Andrew James, Project Director of Pharmacy, Chris O'Brien Lifehouse Cancer Treatment Centre, Sydney, 2014
One of the primary functions of the Department of Pharmacy is the preparation and supply of chemotherapy to patients treated in the Day Therapy Unit. Almost all of these products are prepared ‘in-house’ in a state-of-the-art clean room facility located within the pharmacy department. The ‘manufacture’ and labelling of each product for every patient is ‘controlled’ by a work sheet which was produced manually by dispensary staff. The work sheets and labels were then supplied to the clean room the day before or on the day of the patients’ scheduled treatment.
Due to the fact that every work sheet and label was produced manually proved to be a considerable workload for the dispensary and clean room staff and also meant there was significant opportunities for errors relating to the spelling of patient names, dates of birth, names and strengths of products, expiry dates and batch numbers. The preparation of these work sheets and labels was extremely labour intensive and meant that clean room staff were always ‘catching up’ with patient appointments and pharmacy staff were working long hours with considerable overtime being accrued.
In December 2013, approximately one month after opening, a decision was made to engage Sláinte Healthcare to create and electronic chemotherapy manufacturing work sheet in ‘Vitro’. This was done with the objective of automating a number of the manual steps in the preparation of the work sheets and also removing error-prone data entry by using patient information contained within ‘Vitro’ such as patients name and date of birth. The new functionality of ‘Vitro’ went ‘live’ on 24 February 2014 after comprehensive testing.
The advantages of using ‘Vitro’ in the preparation of clean room work sheets and the partial automation of this process may be summarised as follows:
- Patient demographic including patient name, date of birth and medical record number (MRN) details are automatically carried from the PAS into the work sheets and labels eliminating the need for manual entry;
- Dosages and volumes are automatically calculated;
- Specific limits to dosage, volumes and other parameters may be built into the work sheet to minimise the likelihood of products exceeding manufacturer or professional guidelines;
- Expiry dates are automatically calculated based on the ingredients and date of manufacturing;
- Worksheets are checked and electronically ‘signed’ at various stages in their movement throughout the clean room and product production;
- The worksheets are checked, verified & authenticated by staff entering an individual four digit PIN which identifies them in ‘Vitro’;
- The time it takes to create a worksheet for complex regimens has been reduced from 10-30 minutes to less than 5 minutes; and,
- Further enhancements have been undertaken to improve label formatting, production of work sheets and work practices within the clean room.
The benefits to the dispensary and clean room have been enormous with considerable improvements in working conditions for pharmacy staff. More importantly, waiting times for patients attending the Day Therapy Unit has significantly reduced. Late changes to treatment regimens and dose changes are no longer causing delays to treatment even when these changes are communicated at the last minute.
Furthermore, Sláinte Healthcare has been a pleasure to work with and have been extremely responsive to feedback from pharmacy staff. They have also been very accommodating regarding changes and enhancements to this component of ‘Vitro’. They appear to have a comprehensive understanding of hospitals and processes which has brought immeasurable benefit to us. Ultimately they have delivered an invaluable, highly successful implementation, on-time and on-budget.
Andrew James
Director of Pharmacy