Preparation of 5 FU infusers: from anarchy to dose banding

With the aim of optimizing the circuit of 5 FU infusers, from prescription to administration, a feasibility study of dose banding was initiated by the Pharmacy Departement and the Coordinated Center of Oncology (CCO). The objectives were:

1. to improve deadlines for provision of infusers;
2. a better organisation by smoothing the peaks of activity at the pharmacy;
3. a decrease of infuser returns.

Method

Retrospective analysis of production of 5 FU infusers in 2010.
Analysis of returns of unused infusers during 2011.
Feasibility study of standardisation of 5 FU doses.

Results

In 2010, 837 5 FU infusers were produced for 132 patients, inlcuding 91 different dosages from 300 to 9000 mg. These infusers included 781 48-hour infusers (93 %), 36 5.5-day infusers and 20 7-day infusers. A retrospective analysis of 2010’s production of 48-hour infusers with 109 patients and 52 different dosages from 2500 to 4900 mg showed that intervals of +/-5 % and 4 standardised dosages (3600, 4000, 4400 and 4800 mg) would have covered 92 % (n=716) of preparations. By widening the interval to +/-10 %, 3 standardised dosages (3250, 4000 and 4800 mg) could cover about 98 % of the production.

In 2011, 152 infusers out of 932 (16.3 %) were returned to the pharmacy. 119 were reusable and 33 were destroyed.

The stability of the molecule (45 days according to manufacturer data) and the frequency of use (> the 800 / year) are tangible elements supporting the implementation of 5 FU dose banding.

Discussion / conclusion

This dose banding project with 4 standardised dosages (+/-5 %) and computerised treatment planning was approved by the CCO. The study is set to begin in July 2012. The first results will be analysed 6 months later on the basis of the three objectives outlined above, with a particular attention on the issue of returns.