Impact of centralization of cytotoxic drug preparations

Abstract

Two types of circuits of injectable cytotoxic drugs still exist in our hospital: one with pharmaceutical centralization of the preparation and the other without. Our goal is to evaluate each circuit from two points of view: quality of patient care and protection of persons handling cytotoxics. For this evaluation, an original assessment was performed before and after centralization in the same pilot health care unit (two periods of 6 weeks each). To evaluate the prescription-preparation-administration process, six checklists consisting as a whole of 158 observable criteria have been constructed. These criteria have been weighted according to the risk of compromising the quality of patient care and the safety of persons. A total of 117 processes have been observed before centralization; after centralization, 91 were observed.From a qualitative viewpoint, we show that the cost of drugs stocked in the medicine chest of the health care unit has been reduced by 80%, that the flow of information between the different participants in the circuit varied, and that two types of dysfunctions exist: organizational and relational. From a quantitative viewpoint, we demonstrated that pharmaceutical intervention improves the quality of patient care ( 2 test, P < 0.001) and reinforces the protection of manipulators ( 2 test, P < 0.001). Pharmaceutical centralization of the preparation of cytotoxic drugs increases the efficiency of the circuit, from the prescription to administration.

Parenteral cytotoxic drug wastage at a tertiary hospital in Kuala Lumpur: How much and why?

“…The centralisation of CDR service has been proven to reduce the cytotoxic drug wastage by enabling vial-sharing practice where the same cytotoxic drug prescribed at the same time for different patients could be reconstituted together as well as pooling required human resources in CDR services to increase the efficiency of cytotoxic drug preparation. [22][23][24][25] Moreover, the Oncology Pharmacy is also extending the shelf life of single-use vial beyond manufacturer recommendation by using the stability data provided by reference books 26 in order to reduce the cytotoxic drug expenses. 27 The cost-saving effect of these strategies has already been studied by several studies.…”