Drug administration optimization : trial of a new safety infusion system

Face to the risk of nurses exposure to cytotoxic drugs, chemotherapy infusions are first connected to a IV set priming with the dilution solvent in our pharmaceutical chemotherapy production unit. However, the absence of rinsing after infusions causes a potentially significant underdosing. The aim is to evaluate a secure cytotoxic administration system.

The CAREFUSION® system, which consists of a multy-way connection set and secondary sets, was tested for 10 days in the hematology-oncology unit (61% activity). Two scoring tables were developed to assess pharmaceutical technician’s and nurse’s satisfaction on technical criteria, scored from 0 (low) to 3 (very good). A cost analysis was also performed.

About the secondary sets, 7 pharmaceutical technicians assigned a satisfying score (2,75/3). They pointed an improvment in purge duration (40 min/d) and ease of use. About the multy-way connection set, 8 nurses assessed the system secure delivering it an overall score of 2,1/3. The troubles identified were a longer installation time, a rinsing complexity (1.25/3) and a poor visibility due to infusion bags obstruction (0.75/3). The overhead on the use of this system is estimated at €43,500 for a production of 30,000 infusion bags per year.

The easier preparation in isolator is associed with a simplified supply management, regardless of the hospital contracts for infusion pump. The administration of the total dose is more reliable and a single action of connection/disconnection is performed by chemotherapy session, to ensure a secure administration for caregivers and patients.
Despite the extra cost, this study highlights the security interest of this system, according to the recommendations on handling hazardous drugs [1]. It is a part of the project chemotherapy traceability RFID (Oncotrace®) which try to answer to every stakeholders’ requirement in the process.