Leveraging advanced preparation of oncology medications: Decreasing turnaround-times in an outpatient infusion center.

INTRODUCTION: Many oncology infusions are provided in hospital-based infusion centers. With hospital-based infusion centers seeing increased volumes, patient wait times continue to be a priority. Extended wait times for oncology infusions have been shown to lead to patient dissatisfaction. METHODS: Advanced Preparation of oncology infusion medications allows pharmacy to verify and prepare specific medications the day before a patient's infusion appointment. Our study targeted lower cost, commonly used medications to prepare in advance. Data analyzed included turnaround time (TAT), medication waste, and oncology infusion preparation volumes. Implementation took place in two phases to allow time for the healthcare team to adjust to the new workflow. Phase I medications include a small amount of medications prepared manually by pharmacy technicians. Phase II medications included all phase I medications plus additional medications that were compounded in the intravenous (IV) robotic compounding system. RESULTS: Our study demonstrated significant decrease in median TAT for medications prepared in advance. 537 infusions were prepared using the Advanced Preparation module with a median TAT of 24.2 minutes (IQR, 18.0-34.0). The pre-implementation median TAT was 45.0 minutes (IQR, 36.0-56.0), which represents a decrease of 20.8 minutes (46.2%) following implementation of the program, (p<0.001). There were a total of 149 advanced preparation doses that were wasted (21.7% of doses). CONCLUSION: We have seen a statistically significant reduction in TAT for Advanced Preparation medications. Low volume of Advanced Preparation medications compared to total infusion volume limited impact on overall TAT.

Comparison of IV oncology infusions compounded via robotics and gravimetrics-assisted workflow processes.

PURPOSE: A study was conducted to compare an intravenous (IV) gravimetric technology-assisted workflow (TAWF) platform to an IV robotic system. In the study we reviewed both IV technology platforms using the same gravimetric quality assurance system, which allowed for direct comparison. METHODS: All oncology preparations compounded from January 2016 through December 2018 using either system were included in our retrospective analysis. Final preparation accuracy, IV system precision, and workflow throughput (analyzed using lean process methodologies) were evaluated. RESULTS: Data analysis indicated that use of the IV gravimetric TAWF system was associated with a significantly lower percentage of accuracy errors compared to the IV robotics system (1.58% vs 2.47%, P < 0.001), with no significant difference in absolute precision (1.12 vs 1.12 P = 0.952). Lean analysis demonstrated that overall completion time (17:49 minutes vs 24:45 minutes) and compound preparation time (2:39 minutes vs 6:07 minutes) were less with the IV gravimetric TAWF vs the IV robotics system. CONCLUSION: Implementation of either an IV gravimetric TAWF system or IV robotics system will result in similar compounding accuracy and precision. Preparation time was less with use of the IV gravimetric TAWF vs the IV robotic system, but the IV robotic system required less human intervention. Both systems ensure medication safety for patients, although the IV robotic system has increased safeguards in place. Therefore, the primary driver for implementing these systems is alternative factors such as cost of systems implementation and maintenance, employee safety, and drug waste.

Comparative Effectiveness and Safety Analysis of Dual Antiplatelet Therapies Within an Integrated Delivery System.

BACKGROUND: Dual antiplatelet therapy is a mainstay of care for percutaneous coronary intervention (PCI) patients; however, uncertainty exists in real-world practice about comparative effectiveness and safety outcomes. OBJECTIVE: To evaluate outcomes of different oral P2Y12 inhibitors in PCI patients. METHODS: We retrospectively studied patients treated between July 1, 2010, and December 31, 2013. Patients received clopidogrel, prasugrel, ticagrelor, or more than 1 antiplatelet (switch) during PCI. Outcomes were evaluated for major adverse cardiovascular events (MACE) and bleeding at 1 year. Propensity score matching with Cox proportional hazards analysis was used to determine predictors of MACE and bleeding. RESULTS: A total of 8127 patients were included: clopidogrel (n = 6872), prasugrel (n = 605), ticagrelor (n = 181), and switch (n = 469). Treatment with prasugrel was associated with the lowest risk of MACE using multivariate regression (odds ratio [OR] = 0.57; 95% CI = 0.36-0.92; P = 0.02). In the propensity score-matched analysis, only the prasugrel group was associated with a lower risk of MACE compared with the clopidogrel group. Clopidogrel was associated with the lowest risk of major bleeding using multivariate regression (OR = 0.64; 95% CI = 0.42-0.98; P = 0.042). Both ticagrelor (hazard ratio [HR] = 2.00; 95% CI = 1.11-3.59) and the switch groups (HR = 1.65; 95% CI = 1.09-2.50) were associated with a greater risk of major bleeding compared with clopidogrel. However, no differences were found in the propensity score-matched analysis. CONCLUSIONS: Dual antiplatelet therapies differed in both MACE and bleeds in a real-world setting of PCI. Prasugrel was associated with fewer MACE, whereas clopidogrel had fewer major bleeding events.