Implementation of a standardised pharmacist check of medical orders prior to preparation of anticancer drugs to reduce drug wastage

Abstract

Background The increasing cost of anticancer drugs is now being recognised as a global problem, and measures against drug wastage are among the most important cost containment strategies for anticancer drugs. Objective When blood examination results or changes to a patient's condition necessitate dose reduction or discontinuation of anticancer drugs after their preparation, the compounded anticancer drugs are discarded. To reduce anticancer drug wastage after preparation, we developed a protocol that set the eligibility, start of treatment, dose reduction and discontinuation criteria for injectable anticancer drugs and assessed the effect of pharmacists' checks of these criteria based on the present protocol prior to preparation of injectable anticancer drugs. Method Observations before and after introduction of the protocol were conducted at Gifu University Hospital. We recorded the number, type and cost of anticancer drugs discarded after preparation and the reason for discarding these drugs in our dedicated database. Results Checking the criteria for anticancer drug administration before preparation significantly reduced the rate at which anticancer drugs within a chemotherapy cycle were discarded after preparation compared with that prior to the protocol's introduction (0.367% [18/4909] vs 0.032% [2/6248], P < .001). Additionally, the total cost of anticancer drugs discarded after preparation was reduced from JPY 2 041 786 (USD 18 562) to JPY 398 414 (USD 3622). Conclusion Pharmacists' checks of the eligibility, start of treatment, dose reduction and discontinuation criteria for anticancer drugs based on the present protocol prior to preparation of injectable anticancer drugs was useful for reducing drug wastage after preparation.

Medication Wastage in a University Hospital in Japan

“…In order to minimize this medication wastage, physicians and hospital pharmacists should carefully ensure that the medications are suitable for administration to the patient before preparation, especially high-priced medications such as anti-cancer agents. 20,21) Our study had some limitations. First, this study was conducted in a single center; therefore, our results may not be transferable to other hospitals in Japan.…”

A pharmacist check of patients’ infection-related condition prior to drug preparation reduces anticancer drug wastage after mixing: a retrospective study

“…Through implementing our previous protocol, in which pharmacists checked the eligibility, start of treatment, dose reduction and discontinuation criteria for injectable anticancer drugs prior to mixing, we were able to significantly reduce anticancer drug wastage in our hospital [ 11 ]. In some cases, however, patients with a body temperature < 38 °C were identified by medical staff as having possible infection after anticancer agents had already been mixed, leading administration of anticancer drugs for the day to be discontinued.…”

“…Patients who received anticancer agents that were not mixed by pharmacists were excluded. Before protocol modification, pharmacists checked the eligibility, start of treatment, dose reduction and discontinuation criteria for injectable anticancer drugs based on the protocol prior to mixing, as reported in our previous report [11]. After protocol modification, pharmacists additionally checked for a body temperature ≥ 37.5 °C or elevated CRP or WBC count from baseline (Fig.…”

“…If a decision to adjust the dosage or discontinue administration of anticancer drugs is made after mixing the necessary agents, the mixed anticancer drugs must be discarded. We previously reported that a pharmacist check of the eligibility, start of treatment, dose reduction and discontinuation criteria for anticancer drugs based on a standardized protocol before the mixing of injectable anticancer drugs was useful for reducing drug wastage after mixing [ 11 ].…”

“…Daily monitoring of infection in patients receiving chemotherapy is, therefore, important. The criteria for body temperature at the start of treatment with anticancer drugs is typically < 38 °C in the past 24 h. Our previous standardized pharmacist check protocol was implemented based on this criterion for body temperature [ 11 ]. However, when implementing our protocol, we encountered cases with a body temperature ≥ 37.5 °C but < 38 °C for whom the planned anticancer drug dose was discontinued on the day of administration because of concerns related to infection.…”