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