(148) Implementation of Best Practice Alerts to Enhance Pharmacist Dose Rounding Compliance of Biologic and Cytotoxic Oncologic Agents Across a Healthcare System

Poster Abstract: Hematology/Oncology Pharmacy Association (HOPA) released a position paper stating that rounding biologic and cytotoxic oncologic agents within 5-10% to the nearest vial size reduces drug waste, has substantial cost-savings, and does not alter efficacy outcomes. The implementation of a dose rounding protocol at Ochsner Medical Center began in February of 2020, but further analysis found that many missed opportunities occurred with the paper policy.

The initiation of automated best practice alerts (BPAs) notified pharmacist during verification that the specific medication was available for rounding. The feasibility of having electronic health records (EHR) automatically round doses across the Ochsner Health system would be quite an undertaking; this process would take years to implement. The use of BPAs was a simpler and quicker way to potentially increase rounding compliance.

The purpose of this study is to determine if implementation of BPAs can increase compliance of pharmacist dose rounding during order verification.
Our objective is to compare compliance with the policy before and after all EHR alerts were implemented for cytotoxic and biologic oncologic agents. We will also assess the cost-savings associated with these adjustments.

This is a retrospective cohort study conducted within a multi-hospital health system. Medications assessed include any oncologic cytotoxic or biologic eligible for dose rounding that was administered between June 2020 - May 2021 and January - December 2022. Exclusion criteria are patients age < 18 years old, those age > 18 years following a pediatric protocol, and medications given as part of an investigational drug record. Outcomes will be assessed before and after implementation of BPAs. The primary endpoint is compliance of dose rounding by the pharmacists. Statistical analyses will consist of discrete variables, and differences will be analyzed with chi-squared or Fischer-exact test. Data will be collected from EPIC and recorded in a secure REDCAP database that is password protected.

Results, discussion, conclusion: not yet available

References (must also be included in final poster): Dela-Pena JC, et al. Financial Impact of an Automated Oncology Dose-Rounding Initiative, JCO Clin Cancer Inform 5:805-810. ascopubs.org/doi/10.1200/CCI.21.00024. Accessed 1 Sept. 2023. 

Fahey O, et al. Automated Parenteral Chemotherapy Dose-Banding - Sage Journals, journals.sagepub.com/doi/full/10.1177/1078155219846958. Accessed 1 Sept. 2023. 

Fahrenbruch et al. Dose Rounding of Biologic and Cytotoxic Anticancer Agents: A Position Statement of the Hematology/Oncology Pharmacy Association. Journal of Oncology Practice. 2018; 14(3): e130-e136.

“Reducing the Cost of Cancer Care with Automated Dose Rounding and Biosimilars.” EpicShare, www.epicshare.org/share-and-learn/ucsf-mayo-anticancer-cost-savings. Accessed 1 Sept. 2023.

Vishal Shah, et al. Decreasing drug waste, reducing drug costs, and improving workflow efficiency through the implementation of automated chemotherapy dose rounding rules in the electronic health record system, American Journal of Health-System Pharmacy, Volume 79, Issue 8,15 April 2022, 676–682, https://doi.org/10.1093/ajhp/zxab479