DEVELOPMENT OF ONCOLOGY TTO CUPBOARD
Sue Marsh, Lead Pharmacist Cancer Services; Sam Neale, Lead Chemotherapy Nurse;
Rebecca Aaron, Cancer Services Pharmacist; Arden Cancer Centre (ACC), University
Hospitals Coventry & Warwickshire (UHCW) NHS Trust, Coventry.
Introduction
Most patients receiving chemotherapy require prescriptions for adjuvant supportive therapy
including anti-emetics. A generic anti-emetic prescription, limited planning in advance and
large daily workload often resulted in delays to patients receiving their drugs.
The implementation of an electronic prescribing system for chemotherapy, supported by
updated clinical guidelines(1) and regimen protocols(2), offered an opportunity to
individualise and standardise supportive therapy for each chemotherapy protocol and
improve the current supply process.
Aim
To improve the patient experience relating to supportive therapies for chemotherapy by
introducing a TTO cupboard in to the Cancer Centre.
To assess the impact of the TTO cupboard on pharmacy and nursing workload and drug
costs.
Method
Anti-emetics were identified as the most commonly prescribed supportive medications in the
ACC.
Anti-emetic requirements for each chemotherapy regimen had been included as part of the
electronic prescription for that chemotherapy protocol.
A suitable lockable cupboard within the ACC was stocked with TTO packs of the
standardised anti-emetics.
Nurses were trained to assess patients’ requirements, dispense TTO packs and record all
supplies issued.
Initial Results
Anti-emetic TTO Packs Created
Drug
Ondansetron 8mg tablets x 10
Domperidone 10mg tablets x 30
Dexamethasone 2mg tablets x 9
Dexamethasone 2mg tablets x 18
Label
One tablet twice daily for two days
….. tablets to be taken every …… hours
when required as directed
One tablet to be taken three times per day
for three days
Two tablets to be taken three times per day
for three days
Impact on Pharmacy Workload
Pre TTO Cupboard
July – Dec 08
Post TTO Cupboard
Jan – May 2009
Percentage
Change
Prescriptions
received in
dispensary
378
207
45% reduction
Items dispensed
1277
629
51% reduction
Items returned or
wasted
240
97
60% reduction
Average Per Month
Discussion
The successful introduction of the TTO cupboard in the ACC has been welcomed by staff
and patients alike. It has reduced pharmacy and workload and provided nurses with the
opportunity to clinically assess patients more thoroughly. Patients no longer wait for their
supportive medications and only receive those drugs they actually require reducing waste.
Ongoing investigations include a patient satisfaction survey, effect on nurses time, cost
implications and an extension of the scheme to other supportive therapies and other clinical
areas.
References
1. Arden Cancer Network Anti-emetic Guidelines for Adults receiving Chemotherapy
2009
2. Arden Cancer Network Chemotherapy Regimen Index 2009Abstract
Title:
DEVELOPMENT OF ONCOLOGY TTO CUPBOARD
Authors:
Sue Marsh, Lead Pharmacist Cancer Services
Sam Neale, Lead Chemotherapy Nurse
Rebecca Aaron, Cancer Services Pharmacist
Name:
Sue Marsh
Address:
Pharmacy Department
University Hospitals Coventry & Warwickshire (UHCW) NHS Trust
Clifford Bridge Road
Coventry
CV2 2DX
Telephone:
02476 966773 or 02476 964000 Bleep 2354
Fax:
02476 966795
E-mail:
sue.marsh@uhcw.nhs.uk