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Dear Julie,




What steps of the pharmacy process (incl. drug preparation & administration) are there? Please draw the individual steps in the space below.

-screening the prescription for the patient;
-calculating the dose for the patient according with the BSA
-checking if the patient is o k to undertake the treatment( bloods ok, fit for sact)
- label the prescription;
-process checking the prescription (this include calculating the dose,volume and concentration;
-tray reconciliation sheet(picking up the necessary drugs,bags and consumables)
-assembling the tray for compounding;
-checking the ingredients(drug,bags of saline or glucose and the syringes)
-spraying the tray inside of the first hatch in the support room;
-dessinfecting the tray and sending the tray in the clean room to be prepared;

-compounding the final product (bags or syringes)
-sending the final product out of the clean room to be checked for particles ,labelled and then dispensed for the patient.


In what steps are you involved in?

I am involved in the process checking,TRS-ing, assembly, dessinfecting and compounding.


What are the unmet needs or pain points related to…

- Storage conditions incl. temperature and shelf life

The pain with frozen stock is that always you need to take the thermometer out immediately and stop it and the read the graphic.
-when final checking the chemo and selecting the shelf in the fridge can be a pain to find the patient you are looking for.
-Temperature excursions in summer time
-some drugs have short shelf live and they need to be prioritized (azacitidine needs to be checked in 45 minutes after compounding;
-melphalan has only 4 hours expiry and need  to be kept at room temperature and can't be made in advance;The whole  process is long and difficult to make as the drug precipitate quickly.



- Handling procedures i.e. dose calculation, preparation procedures

Dose calculation for busulfan is complex because the diluent had to be 10 times more than the dose and the selection of bags is difficult for not meeting the final volume.
-to calculate the rate of infusion can be complicated ;
-Some drugs are very difficult to prepare;
-vials are very pressurized and it's difficult to draw up;
-viscous drugs a pain to make;
-some drugs as monoclonal antibodies cannot be shake and it's taking a long time to prepare it.

- Administration of drugs, i.e. route of administration, frequency and devices used
- some drugs are pumps which need a long time to be administered( 46 hours)
-extravasation of drugs
-vesicant drugs;
-long hidration before administering the active drug;
-inhalers can be a pain to use or to explain to an old patient how to use it.
-difficult to swallow big tablets etc

   - Packaging (i.e. primary and secondary) for parenteral administered molecules



… specifically with regards to Biologics/ Biosimilars?




What are the key improvements you have faced?

-we have new isolators which are not so noisy.
-i
-better chemo spikes
-electronic prescribing and tracking the confirmation for patients ARIA





Do you have any suggestions for improvement?





Please take pictures of drug storage in pharmacy (if possible). Please attach the picture/(s) below or send them

separately by email to me.



Could you please think about specific examples of molecules considering the processes in the following areas …





Processes:

Storage conditions incl. temperature and shelf life

Handling procedures, i.e. dose calculation, preparation and administration procedures

Administration of drugs, i.e. route of administration, frequency and devices used

Packaging (i.e. primary and secondary) for parenteral administered molecules







What works well?



What can be improved in general and what improvements could have an impact on time, budget and resources?