Evaluating the potential clinical and economic
impact of chemotherapy prescribing by pharmacists
at a university teaching hospital
Nally S 1, Dalton K 2
1 Pharmacy Department, University Hospital Limerick, Limerick, Ireland.
2 School of Pharmacy, University College Cork, Cork, Ireland.
[email protected] Background and Importance Results
• Chemotherapy medication errors can cause serious patient • In the comparative sample of 155 prescriptions, there were 714
harm; most of these occur at the prescribing stage, with high medications each prescribed by doctors or pharmacists:
rates reported for chemotherapy prescribing errors1. ➢ 352 anticancer and 362 supportive medications.
• Whilst pharmacist prescribing is well established in many ➢ mean 4.6; standard deviation 3.94; range 1-18.
settings worldwide and has shown to be effective, there is • 53.1% of all errors were due to the incorrect dose prescribed.
limited research on pharmacists prescribing chemotherapy2,3. • Doctors made significantly more errors than pharmacists (p<0.05)
➢ 105 in 40.6% of prescriptions versus 23 in 14.8% of prescriptions.
Aim and Objectives • The mean severity scores for
Table 1: Mean error severity scores
• Aim: To assess the potential clinical and economic impact of all prescribing errors that
introducing pharmacist prescribing versus medical prescribing could have reached a patient Peer Review Doctor Pharmacist
of chemotherapy regimens at a university teaching hospital. Panel Mean Prescribing Prescribing
(n=124) are shown in Table 1. Severity Score n (%) n (%)
• Main objectives: to quantify pharmacists’ and doctors’
Minor 50 (49%) 13 (59.1%)
prescribing errors, assess their potential severity and • 17.6% of doctor-prescribed Moderate 35 (34.3%) 9 (40.9%)
probability to cause an adverse drug event (ADE), and errors were classified with a Severe 17 (16.7%) 0 (0%)
thereafter estimate the associated costs of pharmacists ‘high’ ADE probability versus
Total 102 22
prescribing versus doctors prescribing. 0% for the pharmacists.
Methods Cost Avoidance: ADE and Labour Costs
• The estimated ADE cost for these 102 doctor errors and 22
• This prospective study examined the same set of prescriptions pharmacist errors was €23,004 and €2,448 respectively.
prepared by doctors and pharmacists independently. ➢ Extrapolated to reflect annual figures: this was €1,389,144.77
➢ Doctors were not aware of the study but were aware that and €147,827.61 – i.e. a €1,241,317.16 difference in ADE costs.
their prescriptions would be screened for errors as normal.
• Patients aged ≥18 years receiving chemotherapy on the • Table 2 shows that pharmacist prescribing had an annual labour
haematology-oncology inpatient and outpatient wards in a cost saving of €43,026.51 when comparing costs of prescribing,
562-bed university teaching hospital in Ireland across a 2-week correcting errors, re-prescribing, and additional infusion times.
time period in June 2022 were included. ➢ Doctors had 26 incorrect infusion times while pharmacists had 5
• Prescribing errors were quantified, classified4, and analysed (an avoidable 835 and 30 nursing minutes respectively).
using descriptive and inferential statistics. The time taken to
Annual Labour Costs Doctor Pharmacist
correct any error and re-prescribe was calculated. Table 2:
Prescribing Prescribing
• Assuming errors were not spotted and reached the patient, an Extrapolated annual
Initial Prescribing €20,818.62 €23,841.94
independent blinded peer review panel assessed the errors’ labour cost comparison
for doctor prescribing Correcting Errors €31,417.53 €3,691.66
potential severity5 and their probability of an ADE occurring6. versus pharmacist Re-prescribing €3,626.47 €1,845.83
• The ADE cost avoidance was calculated using the Nesbit et al. prescribing Additional Nursing Time €17,159.84 €616.52
method6 by multiplying the cost of a potential ADE (€1200 – Total Cost of Service €73,022.46 €29,995.95
adjusted for inflation)7,8 by the ADE probability score. • Assuming that errors were not spotted and reached the patient,
• The annual cost avoidance associated with providing the net cost benefit of utilising a pharmacist chemotherapy
pharmacist prescribing chemotherapy was estimated and prescribing service would have been €1,254,347.72 annually.
compared to the current doctor prescribing service. ➢ (ADE Cost Difference + Labour Cost Saving) – Cost of Service
Conclusion and Relevance
• This study has shown that pharmacist prescribing: • With patient safety as the priority,
➢ results in significantly fewer chemotherapy prescribing errors than doctors. pharmacist prescribing should be
➢ minimises workload for healthcare professionals. considered for more widespread
➢ reduces the risk of ADEs and patient harm. implementation in hospital cancer
➢ has the potential for substantial cost savings for hospitals. care services in future.
Acknowledgements: We would like to thank the pharmacists References: tinyurl.com/njef9yj9 Abstract Number: 4CPS-137
who prescribed in this study and the peer review panel for
evaluating the prescribing errors’ severity and potential for harm. Disclosures: None. ATC code: L01 – Antineoplastic agents
