News and Information

Centerpoint Winter 2009 (PDF)

Oncology Pharmacy Team Plays Critical Role in Patient Safety and Care

Patients get to know their physicians and nurses during visits to Yale Cancer Center but many may not know there is a staff of oncology pharmacists providing expertise and support behind the scenes.  These specialized pharmacists ensure that each patient’s chemotherapy treatment is correctly ordered, prepared, and administered.  In 2008, Yale-New Haven Hospital oncology pharmacists provided over 45,000 doses of chemotherapy to cancer patients treated by Yale Cancer Center physicians; a number that has increased by over 30% over the last three years.  The pharmacy team thoroughly evaluates each chemotherapy order through a series of multiple checks, before any patient is started on their treatment, providing a critical component to enhanced patient safety.

“The pharmacists in the oncology clinics are a critical element of patient treatment and quality control at Yale Cancer Center.  Their expertise and commitment to patient safety helps to ensure that we provide the optimal care for each patient we see,” Edward Chu, MD, Chief of Medical Oncology and Deputy Director of Yale Cancer Center, said.

Led by Nancy Beaulieu, RPh, a Board Certified Oncology Pharmacist (BCOP), and Manager of Oncology Pharmacy Services, the pharmacy staff reviews each physician’s order for accuracy, dosage, frequency of chemotherapy, possible side effects, potential negative drug interactions, and the inclusion of appropriate supportive care medications.  In the clinic setting, once the order has been verified for treatment, a multistep process ensues, which includes processing the order in the pharmacy computer system, performing mathematical calculations, and reviewing the patient’s latest blood results to ensure an adequate blood count for treatment.  In addition, laboratory results measuring kidney and liver function are reviewed to assess that the patient can fully metabolize and eliminate each chemotherapy drug administered.   Next, the correct medications and supplies are gathered to prepare for mixing.  A trained oncology technician mixes the chemotherapy in a clean room (a specifically designed environment for preparing intravenous medications), bags the completed mixture using safe handling procedures, and sends it out for final preparation check.  At this time, a second pharmacist then performs the final product check before it is sent to the nurses for infusion. 

“Each patient’s chemotherapy medication is custom made to their individual requirements.  This ensures that every patient receives the correct dosage and treatment.  Pharmacy is an integral line of defense in the patient safety process of chemotherapy administration at Yale,” Beaulieu explained.  Additionally, when non-routine treatment is ordered, Ms. Beaulieu and her team research the prescribed treatment and analyze the available data before proceeding with the therapy. 

Ms. Beaulieu has been specializing in oncology at Yale-New Haven Hospital for over 15 years and while the practice has grown substantially, the priorities of the pharmacy team have remained the same.  “We are here to provide the oncology pharmacy expertise needed to support the physicians and nurses in the care of each cancer patient,” Beaulieu said.  “It is important that patients know we are available to discuss their drug treatment plan and answer any questions or concerns they have regarding medications.  One of our ongoing goals is to make our presence more visible in the clinics.”

Many of the pharmacists focus on specific disease areas and work with the Yale Cancer Center clinical program teams by attending team meetings, conferences, and research site initiation visits.  The new Smilow Cancer Hospital will combine the three existing oncology pharmacy locations into one facility on the 8th floor of the building.  “The Smilow Cancer Hospital will allow us to become even more integrated in the clinical program teams,” Beaulieu said.

Keeping current with new therapies, dosages, and indications for treatment is an ongoing challenge for oncology pharmacists.  In the last few years, Ms. Beaulieu and her team have seen the frequency of treatments multiply, increased use of oral medications, and fresh challenges created by the side effects from innovative-targeted therapies.  New protocols emerge daily and the constantly evolving cancer treatment environment demands continuing education.

Clinical research and teaching are critical components of Yale Cancer Center’s mission.  The pharmacy team participates in research advances by supporting the treatment strategies of the numerous clinical trials through the trial protocols.  Pharmacists are also actively involved in formal teaching, by instructing classes at the Yale University School of Nursing and the University of Connecticut School of Pharmacy.  In addition, Yale-New Haven Hospital offers an oncology residency program for pharmacists to specialize their education in cancer care.  Working along with the specialized pharmacists and the cancer clinical programs helps the residents gain first-hand experience to tailor their career in oncology services.  The intellectual challenge and the desire to make a positive impact in patient’s care is what keep the pharmacy staff interested and committed to their clinical role at Yale. 

“Having witnessed so many improvements in cancer therapy over the last 15 years, there is an incredible level of satisfaction in knowing that as an oncology pharmacist you provide the drug therapy that may cure a patient’s cancer today or in the future.  There is no greater gratification than seeing a patient years out from treatment, walking through the center just to say hello,” said Beaulieu.