Mixing safety and workload assessment: Implementing “one mix at a time” in oncology pharmacies

May 2011 to December 2011


In the study Improving the Safety of Ambulatory Intravenous Chemotherapy in Canada, a serious safety concern emerged relating to the organization of materials and work processes during pharmacy admixture. The study report included a recommendation that only one mix at a time enter the biological safety cabinet (BSC). The response to this recommendation from the pharmacy community in Canada has been positive and there is an interest in implementing this change across the country. However, there has been a concern that this approach to mixing will increase preparation times and that additional staffing may be required. This potential impact had not yet been validated or quantified.

Objectives for this project were to:

  • Determine the impact of “one mix at a time” on the average time required to prepare a variety of chemotherapy regimens
  • Provide guidance to oncology pharmacies on the increase in workload (if any) caused by preparing one mix at a time so that staffing requirements can be better justified
  • To recommend strategies for successfully implementing one mix at a time in different settings

At two community sites, current practices were observed and analyzed. Staff then performed pre-determined mixes of real chemotherapy regimens for simulated patients, while their actions and timing were documented. HumanEra then worked with local staff to make workflow changes, and after a month, returned for more observations and a repetition of the mixing simulation.

Results showed that when sites performed one mix at a time, their practice was at least as efficient, or more efficient. The study also helped better define the concept of “one mix at a time” and identified some additional safety improvements that could be made to practice in oncology pharmacies.

Funding Agency

CancerCare Manitoba Foundation

Project Sponsor

Rachel White



White, R. (2012, Oct). Improving chemotherapy preparation safety through process changes: Workload and workflow implications. Presented at the National Oncology Pharmacy Symposium 2012, Saskatoon, Saskatchewan.

Project Team

Rachel White
Melissa Griffin

For more information on this project, contact:

Rachel White