Awareness of errors undetectable by DrugCam^®: Evaluation of recognition by operators

Introduction
Since 2022, the chemotherapy preparation units have been equipped with Drugcam (DC) to secure the process and to educe the need for double human verification. Our analysis of non-conformities (NC) highlights undetected errors by DC that were intercepted by pharmaceutical control.

Objective
The aim of the study is to evaluate the recognition by operators working in cytotoxic preparation unit of errors not detected by DC.

Materials and Methods
A scenario of trastuzumab preparation is developed. Errors undetectable by DC are introduced into the video. It is recorded with DC to replicate real conditions.
The errors are based on NC that have already occured with reflections between pharmacist and interns. Operators watch the video individually and identify preparation errors. The results are presented at a team meeting.

Results
A total of 10 operators were evaluated (100% of the operators working in the unit). The 5 errors to identify are : use of tubing with a filter instead of tubing without a filter ; failure to present the volume of active substance before injecting it into the solvent and intentionally presented an empty syringe ; agitation of a monoclonal antibody vial ; failure to purge the tubing ; validation of the reconstitution solvent by DC and use of another solvent by inversion. All five errors were detected by all operators.
Unanticipated comments in the scenario were recorded by operators : one noted a too short reconsitution time and five noted the injection of solvent was not directed towards the wall of the vial.

Discussion
The results of this evaluation are very satisfactory. It made us aware of the limlits of DC in a playful way. DC validates the key milestones of the preparation but does not ensure the absence of errors ouside of them. DC do not replace the operators concentration and vigilance.
Our suggestions for improving DC would be to add pop-ups to guide the choice of medical devices, provide additional information on how to reconstitute vials (agitation, rest periods…) and ensure continuous control by artificial inteligence, not just key milestones.
The format of this activity was particularly appreciated by the operators and could be continued and adapted to other pharmacotechnical situations (broken vials, product flow, etc.).

Keywords : Drug preparation, professional practice, biomedical technology assessment

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