title: Challenging historical perspectives of the 24-h chemotherapy day: Flexible chemotherapy dose-timing guidelines.
abstract: OBJECTIVE
  Variation in dose-timing within multiday chemotherapy regimens is largely unknown with convention being to administer subsequent days of treatment at 24-h intervals. However, in reality there are many occasions where doses are given either earlier or later to accommodate a variety of clinical and operational priorities. This project aimed to evaluate the degree of existing variation in chemotherapy dose-timing and to investigate whether deliberate variation could improve quality and efficiency outcomes such as reduction of after hours chemotherapy administration or reduced inpatient length of stay.
  
  
  METHODS
  Chemotherapy charts and hospital admission datasets (n = 112) from sarcoma and hematology inpatient regimens were retrospectively audited to ascertain existing variation in dose-timing and overall length of stay. Clinical practice guidelines enabling a safe degree of dose-timing variation for individual chemotherapy regimens were developed, implemented over a 3-month period, and evaluated against safety, efficiency and economic outcomes.
  
  
  RESULTS
  Baseline dose-timing variation was common with administration occurring up to 8 h early and 7 h later than conventional 24-h dosing intervals. Following implementation of clinical practice guidelines, there was a 10% reduction in chemotherapy finishing after hours and a significant reduction in length of stay for two sarcoma regimens, projected to save 24 inpatient bed days (over $20,000) across more than forty inpatient episodes annually.
  
  
  CONCLUSIONS
  Deviation from the standard 24-h chemotherapy day (deliberately or inadvertently) was a common yet unstandardized practice. Clinical practice guidelines enabling flexible dose-timing of chemotherapy provided an opportunity to improve chemotherapy administration safety measures, tailor chemotherapy delivery to ward and patient needs, and in some instances reduce non-value-added length of stay.
authors.affiliation: Department of Pharmacy, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
authors.forename: Marliese
authors.initials: M
authors.lastname: Alexander
authors.affiliation: Department of Nursing, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
authors.forename: Frank
authors.initials: F
authors.lastname: Coenders
authors.affiliation: Department of Quality and Patient Experience, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
authors.forename: Danielle
authors.initials: D
authors.lastname: Murray
authors.affiliation: Department of Pharmacy, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
authors.forename: Sue
authors.initials: S
authors.lastname: Kirsa
authors.affiliation: Department of Hematology-Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Seymour
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012509:Sarcoma / Q000188:drug therapy*
chemical_list: D000970:Antineoplastic Agents
keywords: administration; chemotherapy; dosing; guideline; inpatient