Musgrove Park Hospital has a 14-bed oncology ward, a 12-bed haematology ward and a chemotherapy day unit with 19 chairs. The hospital provides these services to a population of more than 500,000 people. Around 5500 anticancer treatments are given within the trust each year, one third of which are given to haematology patients and two thirds to oncology patients. Patients are generally pre-assessed on set clinic days (for example patients with breast cancer are seen on a Tuesday and those with gastrointestinal cancers on a Wednesday), meaning that vial sharing can be used for certain high-cost agents. Dose-banding and dose-rounding are used, both through the Mosaiq integrated oncology information and electronic prescribing system. Electronic systems were introduced to help manage patient information, prescribing of medicines and clinical booking. Pre-filled bags and syringes are outsourced for a number of routinely used agents.
Chemotherapy services were evaluated using common lean change management techniques such as process mapping, to identify areas of inefficiency following introduction of electronic prescribing and clinical booking. This required stakeholder involvement and agreement from those affected by the changes. Potential solutions were trialled and successful solutions were implemented.