Epic Inpatient: Concurrent IV Chemotherapy and Non-formulary Oral Chemotherapy

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Thu, 04/16/2026 - 19:19
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Megan Elizabeth...
Megan Elizabeth Fragale's picture
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Last seen: 13 hours 49 min ago
Joined: 02/14/2022 - 12:55
Epic Inpatient: Concurrent IV Chemotherapy and Non-formulary Oral Chemotherapy

Issue: Patients admitted for inpatient IV chemotherapy, orders released from Beacon treatment plans; patients also require oral non-formulary chemotherapy (which is not built into Beacon treatment plans).

Concern: Oral chemotherapy could be missed; verbal orders without a double sign or verification placed by pharmacist). Pharmacists take verbal orders for oral chemotherapy because 1) oncologists reportedly do not know how to order non-formulary medications or 2) hospitalists do not know the regimen and struggle to order more complex non-formulary medications.

Seeking any Epic specific solutions that do not circumvent the safety checks in place (dual provider sign off on chemotherapy orders, dual pharmacist sign off on chemotherapy verification) given these are non-formulary orders.

Thank you,
Megan Fragale, PharmD, MS, BCPS
Medication Safety Officer
Skagit Regional Health

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