Impact Analysis of Securing the Chemotherapy Circuit through Computerization and RFID Technology

Introduction
Cytotoxic preparations are high-risk medications that require complete securing of their circuit. To achieve this, computerized means have been implemented in the care service, and identification through barcode readers and radiofrequency identification (RFID) have been established. The objective of this study was to analyse the a priori impact of the sequential implementation of computerization, barcode verification, and RFID identification technology on the chemotherapy circuit.

Methods
A sequential risk analysis was conducted on three key stages of organizational transformation (initial, computerized, and secured by RFID). Six 2-hours brainstorming meetings were conducted by three multidisciplinary groups composed of stakeholders involved in the patient care pathway. The SWOT (Strengths, Weaknesses, Opportunities, Threats) method was used to identify risks, and two Failure Mode Effects and Criticality Analyses (FMECA) were performed to define the necessary corrective actions for developing a technology deployment strategy. Residual blocking points were highlighted, and control measures were validated and prioritized over time through an impact analysis.

Results
The SWOT analysis identified 5 weaknesses in the initial circuit, 5 threats in the computerized and barcode-secured circuit, and 5 threats brought about by RFID. 56 failure modes were analysed using the FMECA method. During barcode securing, unacceptable and tolerable risks under control were reduced from 31 to 26 (-9%), with a reduction in unacceptable risks from 14 to 7 (-50%) due to corrective actions. During RFID securing, unacceptable and tolerable risks under control were reduced from 26 to 16 (-18%), with a reduction in unacceptable risks from 7 to 2 (-71%). Finally, the impact analysis identified 9 blocking points for the deployment of different securing phases. 3 were to be addressed during the computerization of the service (simplification of prescription support), 2 during the RFID testing phase (reliability of stay numbers), 2 during the pilot phase (parameterization), and 2 after the deployment phase (backup).

Discussion
The implementation of a sequential risk analysis combined with an impact analysis allowed for the understanding of a complex transformation phase of the chemotherapy circuit while securing key deployment steps. This method enabled the step-by-step evaluation of the criticality of risks associated with organizational changes, measurement of the effectiveness of control measures, adjustment of the deployment strategy through the impact analysis of actions, and identification of new blocking points. Among the newly identified threats exacerbated by the digitization of work materials, the risk of a cyber-attack will be a major focus area.