Background/rationale
Cancer pharmacy services enhance the safe and effective treatment of patients however cancer care often occurs outside of standard pharmacy hours. Clinicians have called for continuous availability of cancer pharmacy services through on-call service provision, to provide timely expert advice and verification of new or altered therapies. Additionally, the widespread adoption of electronic chemotherapy prescribing systems (ECPS) requires continuous clinical support to facilitate their safe and efficient use.
Methods
A 4-month pilot of a clinical cancer pharmacy on-call service in a major tertiary hospital evaluated service need to inform an ongoing model across a statewide pharmacy service. Ten calls were received; 80% for haematology and 20% for oncology patients. 60% of calls were avoidable, appropriate for a non-cancer on-call pharmacist or management within business hours. 80% of calls were simple to moderate in complexity. A concurrent on-call service providing clinician support for a new statewide ECPS receiving an average of 5 calls per month.
Impact on practice
An infrequent but important need for cancer pharmacy services outside of standard hours was identified. The clinical cancer pharmacy and ECPS on-call services were merged and extended statewide to 18 adult cancer centres. A centralised team of cancer pharmacists with expertise across both areas provides the service, which includes clinical and digital escalation pathways. Five months post implementation, on-call support has been provided to 41 patients / clinicians. 19.5% have required cancer pharmacist services and 80.5% have required ECPS support.
Discussion
This unique on-call service model enables timely and equitable access to cancer pharmacy care across the state. A statewide combined clinical and digital support service is efficient, streamlining pharmacy support and minimising service duplication within a limited workforce. This provides an exemplar for other health services to consider when providing around the clock cancer pharmacy care.