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Centralizing mixing of infusion drugs: A process to comply with USP 797/800, improve efficiency, and reduce costs in a multisite oncology infusion practice.

295 Background: In oncology practices with multiple infusion sites, compliance with USP 797/800 will be difficult to achieve due to increased building costs. Mixing oncology medications in a single-site referred to as “centralized mixing” is an attempt to comply with USP regulations as well to improve safety, quality and decrease costs. Methods: The centralized mixing process was initiated in June 2017 and required patients to have labs drawn 24-48 hours prior to infusion. If results were adequate, infusion nurses contacted the patient to review a symptom checklist to report findings which would preclude treatment. The next day, pharmacists began drug mixing at 6 am and distributed them by courier to five other practice sites by 10am. When patients arrived for treatment, they went directly to the infusion suite. A follow up visit was arranged mid-cycle to see their oncologist prior to the next scheduled infusion. If weekly infusions were required, then follow up visits were scheduled at the discretion of the oncologist. Results: Data from the fourth quarter of 2016 (prior to centralized mixing) was compared to the fourth quarter of 2018. Although physician total work RVUs increased from 12,198 to 16,254, labor costs decreased by $15,194. After implementation of centralized mixing, there were four fewer infusion nurse FTE’s while two registered pharmacists were hired. Labor costs per total work RVU decreased from $38.51 to $27.97 resulting in a quarterly savings of $42,790. Conclusions: Centralized mixing of oncology medication has reduced the cost per physician work RVU of administering chemotherapy by 27.3% and has lead to an annualized savings of $171,160. Increased infusion capacity and improved efficiency were due to streamlining the patient experience: there is no need to wait for drugs to be mixed, for lab results to return or to see their oncologist prior to treatment. The practice is now able to improve environmental safety with USP 797/800 at a single site, improve quality by limiting staff who mix chemotherapy to only two pharmacists, reduce training time for our infusion nurses by six weeks and to delay the need to build additional infusion suites.