For a pharmacist, the most important part of the job is ensuring all your patients get the right drug, at the right dose, at the right time, via the right route.
However, you are constantly faced with challenges such as increasing demands for oncology medication, tightening budgets and staff shortages, which can make achieving this more difficult.
Therefore, solutions are needed to improve the process within oncology and the wider hospital pharmacy to help overcome these challenges.
We are going to look at certain areas where process improvement in oncology can have a big impact on your pharmacy service.
Implementing a gravimetric system during the compounding process
Adopting a paperless workflow
Improving workload management
Optimising inventory management
Using closed system drug transfer devices
Historically, volumetric compounding of intravenous (IV) oncology drugs requires high levels of concentration by the individual compounder or a second checker to manually verify the accuracy of preparation steps during the compounding process.
Gravimetric compounding however uses technology to perform this verification. Via an electronic balance and the known density of each ingredient, gravimetric systems confirm the accuracy electronically of volumes drawn up and doses prepared. This reduces the requirement for manual verification of volumetrically prepared doses.
Benefits of a gravimetric system:
Detection of errors that wouldn’t have otherwisebeen detected
A study in 10 centres across 5 European countries reported the mean out-of-tolerance error rate identified with a gravimetric compounding system of the 759,060 chemotherapy doses, was 10.44%. The study concluded it was highly likely these errors would have gone undetected using traditional volumetric preparation.1 This therefore can help improve patient safety.
Reduction in the requirement to re-makedoses
Due to the gravimetric system identifying errors at the point they occur, it allows the error to be rectified immediately. This reduces the requirement to remake doses, unlike with processes where the errors are primarily identified at the final checking stage. A study showed that due to a reduction in having to remake doses, a gravimetric system can reduce drug waste significantly, and also reduce technician compounding time and pharmacist final verification time per product by 34% and 37% respectively.2This therefore can help reduce costs and increase process efficiency.
BD Cato™ is a system that performs gravimetric compounding. BD Cato™ is an integrated automated* software solution for chemotherapy that provides support throughout all stages of therapy, from prescription, to compounding and administration. During compounding, it connects with electronic scales, resulting in step-by-step gravimetric IV preparation workflow with hard-stop verification.
Manual prescribing and documentation risks illegibility problems, as well as transcribing and processing errors. There is also the risk of loss of paperwork, multiple copies being in circulation, and incomplete documentation.
Electronic workflows allow healthcare staff to have instant access to the information they require, and the most up-todate information. When they integrate with other healthcare information systems such as electronic medical records, it allows complete oversight of the patient care pathway.
Space and resources can be saved from not having to store and archive paper documentation, and analysing workflow trends and metrics is easier when this information is stored electronically.
Adopting a paperless workflow through the implementation of technology such as BD Cato™ can therefore have significant benefits to a pharmacy. For example, its electronic prescribing module ensures legible, complete prescriptions, which are automatically sent to pharmacy. Its compounding module documents all stages of the compounding process electronically, with barcode scanners, cameras and gravimetric scales removing the requirement for manual input of information. This can be seen as a positive step toward process improvement in oncology.
The number of patients diagnosed with cancer continues to rise3, and therefore the workload within a pharmacy compounding unit is likely to as well. Combine this with staff shortages that many organisations face, improving workload management is key.
Either due to the electronic prescribing module of BD Cato™, or through interfacing with a hospital’s EPR system, BD Cato™ allows the pharmacy to see the compounding workload for that day, and future days. This allows the team to plan appropriately. BD Cato™ automatically prioritises the most urgent prescriptions, helping to ensure they are prepared first. It eliminates many non-added value activities within the compounding process, allowing pharmacy staff to be more focussed on clinical work, auditing, and quality management4. The electronic system provides oversight of processes, allowing issues or bottlenecks to be identified, and metrics can be monitored and analysed.
Good inventory management is crucial. Pharmacies are often required to keep stock levels at a minimum; however, this runs the risk of stock-outs, which can have a detrimental effect on patients if it affects their treatment schedule. Ineffective stock rotation could lead to stock expiring, and therefore drug wastage. There is a need for compounding units to have a safe and effective way to return unused drug remaining in vials post-compounding back to stock, preventing the remnants having to be discarded.
BD Cato™ allows real-time oversight of drug inventory within the aseptic unit, and during assembly advises the user on most appropriate materials to use with regards to vial size and stability date. This can help ensure process improvement in oncology through effective stock rotation, and prevention of stock-outs.
After compounding is completed, if there is remaining drug in a vial BD Cato™ permits the return of it to stock. The gravimetric scales can accurately measure the amount remaining, the system calculates the new in-use stability date, and it is returned into the electronic inventory of BD Cato™. A unique barcoded label is printed detailing the quantity remaining and its in-use stability date, which is applied to the vial to allow its physical return to inventory. This vial can now be used for future preparations.
There are many preventative measures in place to protect pharmacy staff from hazardous drug exposure, such as the use of isolators or biological safety cabinets, personal protective equipment, and standard operating procedures. However, despite these measures, exposure can still occur in many aseptic units.5
Closed system drug transfer devices (CSTD) are simple devices used to prevent exposure to hazardous drugs during compounding and administration. They prohibit the transfer of environmental contaminants into the system and the escape of the hazardous drug outside the system.
The BD PhaSeal™ system is an example of a CSTD. One study demonstrated a major reduction of over 93% in the contamination of the work environment when using the BD PhaSeal™ system for drug preparation compared to without it.6
Each of the areas we have covered can play a significant role in both overall process improvement in oncology departments and in the hospital pharmacy compounding unit through improving efficiency, patient safety, and reducing waste.
At East Tallinn Central Hospital, Estonia, they saw dramatic improvements to their oncology processes after the adoption of BD solutions.
Read the full case study here
1
Drug prescription
Clinician prescribes chemotherapy on BD Cato™ Prescribe
BD Cato™ Prescribe:
Prescription is sent electronically to the pharmacy.
2
Venous access
A port is a vascular access device implanted into the patient to provide repeated access to the vascular system. Safe chemotherapy treatment rely on safe vascular access.
3
Order verification
Pharmacist-verified order is sent electronically to BD Cato™ Pharmacy. BD Cato™ Pharmacy automaticallyprioritizes orders according to the patient scheduler. Pharmacist can select the shortest dated vial to ensure that drug wastage is limited.
4
Drug preparation
BD PhaSeal™ close system transfer device is used for preparation and theBD MicroBore secondary set is used to spike the bag
5
Gravimetric analysis
Gravimetric scales checks the right dose is drawn via drug density calculation. Scan the barcode on the vial to identify the right drug. Camera capture each step.
6
Drug verification
Unique barcode medication label is printed once all steps are a corrected followed. Pharmacist verifies preparation.
7
Patient preparation
Nurse prepares patient for administration of hazardous drugs utilizing closed system transfer deviceBD MicroBore set.
8
Patient assessment
BD Cato™ ReadyMed check if it is the right part in and right drug and will automatically document this is the system.
9
Pump programming
Use BD BodyGuard™ Duo with its two independent infusion channels in one intuituve, user-friendly interface, which can help simplify the infusion of even the most complex therapies.
Beyond streamlining oncology processes, we are working across all aspects of oncology to continuously optimise patient outcomes by providing connected workflows and automating manual processes, while continuing to protect healthcare workers. We work with our partners, clinicians and healthcare professional to provide a seamless end-to-end solution for all oncology professionals.
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