"Escape game" in the Cytotoxic Preparation Unit (UPC): will you manage to dispense chemotherapy bags on time?

For in-house training at the UPC, the development of an interactive game for educational purposes was desired. This kind of game is known to strengthen team cohesion while improving communication, knowledge, organization and stress management. The goal was to design an "escape game" based on a chemotherapy prescription circuit at the UPC, and to measure participant’s satisfaction.

Material and methods
Through the scenario there was a fictitious patient with small-cell bronchial cancer, treated by carboplatin, etoposide and durvalumab. Each pair had to solve a series of puzzles as quickly as possible. Eight steps were needed: dressing, hand hygiene, pharmaceutical validation, tray preparation, sterilization, manufacturing, control and dispensing. Each step was accessible after solving tests such as the recognition and use of protective equipment, and the completion of hand hygiene puzzles. Elements required for pharmaceutical validation were identified, so that manufacturing sheets could be validated and edited. Access to equipment for preparing trays was provided after answering questions. Sterilization time was accompanied by a "broken vial" simulation. The bags were prepared using video control software. A crossword puzzle on the control was used to obtain a numerical code, which allows to unlock the SAS for releasing the pouches. The game was timed, and clues could help participants at the cost of additionnal time. Satisfaction was measured through a questionnaire evaluating the quality, difficulty and relevance of the game.

Results
Five teams of compounders and two teams of pharmacists took part in the game, with an average completion time of 55 minutes. The hygiene stage was the most difficult part, with an average of 2 clues given to participants. Most participants were very satisfied with their immersion in the game (71%) and with the way it unfolded (86%), in terms of teaching, the quality of the puzzles and the settings. 87% were keen to have a debriefing. 79% would be interested in repeating this game format in another environment, like the preparation room.

Conclusion
The implementation of an immersive educational game helped to improve team cohesion while fostering experiential learning in the UPC.