The stages of the implementation of standardization doses : the example of paclitaxel

Context

The number of patients followed at our cancer center’s day hospital ward is increasing every year. In this context, we decided to implement cytotoxic drug dose banding in order to minimize patients’ waiting time, but also to smooth the activity throughout the day.

Material and method

In order to choose which cytotoxic drug was suitable for standardization, eligibility criteria were defined. Preparation volume had to be superior to 500 infusion bags a year and standardization rate had to exceed 60%. Physicochemical stability of 12 days had also to be validated by reliable data. A one year retrospective study was performed on 2016’s activity. Paclitaxel was selected and 3 banded doses were defined to limit the deviation to initial prescribed dose to 5%.

Results

Selected banded doses were 120, 132 and 144 mg representing more than 70% of overall paclitaxel infusion bags. Suitable physicochemical stability was validated by a bibliographic search. One preparation sheet and non-nominative labels are edited for each preparation batch. Each infusion bag has its own preparation number and is dosed by a UV-visible Raman coupled analytic method. Once the prescription is scheduled by the physician, the paclitaxel dose is converted into the nearest banded dose by Chimio® software. The prescriber remains free to keep initial calculated dose before prescription validation. When the preparation is required by ward’s medical staff, a preprepared infusion bag is reattributed and a nominative label is edited.

Conclusionel

One month after dose banding implementation, standardization of paclitaxel doses allows us to smooth production activity. Coupled with anticipated production and D-2 phone call to patients, cytotoxic drug dose banding appears efficient for optimizing day hospital activity.