Error simulation in a Centralized Cytotoxic Unit, a playful exercise!

Coulpier E., Figueras N., Parrein P., Lheritier E.
Centre Hospitalier de Dieppe, France

Introduction
Our Centralized Cytotoxic Unit (CCU) produces annually over 5029 injectable chemotherapy. The daily activity is organized around a pharmacist, an intern, a pharmacy technician and a courier.
Preparations are made under isolator. Throughout the preparation process, errors may occur.
In order to secure the production cycle and to promote continuous training of the team, an error simulation has been created.

Materials and methods
Two sessions were proposed to pharmacists, interns and pharmacy technicians on a voluntary basis. In order to target each step of the process, 24 errors were installed: 2 in the entrance airlock, 7 in the isolator, 6 in the control area, 6 in the controlled atmosphere zone and 3 in the exit airlock. In terms of gravity, 4 were identified as critical and 5 as serious. A collection grid and a satisfaction questionnaire were made available to each. The number of errors was not communicated to the participants before their passage. The individual passage time in the CCU was limited to 30 minutes. The correction was made individually after each passage with a discussion of the observed errors.

Results
Two pharmacists, one intern, and the three referent technician’s participated to this experience. The average passage time was 28 min. The average number of errors found was 15/24 (min: 9; max: 18). Each critical error was detected by only 5 out of 6 participants. Of the 5 serious errors, 2 were detected by all participants, 2 by half and 1 by only 2 participants. This exercise has been well appreciated by all.

Discussion
During the debriefing, it became apparent that some errors were clearly identified by all, but some participants were not able to explain why they were an error.
The participants appreciated the rapidity of the game, the playful side and the complete coverage of the process. The simulation enables the participants to reflect upon themselves and their actions in order to improve moving forward. However, it was suggested that a collective correction would be more beneficial.
In conclusion, this exercise could be kept in our unit for the training of the future interns and pharmacy technicians.

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