Aim: Oral anticancer therapies (OACTs) require comprehensive pharmacist clinical verification to assess treatment appropriateness, dosing, drug interactions and patient-specific considerations. As cancer services transition towards paperless prescribing, we evaluated the feasibility of implementing a standardised electronic clinical verification framework for patients commencing OACTs, aligned with the Clinical Oncology Society of Australia (COSA) guidelines for safe dispensing of systemic cancer therapy.
Methods: Oncology pharmacists co-designed standardised electronic documentation templates (SmartPhrases) within the electronic medical record (EMR), specific to all formulary OACTs. Using institutional OACT guidelines and multidisciplinary consensus, templates were developed for 112 OACTs to standardise documentation of treatment protocol, dose verification, laboratory assessment, medication reconciliation, clinically significant drug-drug interactions, monitoring plans, prescriber communication and supportive care recommendations. Following pilot testing, refinement, and pharmacist education, SmartPhrases were implemented in the outpatient pharmacy. Feasibility was evaluated by documentation uptake for eligible new OACT prescriptions, pharmacist feedback, and documentation of protocol deviations.
Results: Post-pilot surveys completed by pharmacists (n=6) demonstrated universal preference for SmartPhrases over previous paper-based documentation, with all respondents supporting adoption as standard practice and reporting improved documentation consistency, workflow efficiency, and auditability. Between April and June 2026, pharmacist clinical verification using SmartPhrases was completed for 193 of 195 eligible new OACT prescriptions (99%). Thirty-eight prescriptions (20%) commenced with cycle 1 dose modifications, all of which included documented clinical justification, most commonly for poor performance status or organ dysfunction.
Conclusion: Implementation of a standardised EMR-based clinical verification framework demonstrated high uptake and supported consistent, auditable documentation for patients commencing OACTs. This scalable approach operationalises COSA recommendations for safe OACT practice, facilitates paperless clinical verification, and provides a practical model for improving documentation quality and supporting pharmacist workflow within the EMR.