title: Impact of clinical pharmacy services in a hematology/oncology inpatient setting.
abstract: OBJECTIVE
  Clinical pharmacists are contributing to safe medication use by providing comprehensive management to patients and medical staff. However, little is known regarding their impact in oncology. The aim of this study was to document and evaluate the role of clinical pharmacy services in a hematology/oncology department.
  
  
  METHODS
  A prospective, descriptive, observational study was carried out from May 2012 to May 2013. Medication reviews concerning hospitalized adult cancer patients were performed twice a week. Medication problems, pharmaceutical interventions and acceptance rate by the oncologists were recorded by a clinical pharmacist.
  
  
  RESULTS
  A total of 4,393 prescriptions (including chemotherapy and support) of 489 adult cancer patients (mean age=63 years) were analyzed. The pharmacist identified 552 drug-related problems (12.6% of the prescriptions) primarily related to anti-infective agents (59.5%). Medication problems included inappropriate medications (20.6%), untreated indications (14.8%), inappropriate administrations (14.1%), underdosing (11.7%), drug-drug interactions (14.3%), lack of monitoring (9.6%), overdosing (8.9%), administration omissions (3.5%) and side-effects (2.5%). Interventions (n=552) led to treatment discontinuation (26.2%), drug dosing adjustments (21.5%), drug additions (16.9%), alternate routes of administration (11.7%), replacement of a drug by another one (10.7%), therapeutic drug monitoring (10.3%) and optimizing administration (2.6%). Most (96%) of the interventions were accepted and implemented by the medical staff.
  
  
  CONCLUSIONS
  The integration of clinical pharmacy services resulted in drug-specific interventions in 12.6 % of the prescriptions of hospitalized adult patients with cancer. Medication problems mostly concerned anti-infective agents. The intervention acceptance rate by oncologists was high. The outcome of care in the hematology/oncology inpatient setting remains to be measured.
authors.affiliation: Pharmacy Department, Strasbourg University Hospital, Strasbourg, France delpeucha@gmail.com.
authors.forename: Amina
authors.initials: A
authors.lastname: Delpeuch
authors.affiliation: Pharmacy Department, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Leveque
authors.affiliation: Pharmacy Department, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Benedicte
authors.initials: B
authors.lastname: Gourieux
authors.affiliation: Hematology/Oncology Department, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Raoul
authors.initials: R
authors.lastname: Herbrecht
mesh_terms: D004347:Drug Interactions; D011307:Drug Prescriptions; D019337:Hematologic Neoplasms / Q000188:drug therapy*; D006801:Humans; D007297:Inpatients; D008508:Medication Errors; D008875:Middle Aged; D010607:Pharmacy Service, Hospital; D011446:Prospective Studies
keywords: Oncology; anticancer agent; clinical pharmacy services; drug-related problem; inpatient setting