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Pharmaceutical care in an inpatient pediatric hematopoietic stem cell transplant service

Unité de Recherche en Pratique Pharmaceutique, Pharmacy Department, Centre Hospitalier Universitaire (CHU) Sainte Justine, Montréal, Québec, Canada

Roxane Therrien, B Pharm MSc

Pharmacy Department, Centre Hospitalier Universitaire (CHU) Sainte Justine, Montréal, Québec, Canada

Colette Demanche, B Pharm MSc

Pharmacy Department, Centre Hospitalier Universitaire (CHU) Sainte Justine, Montréal, Québec, Canada

Diane Larocque, B Pharm MSc

Pharmacy Department, Centre Hospitalier Universitaire (CHU) Sainte Justine, Montréal, Québec, Canada

Jean-François Bussières, B Pharm MSc MBA FCSHP

Unité de Recherche en Pratique Pharmaceutique, Pharmacy Department, Centre Hospitalier Universitaire (CHU) Sainte Justine, Montréal, Québec, Canada, jf.bussieres{at}ssss.gouv.qc.ca

Introduction. Hematopoietic stem cell transplant patients represent a population at high risk for drug-related problems. Our objective is to describe pharmacist interventions in a hematopoietic stem cell transplant pediatric unit.

Methods and Patients. The Hematopoietic Stem Cell Transplant Unit of the Centre Hospitalier Universitaire Sainte-Justine performs around 50 hematopoietic stem cell transplants per year. During a pharmaceutical care specialized residency program, a French pharmacist participated in certain clinical activities. Drug-related problems and clinical interventions were compiled over 31 nonconsecutive days using a tool developed by the Société Française de Pharmacie Clinique. Data concerning patients, drugs, intervention, documentation, approval (if needed), and estimated impact were compiled.

Results. During the 31-day period, 525 interventions were collected (16.9 ± 3.7 per day), targeting 29 patients. The main drug-related problems were adverse drug reactions (N = 125, 23.8%), untreated indication (N = 92, 17.5%) and failure to receive drug (N = 89, 17.0%). The pharmacist's interventions concerned mainly dose adjustment (N = 174, 33.1%) and drug monitoring (N = 132, 25.1%). Among the 324 (61.7%) interventions requiring a physician's approval, 302 (93.2%) were accepted without any change.

Conclusion. A pharmacist is able to perform clinically relevant interventions in a hematopoietic stem cell transplant unit, given the complexity of the pharmacotherapy. Our description of drug-related problems and interventions may help other pharmacists already working or developing pharmaceutical care in a hematopoietic stem cell transplant unit to compare their practice and it is one of the few reported in the literature. J Oncol Pharm Practice (2008) 14: 147—152.

Key Words: pharmaceutical care • pharmacist intervention • clinical pharmacy • documentation • hematopoietic stem cell transplant • bone marrow transplant • inpatient

Journal of Oncology Pharmacy Practice, Vol. 14, No. 3, 147-152 (2008)
DOI: 10.1177/1078155208093929


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