Cancer Services at a large tertiary hospital offer clinical trials (CT) as a key service. CT medicines are prescribed, dispensed and administered using the pharmacy oncology software CHARMTM. Increasing patient enrollments in CT has led to increasing workload for cancer pharmacy staff to process CT prescriptions, with anecdotal reports of long wait times.
To conduct a time in motion study (where the ‘subject’ is substituted for the ‘prescription’) to quantify the time spent by pharmacy staff processing CT prescriptions, to identify where wait times are and where efficiencies may be gained.
Observers recorded the time spent by pharmacy staff processing all CT prescriptions prescribed in the cancer services clinic for one week. The pharmacy areas observed were clinic, dispensary, sterile production center (SPC) and final product release. Tasks observed included clinical verification, stock selection/allocation, dispensing/compounding, checking, patient counselling and completion of trial accountability. Wait times between tasks were also recorded.
The processing of 27 CT prescriptions was observed; 23 required processing in dispensary and 16 in SPC. The median time for CT prescription processing in clinic, dispensary, SPC and final product release area was 13, 22.5, 28.5 and 5 minutes, respectively. The longest wait times were from CT prescription print to clinical verification (median 34.5 minutes) and from clinical verification to either SPC or dispensary (median 7 and 6 minutes respectively). Wait times between all other pharmacy tasks were ≤ 3 minutes.
SPC processing took longer than dispensary, an expected result given the complex nature of investigational product compounding. The wait from CT prescription print to clinical verification may be impacted by confounding factors such as delays in the pharmacist receiving the CT prescription, pending results or trial stock allocation. A review of technology use and communication processes may improve efficiency and decrease wait times.