title: Improving the Safety of Oral Chemotherapy at an Academic Medical Center.
abstract: OBJECTIVE
  Over the last decade, the use of oral chemotherapy (OC) for the treatment of cancer has dramatically increased. Despite their route of administration, OCs pose many of the same risks as intravenous agents. In this quality improvement project, we sought to examine our current process for the prescription of OC at the Abramson Cancer Center of the University of Pennsylvania and to improve on its safety.
  
  
  METHODS
  A multidisciplinary team that included oncologists, advanced-practice providers, and pharmacists was formed to analyze the current state of our OC practice. Using Lean Six Sigma quality improvement tools, we identified a lack of pharmacist review of the OC prescription as an area for improvement. To address these deficiencies, we used our electronic medical system to route OC orders placed by treating providers to an oncology-specific outpatient pharmacist at the Abramson Cancer Center for review.
  
  
  RESULTS
  Over 7 months, 63 orders for OC were placed for 45 individual patients. Of the 63 orders, all were reviewed by pharmacists, and, as a result, 22 interventions were made (35%). Types of interventions included dosage adjustment (one of 22), identification of an interacting drug (nine of 22), and recommendations for additional drug monitoring (12 of 22).
  
  
  CONCLUSIONS
  OC poses many of the same risks as intravenous chemotherapy and should be prescribed and reviewed with the same oversight. At our institution, involvement of an oncology-trained pharmacist in the review of OC led to meaningful interventions in one third of the orders.
authors.affiliation: Abramson Cancer Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA nishah@mcw.edu.
authors.forename: Nirav N
authors.initials: NN
authors.lastname: Shah
authors.affiliation: Abramson Cancer Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Erica
authors.initials: E
authors.lastname: Casella
authors.affiliation: Abramson Cancer Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Donna
authors.initials: D
authors.lastname: Capozzi
authors.affiliation: Abramson Cancer Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: McGettigan
authors.affiliation: Abramson Cancer Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Tara C
authors.initials: TC
authors.lastname: Gangadhar
authors.affiliation: Abramson Cancer Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Lynn
authors.initials: L
authors.lastname: Schuchter
authors.affiliation: Abramson Cancer Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Myers
mesh_terms: D000046:Academic Medical Centers / Q000592:standards; D000284:Administration, Oral; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data; D004512:Education, Pharmacy; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy; D009722:Nurse Practitioners / Q000592:standards; D010595:Pharmacists / Q000592:standards; D010820:Physicians / Q000592:standards; D058996:Quality Improvement; D011787:Quality of Health Care; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents