Setting: Small community hospital with ambulatory oncology program
Target Audience: pharmacy manager who is not an oncology pharmacist
Oncology service level required: Essential
Experience: clinical low, oncology low
Jean-Philip is a pharmacy manager at a rural community hospital and oversees the facility’s pharmacy program. The hospital has an ambulatory oncology program that provides care to approximately 10-15 oncology patients daily. They have 3 pharmacists that provide services for all outpatient clinics and approximately 75 inpatient beds. Oncology orders are processed in the main pharmacy with clinical order review completed by the pharmacist covering the main desk. The oncology clinic regularly asks for support with drug interaction questions and patient education but the pharmacy team has not been able to provide much more than that.
One of the pharmacists has recently retired and they were able to recruit Sylvie who is from the local area and a recent graduate of an accredited entry-level PharmD program. She has completed her institutional placements at the hospital but has had limited exposure to oncology patients during those rotations.
Jean-Philip needs to get Sylvie prepared to provide day to day coverage before their summer vacations start and she will be needed to cover at the desk, which includes reviewing the oncology orders as well as providing support to the oncology clinic when requested.
- How should Jean-Philip approach training Sophie?
Before jumping into the planning for Sylvie’s on-boarding to the pharmacist role, Jean-Philip should take a step back and fully contemplate the need he must fill.
- What must be done by the pharmacist at this site? Jean-Phillip must understand the role as it is desired, not necessarily as it was.
- Jean-Phillip must also understand what Sylvie’s current gaps in knowledge and skills are in relation to what the needs are in the role. To do this, he could ask Sylvie to complete a self-assessment.
- What are the patients’ needs from their oncology pharmacist?
- In this rural setting, pharmacy resources are limited.
- The current focus of the pharmacy team is on order review, product preparation/administration, and staff safety.
- The current focus for the oncology pharmacist is on essential services with the provision of enhanced services when time permits.
- Some patients likely need more consistent enhanced services but current resources limit this.
- Securing additional resources will require advocacy for benefits of oncology pharmacists and role expansion. This is beyond the scope of this section.
- What level of service will be provided - essential or enhanced?
- This case is a scenario where the final state is a pharmacist who is able to perform activities consistent with essential services as their primary role:
- Perform BPMH and reconcile medications.
- Perform drug interaction reviews with BPMH and anticancer/supportive medications.
- Review orders for accuracy, safety, and appropriateness.
- Identify and resolve DTP’s related to anticancer medications.
- Provide effective patient education.
- The oncology patients and collaborating healthcare professionals at this site also need a pharmacist who is able to perform activities from enhanced services on a consult basis when time permits:
- Since a structured, proactive service is likely not feasible, Sophie should be capable of providing reactive management of treatment emergent toxicities including:
- Management of cancer and anticancer medication-associated toxicities or adverse drug reactions.
- Management of anticancer medication adherence.
- Development of a pharmaceutical care plan related to a patient’s cancer or cancer associated medications.
- Since a structured, proactive service is likely not feasible, Sophie should be capable of providing reactive management of treatment emergent toxicities including:
- What competencies should be prioritized for Sylvie’s learning?
- Competencies associated with Essential Services:
- Pillar 1 - Professional Practice in Cancer Care
- Sylvie will need to be able to communicate effectively and work within a multidisciplinary team
- She will need to understand the role and value of each team member
- She should represent pharmacy services professionally
- Pillar 2 - Knowledge of Cancer and its Management
- Sylvie will need foundational knowledge in cancer to understand the patient’s journey and understand the patient’s needs to establish a relationship
- Her training should focus on anticancer pharmacotherapy and understanding of a safe anticancer medication use system including preparation and administration
- Pillar 3 - Safe and Appropriate Use of Anticancer and Supportive Care Pharmacotherapy
- Sylvie will need foundational knowledge in clinical practice of pharmacy within the context of an oncology patient including reviewing diagnosis, treatment selection, and identification/prioritization of DTPs
- She will need to be able to gather the important information required for cancer-related pharmacotherapy assessment including:
- Ensure the cancer-related pharmacotherapy plan is indicated and appropriate
- Ensure the drug, dose, formulation, and scheduling is expected to be effective to meet the cancer-related health outcome
- Ensure the cancer-related drug, dose, formulation, and scheduling is expected to be safe
- Evaluate if the cancer-related drug is reasonably accessible
- Sylvie should be aware of all requirements for safe handling of hazardous drugs by pharmacy team members
- Ensure safety standards are maintained in anticancer pharmacotherapy preparation, distribution, dispensing, and administration
- Pillar 4 - Person-Centred Care in Clinical Oncology
- As a new graduate, Sylvie will require support, coaching and mentoring to help her develop skills to better understand the needs of her patients including:
- Recognizing persons with cancer as individuals with unique characteristics, values and health needs
- Gathering relevant information in the provision of patient care
- Assessing the patient’s cancer-related pharmacotherapy needs
- Identifying actual and potential drug therapy problems (DTPs) affecting cancer-related pharmacotherapy
- Prioritizing health equity, inclusion, and accessibility in patient care activities
- As a new graduate, Sylvie will require support, coaching and mentoring to help her develop skills to better understand the needs of her patients including:
- Pillar 5 - Health Promotion and Advocacy
- Sylvie’s role in advocating for oncology pharmacy practice will focus on the professional provision of her services and advocating for patients to optimize outcomes and wellbeing where appropriate
- Pillar 1 - Professional Practice in Cancer Care
- What competencies could be considered for Sylvie once she has achieved the competencies required for essential services so that she can respond to consults?
