Implementing a Cold Chain System Ensuring Cost Effectiveness and Reducing Unused Dispensed Chemotherapy Sue Hull Helen Wilkinson

Introduction and Background Clatterbridge Centre for Oncology (CCO) treats patients within the Merseyside and Cheshire network Region. CCO covers a number of clinics both in-house and at Network Hospitals. The Pharmacy Department supplies Systemic Anti- Cancer Treatment to these clinics.

Chemotherapy is prepared in advance and taken to the clinics by CCO Nursing Staff where patients are then seen by CCO Consultants. A review of Chemotherapy Services which resulted in repatriation of patients to network clinics, showed an increased use of High Cost Drugs being administered outside of CCO In order to allow patients to be treated closer to home and at the same time minimise any unused chemotherapy a system needed to be put into place to enable reuse of returned chemotherapy.

Implementation To ensure a minimal wastage of chemotherapy drugs, implementation of a Cold Chain System was introduced. Nursing staff were brought on board with the Cold Chain Process. Pharmacy provided fridges to all clinics, these were monitored and results recorded over a period of time to ensure validation.

Validated boxes were sourced to ensure controlled temperature during transport of cold chain chemotherapy. Temperature loggers were also sourced for inclusion in boxes to record temperatures throughout transportation and clinic time. The loggers were to be returned to CCO at the end of the clinic and all data downloaded and recorded.

Specific network clinics were then chosen to be piloted. Any returned chemotherapy was documented to enable us to calculate any cost savings that could be made by reuse of the drugs once the process had been validated. Min TempMax tempMean Kinetic TempComments 3.6˚C 8.4˚C5.9˚CSee file 3.5˚C7˚C4.9˚CAll temps within limits 5.5˚C8.2˚C6.4˚CSee file 4.2˚C7.3˚C5.5˚CAll temps within limits 4.3˚C9.2˚C6.1˚C All temps within limits collection at end of recording) 4.72˚C9.77˚C6.71˚CAll clinic temps within limits (see file) 5.0˚C9.6˚C6.4˚C All temps within limits collection at end of recording) 4.5˚C7.6˚C6.0˚CAll temps within limits See File All temps within limits collection at end of recording) 4.1˚C7.0˚C5.9˚CAll temps within limits

Results Cold chain system implemented at pilot clinics, and a reduction of unused chemotherapy obtained producing cost savings.

Conclusion Further network clinics were established after the pilot scheme proved sustainable, efficient and cost effective. This is now a permanent working practice within the CCO Pharmacy Dept clinics