title: Building an outpatient cancer center pharmacy program across a tristate region.
abstract: OBJECTIVE
  The transition to a hybrid model of oncology pharmacy services including remote order verification across a regional network of cancer centers is described.
  
  
  CONCLUSIONS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Susan J. Skledar, B.S., M.P.H., is Clinical Pharmacy Specialist, University of Pittsburgh Medical Center (UPMC), and Associate Professor, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. Andrew Doedyns, B.S., M.B.A., is Pharmacy Manager, UPMC CancerCenter, Pittsburgh. Bryan Yourich, Pharm.D., is Regional Director of Pharmacy Operations, Department of Pharmacy, UPMC Shadyside, Pittsburgh. skledarsj@upmc.edu.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Skledar
authors.affiliation: Susan J. Skledar, B.S., M.P.H., is Clinical Pharmacy Specialist, University of Pittsburgh Medical Center (UPMC), and Associate Professor, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. Andrew Doedyns, B.S., M.B.A., is Pharmacy Manager, UPMC CancerCenter, Pittsburgh. Bryan Yourich, Pharm.D., is Regional Director of Pharmacy Operations, Department of Pharmacy, UPMC Shadyside, Pittsburgh.
authors.forename: Andrew
authors.initials: A
authors.lastname: Doedyns
authors.affiliation: Susan J. Skledar, B.S., M.P.H., is Clinical Pharmacy Specialist, University of Pittsburgh Medical Center (UPMC), and Associate Professor, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. Andrew Doedyns, B.S., M.B.A., is Pharmacy Manager, UPMC CancerCenter, Pittsburgh. Bryan Yourich, Pharm.D., is Regional Director of Pharmacy Operations, Department of Pharmacy, UPMC Shadyside, Pittsburgh.
authors.forename: Bryan
authors.initials: B
authors.lastname: Yourich
mesh_terms: D000046:Academic Medical Centers / Q000592:standards / Q000639:trends*; D000553:Ambulatory Care / Q000592:standards / Q000639:trends*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D006801:Humans; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D009820:Ohio / Q000453:epidemiology; D010044:Outpatient Clinics, Hospital / Q000592:standards / Q000639:trends*; D010414:Pennsylvania / Q000453:epidemiology; D010593:Pharmaceutical Services / Q000592:standards / Q000639:trends*; D010595:Pharmacists / Q000592:standards / Q000639:trends; D010596:Pharmacy Technicians / Q000193:education / Q000592:standards / Q000639:trends; D014903:West Virginia / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents