International Journal of Clinical Pharmacy

, Volume 38, Issue 5, pp 1124–1132 | Cite as

Clinical and economic impact of pharmacists’ intervention in a large volume chemotherapy preparation unit

  • Ji-Min Han
  • Young-Mi Ah
  • Sung Yun Suh
  • Sun-Hoi Jung
  • Hyeon Joo Hahn
  • Seock-Ah Im
  • Ju-Yeun LeeEmail author
Research Article


Background Even though pharmacists have devoted considerable time to ensuring patient safety during the process of preparing and dispensing chemotherapy, only a few studies have evaluated their efforts. Objective To evaluate the clinical and economic impact of pharmacists’ interventions in a large volume chemotherapy preparation unit. Setting A 1600-bed tertiary hospital in Seoul, Korea. Method Pharmacist intervention records from May 2012 to April 2013 were retrospectively reviewed. The clinical significance of interventions was rated by one physician and one pharmacist. A cost-benefit analysis was conducted. The benefit from interventions was estimated through both cost avoidance based on the potential to avoid an adverse drug event (ADE) and cost savings related to reducing discarded products. Cost was estimated from the pharmacists’ salary corresponding to the time spent in reviewing chemotherapy prescriptions. Main outcome measure Acceptance rate, clinical significance, net cost-benefit, and cost-benefit ratio of pharmacist interventions. Results Among 39,649 cancer chemotherapy prescriptions in 6364 patients, 631 interventions were performed for 435 patients. The acceptance rate was 72.1 %. Most cases of declined interventions were related to dosage adjustment within the range of <10 % of the prescribed dosage. More than half of the interventions were considered as clinically more than “significant” (50.4 %). The cost-benefit analysis showed a clear cost benefit with a net cost-benefit of $116,493 and a cost-benefit ratio of 3.64:1. Conclusion Pharmacists’ interventions in a large volume ambulatory-based chemotherapy preparation unit provided a positive economic impact on health care budget and were effective in preventing clinically significant ADEs.


Chemotherapy Compounding Cost-benefit Korea Pharmacist intervention 





No specific funding for this work was received.

Conflicts of interest

The authors have no conflicts of interest to declare.


