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Section 1: Ordering Chemotherapy 
Section 2: Pharmacy 
Section 3: Nursing 
Administration of New Agents 
Appendix 1  

Section 2: Pharmacy

1. Chemotherapy letters received from Eastern Health must be written by an Oncologist, and reviewed and signed by the Oncologist and the Clinical Oncology Pharmacist.

2. Prior to the preparation of chemotherapy, a written order must be received at the patient’s pharmacy site, from the physician at that site who is responsible for providing chemotherapy services to the patient. 

3. Upon receipt of this order the pharmacist is to verify the order with the original chemotherapy letter to ensure that any necessary adjustments in dosage, due to weight change, are correctly calculated. 

4. The chemotherapy letter from the Oncologist / Hematologist is to be placed in the patient’s specific file in the pharmacy department.

5. Chemotherapy is then prepared as per the policy and procedures of the pharmacy department at the treating facility.

Pharmacy Processing of Chemotherapy Orders
1.The chemotherapy order is received in Pharmacy.  All chemotherapy orders must have an independent double check.

2. The prescription is reviewed by the Pharmacist, ensuring all prescription elements identified in Section 1 above, are included. The prescription is then entered into the patient profile by a pharmacist or technician (trained in chemotherapy order entry) and labels are generated.

3. The pharmacist must verify the following information as correct:
a) Patient name, address and HCN (Health Care Number)
b) Body surface area calculation
c) Relevant laboratory data necessary to calculate dose (e.g., serum creatinine) and relevant blood work to meet specific protocol specifications as indicated on BC Cancer Agency website, Cancer Care Ontario website or other accepted reference.
d) Diagnosis and protocol
e) Correct dosage calculations
f) Directions for administration and infusion time
g) Protocol, including cycle number, frequency and sequencing of therapy
h) Dilution, final volume (if required)
i) Area under the curve dosing (if required)
j) Appropriateness of medication, dose and route of administration, actual or potential allergies and sensitivities, actual or potential interactions as referenced against the site specific Pharmacy computerized patient record and the prescription.

4. An independent double check is performed verifying all points outlined in # 3 (a through j) above.

The final pharmacy check must include but not limited to:

  • Compare the original prescription to the product label to ensure right patient, right drug, and right dosage, ensure correct base solution, route, final volume, drug dilution, volume calculation, protocol, allergies and storage requirements.
  • Ensure required auxiliary labels, preparation and expiry date/time and packaging is completed. 
Verification of Chemotherapy Medication Orders by Pharmacy

If a chemotherapy medication order is not consistent with usual or standard therapy (as defined by the Tumor Board or Pharmaceuticals and Therapeutics Committee and provided to pharmacy), the pharmacist reviews the protocol and any accompanying references to verify the order.
If the medication order is not consistent with usual or standard therapy, the Oncologist must seek approval of the tumor disease site group, Provincial Systemic Therapy Advisory Committee, and the Eastern Health Regional Pharmaceuticals and Therapeutics Committee.  If the Oncologist is seeking a one time approval for a single patient, and treatment cannot wait for the preceding processes to be adhered to, then approval must be requested from the Cancer Care Program Director, Clinical Chief or delegate through the rapid response team approval process.
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Updated Dec 4, 2013