Automation of a dose banded bortezomib campaign dispensing system
- The objective was to introduce automation and campaign working for dispensing of Bortezomib doses with the aim of introducing cost savings.
- Campaign dispensing of bortezomib was introduced using automatically generated worksheets which resulted in £38,000 cost savings per month in the first two months.
- Substantial cost savings can be made by working on a campaign basis particularly where high cost drugs are involved.
Organisations within the NHS have a duty to ensure that funding is used in a manner that ensures best value for money through efficient use of drugs whilst retaining high quality.
Annual expenditure on bortezomib at UHL NHS trust is over £1.2million. A 3.5mg bortezomib vial is sufficient to treat a 2.5m2 patient.
Individual prescriptions arrived in Pharmacy separately and were dispensed on the day of treatment due to expense and expiry. The wastage from dispensing individual doses is a significant proportion of the total cost of bortezomib-estimated at 35% of total mg reconstituted. By compounding doses as a “campaign” multiple doses can be dispensed at the same time, allowing sharing of vials and thus reducing wastage and delivering significant cost savings.
In preparation for Campaign working:
- A risk assessment was completed to identify and manage any additional risks.
- An in-house Change Control - Request Form was completed.
- A New generic campaign working SOP was written, using NHS PQA Guidance document for vial sharing .
- A Bortezomib campaign worksheet was created with additional process checks incorporated in a “word” template.
- Aseptic Unit documents were reviewed by QA Regional Officer.
- Bortezomib Chemocare dose banding was extended to encompass all prescribed doses.
- An automatically generated worksheet was developed using a crystal report from Chemocare to provide all the required elements automatically calculated.
Aseptic staff were trained.
With preparation complete the following process was instigated:
- Bortezomib doses are confirmed by a pharmacist by 2pm the day before they are due.
- A crystal report with all confirmed doses is generated using Chemocare software. The report automatically calculates the doses required, numbers and vials required. The information is presented in the form of a “campaign” worksheet.
- All doses are then pre-emptively compounded together as a campaign.
- Doses are checked against the worksheet and kept in the lab overnight.
- Vials are booked out and entered onto a spreadsheet.
- Doses are released against the individual prescription once authorised.
Cost savings of over £38,000 per month have been demonstrated in the first two months of used.
Patient waiting times have been reduced due to advance dispensing.
Wastage fell from 35% before to 15% of drug dispensed.
Wastage has been minimised due to the effects of dose banding and reuse of unused syringes later in the week.
Substantial cost savings can be made by working on a campaign basis particularly where high cost drugs are involved. This can be achieved by close working with IT support, prescribers, nurses and pharmacy.
The use of dose banding is essential to deliver campaign working in a cost effective manner.
E-prescribing systems and automation can help maximise capacity whilst reducing the risks associated with manual transcription and calculations.
This method could be used as a template to achieve further cost savings on other high cost therapies
 Mark Santillo. Vial sharing in aseptic services. : NHS Pharmaceutical Quality Assurance Committee; 2014.