Evaluation of the lead-time for availability of chemotherapies in four hospital centres
2 Service Pharmacie Centre Hospitalo-universitaire de Rouen,
3 Service Pharmacie Centre Hospitalier d’Aix-en-Provence,
4 Service Pharmacie Hôpitaux Universitaires de Strasbourg.
The production of cytotoxic preparations is one of the responsibilities of pharmacists working in in-house pharmacies (Art 512-6 CSP). Can this activity be an obstacle to the in-house organisation of healthcare services? Our study’s main objective was to evaluate the lead-time for injectable chemotherapy treatments to be made available in 4 hospital centres. We also wanted to know whether the organisations in each unit could exert an influence on this lead-time and whether there were possible solutions to reduce that time.
Centre 1 does not centralise the preparation of cytotoxics. The 3 other centres have pharmaceutical centralisation of their production but with 3 different processes: centre 2 manufactures the cure completely (cytotoxic, monoclonal antibodies and adjuvants) with PSM stock in advance, while the 2 other centres manufacture under a tight flow isolator. Centre 3 only manufactures the cytotoxics and sends them out in bags; centre 4 also manufactures monoclonal antibodies and anticipates 69% of production using an institutional schedule.
Statistical analysis shows a significant difference in lead-times for availability between centres 1 and 3, whose availability ratings are poor (respectively 312 and 96 minutes) as compared with the 2 other centres (respectively 57 and 66 minutes) (p< 0.0001). The survey conducted with the medical staff shows a satisfaction rating of 72% with respect to the work of the Pharmacy. The mean time for availability was reckoned to come to between 1 hour and 2 hours for 57% of them and 70% would like to see this reduced to between 30 minutes and 1 hour.
Discussion / conclusion
This study enabled us to consider ways of making time savings (computerised and anticipatory forwarding of prescriptions, anticipation on preparations and scheduling of transport, etc.) and to propose means to improve safety without loss of time (production of the entire cure, analytical or gravimetric checks, forwarding in bags, etc.).