Securing Azacitidine (Vidaza®) Circuit in Home Hospitalisation

Laurentine MALJEAN1, Camille SERENI1, Fabienne MOREY1, Baptiste MAUGUEN1, Amélie FEYEUX2, Jean Louis BONNEFOUS1 1 Service Pharmacie, CH Bourg en Bresse, France
2 Service HAD, CH Bourg en Bresse, France

Introduction
Azacitidine is an expensive molecule indicated in hematologic malignancies (75mg/m² for 7 days). It is highly temperature sensitive which complicates its circuit: after reconstitution, its stability has been demonstrated to be 45 minutes at 25°C, 8 hours between 2 to 8°C and 8 days at -20°C [1].
In our hospital, 19 patients beneficiated from home hospitalisation.
* Day 1: medical validation, pharmaceutical validation and preparation of chemotherapy cycle, delivery of the first injection and administration in day hospital. The rest of the cycle is put to freeze.
* Day 2: Delivery of the rest of the cycle to patient’s home via a private carrier. Patient receives the cycle and stores it in the freezer (except the second injection which is defrosted and put in the refrigerator until the liberal nurse arrival).
* Day 3 to 7: patient defrost the injection before the nurse arrival.
Our goal was to secure Azatidine circuit, expensive and sensible treatment, in order to optimise the care pathway.

Materiel and methods:
Creation of a working group on securing of chemotherapy circuit in home hospitalisation involving: pharmaceutical staff, home hospitalisation practitioner and haematology ward health executive.

Results:
* Education of day hospital nurses with intervention of the pharmaceutical staff in the ward and labelling of the injection packet, hand-delivery of the injections to the nurses.
* Transportation securing: courier and private carrier education. Purchase of ice chest modelled for frozen applications.
* Securing of home conservation: inspection of patient equipment (freezer) by a HC nurse
* Therapeutic education of the patient and his caregivers by the pharmaceutical team in day hospital before the first treatment. Creation and dispatch with each cycle of an information document (storage and defrosting methods of Azacitidine), packet label allowing tracing time of removal from the freezer and time of placing in the refrigerator.
* Education of private nurses on storage, defrosting and injection methods (verification of homogeneity) and creation of a checklist for each injection.

Conclusion:
In order to improve patient care, a HC circuit has been set up for Azacitidine. Security actions, focused on training of nursing staff and patient education, have been implemented at each stage of the circuit of this sensitive molecule. Other actions are planned such as installation of temperature verification tracers in patients’ homes

References
[1] Stabilis

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