Implementation of dose-banding in a pharmaceutical Chemotherapies Preparation Unit: Results after 3 years

Context
The activity of our pharmaceutical chemotherapies preparation unit rises from 5 to 10% per year, resulting in delays of patients care and peaks of activity. Therefore, the dose-banding of chemotherapies has been gradually implemented since 2017.

Objectives
Study the results after 3 years of dose-banding.

Methods
The implementation of dose-banding took place with help from the tool established by GERPAC (ADOC :”analyses of standardized doses”) for calculating the doses intervals. Then a retrospective analysis of the 2020 production has been done via the CHIMIO^® software, showing the doses that have been produced, attributed and lost.

Results
14 molecules could be produced through dose-banding in 2020 (versus 4 in 2017). Among them, Rituximab (intravenous and subcutanous), oxaliplatine and nivolumab represented a majority.
A total of 4324 standardised doses were produced, which represent 14% of the whole preparations (31 206).
Concerning the molecules that exist in standardised doses, 56% of the preparations have been followed by the attribution of a standardised dose. About 5% (408) of the preparations for which a standardised dose exist, had to be extemporaneously prepared, mainly because of a lack of stock (for 392 preparation, which is 96%).
We observed 4% of loss, which represents 172 preparations. The most involved molecules were Pembrolizumab (41%) and Oxaliplatine (31%)

Discussion
The doses loss percentage shows an adequation between production and real needs of the clinical units, however the attribution percentage can be improved. Following the study of these results, a requesting tool based on monthly extraction has been designed to adjust minimum and optimum stocks of standardised doses. This should reduce the loss rate and the costs, especially for expensive molecules. It is possible to adjust the production with more regularity for the molecules that causes the most of the losses and for the doses that were not coverd by the dose-banding (weekly for some molecules like pembrolizumab for instance). These results also made an awareness-raising of the prescribing professionals about losses and costs possible.

Conclusion
Although the coverage of standardised doses remains low (14%), it has a positive impact on the chemotherapy preparation unit and the clinical units by allowing a homogenous activity through the day. A fine and regular adjustment of the standardised doses allows a safe increase of the production while avoiding losses. With the follow-up of the production, we will reach our standardised doses 30% coverage in 2021. Among future molecules, Bevacizumab, Paclitaxel and Bortezomib’s standardised doses will soon be developped.

See the poster