Presenting Author: Sarah Castelo, PharmD, BCOP, Vanderbilt University Medical Center, Nashville, TN
Co-Author: Nick Hopkins, PharmD, BCSCP, Vanderbilt University Medical Center, Nashville, TN
BACKGROUND: Pharmacists trained in oncology oversee and manage the use of oncology medications from a core pharmacy within the oncology infusion center. There are limited data on the value of a decentralized infusion pharmacist in an oncology infusion center.
OBJECTIVES: To improve efficiency of infusion clinic workflow by integrating an oncology-trained infusion pharmacist with the nursing staff to assist with troubleshooting, problem-solving, and communication with the core pharmacy and the clinical pharmacy specialists. Also, to improve patient care by providing more direct access to a pharmacist.
METHODS: This quality improvement study was conducted at an oncology infusion center at Vanderbilt University Medical Center, Nashville, TN, an academic medical center. A pharmacist worked in the decentralized infusion pharmacist role during peak clinic hours when the operations of the pharmacy could be safely and efficiently managed without the pharmacist physically located inside the core pharmacy. The decentralized infusion pharmacist worked in the oncology infusion clinic, integrated with the nursing staff. Data collected included the number of bedside double-checks for chemotherapy conducted, the number of questions fielded from nursing and the core pharmacy, communication with clinical pharmacy specialists, and patient education. The authors conducted an online satisfaction questionnaire after the pilot program was complete.
RESULTS: A total of 1796 patient visits were completed on 20 separate days from January 2024 to August 2024, when decentralized infusion pharmacist coverage was provided. The most common tasks performed by the decentralized infusion pharmacist included fielding questions from nursing (n=209), bedside double-checks for chemotherapy (n=156), and fielding questions from the core pharmacy (n=86). Of the staff members who completed the satisfaction questionnaire, 60% of nurses reported feeling less busy with the integration of a decentralized infusion pharmacist; whereas 54% of pharmacists in the core pharmacy reported no significant difference in their workload.
DISCUSSION: Decentralization of pharmacy services includes moving the decision-making closer to users. By adapting departmental workflow, pharmacy services are better able to support nurses. There was continuous effort to refine processes to address nursing and pharmacy concerns.
CONCLUSIONS: The integration of a decentralized infusion pharmacist in the oncology infusion clinic improved accessibility to a pharmacist, improved clinic workflow for the nursing staff, and increased the ability to troubleshoot issues. Further studies are needed to fully evaluate the effects the decentralized infusion pharmacist role would have on patient-related outcomes.
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