e-Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2020

Could your workflow be costing you reimbursement? A re-audit post-intervention of missed dispensing for ten high cost parenteral cancer medicines. (#294)

Jacqueline A Leggett 1 , Samantha C Yim 2 , Christine Carrington 2 3 , Marissa Ryan 2
  1. Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  2. Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
  3. School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia


With many cancer therapies costing over $2000 per dose, accurate dispensing is imperative for Pharmaceutical Benefit Scheme (PBS) reimbursement and healthcare service financial viability. For many pharmacies, there is a risk of parenteral cancer medicines being supplied, but not dispensed (termed ‘missed dispensing’) because they are ordered (prescribed), verified, labelled and released using software that is not the dispensing software. A 2018 audit at a cancer services pharmacy of 891 doses of ten parenteral cancer therapies found over $76,000 of missed dispensing.1 The audit recommended an intervention of a sequential four-step process, supported by additional pharmacy assistant resource, and a subsequent re-audit. The four-step process is dispensing (by the pharmacy assistant), releasing (final checking by the pharmacist of the cancer medicine against the order using non-dispensing software), authorising the dispensing (by the pharmacist using dispensing software) and administration of the cancer medicine by nursing staff.



To determine if the recommended four-step process results in less missed dispensing and improved PBS reimbursement accuracy for ten high cost parenteral cancer medicines.



A retrospective re-audit post-intervention was carried out over a four-week period in 2019. Using dispensing software iPharmacy and pharmacy oncology software CHARMTM, the date, time and order of the four steps of dispensing, releasing, authorising and administration for doses of ten cancer medicines was collected. The number and value of any missed dispensing was recorded.



No missed dispensing occurred in the representative sample of 339 doses, and therefore no loss of PBS reimbursement. While the four steps were completed 100% of the time, the correct sequence was not.



The four-step process improves PBS reimbursement accuracy and should be continued; however, reinforcement of the recommended sequence of steps is required and may further mitigate missed dispensing risk. This research highlights the importance of workflow consideration and audit.

  1. Hoang TKD, Ryan M. Review of PBS Dispensing and Reimbursement Accuracy for Selected High Cost Parenteral Chemotherapy, Monoclonal Antibody and Immunotherapy Medicines: A Retrospective Audit [unpublished manuscript]. Queensland: University of Queensland; 2018 [cited 2020 Aug 14].