title: Chemotherapy Order Entry by a Clinical Support Pharmacy Technician in an Outpatient Medical Day Unit.
abstract: BACKGROUND
  Pharmacy technicians are expanding their scope of practice, often in partnership with pharmacists. In oncology, such a shift in responsibilities may lead to workflow efficiencies, but may also cause concerns about patient risk and medication errors.
  
  
  OBJECTIVE
  The primary objective was to compare the time spent on order entry and order-entry checking before and after training of a clinical support pharmacy technician (CSPT) to perform chemotherapy order entry. The secondary objectives were to document workflow interruptions and to assess medication errors.
  
  
  METHODS
  This before-and-after observational study investigated chemotherapy order entry for ambulatory oncology patients. Order entry was performed by pharmacists before the process change (phase 1) and by 1 CSPT after the change (phase 2); order-entry checking was performed by a pharmacist during both phases. The tasks were timed by an independent observer using a personal digital assistant. A convenience sample of 125 orders was targeted for each phase. Data were exported to Microsoft Excel software, and timing differences for each task were tested with an unpaired t test.
  
  
  RESULTS
  Totals of 143 and 128 individual orders were timed for order entry during phase 1 (pharmacist) and phase 2 (CSPT), respectively. The mean total time to perform order entry was greater during phase 1 (1:37 min versus 1:20 min; p = 0.044). Totals of 144 and 122 individual orders were timed for order-entry checking (by a pharmacist) in phases 1 and 2, respectively, and there was no difference in mean total time for order-entry checking (1:21 min versus 1:20 min; p = 0.69). There were 33 interruptions not related to order entry (totalling 39:38 min) during phase 1 and 25 interruptions (totalling 30:08 min) during phase 2. Three errors were observed during order entry in phase 1 and one error during order-entry checking in phase 2; the errors were rated as having no effect on patient care.
  
  
  CONCLUSIONS
  Chemotherapy order entry by a trained CSPT appeared to be just as safe and efficient as order entry by a pharmacist. Changes in pharmacy technicians' scope of practice could increase the amount of time available for pharmacists to provide direct patient care in the oncology setting.
authors.affiliation: BScPharm, MSc, is a Drug Utilization Pharmacist and Pharmacy Research Coordinator with the Central Zone (formerly Capital Health), Nova Scotia Health Authority, Halifax, Nova Scotia.
authors.forename: Heather
authors.initials: H
authors.lastname: Neville
authors.affiliation: BScPharm, MHSc, FCSHP, is Manager of the Systemic Therapy Program, Cancer Care Nova Scotia, and Clinical Co-ordinator for Oncology Pharmacy with the Central Zone, Nova Scotia Health Authority, Halifax, Nova Scotia.
authors.forename: Larry
authors.initials: L
authors.lastname: Broadfield
authors.affiliation: BScPharm, is Clinical Pharmacy Manager for Oncology, Surgery and Research with the Central Zone, Nova Scotia Health Authority, Halifax, Nova Scotia.
authors.forename: Claudia
authors.initials: C
authors.lastname: Harding
authors.affiliation: is a Clinical Support Pharmacy Technician (Hematology) with the Central Zone, Nova Scotia Health Authority, Halifax, Nova Scotia.
authors.forename: Shelley
authors.initials: S
authors.lastname: Heukshorst
authors.affiliation: BScPharm, ACPR, is a Clinical Pharmacist (Hematology) with the Central Zone, Nova Scotia Health Authority, Halifax, Nova Scotia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sweetapple
authors.affiliation: BScPharm, ACPR, is a Clinical Pharmacist (Hematology) with the Central Zone, Nova Scotia Health Authority, Halifax, Nova Scotia.
authors.forename: Megan
authors.initials: M
authors.lastname: Rolle
keywords: chemotherapy order entry; clinical support; pharmacy technician; time- and- motion studiese