Expert Discusses Automated Chemotherapy Dose Rounding

In an interview with Pharmacy Times® at the American Society of Health-System Pharmacists Summer Meetings and Exhibition, Jeff Betcher, BSPharm, MBA, director of pharmacy at Mayo Clinic in Arizona, discusses how automated chemotherapy dose rounding can help decrease drug waste and cost.

Q: What is the pharmacist’s role in an oncology care team?

Jeff Betcher: I think there are a lot of roles for the pharmacist, the oncology care team, starting with cancer screening, and prevention, also patient education with many of these newer oral oncology medications as well as the IV therapies that are available. They're also involved with guidelines, consensus-based guidelines and evidence-based guidelines, and then selecting dosing and therapy management for patients.

Q: How can pharmacists help guide treatment and improve tolerability for patients?

Jeff Betcher: I think that's a great question, especially with all the new oral cancer therapies that are available. I think much of this starts with participation in, again, evidence-based or consensus-based guideline organizations to develop guidelines, and then helping with adherence of those guidelines within your clinical practice. I think also the pharmacist can play an important role as with all medications in selecting the appropriate medication for the cancer as well as the supportive care agents that would be important to that patient. I think we strive to improve and optimize the drug therapy management plans, but also try to eliminate toxicity, minimize toxicity and financial toxicity as well.

Q: A recent study you conducted found that implementing automated chemotherapy dose rounding can help decrease drug waste and cost. What is automated chemotherapy dose rounding?

Jeff Betcher: Automated chemotherapy dose rounding is where you utilize your electronic health record (EHR) to implement guidelines that have actually been supported by different organizations like the Hematology Oncology Pharmacy Association in 2018. Dose rounding guidelines are input into the HER, and those can be standardizing dose rounding to vial size, which is many times utilized. Most centers use within a 5% to 10% of the original prescriber, original dose ordered dose, and then we go ahead and put that into the system. The rules can include dose banding, which takes a range of dosages and puts them within different bands of dosing. Then there's also we also added an additional nuance to the system where even if you were now able to save a vial and round to a vial size, we would round to the next measurable volume that was easily measured. It would minimize technician calculation errors as well as improving efficiency.

Q: How can this improve patient care?

Jeff Betcher: I think it can help improve patient care many ways. One, it can reduce cost to both the patient and the payer. Ultimately, that reduces the healthcare burden financially. Two, it can help improve safety within the pharmacy and the oncology unit as well. If you have multiple practitioners, nurses, pharmacists all doing these dose calculations down to very small minuet quantities, it's many times much easier if you have a rounded dose, and it makes it simpler and much safer.

Q: What is the role of the pharmacist in automated chemotherapy dose rounding?

Jeff Betcher: I think there are multiple cheers to that. I think early on the role is to get the protocol to see the vision put together and implement a team and then get buy in from the provider group as well as the nursing group that you're working with at your institution. Second is to have the right subject matter experts at the table, so you're compounding pharmacist, you're compounding technicians. They're very important to help you decide what those dose bands could and should look like as well as what the next safest volume would be as far as the rounding protocol. Then the pharmacy informaticists is key to being able to develop this within the medical record so that it presents the dose rounded for the physician so that then it's easy for them to apply that to the plan. I can't overemphasize the importance of having the subject matter experts and the informaticist involved with this process.