Pharmaceutical care needs of haematology out-patients receiving cytotoxic chemotherapy

Background and objective To identify pharmaceutical care needs in haematology out-patients receiving cytotoxic chemotherapy through characterisation of pharmaceutical care issues and seeking opinions about the pharmaceutical service from patients and healthcare professionals. Design Retrospective review of records and categorisation of pharmaceutical care issues in 24 patients. Semi-structured interviews were audio-taped with all five haematology consultants, as were two focus groups with seven nursing staff. Consistent codes were used to analyse the transcripts into themes. Questionnaires handed to 100 78 Pharm World Sci (2009) 31:40-141 123 haematology patients or carers (41% response) On which they were asked to select which medicines they received, difficulties encountered when taking medicines, further medicine information needs and preferred source, potential services from clinical pharmacists, satisfaction with current pharmacy service and expected waiting times for medicines given the safety checks which must be undertaken. Setting Haematology outpatient clinic within cancer centre of large teaching hospital. Main outcome measures Number and type of pharmaceutical care issues recorded. Opinions of doctors, nurses and patients about pharmaceutical service needs. Results The mean (SD) age was 69 (11.8) years and 17 (71%) were male. Review of patients with; chronic lymphocytic leukaemia, chronic myeloid leukaemia, acute myeloid leukaemia, essential thrombocythaemia, polycythaemia vera, non-hodgkin's lymphoma and multiple myeloma identified 241 pharmaceutical care issues as potential drug related problems, of which 172 (71%) addressed adverse drug reactions, 30 (12%) identified additional medication needs, 24 (10%) identified unnecessary medication use, 9 (4%) identified doses suspected of being too low, 4 (2%) identified doses suspected of being too high and 2 (1%) concerned prescription of an ineffective drug. Checks or patient monitoring issues were largely due to safety enquiries (75%) and also included medication needs enquiries (22%) and effectiveness enquiries (3%). Most patients reported satisfaction with the pharmacy service, 4 (10%) had unrealistic expectations of waiting \15 min for their prescription. Healthcare professionals reported the need for better team education, communication and systems to target patients receiving complex regimens and those who are elderly and easily confused. Patients (29%) reported problems with compliance which was confirmed by nurses. Proposed solutions to patient waiting times identified doctors' and nurses' lack of awareness of guidelines for the safe dispensing of chemotherapy. Conclusions The care issues confirmed that patients are at risk of adverse drug reactions and interactions between medicines for comorbidities and their chemotherapy. Pharmaceutical care should address these care issues, identify the need for supportive therapy and confirm chemotherapy doses to minimise clinical risk. Improved communication and referral systems are required and educational needs of patients and healthcare professionals have been identified and will be addressed in development of the pharmacy service to meet patient need.