Impact of outpatient interventions made at an ambulatory cancer centre oncology pharmacy in Singapore.
OBJECTIVE
To evaluate the clinical significance of interventions made by pharmacists in an oncology pharmacy in Singapore and their acceptance rate and to identify common drug-related problems and workflow-related interventions.


METHODS
A two-month prospective intervention study was conducted at National Cancer Centre Singapore. During the study, pharmacists documented the reason for intervening and its related drug(s). Each intervention was evaluated for its clinical significance by an expert panel: two oncologists and a pharmacist using a five-point scale. The Kendall's test of concordance and Cohen's weighted kappa were employed for analysis of agreement among the respondents. Other variables were analysed using descriptive statistics.


RESULTS
A total of 331 interventions were recorded: 147 cases were due to missing chemotherapy orders while 184 cases had potential drug-related problems. Among the 184 cases, 60 cases were related to clarification of orders, while the others had drug-related problems. The Kendall's concordance coefficient was calculated to be 0.612 (p < 0.001) while weighted kappa test results showed fair agreement across the evaluators. Acceptance rate of interventions was 93%. Most commonly documented drugs requiring interventions were carboplatin, trastuzumab and capecitabine.


CONCLUSIONS
About half of the documented interventions by pharmacists were evaluated as clinically 'significant' or 'very significant'.
Department of Pharmacy, National Cancer Centre Singapore, Singapore cindy.chew.y.x@nccs.com.sg.
Cindy
C
Chew
Department of Pharmacy, National Cancer Centre Singapore, Singapore.
Joen
J
Chiang
Department of Pharmacy, National Cancer Centre Singapore, Singapore.
T T
TT
Yeoh
D000553:Ambulatory Care / Q000458:organization & administration*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D011307:Drug Prescriptions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D006801:Humans; D008495:Medical Oncology / Q000458:organization & administration*; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D010348:Patient Care Team; D061214:Patient Safety; D010595:Pharmacists / Q000458:organization & administration*; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D024382:Professional Role; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012846:Singapore; D013997:Time Factors; D057188:Workflow
D000970:Antineoplastic Agents
Pharmacist intervention; clinical significance; drug-related problems; oncology