Background With increasing numbers of cancer diagnoses, cytotoxic compounding workload continues to increase, resulting in longer patient waiting times and higher risk for compounding errors. Dose-banding has been proposed as a way to increase efficiency but there is little data available on actual time savings and efficiency improvements. Equally, dose-banded batch compounding requires increased surveillance and traceability, e.g. by using (semi-) automated systems, which may affect time performance.
Purpose The aim was to assess time savings by using dose-banding, while at the same time increasing quality assurance of the finalised preparations using a semi-automated compounding system.
Material and methods From 1 March 2016 to 30 April 2017, total patient waiting times were registered for all sterile cytotoxic preparations for adult patients. During the first phase (1 March 2016 to 9 October2016), baseline performance was registered and suitable molecules were selected through dose-banding simulation (logarithmic approach) on 4 years of compounding data. During the second phase (10 October 2016 to 5 February 2017), paclitaxel was prepared through dose-banding, and five selected molecules (paclitaxel, carboplatin, 5-fluorouracil, irinotecan, trastuzumab, cyclophosphamide) during the third phase (6 February 2017 to 30 April 2017). Median (MPWT) and average (APWT) patient waiting times/week were analysed using segmented regression analysis, after correction for autocorrelation. All dose-banding compounding was done using an i. v. SOFT™ Assist (Omnicell®), allowing for multi-dose vial use, in-process control and traceability.
Results Over 55 weeks, 10 477 preparations were time-registered (baseline: 5660/28 weeks; second phase: 2774/16 weeks; third phase: 2043/11 weeks). At baseline, MPWT was stable at 2167 s/preparation with no significant time-dependent trend (Figure 1). During the second phase, MPWT decreased with −21 s/preparation/week (p=0. 07) but without immediate gains. The third phase resulted in an immediate additional gain of −363 s/preparation (p=0. 02) but without additional time-dependent improvement. APWT (baseline 2341 s/preparation) showed similar results with a significant change in trend during the second phase (−32 s/preparation/week; p=0. 04) but with only limited immediate effect at the third phase (−176 s/preparation; p=0. 39) without further effect on trend. Associated staff cost savings/preparation varied between €−0.76 and €−1.24/preparation.
Conclusion Dose-banded compounding in combination with semi-automation results in meaningful reductions in patient waiting times, together with improved quality assurance and traceability. In case of limited resources, even dose-banding with a single selected molecule can have a significant impact on overall compounding workload.
No conflict of interest
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.