Pharmaceutical Services & Sciences

The ER clinical pharmacist is working as an integral part of the 24/7 service we present to our patients.
ER clinical pharmacy team is reviewing new orders, revising the patient’s profile and making medication reconciliation to avoid any contraindications or interactions.

As part of the health care team, our rule is to communicate with the prescribing physician addressing any concerns or interventions accordingly, with the nurse in charge to maximize the medication administration part, and with the consultants in some cases concerning the patient’s upcoming plan.

In each case, we review the patient’s diagnosis, the last chemotherapy cycle he has received, any significant history, and his ambulatory profile to ensure maximum level of care. Medication reconciliation with the patient himself or his caregiver is an essential part of our role with every admission and adjusting dosage according to patient’s renal and hepatic functions.

The ER pharmacist will also ensure that medications are received on time in coordination with the production team to reach better outcomes and optimize quality of care.

Finally, the ER pharmacist will monitor patient’s progress daily, participate in rounds and in discussing new plans, and will follow up with the personalized medicine unit with respect to therapeutic drug monitoring especially for medications with narrow therapeutic index.

Scope of work

The OPD clinical pharmacist acts as a mini- drug information center answering questions of patients or consultants relevant to protocols or individual chemotherapy agents especially if it’s a new protocol and he’s performing the first review following the consultant’s orders in outpatient solid and hematology clinics.

OPD clinical pharmacy team is revising the patient’s profile and making medication reconciliation to avoid any contraindications or interactions in order to confirm the medications ordered to be prepared.
As part of the health care team, our rule is to communicate with the prescribing physician addressing any concerns or interventions with the consultants in some cases concerning the patient’s upcoming plan.

In each case, we review:

• The patient’s diagnosis and the last chemotherapy cycle he has received.
• Current cycle of chemotherapy including: doses, frequency, infusion time and sequence of medication administration.
• Any significant history relevant to the prescribed orders.
• Minimum requirements to start this cycle of chemotherapy regarding (CBC, liver and kidney functions) according to each treatment protocol.
• His ambulatory profile to ensure maximum level of care and adjust dosing per patient’s renal and hepatic functions.

Scope of Work for Clinical Pharmacy

Daycare Unit Pharmacy for

1. Chemotherapy
1. Checking Chemotherapy Pharmacist:
• Review patient name, MRN & demographics (weight, height, BSA & age).
• Review patient diagnosis, risk stratification and stage.
• Review at least 2 previous cycles of chemotherapy according to the road map of each protocol and combined clinic if there’s any.
• Review the required cycle of Chemotherapy (medications, doses, frequency, minimum dilutions, route of administration, rate and duration according to time of infusion ) according to each protocol.
• Review patient previous history of allergies and toxicities to consider dose modification if required.
• Calculate doses of prepared medications comparatively to the written physician order acc. to KG or metric dosing, rate of infusion, diluents, minimum dilutions and clarity.


2. Chemotherapy Administration Audit:


• Section I Patient Education:



Initial Step: (Through Patient’s File or Cerner)

• Review patient name, MRN & demographics (weight, height, BSA & age).
• Review patient diagnosis, risk stratification and stage.
• Review at least 2 previous cycles of chemotherapy according to the road map of each protocol and combined clinic if there’s any.
• Review the required cycle of Chemotherapy (medications, doses, frequency, minimum dilutions, route of administration, rate and duration according to time of infusion ) according to each protocol.
• Review patient previous history of allergies and toxicities to consider dose modification if required.
• Check minimum requirements to start prescribed cycle according to the treatment protocol.
• Review patient’s current status and history of Radiotherapy and Surgery.
• Check if patient is currently on Multispecialty or supportive medications.
• Check drug interactions between all current medications and the prescribed cycle of chemotherapy.



2nd Step: (Through a Patient or Legal Guardian Comprehensive Interview) attached

• Positive patient identification.
• Adapt the interview technique according to the current needs of the patient.
• Combine Pharmaco-therapeutic knowledge with a solid foundation of excellent communication and patient-interviewing skills.
• Explain to the patient why this interview is conducted and how long it takes.
• Encourage the patient to have a two-sides conversation.
• Assure that all collected data will be documented in the patient’s medical record.
• Check the currently administered medication, its rate and specific per-patient precautions if any.
• Confirm on the patient the duration of his chemotherapy cycle and total number of days.
• Collect all data by filling in patient education form on Cerner using open-ended questions.
• Illustrate the common side-effects that patient may experience and how to minimize.
• Illustrate all necessary instructions and checkpoints during administration of current cycle.
• Illustrate all required precautions at home and immediate corrective actions or ER referral.
• Assure that patient is taking his home medications correctly to optimize adherence.

Ask if the patient has any kind of questions

• Section II Nursing Team Education:
• Performing twice per week sessions for discussing:
1. Safe Handling techniques while dealing with chemotherapy.
2. The classification of different cycle of chemotherapy based on duration of infusion.
3. The precautions needed before/during infusion of commonly used IV chemotherapy.
4. Extravasation properties for those IV chemotherapy and how to manage.
5. Administration and storing prepared IV chemotherapy under its adequate conditions.
6. The most common drug-drug interactions.
7. The ideal sequence of chemotherapy infusion to optimize its effect.
• Assure on daily basis that nurses are following all necessary instructions and checkpoints during chemotherapy administration.
• Assure a good communication plan with OPD Pharmacists to provide all necessary instructions upon administering a new chemotherapy or following a new protocol.
• Educate nurses about all chemotherapy side-effects the patient may experience during or after administration.


2. Supportive Care Unit Pharmacy:
• Review patient’s name, MRN, and demographics.
• Review patient’s medical history and ambulatory profile.
• Review patient’s previous allergies and history of toxicities.
• Medication reconciliation on Cerner.
• Providing patient education and assessing patient’s medication use and compliance.
• Review laboratory tests, microbiology and blood culture results.
• Check the appropriateness of the medications prescribed according to guidelines.
• Calculate the doses of the medications prescribed.
• Check for drug-drug interactions.
• Check rate of infusion and minimum dilution if necessary.
• Ensure correct and timely medication delivery and administration.
• Provide up to date drug information to physicians and nurses.


3. Take-Home Oral Medication Daycare Pharmacy:
• Positive patient identification.
• Review medications from copy of physician order or patient’s medical record on Cerner.
• Inform the patients’ parents about medications, doses, frequency, durations, side effects and interactions if there are any.
• Confirm with parents that all instructions are clear enough for medication adherence.
• Ensure patients’ compliance for their medications.
• Ask parents for any further questions or more verification.