Moving Cytotoxic compounding in the 21st century

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Moving Cytotoxic compounding in the 21st century

• Ann Jacklin
• Chief of Service Pharmacy Therapies
• Imperial College Healthcare NHS Trust
• and
• Visiting Professor The School of Pharmacy
  University of London
• Conventus September 2008

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The Trust

• Income
• gt700 million healthcare per annum
• gt100 million RD and teaching
• Activity
• gt170,000 in patients pa
• gt690,000 outpatients pa
• Staff
• 9,700

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Pharmacy in ICHT

• Pharmacy departments on 4 sites CXH, HH , STM
  WEH
• 250 staff
• Approximately
• 110 pharmacists
• 100 technicians
• 40 admin/support
• Pharmacy spend gt9 million per annum
• Drugs spend gt50 million per annum

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Aseptic Services

• Aseptic units at both HH CXH
• Cytotoxics 29,500 doses pa
• 19,600 _at_ CXH
• 9,900 _at_ HH
• Parenteral nutrition 7,200 doses pa
• 2,700 adult _at_ CXH
• 4,500 neonatal _at_ HH
• Other 600 panot enough!
• STM currently outsourced approx 2,000
  cytotoxics pa

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Issues aseptic services

• demand rising
• also changing from IP to ambulatory
• processes manual labour intensive
• repetitive strain injury prone
• highly regulated
• Medicines Healthcare Products Regulatory
  Authority (MHRA) licensed units
• heavy training accreditation load
• opportunity costs
• arising from no spare capacity
• Slow and inefficient
• patient safety achieved at cost of timeliness and
  efficiency

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Potential solutions

• Standardised adult and neonatal TPN
• Oral chemotherapy
• Cytotoxic dose banding and standardisation of
  dose preparations
• Contracted out compounding services
• Industry provided licensed for use doses
• Automation

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CytoCare

• Offers
• Automation
• with
• Process re-engineering

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• A short video.

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CytoCare expected to deliver

• Increased capacity
• Improved turn around time
• Reduced Repetitive Strain Injury/Upper limb
  disorder RSI/ULD
• Reduced paperwork
• Reduced process steps
• Improved staff satisfaction

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Hammersmith Hospitals business case September
2006

• Capacity
• We will do more with existing staff
• We will improve the patient experience
• We will help attract more business
• Drug costs
• We will go back to vial sharing
• Staff safety
• We will avoid RSI/ULD

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The Safechemo Project www.safechemo.eu

• EU funded market validation project
• Consortium
• Commercial Partners
• B Braun
• BTC
• Medarchiver
• Pilot sites
• Bolzano
• Copenhagen
• London

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Safechemo ctd

• April 2007 January 2009
• Pilots validate
• Safety - accuracy, micro, particulates, cytotoxic
  exposure
• Efficiency - reliability, error reduction, cost
  reduction
• Human Aspects improved process flows, user
  acceptance and use
• Interim results
• EAHP Maastricht 28 February 2008
• EAHP Barcelona March 2009

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Where are we now? Localisation almost completed
validation underway

• Safety
• accuracy
• particulates
• micro
• Efficiency
• reliability
• error reduction
• cost saving
• Human Aspects
• user acceptance
• improved process flows

Still too early to say

?

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go live

• Scheduled w/c 3 November
• 5 FU initially.
• Fingers crossed

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