ACCC Pharmacy Survey 2007
In March 2007 ACCC surveyed its close to 1,000 Oncology Pharmacy Education Network (OPEN) members. A total of 144 responses were received. The survey was sponsored by Cardinal Health.
The majority of respondents (78 percent) practice in the hospital setting (or hospital-based cancer center), while 17.5 percent practice in the physician office or clinic. Other practice sites included specialty pharmacy (3.5 percent) and other (1 percent), including mixed practice and hospital setting.
The majority of respondents (88.8 percent) are pharmacists. Other respondent positions include: administrator (10.5 percent), pharmacy coordinator/manager (3.5 percent), oncology nurse (2.1 percent), and pharmacy technician (1.4 percent).
About 80 percent of respondents indicate they employ a PharmD clinical pharmacist. About 37 percent report the clinical pharmacist is board-certified, while 39 percent report the clinical pharmacist is residency trained. About 16 percent report the clinical pharmacist is PGY2-specialty residency trained in oncology.
Overwhelmingly, at 97 percent, pharmacists review the chemotherapy order. In addition to the pharmacist, 46.2 percent of respondents indicate that chemotherapy orders are reviewed by the nurse, and just 20.3 percent indicate that the physician is involved in reviewing the order. Two respondents indicate that the order is reviewed by whoever is available.
Do the pharmacies have standardized orders or protocols for more than 80 percent of their chemotherapy orders? About 41 percent say, “no.” Of the 49 percent who say they do have standardized orders or protocols, about one in three have pre-printed orders; 14 percent have order protocols built into the computer software; and 15 percent have a combination of pre-printed or computer-based order protocols.
A majority of respondents (57 percent) indicate that patients are assessed by a nurse at each visit for current symptoms, adverse reactions, organ function, and quality of life issues. Other staff who assess the patient include: a combination of nurse, pharmacist, and physician, 43.7 percent; physician, 23.2 percent; or pharmacist, 4.2 percent. Two respondents indicate the patient is assessed by whoever is available. Six respondents indicate that patients are not assessed at every visit.
When a drug dose requires adjustment, is a pharmacist included in the decision? About one in three respond, “no.” This is done only by a physician. Two out of three indicate a pharmacist approves all adjustments prior to implementing or the pharmacist calculates all adjustments prior to physician approval.
Most respondents indicate a pharmacist or trained technician prepares chemotherapy for administration. Just 4 percent indicate a nurse does the preparation.
A majority of respondents (58.5 percent) indicate they have a dedicated room with a Class II biosafety hood or isolation chamber to prepare injections and IV solutions. Close to 42 percent indicate they have a dedicated room that meets USP 797 standards and with Class II biosafety hood or isolation chamber. Just two respondents indicate they have an open counter top, and one has no dedicated facility, although it does compound drugs. No one reports they outsource drug preparation.
Just 15 percent report that personnel who compound chemotherapy are not certified. The other 85 percent report certified personnel. The majority of these are certified by their own standards or national standards. Just 4.9 percent are certified by an outside agency.
Of those certified, most (71 percent) are re-certified yearly. About one in five are certified only during their initial training or orientation period. Just five respondents indicate they are certified more frequently than once a year.
Turn-around time for urgently needed drug therapy such as drugs for a febrile neutropenic patients is less than an hour for 92 percent of respondents. Ten respondents report turn-around time of one to two hours. One respondent indicates turn-around time of three to four hours.
The overwhelming majority of respondents indicate they do have policies in place for writing chemotherapy orders. Most (75 percent) have their own policy. About 14 percent follow ACCC guidelines, and 14 percent follow other guidelines. Just 6 percent report no policies in place for writing chemotherapy orders.
About 80 percent of respondents report they have their own policies in place for reviewing chemotherapy orders. About 13 percent follow ACCC guidelines; while 15.5 percent follow other guidelines. Eight respondents indicate they do not have a policy in place for reviewing chemotherapy orders.
About 62 percent of respondents report they have their own policies in place for monitoring patients. About 10 percent follow ACCC guidelines; while 15 percent follow other guidelines. One in five respondents indicates no policy in place for monitoring patients.
About 77 percent of respondents report they have their own policies in place for preparing chemotherapy. About 11 percent follow ACCC guidelines, while close to 30 percent follow other guidelines. Just one respondent indicates no policy in place for preparing chemotherapy.
Seventy-three percent of respondents report they have their own policies in place for administering chemotherapy. About 14 percent follow ACCC guidelines, while 29 percent follow other guidelines. Just one respondent indicates no policy in place for administering chemotherapy.
About 87 percent of respondents report employing a pharmacy technician in the practice site. Just 13 percent report no pharmacy technician.
A majority of respondents (63 percent) are not familiar with ACCC Pharmacy Guidelines.
Staffing and Services
- Average number of full-time equivalent pharmacists employed is 5.5. The median number is 2.
- Average number of full-time equivalent pharmacy technicians is 1.2. Median is 2.
- Average number of full-time equivalent nurses is 11.6. Median is 6.
- Average number of oncology physicians in practice, or with privileges is 3.3. Median is 6.
- Average number of cancer patients who receive drug therapy per day is 11. Median is 20.
- Average number of chemotherapy preparations administered per day is 15.5. Median is 27.