The increasing demands on oncology services continue to stretch healthcare budgets, with the number of new cancer patients in Europe each year at 3.7 million1 and the total annual cost of cancer in the region at €199 billion2.
Cancer care currently consumes around 5% of all healthcare costs globally, with the growth in spending on cancer outstripping the growth in total health expenditure.3,4 This is not sustainable: budgets cannot keep rising indefinitely to meet these increasing needs.
One solution to help reduce oncology costs is through the implementation of automated* workflows. They can transform the oncology treatment pathway within hospitals, allowing organizations to increase efficiency, maximise resources, and ultimately reduce costs.
The initial investment required to implement new technologies can be a daunting prospect, especially as healthcare organisations are often already financially stretched. Therefore, having evidence demonstrating short-term horizon return on investment from the adoption of automated* workflows is important for key decision makers.
We will look at how automated* workflows within the oncology prescribing, compounding and administration processes can help:
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Reduce medication errors
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Reduce medication waste
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Streamline the workflow from prescription to administration to increase capacity and free up staff time for other value-added tasks
Reducing medication errors
The focus on medication safety with regards to drug errors is critical, as organisations want to ensure cancer patients are safe and receive the highest quality treatment.
However, another reason they are important is due to the cost implications of medication errors. This can be a result of staff time and the consumption of resources required to investigate and rectify the error, the patient requiring additional treatment and an increased length of hospital stay, litigation claims, potential damage to an organisation’s reputation, and so on. A 2011 study on chemotherapy in hospitalised patients showed that 449 errors generated an additional cost of €100,000 and if they had remained undetected, would have generated 216 additional days of hospitalisation.5 Error reduction, therefore, means reduced oncology costs.
The compounding of chemotherapy drugs by the pharmacy is a process where there is high risk of error. With manual compounding methods, many of these errors go undetected and potentially reach the patient. Automated* workflows within the compounding process via the integration of IV workflow software, barcode scanners, gravimetric scales and cameras, helps ensure the correct preparation of a drug. This was demonstrated by a large-scale European multi-center study that assessed the impact of automation. The study involved 759,060 chemotherapy preparations and showed the mean out-of-tolerance error rate during compounding to be 10.44%.6 These errors outside the accepted tolerance level were detected by the gravimetric technology and able to be corrected. The study concluded that it was unlikely these errors would have been detected using a manual compounding process.
Chemotherapy prescribing is also a high-risk area for error. Two independent studies showed that Computerized Physician Order Entry (CPOE) systems cut oncology medication error rates in hospitals by approximately two-thirds7,8 when compared to handwritten prescriptions.
Reduce medication waste
Drug expenditure in oncology is significant. Within Europe, €32 billion is spent annually on cancer drugs, and this figure continues to rise.9 Therefore, looking for ways for your organisation to reduce drug expenditure and oncology costs is key.
Reducing medication waste within oncology is one way to achieve this. One study reported drug wastage accounted for 8.3% of the oncology department’s annual drug expenditure.10
Areas where waste often occurs include:
- Disposing of vials with remaining drug in them after compounding due to the lack of a safe and effective inventory management system to permit their return to stock
- Vials expiring due to lack of oversight of drug inventory
- Changes/ cancellations made to a patient’s treatment, but pharmacy not updated in real time and so continue to prepare an incorrect dose
- Discarding a compounded product due to an error only being identified at the final verification or administration phase, rather than at the point it occurred
- Part-used vials expiring due to microbial contamination
The implementation of automated* workflows can help address these causes of medication wastage and potentially reduce oncology costs overall.
An automated* IV workflow software system can be used to electronically record the return of part-used vials to the pharmacy’s inventory. It produces a vial label detailing the remaining contents of the vial, with a suitable use-by date as per the manufacturer’s recommendations post reconstitution. The system also suggests the most appropriate vial to select during the assembly process prior to compounding, helping to ensure effective stock rotation and any part-used vials are used up where possible to minimise waste.
Any changes made to a prescription are updated in real time to all users. Therefore, if a treatment is cancelled, this will be visible to the pharmacy department immediately, reducing the likelihood that the dose continues to be prepared in error.
Additionally, automated* workflow systems identify errors at the point they occur in the process, allowing them to be corrected immediately. This reduces the likelihood of having to remake the entire dose, which incurs costs through drug wastage and time. This benefit is demonstrated in the Reece et al study11, which assessed the impact of a gravimetric i.v. workflow software system (BD Cato™) in an oncology ambulatory care pharmacy. All the 49 errors detected using a manual workflow system (prior to the implementation of BD Cato™) resulted in the entire preparation having to be discarded, amounting to over $56,000 in waste. Post implementation of BD Cato™, 12 errors detected required discarding of the drug, resulting in $12,398 in waste. However, the remaining 1,114 errors detected with the software were corrected before the final dose was completed and did not incur waste.
The closed system transfer device BD PhaSeal™ helps prevent microbial contamination of the vial during compounding, which may lead to a reduction in drug waste and cost savings. One study revealed that using the BD PhaSeal™ system, the pharmacy avoided nearly half of potential waste and saved a mean of 29% per vial. This equates to an annual cost saving of $703,047.67, which more than offsets the original cost of the BD PhaSeal™ system12.
Streamline workflows
Streamlining workflows to improve efficiency within the oncology process can result in both time savings, meaning staff can invest time in other value-added activities and direct patient care, and increased capacity, so more can be done with the same resources.
A large-scale European multi-center study looked at the impact of automation on staff time6. It reported a reduced technician compounding time and a reduced pharmacist final verification time of 34% and 37% respectively using gravimetric technology compared to manual preparation. This was primarily due to the detection of errors with the gravimetric system at the point they occurred, meaning they did not need to be corrected post-production, which is time consuming.
With regards to increasing capacity, a case study at the East Tallinn hospital found that after the introduction of automation in pharmacy thorough BD Cato™, they doubled their output of compounded chemotherapy doses per annum, without an increase in staff headcount.13
Another example of automation streamlining an oncology workflow is with Barcoded Medication Administration (BCMA) technology. BCMA is technology that enables nurses to check the five rights of medication administration. In the paper, ‘Impact of a Barcode Medication Administration System on Patient Safety’ it was concluded that BCMA is a useful technology that could help nurses increase the time spent on direct patient care activities14. This is also backed up by the case study at the East Tallinn hospital, which concluded BCMA (BD Cato™ ReadyMed) saved over 3 hours of nursing time daily on an oncology day unit.13
Return on investment
We have demonstrated above that BD solutions within oncology prescribing, compounding and administering processes can help reduce medication errors, reduce medication waste and streamline workflows, which all result in reduced oncology costs to an organisation. In practice, this translates to the ability to offer substantially more treatment from the same resources, all the time protecting your patients, your staff, your budget and your reputation.
BD has the tools and expertise to help hospital administrators to calculate the ROI on BD solutions for their hospitals, using the scientific literature and the hospital’s specific input to deliver an accurate, tailored calculation. Many hospitals have already been through this process and have been able to see the huge difference that a BD solution has made to their efficiency, efficacy and balance sheet.
Unmistakably BD Oncology.
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