Strong interdisciplinary relationships between healthcare providers, specifically pharmacy and nursing, can play a crucial role in patient success with oral chemotherapy regimens.
Combining the vast knowledge of the pharmacist with nurse-led comprehensive patient education can ultimately lead to best effective practice.
“Healthcare professionals need to be aware that patients tend to think of oral chemotherapy as ‘safer’ and common nonlife threatening side effects as an inconvenience,” says Jerry Wu, PharmD. “These factors lead to missed doses, self-initiated dose reductions, or discontinuation. Patients need to be educated to take as directed to maximize the therapeutic benefits and encouraged to report any adverse events, no matter how minor.”
ENSURE SAFE HANDLING
Discussion of safe handling practices is imperative to prevent unwanted adverse effects and exposure to caregivers and family members. This time should also be used to dispel any incorrect misconceptions surrounding the safety of the medication.
• If possible, pregnant caregivers should not handle medication to decrease potential exposure.
• Caregivers should be sure to wash their hands thoroughly pre-and post-administration, ideally wearing gloves.
• Medication should be provided to the patient in a plastic cup or syringe, and never crushed or broken, as this can aerosolize the drug.
• Ensuring patients are able to swallow medication in pill form prior to the initial dose can prevent incorrect dosing related to chewing medication.
In addition, it is vital that patients and caregivers know how to store medication appropriately. Oral chemotherapy should be stored in places avoiding heat and sources of light, as well as kept out of reach from children and pets. It should be kept in prepackaging, if possible, and never mixed in pill boxes with other medications.
Jaclyn Aremka, PharmD Candidate 2018 at Drake University adds, “Storage of medication is important to make certain the patient is getting the full benefit of the medication by protecting it from degradation. Medication can degrade in a variety of different ways, but one of the most common form is moisture.”
“Most patients tend to store their medications in the ‘medicine cabinet’ located in the bathroom. Bathrooms cause moisture to accumulate not only on the mirrors, but also on medications,” she says.
Disposal instructions may vary with differing medications, however standard practice includes never flushing medication down the toilet or placing in a regular garbage bin.
Patients should be advised/provided with disposal regulations specific to their state of residence, as pharmaceutical waste practices can differ. Encourage patients to ask their pharmacy if any prescription take back programs are offered, where the issue of proper disposal is handled for them. Examining lifestyle factors and anticipating patient issues surrounding adherence to long-term oral therapies can be much more comprehensive when using the combined knowledge of pharmacy and nursing. Together, these two departments can foresee and tackle many preventable issues related to noncompliance and dosing discrepancies, providing thorough patient and family education.