Simulation in pharmaceutical compounding: generality and interest for operators preparation

The drug management of patient is a complex process, particularly at risk. The origins of failures are multidimensional, related to human and organizational factors. Among the different steps of this process, pharmaceutical compounding is particularly subject to the risks since it will require theoretical and technical expertise but also involve organizational and relational aspects through teamwork.

Simulation in health is an educational method based on experiential learning and reflective practice, which is aimed at all healthcare professionals in education and training, validating continuing professional development – CPD. It consists in the use of hardware, virtual reality or a standardized patient to reproduce situations or environments of care, to teach diagnostic and therapeutic procedures and allow to repeat processes, clinical situations or decisions by a health professional - or team of professionals.

Of relatively recent origin on the ground, it is now well formalized with Good Practices developed by the Health Authority (HAS). It can be deployed in simulation centers, in hospitals or university.

The simulation is ideal for training in the field of pharmaceutical compounding because it is based on the use of scenarios, more or less complex, allowing:

• training of technical acts (usual or unusual) : handling routine or exceptional gesture ;
• implementation of procedures (individual or team) : hygiene, preparation of the isolator ;
• training in diagnostic or therapeutic clinical reasoning : analysis of prescriptions, manufacturing orders/ instruction cards;
• behaviour management (professional simulation, teamwork, communication) : stress management during strong activities;
• Risk management (reproduction of adverse events, ability to cope with exceptional situations): medication errors, vial/glass breakage, extravasations, …

Depending on the educational objectives and scenarios set, the most appropriate simulation technique will be chosen from those validated:

• standardized patient or role play for relationships with the patient
• low or high fidelity procedural simulators : global or partial isolator, model if the administration’s step is involved
• 3D environment such as serious games

At the present time, simulation in health remains underused in pharmaceutical compounding but should grow significantly in the next years. Therefore its assessment should be formalized.

Links of interest: a simulation project in chemotherapy is underway at Nice University Hospital with the support of Sieve, BMS, MSD and Merck Serono