ChimioPREP^®: a too to secure a centralized pharmacy unit for cytotoxic drugs

Background
The cytotoxic reconstitution unit (URCC) of Mayotte hospital is facing various challenges to align to the national regulatory requirements. The unit is exposed to multiple factors related to organization (absence of a local Cancer Coordination Center, no structured oncology network, no permanent oncologist on site) and to internal factors (staff annual turnover of over 50% of pharmacy technicians and pharmacists).

Goals
To set up a quality improvement project with evaluation of the current process of preparation of cytotoxic drugs, implementation of an action plan and reassessement the process using a PDSA cycle (plan-do- study-act). We used ChimioPREP^® which is a standardized tool provided by the Regional Health Agency (ARS) Ile-de-France.

Materials and methods
The evaluation team was multidisciplinary (pharmacy resident, pharmacists, pharmacy technicians, unit managers and nurses and doctors from Oncology Daycare, Quality Department, maintenance staff) and used the ChimioPREP® tool to evaluate. The tool, consisting of questionnaires, was completed and generated risk control scores. A high score indicates a good risk control. According to these results, an improvement action plan was designed, followed by a reassessment 5 months after implementation, in order to quantify compliance.

Results
The ChimioPREP^® tool showed that the Steering and Management category was associated with a risk control score of 77%, including scores of 74% for premises, 73% for the information system and the management of Quality-Hygiene-Risk (QHGR), 80% for staff, 74% for premises and 100% for communication. The Process category was associated with a score of 65%, with risk control scores of 50% for prescription, 78% for pharmaceutical validation, 37% for preparation, 42% for delivery and 47% for reception. An improvement plan was implemented according to these results. The second evaluation reported a Steering and Management score improved up to 81%, due to the better compliance of items linked to the QHGR category (84%) and premises (79%). The Process category score improved up to 71%, mostly due to the better compliance of items linked to preparation (score 53%) and delivery/reception (60%).

Discussion
Work on the premises, the installation of new equipment, the revision of workflows and the drafting of procedures during the following months will enable the compliance of other items. Further assessment sessions will be required to pursue this quality improvement approach.

Conclusion
The use of collaborative standardized tools such as ChimioPREP® helped us to improve the processes within the URCC unit in our hospital. The specificities of our hospital are challenging (isolated structure, high staff turnover, unstable processes) and we plan to continue this quality improvement project with further assessments.

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