Authors (including presenting author) :
Tse HK(1), Cho HY(1), Chow CH(1), Wong CL(1), Poon MH(1)
Affiliation :
(1)Pharmacy Department, Hong Kong Children’s Hospital
Introduction :
HKCH pharmacy prepares more than 900 cytotoxic products per month. Due to the wide range of body sizes and fluid requirements in children, the compounding of these cytotoxic products often requires multiple manipulations, which requires stringent supervision during the preparation process. Traditionally, preparation of intravenous (IV) chemotherapy were depended on the volumetric approach by checking the correct volume of drug and diluent being withdrawn. Our aim was to introduce a computer-assisted gravimetric checking so as to reduce the potential errors associated with visual inspection. The complexity of pediatric chemotherapy protocol dosing schedules also necessitates a close communication between clinical pharmacists and the aseptic dispensing unit (ADU) to avoid missing orders, in which an electronic dashboard on items to be prepared at real-time would be useful.
Objectives :
To improve medication safety and service quality, a computerized workflow management and gravimetric checking system- CYtotoxic Product MANagement System (CyMans) was developed and implemented in our pharmacy.
Methodology :
CyMans was developed as a pharmacy workflow management system with the gravimetric checking module incorporated within. As for workflow management, CyMans provided the daily list of chemotherapy products to be prepared for clinical pharmacists in wards as well as the pharmacy aseptic dispensing unit (ADU) to follow, the product list was also printed and faxed to ward for confirmation. Besides, the manufacturing stage of each product was indicated in the dashboard to assist pharmacy work scheduling and monitoring.
CyMans also provide gravimetric checking to ensure the accuracy of the prepared volume fell within acceptable margins of error. All chemotherapy products contained in IV bags underwent a gravimetric verification at final checking. The final weight of the product was compared with the expected weight calculated by CyMans. The calculations were based on specific gravity values provided by manufacturer. For better accuracy in pediatrics, product specific acceptance criteria were determined based on big data analytics using previous gravimetric checking data. Evaluation was performed using the passing rate in gravimetric checking.
Result & Outcome :
Since the launch of the system in mid-July 2021 to September 2022, gravimetric checking was performed for more than 8000 products using CyMans. During that period, 99.2% of products passed the gravimetric checking, and out-of-range products were reviewed to ensure a correct compounding procedure. No medication incidents related to chemotherapy compounding was reported during the evaluation period.
Implementation of a computerized gravimetric compounding function in the chemotherapy workflow management system was found to be an effective way to improve medication safety and workflow efficiency
