The impact of workload changes and staff availability on IV chemotherapy services

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Abstract
Objectives. To determine the extent of change in intravenous (IV) chemotherapy workload in recent years, the availability of specialist pharmacy and nursing staff to carry out this work and the service implications of any mismatch between these two parameters. To determine the volume of chemotherapy currently administered for metastatic colorectal cancer (MCRC) to allow assessment of the possible workload implication of a switch to oral fluoropyrimidine therapy. Design. An anonymous postal survey of pharmacist members of the British Oncology Pharmacy Association (BOPA) and their nursing colleagues. Response. 0f 104 questionnaires distributed, 54 were returned (response rate 51.9%). Data summary. Ninety-three per cent of pharmacists reported an increase averaging 178% (range 15]/500%) in the volume of IV chemotherapy being prepared by their units over the last five years, with the average unit currently producing 896 (range 110]/5000) doses each month. Pharmacist and nurse recruitment difficulties were also reported almost universally. The combination of these two factors led to reported problems for both staff and patients, with a majority of nursing and pharmacy staff noting increased staff stress and prolonged patient waiting times. A significant minority of departments have already taken, generally undesirable, steps to address a significant imbalance between chemotherapy workload and service capacity, including restricting clinical trial activity and other aseptic dispensing work. Conclusions. Rapid expansion in the use of IV cytototoxic chemotherapy has resulted in pharmacy and nursing services facing severe pressure. Imaginative solutions are necessary if safe and efficient services are to be maintained. These may include increased use of oral fluorpyrimidines for the first-line treatment of MCRC, which this survey indicates accounts for about 10% of IV chemotherapy administered in the UK.