2026 Eastern States Conference

     The objective of this project is to increase awareness and utilization of the Pharmacy Dose Adjustment Standard Operating Procedure and Veterans Health Information Systems and Technology Architecture (VistA) Chemotherapy Manager Business Rules to promote cost savings within the Veterans Affairs Medical Center. Through pharmacist education and evaluation of current practices, the goal of this project is to enhance appropriate dose rounding of weight based parental medications administered in the outpatient infusion clinic.

     This quality improvement project will consist of three phases including baseline assessment, educational intervention, and post intervention evaluation. The primary outcome is to evaluate change in utilization of the Pharmacy Dose Adjustment Procedure and VistA Chemotherapy Manager Business Rules dose adjustment allowances for weight based parental medications administered in the infusion clinic. A retrospective review of medication orders from the previous six months will be conducted. Data will be collected on weight based parental medications using VistA reporting tools.

     For each medication order, the prescribed dose and corresponding vial size will be analyzed to determine whether the dose was appropriately rounded in accordance with our procedure. The SOP states rounding to 10% for non-chemotherapies ordered in CPRS is appropriate. The SOP states chemotherapeutic agents are not to be followed by the SOP, so orders must follow the VistA Chemotherapy Manager business rules which allow for 5% rounding. Orders will be categorized into no intervention or opportunities for intervention groups.

     Pharmacist education will be provided including a review of the procedure and business rules, guidance on appropriate dose rounding, and emphasis on the importance of following procedures given potential cost savings. Pharmacists will complete a pre-test and a post-test consisting of a patient case to evaluate effectiveness of education. A medication order review will be completed six months post education and will evaluate change in dose adjustment procedure utilization. The secondary outcome is cost savings and will be analyzed using inventory records from our wholesaler.