« Done for Mrs B ! » : Comparison of a chemotherapy oral validation versus a conventional validation circuit

Introduction
In order to provide optimal patient care, the French Pharmaceutical Oncological Society (SFPO), recommends a maximum time limit of 60 minutes between the medical validation (MV) of the chemotherapy cure and its administration. In our hospital, we have 2 cure MV systems at our disposal: a computer validation system (CVS) through Chimio^® and an oral validation system (OVS) through an oncology specializing nurse. The latter consists of an early validation on Chimio®, followed by a phone confirmation once the patient has been clinically examined.

Objective
To compare the OVS to the CVS, we assessed their respective conformity rate to the SFPO recommandations.

Method
To do so, we identified the times of the cures MV, of the chemotherapy bag release and of their dispatch to the service. Using this data, we calculated the delays between MV and bag release, between release and dispatch, and between MV and dispatch.
The delays between MV and dispatch allowed us to compare each system’s conformity rate to the recommandations, rates that we compared to one another by a Normal Law test.
The delay between MV and pharmaceutical analysis (PA) was analyzed only for the CVS, as the pharmaceutical analysis was made beforehand for the OVS. When the cure contained several molecules, only the times of the first bag were collected. This study took place for 4 weeks.

Results
163 chemotherapy bags were studied: 98 through the CVS and 65 through the OVS.
The PA average time was 6min for the CVS. The average delays between MV and bag release were respectively 62 and 44min.
At the end of the release, the MV had taken place 60 minutes earlier for 54% of the CVS bags and for 74% of the OVS bags. Between the release and the dispatch, there was an identical average delay of 15 minutes for the 2 systems, which corresponds to the wait for the courier.
All in all, the average delays between MV and dispatch were 76min (standard deviation : 23min) for the CVS and 59min (standard deviation : 26min) for the OVS, which represents a difference of 18 minutes. Thus, the compliance rate to the SFPO recommendations were respectively 26% for CVS and 45% for OVS, a significantly higher rate for the OVS (p<0.01).

Discussion
We note a conformity rate improvement to the SFPO recommandations with the OVS.
It can be explained thanks to the pre-PA and the production fluidization by the upfront trays preparation and sterilization.
The OVS also enables to upgrade the patient’s comfort thanks to quicker patient care and to secure the PA by doing it out of production schedule. However, the compliance rate stays limited compared to the recommandations.
We identified 3 improvement axis: to increase the number of OVS validation, to equip the laboratory with a second insultor with a quicker sterilization system and to optimize the chemotherapy dispatch track.

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