The impact of logarithmic dose banding of anticancer drugs on pharmacy compounding efficiency at Ghent University Hospital

Claus, Barbara; Pourcq, Kaat De; Clottens, Nele; Krüse, Vibeke; Gemmel, Paul; Vandenbroucke, Johan

doi:10.1136/ejhpharm-2016-001093

Cited by 7 publications

(9 citation statements)

References 11 publications

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“…PIs can also generate cost avoidance due to the prevention of adverse drug events: according to a study, the mean cost avoidance generated by a PI was 166€ [13,14]. PIs may have also organizational impacts: pharmacists can engage actions to improve the quality of care process from the perspective of healthcare providers to optimize preparation and administration workflow [15,16].…”

Section: Introductionmentioning

confidence: 99%

Clinical, economic and organizational impact of pharmacist interventions on injectable antineoplastic prescriptions: a prospective observational study

Zecchini

Chanoine

et al. 2020

BMC Health Serv Res

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Background: Pharmacists play a key role in ensuring the safe use of injectable antineoplastics, which are considered as high-alert medications. Pharmaceutical analysis of injectable antineoplastic prescriptions aims to detect and prevent drug related problems by proposing pharmacist interventions (PI). The impact of this activity for patients, healthcare facilities and other health professionals is not completely known. This study aimed at describing the clinical, economic, and organizational impacts of PIs performed by pharmacists in a chemotherapy preparation unit.Methods: A prospective 10-week study was conducted on PIs involving injectable antineoplastic prescriptions. Each PI was assessed by one of the four multidisciplinary expert committees using a multidimensional tool with three independent dimensions: clinical, economic and organizational. An ancillary quantitative evaluation of drug cost savings was conducted. Results: Overall, 185 patients were included (mean age: 63.5 ± 13.7 years; 54.1% were male) and 237 PIs concerning 10.1% prescriptions were recorded. Twenty one PIs (8.9%) had major clinical impact (ie: prevented hospitalization or permanent disability), 49 PIs (20.7%) had moderate clinical impact (ie: prevented harm that would have required further monitoring/treatment), 62 PIs (26.2%) had minor clinical impact, 95 PIs (40.0%) had no clinical impact, and 9 PIs (3.8%) had a negative clinical impact. For one PI (0.4%) the clinical impact was not determined due to insufficient information. Regarding organizational impact, 67.5% PIs had a positive impact on patient management from the healthcare providers' perspective. A positive economic impact was observed for 105 PIs (44.3%), leading to a saving in direct drug costs of 15,096 €; 38 PIs (16.0%) had a negative economic impact, increasing the direct drug cost by 11,878 €. Overall cost saving was 3218€. Conclusions: PIs are associated with positive clinical, economic and organizational impacts. This study confirms the benefit of pharmacist analysis of injectable antineoplastic prescriptions for patient safety with an overall benefit to the healthcare system.

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Section: Introductionmentioning

confidence: 99%

Clinical, economic and organizational impact of pharmacist interventions on injectable antineoplastic prescriptions: a prospective observational study

Zecchini

Chanoine

et al. 2020

BMC Health Serv Res

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“…The existing literature concerning dose-banding consists in surveys regarding acceptability, feasibility or awareness, 9,[25][26][27][28][29][30][31] but clinical data concerning patients treated with chemotherapy using dose-banding were still lacking and were a hindrance to a full endorsement of the concept of dose-banding. [25][26][27] The dose-banding approach consists in administering a lower or higher dose than that prescribed according to the drug approval, within a predefined range.…”

Section: Discussionmentioning

confidence: 99%

Investigating the clinical impact of dose‐banding for weekly paclitaxel in patients with breast cancer: A retrospective and monocentric study

