Design of a pharmaceutical care plan for haematology transplant patients

Background and objective To design a tool to provide pharmaceutical care to patients receiving haematopoietic stem cell transplants for the treatment of haematological malignancy. Design Retrospective review of case notes and validated (inter-rater reliability testing) categorisation of pharmaceutical care issues (PCIs) in 36 patients. Design and multi-disciplinary peer review of a draft pharmaceutical care plan (PCP). Modification of the PCP following national piloting and evaluation (postal questionnaire) by specialist clinical pharmacists. Setting Transplant unit within Cancer Centre at large teaching hospital. Piloted at five transplant units across Scotland. Main outcome measures Number and type of pharmaceutical care issues (PCI). Perceptions about clinical use of PCP by specialist clinical pharmacists. Results PCIs were identified from 36 patients (42% male), 11 had allogeneic [mean (SD) age 38 (10.8)] and 25 had autologous haematopoietic stem cell transplants [mean (SD) age 46 (11.5)]. Of the 1079 care issues, 43 different PCIs occurred [mean (SD) 30 (4.2) PCIs per patient per admission]. PCIs were categorised as: adverse drug reaction (15%), additional medication needs (20%), dose too low (20%), dose too high (12%), unnecessary medication use (10%), inappropriate patient compliance (2%) and ineffective drug prescribed (2%). The checks or enquiries carried out by the pharmacist were mainly medication needs (41%), safety (39%) and effectiveness (13%). Incidence of PCIs was similar in autologous and allogeneic transplants except monitoring immunosuppressive medication (allogeneic = 100%, autologous = 0%). Thirteen PCIs occurred in every patient. The inter-rater reliability test demonstrated 'good' (k = 0.61- 0.80) or 'very good' (k = 0.80-1.0) reliability of categorisation by the investigator. Pharmacists who piloted the pharmaceutical care plan rated the content, layout and ease of use of the document as good or very good. All would use the document in their clinical practice. Conclusions A pharmaceutical care plan has been developed, validated and agreed for use in haematopoetic stem cell transplantation in Scotland. The document will facilitate the equitable provision of Pharm World Sci (2009) 31:40-141 55 123 pharmaceutical care to, assist in training of less experienced pharmacists and serve as a tool for the prospective audit of pharmacist activities.