Reducing parenteral systemic anti-cancer therapy (SACT) wastage in chemotherapy day care unit

ABSTRACT

Background: With an increasing use of parenteral systemic anti-cancer therapy (SACT) for a growing cancer population, cytotoxic aseptic units in theUKare experiencing an increase in workload. Having finite production capacity, it is imperative to use resources efficiently to meet the growing demand for SACT. UCLH (University College London Hospitals) Macmillan Cancer Center is one of the largest cancer centers in London, providing chemotherapy treatment for around 350 patients with haematology or oncology conditions in day care unit each week. SACT provided at UCLH are either manufactured locally in UCLH cytotoxic unit or outsourced from commercial aseptic units. Nurses working in the day care unit noticed and reported increases in daily SACT wastage. Wastage of 1 item had increased to around 5 items since the Covid-19 pandemic. The aim of this improvement work was therefore to reduce wastage, and this would be achieved using quality improvement (QI) methodology. QI team was formed, and SMART objective agreed reduce parenteral SACT wastage by 50% for day case treatments by 31st May 2021. Methods: During the pandemic new patient pathways were established. Using process mapping of these doctor consultation to administration of SACT, it was identified that wastage was occurring due to 1) patients being unwell on the day of treatment, 2) unsatisfactory blood results and 3) weight changes. As a team we decided that the process to improve would involve obtaining advance weights for patients. We adopted the IHI (Institute for Healthcare Improvement) model for improvement with a series of PDSA (Plan-do-study-act) cycles. Our first change for PDSA cycle 1 was regular weight documentation by day care staff using a checklist To improve on these results we educated the oncology pharmacy team on weight checking when preparing for clinics and during SACT verification. Daily wastage and compliance to weight documentation were recorded throughout a three-week baseline data collection period and the two PDSA cycles. Results: The baseline data showed average daily wastage of 4 infusions. Following PDSA cycle 1 the number of SACT wastage reduced to 3 infusions a day. After PDSA cycle 2, this reduced to 2.2. The compliance to weight documentation improved from a baseline of 30% (n=80) to 95% (n=215). Discussion: There was a reduced SACT wastage following the PDSA cycles. It is unclear whether regular weight documentation and education on weight check have led to the improvement. Although the project aim has not been achieved, PDSA cycle 1 and 2 were thought to be good practice to ensure appropriate SACT dose prescribed while reducing patient waiting time in the unit. Therefore, both changes are likely to be sustainable. Similar improvement work can be carried out over a longer timeframe in the future to establish whether these changes can make a positive impact on improving SACT wastage.