  1. 1.
    National Cancer Information Center. Cancer facts and figures 2013 in the Republic of Korea. Goyang: National Cancer Information Center; Accessed 1 Dec 2015.
  2. 2.
    Ranchon F, Salles G, Spath HM, Schwiertz V, Vantard N, Parat S, et al. Chemotherapeutic errors in hospitalised cancer patients: attributable damage and extra costs. BMC Cancer. 2011;11:478.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Vantard N, Ranchon F, Schwiertz V, Gourc C, Gauthier N, Guedat MG, et al. EPICC study: evaluation of pharmaceutical intervention in cancer care. J Clin Pharm Ther. 2015;40:196–203.CrossRefPubMedGoogle Scholar
  4. 4.
    Kohn L, Corrigan J, Donaldson M. To err is human: building a safer health system. Washington, DC: National Academies Press; 1999.Google Scholar
  5. 5.
    Voeffray M, Pannatier A, Stupp R, Fucina N, Leyvraz S, Wasserfallen JB. Effect of computerisation on the quality and safety of chemotherapy prescription. Qual Saf Health Care. 2006;15:418–21.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Sievers TD, Lagan MA, Bartel SB, Rasco C, Blanding PJ. Variation in administration of cyclophosphamide and mesna in the treatment of childhood malignancies. J Pediatr Oncol Nurs. 2001;18:37–45.CrossRefPubMedGoogle Scholar
  7. 7.
    Muller T. Typical medication errors in oncology: analysis and prevention strategies. Onkologie. 2003;26:539–44.PubMedGoogle Scholar
  8. 8.
    Phillips J, Beam S, Brinker A, Holquist C, Honig P, Lee LY, et al. Retrospective analysis of mortalities associated with medication errors. Am J Health Syst Pharm. 2001;58:1835–41.PubMedGoogle Scholar
  9. 9.
    Bates DW, Spell N, Cullen DJ, Burdick E, Laird N, Petersen LA, et al. The costs of adverse drug events in hospitalized patients. Adverse drug events prevention study group. JAMA. 1997;277:307–11.CrossRefPubMedGoogle Scholar
  10. 10.
    Kopp BJ, Mrsan M, Erstad BL, Duby JJ. Cost implications of and potential adverse events prevented by interventions of a critical care pharmacist. Am J Health Syst Pharm. 2007;64:2483–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Lee AJ, Boro MS, Knapp KK, Meier JL, Korman NE. Clinical and economic outcomes of pharmacist recommendations in a veterans affairs medical center. Am J Health Syst Pharm. 2002;59:2070–7.PubMedGoogle Scholar
  12. 12.
    Bedouch P, Tessier A, Baudrant M, Labarere J, Foroni L, Calop J, et al. Computerized physician order entry system combined with on-ward pharmacist: analysis of pharmacists’ interventions. J Eval Clin Pract. 2012;18:911–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Fernandez-Llamazares CM, Calleja-Hernandez MA, Manrique-Rodriguez S, Perez-Sanz C, Duran-Garcia E, Sanjurjo-Saez M. Impact of clinical pharmacist interventions in reducing paediatric prescribing errors. Arch Dis Child. 2012;97:564–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Goldspiel BRDR, Daniels CE. A continuous-improvement approch for reducing the number of chemotherapy-related medication errors. Am J Health Syst Pharm. 2000;57:S4–9.PubMedGoogle Scholar
  15. 15.
    Sano HS, Waddell JA, Solimando DA Jr, Doulaveris P, Myhand R. Study of the effect of standardized chemotherapy order forms on prescribing errors and anti-emetic cost. J Oncol Pharm Pract. 2005;11:21–30.CrossRefPubMedGoogle Scholar
  16. 16.
    Nerich V, Borg C, Villanueva C, Thiery-Vuillemin A, Helias P, Rohrlich PS, et al. Economic impact of prescribing error prevention with computerized physician order entry of injectable antineoplastic drugs. J Oncol Pharm Pract. 2013;19:8–17.CrossRefPubMedGoogle Scholar
  17. 17.
    Dinning C, Branowicki P, O’Neill JB, Marino BL, Billett A. Chemotherapy error reduction: a multidisciplinary approach to create templated order sets. J Pediatr Oncol Nurs. 2005;22:20–30.CrossRefPubMedGoogle Scholar
  18. 18.
    Womer RB. Multidisciplinary systems approach to chemotherapy safety: rebuilding processes and holding the gains. J Clin Oncol. 2002;20:4705–12.CrossRefPubMedGoogle Scholar
  19. 19.
    Schwappach DL, Wernli M. Medication errors in chemotherapy: incidence, types and involvement of patients in prevention. A review of the literature. Eur J Cancer Care (Engl). 2010;19:285–92.CrossRefGoogle Scholar
  20. 20.
    Kloth DD. Prevention of chemotherapy medication errors. J Pharm Pract. 2002;15:17–31.CrossRefGoogle Scholar
  21. 21.
    Suzuki S, Chan A, Nomura H, Johnson PE, Endo K, Saito S. Chemotherapy regimen checks performed by pharmacists contribute to safe administration of chemotherapy. J Oncol Pharm Pract. 2015;0:1–8.Google Scholar
  22. 22.
    Pharmaceutical Care Network Europe. DRP-classification V5.01. Accessed 20 Feb 2013.
  23. 23.
    Overhage JM, Lukes A. Practical, reliable, comprehensive method for characterizing pharmacists’ clinical activities. Am J Health Syst Pharm. 1999;56:2444–50.PubMedGoogle Scholar
  24. 24.
    Nesbit TW, Shermock KM, Bobek MB, Capozzi DL, Flores PA, Leonard MC, et al. Implementation and pharmacoeconomic analysis of a clinical staff pharmacist practice model. Am J Health Syst Pharm. 2001;58:784–90.PubMedGoogle Scholar
  25. 25.
    Delpeuch A, Leveque D, Gourieux B, Herbrecht R. Impact of clinical pharmacy services in a hematology/oncology inpatient setting. Anticancer Res. 2015;35:457–60.PubMedGoogle Scholar
  26. 26.
    Elsaid K, Truong T, Monckeberg M, McCarthy H, Butera J, Collins C. Impact of electronic chemotherapy order forms on prescribing errors at an urban medical center: results from an interrupted time-series analysis. Int J Qual Health Care. 2013;25:656–63.CrossRefPubMedGoogle Scholar
  27. 27.
    Nerich V, Limat S, Demarchi M, Borg C, Rohrlich PS, Deconinck E, et al. Computerized physician order entry of injectable antineoplastic drugs: an epidemiologic study of prescribing medication errors. Int J Med Inform. 2010;79:699–706.CrossRefPubMedGoogle Scholar
  28. 28.
    Le Guen R, Madelaine I, Tournamille JF, Bellanger A, Astier A, Braguer D, et al. Study impacto: descriptive analyzis of pharmacist’s clinical practice in onco-hematology. Ann Pharm Fr. 2015;73:223–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Knez L, Laaksonen R, Duggan C. Evaluation of clinical interventions made by pharmacists in chemotherapy preparation. Radiol Oncol. 2010;44:249–56.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Chew C, Chiang J, Yeoh TT. Impact of outpatient interventions made at an ambulatory cancer centre oncology pharmacy in Singapore. J Oncol Pharm Pract. 2015;21:93–101.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing 2016

Authors and Affiliations

  • Ji-Min Han
    • 1
  • Young-Mi Ah
    • 2
  • Sung Yun Suh
    • 1
  • Sun-Hoi Jung
    • 1
  • Hyeon Joo Hahn
    • 1
  • Seock-Ah Im
    • 3
  • Ju-Yeun Lee
    • 2
    Email author
  1. 1.Department of PharmacySeoul National University HospitalSeoulSouth Korea
  2. 2.College of Pharmacy, Institute of Pharmaceutical Science and TechnologyHanyang UniversityGyeonggi-doSouth Korea
  3. 3.Division of Hematology and Medical Oncology, Department of Internal MedicineSeoul National University College of MedicineSeoulSouth Korea

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