| • White Paper (4)
• MURs (2)
• Dispensing errors
• Chemotherapy
• Medication review
• Pfizer
• Locum pharmacy
Letters to the Editor
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Chemotherapy
More and more cancer patients are likely to receive chemotherapy outside hospitals
From Mr T. R. Root, MRPharmS, and Mr A. L. West, MRPharmS
We note the letter from John
Murphy (PJ, 21 April, p457) drawing attention
to two deaths after misinterpretation of the
Z-DEX protocol for the treatment of myeloma led to three patients being
prescribed a four-fold overdose of idarubicin.
It is, of course, of great concern that an error of this sort, which
is well documented, not least as the cause of the much publicised death
of Betsy Lehman, a reporter on the Boston Globe, who died at the Dana
Faber Cancer Institute in the US in 1994, has occurred again not once
but three times.
Our main point in writing, however, is to draw the attention of colleagues
to the work of the National Confidential
Enquiry into Patient Outcome and Death (NCEPOD). This is an independent organisation mandated by
the Department of Health and the General Medical Council to review
clinical practice in the NHS and independent health care sectors and
to make recommendations for improving quality of care. More information
can be found at www.ncepod.org.uk
We particularly want to take this opportunity to highlight that NCEPOD
is presently conducting a study into cancer chemotherapy-related deaths
in England and Wales. From its inception in 1990, NCEPOD’s focus
has been on surgery: it has not previously studied medical treatments
and hence has not worked directly with pharmacy staff. During the course
of planning and launching the chemotherapy study earlier this year,
it has become apparent to us that that many pharmacists are unaware
of NCEPOD and its important role and we believe it is important to
try to remedy
this.
We would also like to draw attention to a collaborative project due
to be initiated soon between the National Patient Safety Agency and
the DoH Cancer Action Team on managing the risks of cancer chemotherapy.
The recent publication of the “Safety first” and “Safety
in doses” reports, establishment of the National Patient Safety
Forum and of strategic health authority-based patient safety action
teams,
have all raised the stakes for the patient safety agenda in general
and for medicines safety in particular.
Changing models of care mean that in the near future more and more
cancer patients are likely to receive anticancer treatment, including
cytotoxic chemotherapy, outside hospitals, on which almost all of our
current risk management strategies for these treatments are based.
The pace of innovation and development of new treatments means that
more anticancer medicines will be given orally and over many months
or years; some may well, in due course, be prescribed by GPs and dispensed
by community pharmacists.
If these new models of care are to be achieved safely it is essential
that all pharmacists are aware of the issues involved and are actively
engaged in the risk management agenda. Effective engagement must be
based on a comprehensive awareness, knowledge and understanding of
the wider patient safety agenda and all its stakeholders.
Tim Root
Specialist Pharmacist, Clinical Governance and Technical Services
Chelsea and Westminster Hospital
Tony West
Chief Pharmacist
Guy’s and St Thomas’s Foundation Trust, London
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The
Pharmaceutical Journal