Background Delivering chemotherapy efficiently and economically to the right patient at the right time is becoming more difficult. This is a challenge for both the hospital ward and pharmacy. They must find a way to increase capacity using the same facilities and the same number of personnel.

Traditionally chemotherapy doses are prepared after the patient’s blood tests have been confirmed by the doctor. The orders come in at a rush causing an enormous work load for the pharmacy, resulting in long delays for the wards and in the patient’s treatment.

Purpose To determine the consequences of preparing injections in advance.

Materials and methods The cytotoxics preparations were divided into cheap and expensive drugs. Statistics from our production records were used to determine how many doses were changed or not used and wastage was calculated. The Lillehammer Hospital pharmacy decided to make up all the doses whose ingredients cost less than NOK 1000 (125 euros) before the blood test results were confirmed.

Production time studies were carried out before and after the introduction of production in advance.

Results Practice shows that production in advance provides cheap drugs for the ward with ‘zero’ waiting time, and reduces the waiting time for expensive drugs to approx. 15 min.

The average time to prepare a reconstituted dose is 5-10 mins.

Total production time has been reduced from 11 mins. to 6 mins.

Unfortunately production in advance generates some drug waste. The cost of drug waste has been measured at less than 1% of total drug cost.

Conclusions Preparing cytotoxics in advance has resulted in reduced preparation time in the pharmacy, and less waiting time on the wards. The cost of waste (both labour and drug costs) were minimal compared to the advantages for both the pharmacy and wards.

An effective work flow in the pharmacy helps to increase the production capacity while increasing throughput of patients on the ward. The hospital pharmacy can work in a continuous, less stressful and less error prone manner instead of working in bursts when lots of chemotherapy is confirmed at the same time.

No conflict of interest.