How Are Cancer Treatments Prepared? Safety and Protocols in Hospital Pharmacies
Following the tragic deaths of two cancer patients due to treatment errors, the Spanish Society of Hospital Pharmacy (SEFH) outlines in detail how cancer medications should be prepared, controlled, and administered within hospital settings.
Dispensing Oncology Treatments in Hospital Pharmacies
Cancer treatment employs a variety of products from different sources. What most people refer to as chemotherapy is somewhat of an outdated term; it encompasses highly dangerous chemical substances. Now, nearly half of cancer patients also use biologically derived substances, which present unique challenges in their administration.
Administration Routes for Cancer Treatments
The administration methods for these treatments are diverse, including oral, intravenous, subcutaneous, or intramuscular routes. They are specified according to the treatment protocol for each patient.
Key Considerations for Cancer Treatments
Cancer medications are classified as high-risk because they often involve aggressive dosages aimed at destroying malignant cells. This can lead to significant toxicity in the body, which must be carefully managed. Therefore, dosages are tailored to each individual, considering critical data such as height, weight, body surface area, and creatinine clearance (a measure of renal function).
The Hospital Circuits for Dispensing Oncology Drugs
Cancer treatments follow distinct circuits for prescription, preparation, and administration in hospitals. These circuits have been designed with specific safety measures that surpass those applied to most other medications. The safety circuit typically begins with the management, acquisition of the drug, and its entry into electronic systems.
In Spain, about 97% of hospitals dealing with oncology medications have computerized a significant portion, if not all, of this process. Once the treatment is selected, some form of automation is always in place within the pharmacy service, even if it’s just for dosage calculations and label generation. Each process is individualized, resulting in labels that prominently display the patient’s name.
Quality Control in the Pharmacy During the Preparation Process
The process begins with a prescription. Oncologists and hematologists cannot prescribe freely; they must follow established protocols, leveraging safety tools within software that limit dosage ranges to safeguard patient welfare.
A double-check system must always involve a pharmacist. While the software acts as the first control point, a pharmacist’s validation assures the suitability of the prescription. This verification extends to dosage calculations for preparing mixtures, creating a robust double-check system that can be semi-automated or manual.
Preparing the Prescribed Formula
Based on the work sheets, labels, and materials, the production phase commences. Here, the double-check occurs at every point. Many centers incorporate some control measures, such as identification codes for materials (before and after preparation), gravimetric control (by weight), or even automated assembly with robotics. This ensures that the final product that leaves the Pharmacy Service has an identifiable label and quality control checks verifying its contents align with prescriptions.
Administering the Prepared Dose
Administration may also be automated or manual. In either case, there needs to be an evolving set of medical orders that the nurse must verify before executing any treatment. Chemotherapy isn’t solely about the main drug; it often necessitates prior premedication—such as volume infusion, antiemetics, and corticosteroids—that affects both efficacy and safety.
Special Monitoring and Care Protocols
In outpatient settings, protocols exist for managing what are termed infusion reactions. These protocols involve stopping the medication, notifying the physician, and assessing whether re-administration of the drug is advisable.
Special care includes administering antiemetics to prevent nausea and using corticosteroids or interleukin inhibitors to manage predictable reactions. Adverse effects are frequently linked to other medications and are factored into the protocols. Programs for desensitization are also available for patients who have experienced allergic reactions but for whom a particular drug remains the best therapeutic option. Any incidents are meticulously documented in the patient’s clinical history.
Monitoring Adverse Effects and Alerts
A system must be in place to document any adverse reactions consistently in the medical record. It is essential to differentiate between expected side effects (like nausea from carboplatin or paclitaxel) and unexpected adverse effects, such as glottis edema. Every reaction is noted in the patient’s record for careful management in future prescriptions and administrations.
By adhering to these stringent protocols, hospitals aim to enhance patient safety and minimize the risk of error in cancer treatment delivery, ensuring better outcomes for those facing this challenging diagnosis.