centers in North Carolina. Proposed benefits of using a checklist in order review include standardization of review for better communication between collaborating pharmacists, a training tool for new or cross-training pharmacists, and an educational tool for students.

Community pharmacists' knowledge of and attitudes toward oral chemotherapy.

OBJECTIVE: To assess community pharmacists' attitude toward and knowledge of oral chemotherapy (OC) in terms of drug indications, general dosing principles, drug interactions, adverse effects, and special handling precautions. DESIGN: Descriptive, nonexperimental, cross-sectional survey. SETTING: Colorado, Kansas, and the southeastern United States in May and June 2005. PARTICIPANTS: 1,080 pharmacists in four divisions of a large community pharmacy chain. INTERVENTIONS: Web-based survey. MAIN OUTCOME MEASURES: Pharmacist knowledge of and attitude toward OC. RESULTS: 243 surveys were returned (response rate 22.5%). Overall, pharmacists answered 49.7% of knowledge questions correctly. Pharmacists were most knowledgeable about general dosing principles (69%) and least knowledgeable about adverse effects (45%) and special handling (25%) of OC. Higher scores were seen for pharmacists who dispensed a greater number of OC prescriptions. Percentages of correct responses did not vary based on years of experience or number of OC continuing pharmacy education (CPE) programs attended. On a Likert-type scale of 1 (low) to 5 (high), the average comfort in dispensing OC was 2.4. On average, pharmacists indicated that knowing about OC was important to their practice (3.7) and expressed interest in participating in additional CPE programs on OC (4.2). Of respondents, 94.7% indicated that their pharmacy did not have a counting tray devoted to cytotoxic drugs. CONCLUSION: This survey identified several areas in which pharmacists' knowledge of OC could be enhanced. Handling of OC is an area of important need, given the low number of pharmacists reporting separate counting trays for cytotoxic drugs.