PACT-chemo: Improving chemotherapy flow, safety, and value through physician–pharmacist EHR activation at SSMC, a tertiary hospital in the Middle East.

Abstract

e23317 Background: Chemotherapy order activation is a major ambulatory infusion bottleneck and a key point to intercept high-risk medication errors. Scalable physician oncology hematology clinical pharmacist partnership policy backed model for Day 2+ activation with international benchmarking remain limited. The structure aimed to achieve universal visit coverage for chemotherapy activation days, reduce infusion center delays, and quantify clinical and economic impact. Methods: Prospective quality improvement program at a tertiary oncology center (Abu Dhabi, UAE), January 2022–December 2025. PACT CHEMO implemented a standardized multistep activation workflow multi-day chemoactivation formally delegated to Oncology clinical pharmacist while Most Responsible Physician retained responsibility for future initiation and Day-1 activation, as well as multistep oncology pharmacist verification protocol, and electronic health record integration to enable parallel processing, semi-automated lab-to-pharmacy alerts, nurse to pharmacy communications, and conditional physician escalation for protocol deviations/complexity. Clinical pharmacists prospectively reviewed and activated 100% of systemic therapy visits on treatment Day 2 Plus cycles . Primary outcome was mean time from order activation to drug preparation. Secondary outcomes included prescriber acceptance, intervention clinical significance, medication error rate, cost avoidance (70–130% sensitivity), and equity. Intervention-level analysis used 10,687 interventions (Oct 2024–Oct 2025) across 10 high-risk agents; results were benchmarked against internationally reported QOPI. Results: Mean activation-to-preparation time decreased from 83.5 minutes (2022) to 40.6 minutes (2025), a 56.4% reduction, with improved reliability (SD 8.2→2.1; 74% reduction). Prescriber acceptance was 99.4% (10,623/10,687); 92.9% of accepted interventions were rated major/severe. Medication error rate declined from 6.8% to 1.7% (75% relative reduction; p < 0.01). Year-3 cost avoidance was AED 2,044,650 (US$557,000), representing 48.7% of baseline operational risk, yielding +46.0% ROI and a 2.3-year payback. Acceptance did not differ by age (p = 0.98), sex (p = 0.76), or ethnicity (p = 0.84). Compared with Singapore NCCS, activation time was 40.6 vs 55 minutes and acceptance 99.4% vs 93% (p < 0.001). ASCO QOPI targets across seven quality domains were met or exceeded. Sustained annual gains reduced waiting-time inequity without demographic disparities in daily care. Conclusions: An EHR-enabled physician–pharmacist activation partnership achieved sustained improvements in chemotherapy flow, safety, value, and equity, meeting or exceeding international benchmarks and supporting broader adoption across ambulatory infusion services.