Capacity Planning for Chemotherapy
Chemotherapy workload in most hospital units is increasing due to new drugs and complex regimens taking longer to prepare than other, more simple regimens.
Capacity planning is an audit requirement for aseptic dispensing in the NHS. Often pharmacists develop their own capacity plans for individual units. This however has the disadvantage that often there is no direct way of comparing one hospital with another.
It was decided within the Northern Cancer Network to produce a capacity plan that could be used across all hospitals within the network to compare workload and staffing.
The capacity plan produced uses a generic template which enables units to input their own figures in order to calculate the level of chemotherapy activity in their aseptic units and to relate this to demands on the service. It is based around the principle of establishing a capacity rating for every chemotherapy item prepared. This rating or “number of adjusted items” is directly linked to the time taken to prepare the product (each “adjusted item” is five minutes). By combining capacity ratings with the time taken for all other activities to prepare chemotherapy the number of pharmacy staff required to deliver the chemotherapy service can be calculated.
The formula produced for the time taken per month to prepare chemotherapy is
Monthly items x (19P + 21T + 11A)
+ Number of sessions per month x 52T
+ Adjusted items per month x 5T
Where P = pharmacist minutes
T = technician minutes
A = Assistant minutes
By following the methodology of the tool, units are able to report their activity in a format that can easily be compared to other units, either within or outside of their cancer network. They are also able to estimate the impact on capacity of any requests for preparation of new chemotherapy drugs.
After publication this capacity planning tool was used by the Cancer Service Collaborative to produce “Modernising Chemotherapy Services – A Practical Guide to Redesign”. This document linked the total time taken for a patient visit, combining the capacity of nursing staff, pharmacy and oncologists. By following this document, service providers can identify any delays in the various steps and so streamline the process.
Following on from this document, a computerised version, C-PORT, is in the process of being implemented. C-PORT is a web–based tool which enables cancer networks to input local data and assumptions in order to understand current and future processes. It is a simulator which can forecast how each patient will experience care. It can also simulate the impact on service delivery due to the addition of a new treatment or a change in availability of resources.