National survey on the management of urgent requests for injectable chemotherapy preparations outside of chemotherapy reconstitution units (CRU) working hours

L. Champmartin, E. Nevado, S. Huet, G. Maillan
Pharmacy, University Hospital Center Dupuytren, 2 avenue Martin Luther King, 87000 Limoges

Objective
In order to revising our circuit for managing urgent requests for the preparation of injectable cytotoxics (ITCs) outside the production unit’s working hours, we conducted a national survey of centers preparing ITCs.
The objective was to conduct a survey of practices in health care institutions (HECs) preparing ITCs to guide the revision of our internal circuit.

Methods
A national survey was carried out using an online questionnaire for pharmacists working in CRUs. It was distributed by e-mail via a mailing list of expert centers. Participants were able to respond over a period of one week, during the month of June 2021.

Results
82 responses were collected. 18 HECs did not deliver any ITAs outside of CRU hours. 29% (n = 24) of HECs have an on-call line for ITA preparation. This line is effective on week nights in 67% of cases, on weekends and public holidays in 96% of cases, and on weekend nights and public holidays in 71% of cases, depending on the institution. The person performing the on-call duty is a person not working in the CRU in 60% of cases. Preparations are made by a single person in 37% of cases (50% pharmacist, 30% pharmacy intern and 20% pharmacy technician), and in pairs in 63% of cases. The departments concerned by urgent requests are hematology, oncology, pediatrics, gynecology and intensive care. The molecules mainly concerned by these emergencies are methotrexate and idarubicin. In 48 HECs, no preparations are made in the care departments. If this is not the case, the preparation is mostly performed using a secure device: mainly Tevadaptor®. These devices are stored in the pharmacy and dispensed with the vials in most cases. Staff training was carried out in 91% of cases, mainly in person, with the hand delivery of a quality document.

Discussion-Conclusion
This review shows heterogeneous practices with a "center-dependent" management. Through the participants feedback, we found that this was a problem present in other centers. The provision to care services of a secure device for the delivery of ITCs ensures continuity of care for emergency patients in the event of the absence of an on-call line. Therefore, we plan to implement this system in our hospital. To do this, we will support the care department, including staff training through simulation.

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