review
Integrating RTA gemcitabine
into e-prescribing protocols
This article focuses on transition to national standard dosing and adopting licensed chemotherapy
infusions into e-prescribing solutions to support safe prescribing, dispensing and administration
at a UK hospital Trust
Colin Ward MSc
MRPharmS
University Hospitals of
Derby & Burton NHS
Foundation Trust (Royal
Derby Hospital Site),
Derby, UK; and NHS
England Specialised
Commissioning (Midlands
& East Region), UK
Historically, intravenous chemotherapy doses
have been calculated for individual patients
based on weight or body surface area. This has led to
a large number of similar, but not identical,
products being made as bespoke orders within
compounding units. These small product differences
significantly increase time and costs of preparation
and costs of drug wastage. There is no robust
evidence to suggest that standardised doses affect
toxicity or clinical outcomes. 1
A number of hospitals have already moved to
a system of dose banding where a range of doses
are delivered to closely match vial size. 2 This means
there is reduced waste and, as these doses tend to
be ready made, it also reduces the waiting time for
patients in the chemotherapy unit.
National dose standardisation
The chemotherapy dose standardisation initiative
was developed by NHS England’s Medicines
Optimisation and Chemotherapy Clinical Reference
Groups. NHS England supports the standardisation
of chemotherapy doses, which will deliver
benefits for patients and hospital Trusts, and
achieve improved value from our investment in
chemotherapy services.
In April 2016, 19 NHS National dose banding
tables and a ‘how to’ guide 3 were published for use
by hospital Trust pharmacy teams to ensure
a standard approach to dose banding of
chemotherapy across all Trusts. The initiative was
initially focussed on 19 commonly used drugs.
Additional banding tables have been published
subsequently. This scheme will help the NHS
achieve improved value through the ability to
purchase standard off the shelf products. One
such product (gemcitabine 4 ) is already available
as licensed infusion bags covering some of the
national dose banded doses. Other drugs are
understood to be in the pipeline for development
as licensed products.
Local implementation of national dose
standardisation
Derby Hospitals had been dose-banding chemotherapy
for over a decade at the time that the initial national
dose standardisation tables were published. 5 However,
like many other providers, the local dose-banding
tables did not match the new national tables and so
a transition had to be managed.
At a similar time, the Trust was implementing
ChemoCare ® (CIS Oncology) as its electronic
prescribing solution. This gave an ideal opportunity
to manage the transition to national standard dosing
and adopt licensed infusions where available while
optimising the functionality of the e-prescribing
solution to support safe prescribing, dispensing and
administration.
table 1
Main steps and key messages for the switch
Staff group Key messages
Pharmacy storekeepers • Importance of product segregation
Pharmacy technical
staff • Need for existing stocks of unlicensed gemcitabine and 38mg/ml vials to be
depleted prior to transition
• Manual ordering leading up to transition
• Change to 100mg/ml vials for aseptic dispensing
• Automation of dose banding and dose dependent volumes within ChemoCare ®
(that is, no action required by pharmacists whereas previous prescribing system
required manual change on printed prescription – a source of risk)
Nursing staff • Change of presentation of gemcitabine infusions compared to historic fixed volume
Prescribers • Change of volumes on prescribing software for doses available as licensed
(250ml) for doses available as licensed infusions
infusions
• Automation of dose banding and dose dependent volumes within ChemoCare ®
(that is, no action required by prescribers)
16 | Issue 90 | 2018 | hospitalpharmacyeurope.com