Indexing of a new 5-fluorouracil diffuser: Why? How?

E. NEVADO, F.A. CHASTANG, S. HUET, G. MAILLAN Pharmacie à usage intérieur, CHU Dupuytren, 2 avenue Martin Luther King, 87042 Limoges (France)

Introduction

In our University Hospital Center, for the preparation of 5-fluorouracil (5FU) diffusers that dispense over 46 or 48 hours, we used BAXTER® SV 2 mL/h diffusers (for volume 5FU ≤ 92 mL) or BAXTER® LV 5 mL/h diffusers (for volume 5FU > 92 mL). We wanted to implement a new type of diffuser: the FOLFUSOR® SV 2.5 mL/h by BAXTER® that would replaces the two other references.

Material and method

Our evaluation is based on multiple criteria:

  • From an economic point of view, data was extracted from the software CHIMIO®, that was then analyzed via Excel®.
  • For the preparation time, the manufacturing time of 10 SV 2.5 mL/h diffusers were evaluated.
  • A satisfaction survey was given to the pharmacy technicians working in our anticancer preparation unit.

Results

From january 2017 to august 2017, 699 SV 2mL/h and 307 LV 5mL/h diffusers were prepared. After projection over a year, 1359 diffusers would be made in all. The price for the SV 2.5 mL/h is identical to the price of both SV 2 mL/h and LV 5mL/h. However, these diffusers are filled with glucose 5% (G5%) to obtain an identical final volume no matter the volume of 5FU needed. With the use of SV 2.5mL/h diffusers, a decrease in G5% used of 16 435 mL is expected over a year, which is about 50 euros saved. In terms of preparation time, the fabrication of a SV 2.5 mL/h for a predefined volume of 5FU is 13 seconds longer compared to a SV 2 mL/h and 75 seconds shorter compared to a LV 5 mL/h. This represents a gain of three hours of technician work time over a year. As there is a double human verification, it is also a gain of 3 hours of verification. The hospital pharmacy technicians were all very satisfied with the new diffuser. Their perception is correlated to the decrease in preparation time as, for then, the same time is needed to make a SV 2 mL/h or a SV 2.5 mL/h whereas more time is needed for a LV 5 mL/h. The principal advantages are: a time saving, less manipulation, a removal of the risk of confusion between two types of diffusers and a logistical improvement of these medical devices.

Discussion/Conclusion

The use of SV 2.5 mL/h as a replacement of both SV 2mL/h and LV 5 mL/h doesn’t incur any real economic gain. It does, however, save technician time as much during preparation then verification. The decrease in the number of actions and their difficulty (G5% withdrawal and injection into the diffusers) helps prevent the risk of musculoskeletal disorders of the personnel working in the unit. The switch of 2 diffusers to one facilitates the organization of medicals device orders and stops any confusion between the types of diffusers needed. The pharmacy technicians are very satisfied with the new diffuser. This indexing could also promote setting up standardized dose of 5FU.

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