Audit of pharmacotechnic pharmacists’s professional practices : from the validation of the prepation to the release of anticancerous drugs preparations

4 October 2023

P. Carlier, R. Devaux, C. Tan, A. Danckaert, D. De-Bertoult, D. Dautel, H. Huyghe, L. Real
Centre Hospitalier d’Arras, France

In 2020, an audit on the whole Anticancerous Drugs (AD) preparation circuit concluded to several axis of improvement, espacially on the pharmaceutical part. Knowing this, validation procedure and pharmaceutical release of the AD were updated in order to harmonize the practice.

Assess pharmacist’s practices from validation to release of the preparation after reviewing and spreading of the corresponding procedure.

3 pharmacists are audited by a student pharmacist during 3 months, each with 8 initiation cures and 12 pursuit cures with 5 syringes and 7 infusion bags, randomly chosen. An audit grid was etablished on a basis of criteria listed by the French Society of Oncologic Pharmacy (SFPO) and on basis of criteria chosen from inside. It is made of 3 parts, first is pharmaceutical validation of the cure, during the initiation or the pursuit of the cure with respectively 9 criteria and 8 criteria. Second part with 9 criteria is about editing the production card with the highlighting of the factors allowing the Hospital Pharmacy Preparer (HPP) to be faster and more effective. Finally, 13 criteria regarding the controls to achieve in order to deliver the preparation.

Conformity of initial prescription with the report of the multidisciplinary meeting is always checked. However, for 33% of them, conformity between weight/height in our Computerized Patient Dossier and our Software Chimio® is not checked wich may induce dose mistake. For the pursuit of the cure, respect of intercycles and days of administration were checked in 100% of cases. Evolution of the patient’s physiologic data was not checked in 28% of cases, but on the 10 prescriptions concerned, only 1 was dependant of these datas to choose the dose. All the first infusion bags were indicated in order to ease the order of prioritization by the HPP, the product storage in fridge was not indicated on 18% of the cards, causing a waste of time in the production process. The right concordance between the preparation and the elements of the manufacturing cards was systameticaly checked during the release of the preparation. The purge and clampage are not checked in 13% and 2% of cases. Integrity of AD’s preparations with the absence of leakage and particles is not checked in 17% and 15% of cases. Finally, signature and initials of the pharmacist checking the conformity of preparations are forgotten in 10% of cases.

This new audit enabled to conclude to global harmonization of the pharmaceutical validation between pharmacists. But, gradually, some driftings appeared, so it is important to carry out regular audits in order to be able to recall good practices and correct driftings.

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