Digital error isolator : use of DRUGCAM® for continuous training of pharmacy technicians

Introduction
In order to supplement the continuous training of pharmacy technicians of the Centralized Cytotoxic Reconstitution Unit (CCRU), we have created a digital error isolator inspired by the "error chamber" with DrugCam^®. With the aim of securing preparation of chemotherapy, our CCRU has been equipped with the DrugCam^® video capture system since June 2017, wich is interfaced with our Chimio^® software for the validation of the critical steps of the preparation. Therefore, this project is part of a continuous training process for pharmacy technicians in order to assess good practices in chemotherapy preparation.

Material & Method
We produced 3 “error” videos with the help of the pharmacy technicians who is referent for the training of the CCRU. The 3 videos are relating to the preparation of a fluororacil chemotherapy bag with 14 errors, the preparation of a cytarabine syringe with 5 errors and the preparation of a cisplatin chemotherapy bag with 11 errors. Most of the errors were inspired by errors already reported by the pharmacy technicians. The errors to find concerned handling (position of the spikes, purging infusers, etc.), risk of contamination (contaminated field, absence of sterile glove, etc.), and working environment (used syringes not thrown away, full trash not emptied ...). After the realization of a powerpoint tool, we organized training sessions in groups of 2 or 3 pharmacy technicians, with time for a discussion between each video and corrections, with a reminder of good preparation practices, in order to harmonize our practices.

Results & discussion
All the pharmacy technicians working in the CCRU attended to the error isolator viewing sessions (n = 15). On the “error” video of the preparation of a fluororacil chemotherapy bag, they found an average of 8.5 errors out of 14, 3.7 out of 6 for the preparation of a cytarabine syringe and 7.6 out of 12 for the cisplatin chemotherapy bag preparation. The most detected errors were the absence of sterile gloves, presence of multiple vials of residue on the work site, non-purging of the infuser or readjustment of the syringes without protective compress. On the contrary, they didn’t see the contaminated field, nor the incorrect position of the label on the chemotherapy bags. Some errors were not detected due to a lack of video quality.

Conclusion
This exercise was highly appreciated by all the pharmacy technicians, because of the "innovative” video format which makes it possible to anchor this exercise in the continuous training plan. This project could also be adapted to other types of preparations to supplement the continuous education of pharmacy technicians and new arrivals.

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