[Implementation and assessment of anticancer drugs batch preparation circuit in a teaching hospital]

[Preparation of injectable anticancer drugs within chemotherapy preparation unit: What levers are available to optimize and secure production?]

Preparation of injectable anticancer drugs is centralized within chemotherapy preparation unit of hospital pharmacies under pharmaceutical responsibility. Improving the chemotherapy preparation unit's efficiency in the face of increasing demand, resource constraints and the need to ensure high quality is a challenge. Hospital pharmacists in search of efficiency in order to combine productivity and quality, have several tools to respond to this problem. These are in particular the quality management, whether they go through certification or not, a source of rationalization of activities and which will strengthen the cohesion of the staff through common objectives. The management of production flows, early preparation or dose-banding will allow a smoothing of activity reducing the risk of medication error and patient waiting times. The continuous training of hospital pharmacy technicians is an important lever so that they acquire and then maintain these specific skills. Finally, the use of the most recent technologies constitutes an important part of the possibilities offered to hospital pharmacists : computerization, automated production and quality controls.

Preparations of exploration of immediate hypersensitivity to antineoplastic agents: An oncology pharmacy perspective

BACKGROUND

Cancer patients are being exposed to antineoplastic drugs more frequently and for longer periods, resulting in a higher risk of hypersensitivity reactions. The aim of this study was to assess the pharmaceutical time and direct cost of drug allergy explorations following immediate hypersensitivity reactions to antineoplastic agents.

METHODS

A micro-costing method was used to collect data on consumption of human and material resources for allergy exploration preparations. The monetisation was carried out on the basis of prices and hourly wage costs applied in 2018. The number and type of allergy explorations prepared by the pharmacy as well as nature of antineoplastic drugs tested, and the number of culprit drugs reintroductions were collected.

RESULTS

Almost 1.5 h is required to realise allergy tests for one patient including pharmacist time for prescription analysis and pharmacy technician's time for tests preparation. The mean manufacturing cost of these tests is estimated at €62.87 (€57.82-65.49) per culprit drug for one patient. Programming patients according to culprit drugs tested allows rationalising healthcare provider time and increasing efficiency. From January 2010 to December 2018, 277 patients were tested and 490 allergy explorations were performed, corresponding to more than 5000 preparations. Mostly, the culprit drug could be reintroduced (n = 383, 78.2%) allowing patients to receive the best possible treatment.

CONCLUSION

Management of hypersensitivity reactions is constantly progressing, as it contributes to improving patient care in oncology. This activity is time-consuming for the pharmacy team but allows patients with previous hypersensitivity reaction to continue effective treatment.