Spending on oncology medication now exceeds €32 billion per annum in Europe1. Traditionally, cancer drugs have always been expensive, but the increasing cost of new drugs, such as the molecular targeting ones, has resulted in a marked increase in expenditure. Healthcare organisations are therefore constantly looking for solutions to address this challenge.
One way to help reduce drug expenditure is by the reduction of waste of oncology drugs within the pharmacy compounding process. Here, we are going to look at where this wastage originates during the process and provide solutions to help reduce waste from occurring.
BD Cato™ is an automated* IV medication workflow using gravimetric technology that can be used for the preparation of oncology drugs. It provides step-by-step instructions to guide the user through the compounding process, and combined with barcode scanners, gravimetric scales and cameras, helps ensure the correct preparation of a drug.
BD Cato™ identifies errors at the point they occur during the compounding process, notifying the user of them with alerts and hard-stops, and preventing the user from continuing until the error has been rectified.
The Reece 2016 study showed the benefit to a pharmacy of BD Cato™ with regards to reducing the frequency of having to remake chemotherapy doses, and the subsequent cost savings from this2. Over the study period, 51,037 chemotherapy doses were prepared without an automated workflow system, with a total of 49 errors (0.096%) reported. 15,843 doses were prepared utilising the new technology, with a total of 1126 errors (7.1%) detected. The 49 errors identified without the workflow system resulted in over $56,000 waste due to doses having to be discarded and remade. However, with the system, despite identifying 1126 errors, only $12,398 was wasted from 12 vials being rejected during reconstitution. The remaining 1,114 errors detected with the software were corrected before the final dose was completed and did not result in drug waste.
Allowing errors to be corrected before completion of the dose can therefore help reduce the waste of oncology medication.
The BD PhaSeal™ system is a CSTD that has been demonstrated to prevent exposure to hazardous drugs during drug preparation and administration. It is an airtight, leakproof system that utilises a membrane-to-membrane technology. It mechanically prohibits the transfer of environmental contaminants into the system and the escape of drug or vapor concentrations outside the system, thereby minimising individual and environmental exposure to drug vapor aerosols and spills. However, it also prevents microbial ingress within an ISO Class V environment with proper aseptic technique. Therefore, an extended shelf-life of a part-used vial can be applied, allowing the vial to be returned to stock and used for future preparations.
A European study3investigated the economic impact on the preparation process of cytotoxic drugs from using CSTDs. The study showed that the CSTD savings due to minimisation of vial wastage was up to €117,971, or up to €38 per preparation.
BWith a gravimetric system and IV workflow software that includes an inventory management module, such as BD Cato™, the amount of unused drug remaining in a vial after compounding can be accurately measured and documented electronically. By the printing of a vial specific label detailing the quantity remaining and its in-use stability date, the vial can be effectively returned to stock for future use.
BD Cato™ provides real-time oversight of inventory and advises the pharmacy user during assembly on the most appropriate starting materials to select with regards to vial size and in-use stability date. The system will suggest use of part-used vials where possible. This will therefore help reduce the amount of drug waste incurred.
The benefits BD can bring in minimising oncology medication waste include:
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 the reduction of medication waste, 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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