Pharmacists' Role in Implementation of an Allogeneic HPC Transplant Program

Abstract

The autologous hematopoietic progenitor cell (HPC) transplant program at USC Norris Comprehensive Cancer Center has been in practice since 1987. In 2011, the planning and implementation of allogeneic HPC transplant program began with efforts of a multi-disciplinary team of experts providing collaborative clinical practice. Pharmacists played a key role especially in the creation of policies, preprinted orders, drug therapy management, and education. Pharmacists reviewed medications for the conditioning regimen, graft-versus-host disease (GVHD) prophylaxis, and various supportive cares by evaluating literature and bench-marking with other HPC transplant centers. The goal was to ensure evidence-based practices as well as to meet current regulatory standards. The pharmacists' diligence in procuring and ensuring adequate supply of medications as well as their timely delivery to patients was crucial in light of recent drug shortage challenges. Instituting standing orders for electrolyte replacements, STAT antibiotics, GVHD prophylaxis, and keeping the majority of medications as floor stock items enabled us to achieve this goal. In order to administer high-dose chemotherapy safely, two pharmacists independently verify chemotherapy doses against the standardized regimen listed on the orders. Monographs for key medications containing information such as drug stability, compatibility, and special handling were compiled to provide a quick reference and educational tool for pharmacists. By participating in daily patient rounds, pharmacists monitored patients' clinical status closely, managed complications of high-dose chemotherapy and adjusted levels of anti-GVHD medications in a timely manner. To ensure optimal therapeutic dosing with minimal toxicity, busulfan pharmacokinetics was implemented under joint leadership of pharmacists and nurses. In addition, pharmacists played a major role in educating nurses on high-dose chemotherapy, immunosuppressive agents and the supportive care for infection, mucositis, nausea and vomiting in allogeneic HPC transplant patients. In conclusion, pharmacists played a critical role by providing their expertise in the management of complex drug therapy, monitoring busulfan pharmacokinetics, educating their peers and thus, contributing to the success of the program.