Puisset

Louedec

Verguet

et al. 2023

Brit J Clinical Pharma

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Dose-banding (DB) consists in approximating the theoretical dose of anticancer drugs calculated according to the body surface area (Dose-BSA) of patients. This concept is supported by pharmacokinetic but not by clinical data. The aim of this study was to assess the clinical outcome of DB defined as dose-fitting up to ±10%.Methods: This was a retrospective study conducted in patients receiving weekly paclitaxel in neoadjuvant (NAT) and metastatic (M+) settings. Three groups of patients were considered according to type of paclitaxel dosing: Dose-BSA, DB approximated down (DB-Low) and DB approximated up (DB-High). Efficacy was evaluated by the rate of pathological complete response for patients in NAT setting and by the median of progression-free survival plus overall survival for those in M+ setting. Toxicity and efficacy were compared in the 3 groups.Results: A total of 224 and 209 patients were assessable in the M+ and NAT settings, respectively. A toxic event was observed for 31.7 and 27.3% in M+ and NAT, respectively. The rate of pathological complete response was 41.6% in NAT. The median progression-free survival was 5.2 (4.1-5.8) months and overall survival was 16.3 (14.6-18.4) months for patients in M+. Efficacy and toxicity were not different in DB-Low and DB-High groups compared to Dose-BSA group. Conclusion:DB with approximated doses up to ±10% does not seem to influence clinical outcome of patients treated with weekly paclitaxel. This is the first study to include clinical observations, which lends support to DB as a safe and effective dosing method.

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“…Benefits would include not having to wait for a medical prescription before starting production, as well as less wasted time and lower financial losses when preparations prescribed in advance are cancelled. 51 Dose-banding, associated with analytical monitoring of the finished product, aids the contribution of automated production, improving production efficiency 52 and operator's safety by limiting human errors and variability.…”

Section: Discussionmentioning

confidence: 99%

Work overload is related to increased risk of error during chemotherapy preparation

Carrez

Bouchoud

Fleury

et al. 2019

J Oncol Pharm Pract

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Purpose Chemotherapy preparation units face peaks in activity leading to high workloads and increased stress. The present study evaluated the impact of work overloads on the safety and accuracy of manual preparations. Method Simulating overwork, operators were asked to produce increasing numbers of syringes (8, 16, and 24), with markers (phenylephrine or lidocaine), within 1 h, in an isolator, under aseptic conditions. Results were analyzed using qualitative and quantitative criteria. Concentration deviations of < 5%, 5%–10%, 10%–30%, and >30% from the expected concentration were considered as accurate, weakly accurate, inaccurate, and wrong concentrations, respectively. Results Twenty-one pharmacy technicians and pharmacists carried out 63 preparation sessions (n = 1007 syringes). A statistically significant decrease in the manufacturing time for one syringe was observed when workload increased (p < 0.0001). Thirty-nine preparation errors were recorded: 30 wrong concentrations (deviation > 30%), 6 mislabeling, 2 wrong diluents, and 1 wrong drug. There was no statistically significant difference in the mean concentration accuracy of final preparations across the three workloads. The overall error rate increased with the number of preparations made in 1 h: 1.8% for 8 preparations, 2.7% for 16 preparations, and 5.4% for 24 preparations (p < 0.05). Conclusion Although pharmacy technicians and pharmacists were able to increase production speeds with no effect on mean concentration accuracy under stressful conditions, there were greater probability errors being made. These results should encourage actions to spread workloads out over the day to avoid peaks in activity.

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The impact of logarithmic dose banding of anticancer drugs on pharmacy compounding efficiency at Ghent University Hospital

Cited by 7 publications

References 11 publications

Clinical, economic and organizational impact of pharmacist interventions on injectable antineoplastic prescriptions: a prospective observational study

Clinical, economic and organizational impact of pharmacist interventions on injectable antineoplastic prescriptions: a prospective observational study

Investigating the clinical impact of dose‐banding for weekly paclitaxel in patients with breast cancer: A retrospective and monocentric study

Work overload is related to increased risk of error during chemotherapy preparation

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