Is the chemo ready yet?! Gaining efficiency in parenteral cancer chemotherapy supply at a large tertiary level hospital (#223)
The cost, complexity and toxicity of cancer chemotherapy requires a specialised pharmacy service and generally requires more preparation and dispensing time compared to other medicines. Enhancing efficiency of this workflow is a priority given the increasing volume of cancer patients, limited service capacity, and both executive and patient expectations. Princess Alexandra Hospital (PAH) sought to achieve this by having more chemotherapy ready prior to the treatment start time. This objective was enabled by targeted protocol dose-banding, outsourced manufacture, and advance prescribing. The effect was measured by tracking:
· Pharmacy ‘turn around time’ (TAT): time from prescription printing to supply for “just-in-time” therapy
· Proportion of therapy processed prior to day of treatment
Data for manufactured items supplied over the period 01/01/2012 to 31/07/2013 was extracted from the chemotherapy record management software (Charm®). Statistical analysis of the data was used to compare the periods before and after each key change was implemented.
In the 19 months, ~26,000 manufactured products were supplied (~1400/month). Initially, 9% of products were outsourced, rising to 38% at the end of the period. Dose banding commenced in April 2012 (~10%) and by the end of the period ~30% of product doses were banded. Time required processing “just-in-time” chemotherapy halved from 66 mins to 30 mins, resulting in a corresponding drop in pharmacy TAT of 88 mins to 45 mins. The proportion of products processed in advance of the treatment day rose from 40% to 50%. Discarded chemotherapy increased from ~3% to ~10% over the period (generally lower cost PBS reimbursed items).PAH Cancer Services has improved timely access to parenteral chemotherapy with key adjustments made at the protocol level, supply level, and clinic level of patient care without requiring extra staffing or material resources. As an additional financial incentive, these changes resulted in reduced stock holding requirement for raw ingredients.