Ontario hospitals surveyed on outsourcing IV drugs

A total of 10 hospitals in Ontario saythey boughtbulk IV medications from Marchese Hospital Solutions, a company linked to an underdosing of chemotherapy patients, a survey suggests.

After about 1,200 people in New Brunswick and Ontario received lower-than-intended doses of the chemotherapy drugs cyclophosphamide and gemcitabine, which were pre-mixed by Marchese Health Solutions, Ontario's Health Ministry asked the Ontario Hospital Association to survey its members about their reliance on external providers of pre-compounded IV medications, including chemo.

The role of the Hamilton, Ont.-based owner of Marchese Hospital Solutions, is also under investigation. The companyhas said the problem occurred in how the intravenous bags of chemotherapy were administered atfive hospitals, not in how they were prepared at the company's Mississauga facility.

The 88 hospitals that responded to the Ontario Hospital Association's survey represented 94 per cent of the province's acute care beds.

Of those 88 hospitals, 40responded thatthey've purchased pre-compounded IV medications in a "ready-to-administer" form from external providers.

"The drugs we are concerned about right now [are]where the drugs are premixed in a large bulk format and then they're handled further in the hospital pharmacy to be prepared for individual patients,"Pat Campbell, president andCEO of the Ontario Hospital Association, said in an interviewTuesday.

"There are 10 hospitals that are securing drugs in that way," aside fromthe hospitals in Peterborough, Oshawa, London and Windsor thatfaced the overdilution issue.

In the survey, the most commonclasses of pre-compounded IV medications purchased from an external provider were:

• Chemotherapy, 7 per cent or six hospital respondents.
• Narcotics, 2 per cent or two hospitals.
• Epidurals, 2 per cent or two hospitals.

"Hospitals are very focused on this and they are looking at their quality assurance that's in place now," Ontario Health Minister Deb Matthews told reporters.

Hospitals said the main reason they compounded in bulkwas for occupational health and safety, given how toxic thedrugs are, Campbell said.

The four Ontario hospitals where patients received overdiluted chemotherapy have all said they no longer purchase bulk IV medications.

Health Canada and the provinces and territories are working to improveoversight, including inspections, ofcompaniesthat aren't federally licensed as manufacturersor provincially accredited as pharmacies.

The work of investigatorsand the acceleration of regulations are happening now, Matthews said. "Hospitals are very engaged in the safety of their drug supply."