Presenting Author: Sarah Hogue, PharmD, St. Luke’s Health System, Boise, ID
BACKGROUND: Dose rounding of injectable oncolytic agents is a well-established strategy to enhance medication safety, reduce drug waste, and optimize utilization without compromising therapeutic efficacy. At St. Luke’s Health System, a standardized dose-rounding policy was built into the electronic health record (EHR) for targeted medications to automate and streamline this practice across oncology services.
OBJECTIVE: To evaluate the financial impact of EHR-enabled dose rounding for oncolytic agents by comparing prepolicy dose-rounding opportunities with actual cost-savings achieved after implementation.
METHODS: A phased EHR implementation was conducted over 6 months (April 2025-September 2025), targeting 52 high-cost injectable oncology medications. The EHR was configured to support automated dose rounding to the nearest vial size within or equal to 10% variance of the calculated dose, minimizing manual intervention and standardizing practice across providers and sites. The monthly drug cost-savings and rounding opportunities were tracked via EHR order and administration data to assess the effectiveness of the implementation.
RESULTS: From July 1, 2025, to August 31, 2025, the rounding of 34 targeted medications resulted in a total drug cost-savings of $455,092 compared with a baseline monthly savings of $73,691, with pharmacists manually rounding select orders, with an additional $123,263 in rounding opportunity identified for 18 additional EHR medication builds. Assuming similar average monthly savings, a projected annual cost avoidance using dose rounding is approximately $3.47 million. These findings demonstrate the substantial financial and operational benefits of integrating dose rounding into the EHR workflow.
CONCLUSION: EHR-enabled dose rounding of oncolytic agents at St. Luke’s Health System has proved to be a successful strategy for reducing drug waste and achieving significant cost-savings. The automation of this policy within the EHR supports consistent clinical practice as well as enhances pharmacy operations and resource stewardship. Continued monitoring and expansion of this initiative may further optimize oncology medication management and support broader institutional goals for value-based care.
- Fahrenbruch R, Kintzel P, Bott AM, et al. Dose rounding of biologic and cytotoxic anticancer agents: a position statement of the Hematology/Oncology Pharmacy Association. J Oncol Pract. 2018;14:e130-e136.