An audit of adherence to National Cancer Care Programme chemotherapy regimens and prescribing standards in systemic anti-cancer therapy prescriptions in an Irish hospital
Authors: Carroll S , Murphy K D 
Published: April 2024

Abstract

Introduction
The availability and usage of systemic anticancer therapy (SACT) has increased significantly over recent years. Whilst SACT has undeniably benefited patients, it also poses a challenge to patient safety as the number of cytotoxic drugs increases. The National Cancer Care Programme (NCCP) has set out to design and implement national policies and practices for oncology medicine in Ireland in order to maintain high levels of patient safety.

Aim
This study aims to evaluate adherence to NCCP national SACT regimens and prescribing standards at an Irish hospital.

Methods
This study was a prospective analysis involving an audit of SACT prescriptions for adherence to NCCP regimens and prescribing standards. The study was conducted from June 6th to June 30th 2023; the cohort was defined as patients who were receiving cancer services’ treatment from the medical oncology and haematology department at the hospital. The data collection tool was developed using template in the NCCP Oncology Medication Safety Review Report 2014. A report was run to identify outpatient patients who received SACT on each working day. For inpatients, a daily scheduling Excel file was consulted. Prescriptions were evaluated to complete the data collection tool. Anonymised data was captured and the results were collated to show any trends in adherence to NCCP regimens and prescribing standards. Descriptive analysis of patient and clinical characteristics was performed.

Results
Pharmacy prescription records of all patients who received SACT during the four-week study period were analysed. A total of 410 SACT prescriptions were reviewed. The median patient age in the study cohort was 59 years (range 23-93 years). Overall, 86.3% of the audited prescriptions adhered to NCCP regimens. The oncology department exhibited a higher adherence rate of adherence to NCCP regimens compared to the haematology department (89.2% versus 82.3%). Melanoma, non-small cell lung cancer, small cell lung cancer, renal cell, prostate, sarcoma, and bladder cancer all had 100% adherence. The lowest adherence rates occurred for CNS (25%), mesothelioma (50%), leukaemia (76.5%), and metastatic colorectal cancer (77.3%). Only 7% of prescriptions were written on pre-printed forms. In this audit, over 98% compliance was observed for eleven of the twenty-four NCCP prescribing standards in the 410 prescriptions: including patient name, patient date of birth, diagnosis, name of supervising consultant, protocol/regimen name, name of drug(s), dose in mg or mg/m2, route of administration, signature of the prescriber and date prescribed. Areas for improvement identified include information about ward/clinic, renal/hepatic function, start date, cycle numbers and medical council numbers.

Conclusion
This is the first audit of adherence to NCCP regimens using prescription data in Ireland, and the inclusion of 410 samples is a strength; however, the data are from a single site. This study has highlighted areas for improvement in prescribing practices. It emphasises the need for further multidisciplinary team education on adherence to NCCP regimens and prescribing standards. Healthcare professionals should ensure that pre-printed SACT prescription forms are used where available. Additionally, the use of regimen-specific pre-printed forms should be expanded.