Our group has previously demonstrated that a structured pharmacist review of medical orders against specific oncology treatment criteria, before compounding injectable antineoplastic therapies, effectively minimizes post-preparation medication waste. To optimize these savings and further curtail the loss of prepared oncology agents, we expanded our established checklist to include a clinical assessment of the patient’s infection status. This study evaluates how effectively the revised screening protocol reduces waste of compounded injectable anticancer medications. The pre-existing pharmacist checklist used for compounding clearance was supplemented. Beyond the conventional oncology administration criteria, pharmacists evaluated the patient’s infection status, defined as a core body temperature ≥ 37.5 °C or an increase in C-reactive protein (CRP) or white blood cell (WBC) levels relative to baseline. We conducted a retrospective analysis comparing the pre-modification and post-modification periods to evaluate changes in the frequency, classification, and financial impact of discarded antineoplastic drugs after preparation, along with the specific clinical reasons for their disposal. Following implementation of the revised screening protocol, the proportion of prepared oncology medications discarded decreased significantly compared with the original framework (0.288% [18/6253] vs. 0.095% [6/6331], P = 0.013). Additionally, the frequency of annual compounding waste specifically attributed to patient infection fell from 11 instances (pyrexia: n = 8; increased CRP or WBC: n = 3) down to a single occurrence (increased CRP: n = 1).Supplementing standard oncology administration benchmarks with a pre-compounding pharmacist review of patient infection status—parameterized by a body temperature ≥ \text{37.5 °C} or elevated baseline CRP or WBC values—serves as an effective strategy to minimize the post-preparation wastage of antineoplastic agents.
