A virtual centralized cytotoxic preparation unit simulation to evaluate the pharmacy staff knowledge

A room of errors simulation to improve pharmacy operators' knowledge of cytotoxic drug production

INTRODUCTION

We used an educational healthcare simulation tool called room of errors (ROE) to raise pharmacy operators' awareness of potential errors in a chemotherapy production process and assessed its impact on their knowledge and satisfaction.

METHODS

Twenty-five errors (compiled from internal procedures, literature and our hospital's reported incidents) were categorised as static (n = 7, visible by the participant anytime) and dynamic (n = 18, made by a pseudooperator in front of the participant). Our simulated cytotoxic production unit (CPU) hosted the 1 h-simulation. Two pharmacists (supervisor/pseudo-operator) welcomed the trainee for a 10-min briefing. During the 20-min simulation, participants watched the pseudo-operator's gestures in a simulated chemotherapy production process. Participants called out each error observed (recorded by the supervisor). A 20-min debriefing followed. ROE's impact on knowledge was measured through participants' answers to a before-and after 18-item questionnaire about CPU's procedures and certainty about answers on a scale (0%-100%). Participants evaluated the training using a satisfaction questionnaire (Likert scale, 1-6).

RESULTS

The 14 participants detected 70.4% ± 11.4% of errors. Least-detected errors were "using non-disinfected vials" (42.9%) and "touching syringe plunger" (0%). Critical errors (expired leftovers or glucose instead of sodium chloride) were detected at 57.1%. Knowledge improved from 60.3% to 94.1% (p < 0.001) and certainty from 75.3% to 98.8% (p < 0.001). Participants appreciated this non-judgmental, informative, and original training (satisfaction 95.7%). Some pointed out difficulties settling into the game quickly and visualising static and dynamic errors simultaneously.

CONCLUSION

This ROE simulation improved operators' knowledge and certainty. Longer-term testing should be done to measure knowledge retention over time.

Use of simulation for education in hospital pharmaceutical technologies: a systematic review

OBJECTIVES

Because of the inherent risks facing pharmacy technicians, and consequently also patients, initial and continuing education on hospital pharmaceutical technologies is essential. Simulation is a pedagogical tool now widely used in healthcare education. This study's objectives are to provide an overview of simulation's current place in the field of hospital pharmaceutical technology education, to classify these uses, and to discuss how simulation technologies could be better used in the future.

DATA SOURCES

Two pharmacists independently searched PubMed, Embase, and Web of Science on 21 July 2020 and included studies in English or French that used simulation as an educational tool in the field of hospital pharmaceutical technologies, whether in academic teaching or professional practice.

DATA SUMMARY

Our search criteria resulted in 6248 articles, of which 24 were assessed for eligibility and 13 included in the qualitative synthesis. Simulation in hospital pharmaceutical technology education is used in three different ways: first, as a playful pedagogical tool, with error-based simulations (cleanrooms and preparation sheets with errors), or game-based simulations (escape games, role-plays, and board games); second, as an electronic tool with virtual reality (virtual cleanrooms and serious games), or augmented reality (3D glasses); finally, to evaluate chemical contamination (fluorescein and quinine tests) and microbiological contamination (media-fill tests) during compounding to periodically requalify pharmacy technicians.

CONCLUSION

Further studies, including non-technical skills evaluations, are needed to confirm the usefulness of this innovative technique in training as efficiently as possible actual and future pharmacy professionals.

[Preparation of injectable anticancer drugs within chemotherapy preparation unit: What levers are available to optimize and secure production?]

Preparation of injectable anticancer drugs is centralized within chemotherapy preparation unit of hospital pharmacies under pharmaceutical responsibility. Improving the chemotherapy preparation unit's efficiency in the face of increasing demand, resource constraints and the need to ensure high quality is a challenge. Hospital pharmacists in search of efficiency in order to combine productivity and quality, have several tools to respond to this problem. These are in particular the quality management, whether they go through certification or not, a source of rationalization of activities and which will strengthen the cohesion of the staff through common objectives. The management of production flows, early preparation or dose-banding will allow a smoothing of activity reducing the risk of medication error and patient waiting times. The continuous training of hospital pharmacy technicians is an important lever so that they acquire and then maintain these specific skills. Finally, the use of the most recent technologies constitutes an important part of the possibilities offered to hospital pharmacists : computerization, automated production and quality controls.

How human activity impacted manufacturing non-compliances: A multivariate analysis in a centralized cytotoxic preparation unit

INTRODUCTION

The aim of the study was to identify risk factors related to human errors in the preparation of anticancer drugs in order to improve the pharmaceutical process by setting corrective actions.

METHOD

Risk factors which could increase the probability of error were identified: daily workload, workload on the previous day and subcontractors' workload, time slot of the preparation, understaffing, incidents which could affect workflow, individual experience of technicians and cleanrooms layout. Drug reconstitution or complex fabrications were also considered as risk factors. We used univariate and multivariate logistic regression analyses to screen for correlation between risks and errors.

RESULT

Among 11 278 preparations analyzed, 115 were non-compliant. Univariate analysis shows significant variables: individual experience of technicians, technicians working in the same cleanrooms and technicians' rotations. 2 technicians are significantly associated with a higher risk of error and 5 with a lower risk. The multivariate analysis confirmed the conclusions of the univariate.

DISCUSSION

As expected, time slot of the manufacture, cleanrooms layout and some technicians increase the risk of error. Surprisingly, technicians' experience led to increase the risk. This study is a first approach to evaluate the human error aspect in non-compliant preparations, in order to optimize security of antineoplastic drugs preparations.

[Methodology to develop a virtual reality training for good practices in the preparation of anti-cancer drugs]

OBJECTIVE

Describe the process for designing and creating SimUPAC 360°, a virtual reality training in anti-cancer drug production units.

METHODS

A multi-centre (a University Hospital, a General Hospital and a Cancer Control Centre), inter-professional (pharmacists, hospital pharmacy technicians and health executives) working group has been set up. It was based on videoconferencing and online document sharing. The work was divided into six phases: choice of target audience and training objectives, definition of the business model, development of the scenario, shooting and editing, creation of the training tool and finally tests, adjustments and validation of the tool.

RESULTS

After brainstorming, 77 errors were proposed. Three areas have been defined: covering area, storage and production area, and isolator. They contained 15 errors among the 77 proposed and 20 points of interest. The shooting was carried out over 2 days, in 2 hospitals. Assembly was carried out by a service provider specialist in real virtuality. Before to go online, the tool was tested and validated by experts.

DISCUSSION

The establishment of a multi-centric and interdisciplinary working group, the choice of target audience, pedagogical objectives and business model ensure the economic viability and scientific and technical robustness of the tool. The scenario development requires to define: activity areas and then, number, difficulty and typology of errors.

CONCLUSION

Creation of a virtual reality training requires a consistent and structured methodology. This methodology will make it possible to develop other training scenarios.