- Competencies associated with Enhanced services:
- Pillar 2 - Knowledge of Cancer and its Management
- If consulted, Sylvie will need to acquire and maintain knowledge and skills to provide enhanced oncology services such as:
- Supportive care and toxicity management
- If consulted, Sylvie will need to acquire and maintain knowledge and skills to provide enhanced oncology services such as:
- Pillar 3 - Safe and Appropriate Use of Anticancer and Supportive Care Pharmacotherapy
- Sylvie may be consulted to discuss strategies to optimize patient adherence to cancer-related pharmacotherapy
- She should also be aware of the required assessment and follow up prior to subsequent cycles of treatment
- Pillar 4 - Person-Centred Care in Clinical Oncology
- When consulted, Sylvie will need to be able to communicate effectively with patients to gather the required information and make decisions about a patient’s treatment with their individual needs/goals in mind including:
- Establish and maintain a professional relationship with the person with cancer and their care partner(s)
- Gather relevant information in the provision of patient care
- Assess the patient’s cancer-related pharmacotherapy needs
- Identify actual and potential drug therapy problems (DTPs) affecting cancer-related pharmacotherapy
- Develop a patient-centered care plan addressing cancer-related pharmacotherapy needs
- Implement and follow-through with the care plan
- Educate, engage, and support patients and care partner(s) regarding cancer management
- Prioritize health equity, inclusion, and accessibility in patient care activities
- Pillar 5 - Health Promotion and Advocacy
- By providing consultant enhanced services, she will showcase the need for increased resources to provide care more consistently to all oncology patients
- Pillar 2 - Knowledge of Cancer and its Management
- What other issues should Sylvie and Jean-Phillip address in consultation with their senior pharmacy leaders, physicians/prescribers and allied healthcare practitioners?
- Which patients to target
- Given the lack of resources at this site, focus should be on essential services
- Refer to the evidence section of the toolkit …
- What needs/gaps are identified by the healthcare team from their current patient care services?
- These services will likely only be available on a consult basis
- What is the timeline? When do they need Sylvie trained and ready to step in?
- Dependent on the needs of the clinic and background of the new pharmacist
- Targeted orientation if needed (e.g. focus on order review initially and build to toxicity management over time)
- Dependent on competency and knowledge uptake
- Timeline may be extended if needed
- Dependent on the needs of the clinic and background of the new pharmacist
- What are the goals and objectives for Sylvie’s training period?
- Perform Chemotherapy Order Verification
- Provide Patient Education on Oncology Therapies
- Identify and Manage Common Oncology Toxicities
- Apply Institutional Oncology Protocols and Resources
- Communicate Effectively within the Healthcare Team
- What strategies will be taken to achieve these goals?
- Refer to resources document to select resources whose learning objectives align best with the learning objectives for Sylvie’s training
- What approaches can be added to develop skills and attitudes? In addition to the required knowledge to fulfill the role, what opportunities can Jean-Philip arrange for Sylvie to facilitate preparedness for oncology practice?
- Identifying a mentor within the pharmacy team if available
- Training shifts that incorporate oncology order review
- Progression from observation to practice with guidance/coaching to independent practice with the pharmacist as a resource
- Structured shadowing (with objectives) developed including:
- Pharmacist
- Reviewing essential and enhanced service roles for pharmacists
- Oncology technician mixing/checker
- Drug storage
- Preparation
- Final product checking
- Drug Access Navigator
- Funding process
- Needs for pharmacist
- Nursing
- Drug administration process
- Patient support process
- Needs for pharmacist
- Prescriber/oncologist/hematologist
- Patient assessment, treatment decision making
- Needs for pharmacist
- Pharmacist
- What is the implementation plan?
- Schedule for training
- Individualized to trainee’s self-assessed needs
- Assessment plan
- Jean-Phillip should schedule regular check-ins with Sylvie
- Jean-Phillip should schedule separate, regular check-ins with Sylvie’s mentor
- Jean-Phillip should plan to follow up with other members of the pharmacy team and the other Healthcare Professionals in the clinic
- Role of everyone involved
- Clear expectations for Sylvie, her mentor and other members of the pharmacy team
- Clear communication with other Healthcare Professionals in the clinic
- Schedule for training
- Evaluation
- Plan to determine whether goals and objectives are achieved
- Feedback from everyone involved about the process
