BACKGROUND Advanced Practitioners (APs) are a well-prepared, masters or doctoral degree educated individuals, many with extensive experience within their team. APs role in prescribing antineoplastic therapy is widely variable at this time from institution to institution. Little is published outlining process and requirements at this time. In 2017, Ohio revised code was updated to remove barriers for APs prescribing practices. Although this regulatory change occurred, antineoplastic therapy prescribing was still restricted to only physicians in our academic institution.
METHODS Our AP leadership team collaborated with a multidisciplinary team of professionals to establish a proposal for advancing practice to support prescribing of antineoplastics to include APRNs, PAs, and Clinical pharmacists. The task force met over a 3-month period of time to outline the requirements for the APs, roles and responsibilities of the APs, as well as a quality assurance process. An inventory of institutions participating in chemo prescribing were identified and contacted for collaboration of processes and potential requirements.
RESULTS After collaboration and consideration, the requirements for eligibility for prescribing antineoplastic therapy were decided to be: 2 years of experience in oncology; managing patients on active chemotherapy; acknowledgement/agreement form signed by the Disease Program Director/Site Physician; completes/passes chemotherapy examination; 50 questions prepared by the multidisciplinary task force; completes a proctoring period consisting of 50 prescriptions cosigned by the physician sponsor. The scope of prescribing includes: subsequent antineoplastic orders of any route, inpatient and outpatient, main campus and regional facilities who report through the cancer center, Ohio locations. Out of scope prescribing includes: new start drugs/regimens, any orders requiring 2 signatures, clinical trial drugs, BMT preparative regimens, non-Ohio locations, or APs not reporting through the cancer center.
CONCLUSIONS Quality assurance is an essential component to building trust within the multidisciplinary team. It was determined the chemo pharmacist will have an electronic list of approved prescribers in order to appropriately verify the orders. The AP manager will perform 10 annual audits on antineoplastic ordering. Quality domains included in the audit are: chemo orders within the APs scope of practice, medically appropriate, guidelines/SOPs were followed, no serious safety events reported, documentation of collaboration in a clinical note as necessary. APs falling outside the SOP would be removed from prescribing antineoplastics. Anticipated outcomes when proposing this plan include: Improved workflow, limited missing orders, minimize patient wait times for unsigned orders, and improve patient and caregiver (physician, infusion nurse, etc.) satisfaction. Assessment of these outcomes will be addressed at 6 months and 1 year post implementation using internal metrics such as chair time, patient wait times, unsigned orders report, and qualitative interviewing with the multidisciplinary team.
IMPLICATIONS The APs role in prescribing antineoplastic therapy can be an effective method of improving patient care in a variety of settings. Multidisciplinary team buy-in and support can create a supportive and inclusive environment for practice changes to occur. As APs, we must continue to innovate new ways in order to work at the top of license and growing our roles by providing highly reliable, quality care for patients as well as on our teams. Sharing oncology processes within a professional organization is vital to growing as a specialty and building a foundation of standards to hold in our practice.
