Canterbury DHB

Prescription and Preparation of Cytotoxic Drugs

• Cytotoxic medications (Oral and IV) are only to be prescribed by a Consultant or a Haematology Advanced Trainee (Haematology Registrar) with the appropriate experience. A Haematology Registrar new to the department may not be allowed to prescribe IV Cytotoxics for a 3–6 month trial period. An assessment of their experience and their suitability to prescribe IV cytotoxic drugs will be done at one of the Registrar Quarterly Review meetings. Until this is done, all their IV cytotoxic prescriptions will need to be countersigned by a Consultant.
• Continuation of oral cytotoxics may be prescribed by the House Surgeon after approval from the Haematology Registrar.
• Oral cytotoxic drugs prescribed to Outpatients should be written on an Outpatient prescription form. These do not need to be countersigned by a Consultant but must be checked carefully by the prescriber, as outpatient pharmacies may have less experience with the dosage of cytotoxic drugs.

Prescription of Cytotoxic Drugs

• Cytotoxic medication is prescribed where possible on a prepared chemotherapy template. Oral cytotoxics prescribed as part of a continuous treatment regime should be charted on the patient’s drug treatment chart, if an inpatient, (MedChart) and labelled as cytotoxic, or on an Outpatient Prescription Form.
• Intrathecal chemotherapy must only be prescribed on an intrathecal chemo chart C160016 by a doctor designated on the IT chemo register as able to prescribe.
• All intensive chemotherapy schedules requiring inpatient care [e.g. UKALL14, AML19 (CODOX-M / IVAC), Hyper CVAD, etc] may be written by the Haematology Ward Registrar. They are usually, but not always, an Advanced Trainee with the appropriate experience (see above). However such Cytotoxic Prescription Charts must always be countersigned by the Ward Consultant.
• If the first course of any less intensive chemotherapy schedule (e.g. R-CVP, R-CHOP, C-Thal-Dex, Fludarabine containing schedules, etc) is to be given (oral or IV), any registrar prescription must be countersigned by the consultant. For second or subsequent courses of these schedules, appropriately experienced Advanced Trainee Registrars do not need their prescription countersigned.
• We recommend the Registrar goes to the Drug Usage in Haematology section of the Red Book, then to Chemotherapy Drugs - Patient Information Leaflets and opens the Prescription Sheet on the screen. This should either be completed on the screen (Word version) and printed out, or printed out (PDF Version) and completed using a black pen. The completed prescription sheet should then be sent to the consultant in the most convenient and agreed manner.
• After signing the prescription, the consultant should FAX the prescription sheet to Pharmacy. The original prescription sheet must be sent to the B6 to file in the patient’s notes, indicating that this has been faxed to Pharmacy.

Preparation of Cytotoxic Drugs

All reconstitution and dilution of cytotoxic medications is outsourced to Baxter Pharmacy Services. To facilitate the timely ordering and manufacture of chemotherapy, chemotherapy should be prescribed and faxed to Pharmacy as early as possible before treatment, and routinely at least 48 hours in advance. Achieving this sort of lead time for 90% of requests ensures truly urgent requests can be accommodated more easily. It is important that the pharmacy is advised promptly of any dose change, withholding of doses, or suspending treatment.

Topic Code: 5719