Implementation of the standardization of anticancer doses in a university hospital

Introduction
Given the constant increase in chemotherapy activity, the implementation of standard doses (SD) is one of the solutions for improving productivity and the quality of patient care by anticipated production per campaign.

Objective
The objective is to set up standard doses for cytotoxics and antibodies within the establishment.

Method
In order to select the molecules eligible for standardization, the selection criteria used were: frequency of prescription (at least 500 preparations/year) and the determination of SD with a variation of +/-10% of the dose and a maximum of 6 bands covering more than 50% of the production. The SD were then validated by the prescribers of the oncology and hematology departments and were parameterized in the Chimio^® software via the Standard Dose module. Finally, a review of the SD prescriptions was performed at 3 months.

Results
A total of 14 cytotoxics and 9 antibodies met the selection criteria. The mean number of established bands per molecule was 3.32 [1;5] with an estimated 57% SD production coverage.
The 3-month assessment of the SD implementation showed that 32% of the production was covered by the SDs. The average SD prescription rate was 64%. It was almost 100% for 8 anticancer drugs, including 7 antibodies, and less than 20% for 3 cytotoxic drugs (Docetaxel, Oxaliplatin and Paclitaxel).

Conclusion
Following these results, a readjustment of the SDs was made in agreement with the prescribers. Docetaxel, Oxaliplatin and Paclitaxel were defined as cytotoxic drugs with a narrow therapeutic range and the authorized deviation was reduced to +/- 3% and 5%. At the same time, a reduction of the deviation to +/-8% was implemented for the other cytotoxics.
The implementation of these modifications increased the average prescription rate in SD to 71%, with an increase in this rate to 90% for the 3 cytotoxics with a narrow therapeutic range.
It is now necessary to implement manual and automated campaigns in order to anticipate production and reduce patient waiting time.

Key words: dose banding, optimization, anticipation

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