HPE What price can you put on safety? - Page 5

Commissioning for Quality and Innovation (CQUIN) points rewarding the purchase of dose banded products and the increased capacity within Trust aseptic units resulting from outsourcing. Contracting sits with regional procurement specialists, and the Trust decides whether or not to take part. Bag design, connecting sets and saline priming The delegates were invited to put their artistic skills to work, by way of describing to their colleagues the confi guration of IV connecting sets in their countries. In the Netherlands, the bag is accessed with a simple spike (bag will have a spike port), or with a male Luer Lok (bag will have a female Luer Lok, as illustrated below). In describing confi gurations in their own countries, the delegates were directed to focus on views on saline priming, and preference for spiked port or Luer Lok. Regarding saline priming, it was pointed out that it takes a substantial amount of time to fl ush, and that there are no advantages to priming, assuming that you have the correct administration system to assure nurses that there will be no ‘contamination’ droplets. It is always easy to expel air from the drip chamber of any administration set, now made super easy with the use of a wing valve (CODAN) at the top of the drip chamber. There was 100% consensus that saline priming was unnecessary – the delegate from the Netherlands committing to checking with his pharmacy the following day to learn if wing valves had been adopted. There was also 100% consensus that spike ports (spikes, not needles) or Luer Loks would be equally acceptable for bag access, and industry was encouraged to equip bags with both spike ports and Luer Loks, so as to service all markets. Dose banding vs fi xed doses Fixed dose refers to the absolute dose of medicine that meets the respective indication, regardless of body mass index (BMI) or body weight. Dose banding is a series of standardised doses at intervals of BMI or body weight. The dosing regime may not solely be determined by the SmPC, but also by the prescribing physician: the doctor prescribes the fi xed dose, and the pharmacist calculates the individual dose (software) and rounds to the band. Doses may be adjusted (on the authorisation of the physician) to fi t pre-fi lled drug bags so, in this sense, the terms ‘fi xed dose’ and ‘dose band’ become interchangeable in practical terms. In the UK, it was suggested that the reason that dose banding is incentivised is because it is seen to save money. As fi xed dose gemcitabine bags are available in several volumes, there will always be one concentration that falls within the acceptable 5 – 6% range and, as such, they are used in the UK. In the Netherlands, dose banding is not allowed. As in Italy, the two main fi xed dose 10mg/ml gemcitabine bags are 1,400mg and 1,600mg. This means less of a storage issue, and you use vials for those patients that use other doses. It follows, therefore, that, when Industry is looking to license new products of this type, they might want to look at what dose bands there already are. The key is, above all, to administer the right concentration. I prefer to use these special administration systems where I don’t have to prime the line Irene Krämer, Germany in the compounding unit and decreasing the time in processing each task. So capacity is released within the aseptic unit, at a time when everybody’s aseptic unit is under stress. • RTA IV oncology bags free up robots to get on with other tasks. • Other benefi ts of RTA IV oncology bags include: – There is no waiting time for patients, doctors and nurses – Medication errors are eliminated – Quality and sterility are guaranteed – Risk of exposure to potentially hazardous drugs is greatly reduced – Risk of needlestick injury is diminished – Capacity is increased and stress is reduced in compounding units – Use of medical disposables is reduced – Waste is reduced Barriers to buying • In the past ten years, the rate of normal drug shortage has been multiplied by 20. And that means that hospitals must retain the capability to prepare products in house where practicable and safe. • Germany pharmacists are incentivised by Health Insurers for compounding gemcitabine bags for outpatients, at a rate of €49 per bag, i.e. an incentive not to use licensed RTAs. This is a major barrier to Piggy-back IV infusion (Netherlands) Drug NaCl Piggy-back IV infusion Female Luer Lok Male Luer Lok Drip chamber Roller clamp Costs/Benefi ts • RTA IV oncology bags improve capacity within pharmacy by decreasing the number of preparations hospitalpharmacyeurope.com | 2020 | 5