Optimization of chemotherapy circuit (short circuit) in oncology day hospital: feedback

Activity’s increase motivates jointly oncology unit and pharmacy to create a short circuit (SC) for patients who need a subcutaneous injection of trastuzumab, rituximab, D n+1 of Vidaza® (azacitidine) and D4/D11 of Velcade® (bortézomib) (early preparation done by Cytotoxic Drug Reconstitution Unit (CDRU)). When the patient arrives at the day hospital, the nurse calls the CDRU who delivers early preparation. Our objective is to evaluate the circuit’s efficiency.

Quantitatively, the nurses estimate efficiency recording medicated patient’s duration of stay. Qualitatively, the pharmacist spreadsheet’s analysis estimate efficiency recording the number of preparation, the number of patients treated by velcade, the respect of provisional schedule, reasons of cancellation and their cost. Costs and income comparison between conventional hospitalization and home hospitalization was evaluated.

Thirty five days of study, median of hospitalization was 40 minutes [12 minutes to 8h] including 128 data collection for 42 patients. Qualitatively, in 80 days, 17 unconformities have been shown basically at the beginning among which 7 planning errors and 6 protocol errors. There were 3 last-minute cancellations (planning error, hyperthermia, administration cancellation), 2 syringes were recycled and one destroyed (wastage of 685€). After 4 months, 57 preparations of Velcade® were done inside the SC for 23 patients. First data show that the occupancy rate is more than doubled compared to the classic circuit which assumed a saving.

This collective reorganization improves the operation of the CDRU by an anticipated production and seems to optimize patient care (nurses and patients’s satisfaction survey in progress) even if some preparations are not used immediately (geographical distance of the CDRU). If medico-economic impact is significant, this circuit has to be developed.