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Implementing a closed system drug transfer device to enable nurses to prepare monoclonal antibody treatment

23 May 2024
Volume 33 · Issue 10



Efforts to increase capacity for oncology treatment in the author's Chemotherapy Day Unit, while allowing staff to treat more patients and offer more flexibility to patients, increased strain on the Aseptic Pharmacy at the author's Trust. Therefore, the possibility of nurse-led drug preparation was explored.


Nurse-led monoclonal antibody (MAb) preparation was piloted to investigate whether a reduction in reliance on Aseptic Pharmacy could co-exist with maintaining optimal treatment capacity. The effectiveness of a closed system transfer device (CSTD) to protect nurses against drug exposure was also explored.


A risk assessment for MAbs considered for nurse-led preparation was created, alongside a procedure for the safe handling of systemic anti-cancer therapy (SACT) with the use of a CSTD.


The pilot resulted in an 89% reduction in the time patients had to wait for MAbs to be prepared. Seven oncology drugs were included in the new procedure without increasing the risk of exposure for nurses.


The pilot successfully reduced demand on Aseptic Pharmacy while enabling efficient capacity use on the Chemotherapy Day Unit. The use of the CSTD minimised the risk of nurse exposure to SACT.

Monoclonal antibodies (MAbs) have been used in oncology treatment since the 1990s (Carter et al, 1992) and work by binding to antigens on the surface of cancer cells to mimic the body's own immune response (Bayer, 2019). Many MAbs can be administered via subcutaneous injection, reducing treatment time by up to 97% compared with intravenous infusion alternatives (DuMond et al, 2021).

Since 2018, increasing numbers of MAbs have been licensed and introduced in the Chemotherapy Day Unit at the author's Trust, as well as nationally, which has coincided with year-on-year increases in patient numbers (Cancer Research UK, 2024). The regimens for MAbs often require patients to attend multiple cycles of treatment over several months or years, putting further pressure on treatment capacity. The onset of the COVID-19 pandemic and its impact on patient care further compounded these pressures, and consequentially triggered a comprehensive pathway review.

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