Conception and Evaluation of a regional tool for risk situations of errors or exposure related to the use of cytotoxics

Objectives of the project
As a continuation of the health simulation project led by the French National Authority for Health (HAS), a tool was developed for cytotoxic reconstitution units (URCs). Its aim is to raise awareness among healthcare professionals about the risks of errors associated with the use of cytotoxics, by reminding good practices. The project offers a dematerialized, quick-to-use simulation exercise.

Methods
The first step involves collecting practical cases and frequent high-risk situations, with the active participation of URCs (pharmacists and pharmacy technicians [PPHs]).
To illustrate this work, five display banners ("kakemonos") were designed, covering the following topics: Prescriptions and Dose Calculations; Preparation Trays Errors ; Manipulation Errors; Cytotoxic Exposure; Administration. Each display includes a specific objective and targets some professional categories.
Participants, either individually or in small groups, read the instructions and then access an interactive module via QR code (with Q&A and/or additional content). Each URC identifies a trained local coordinator to assist participants. A satisfaction questionnaire, also accessible via QR code, circulate to collect feedback and comments.
The kakemonos rotate between URCs according to a predefined schedule from January to September 2025.

Results
Five URCs contributed high-risk situations that had previously led to internal corrective actions. The visuals and content of the kakemonos were then approved by the anti-cancer commission.
The tool was implemented in six centers across three departments. Half of the participants were pharmacists or pharmacy interns, and the other half were PPHs and nurses. Local coordinators were pharmacists specialized in pharmacotechnology.
The satisfaction questionnaire assesses the visuals of the kakemonos, the relevance of the presented cases, the tool’s usability, and the difficulty level. It also includes an open section for suggestions or error reporting (as module content can be edited).
The first feedbacks highlight the originality and variety of the exercises, including videos, photos, illustrations, and riddles. Some cases were considered less applicable across all URCs, such as labeling procedures, the use of frozen infusion bags with azacitidine syringes, or exclusive use of isolators.

Discussion/Conclusion
Overall, users describe the tool as relevant and educational. Inter-center collaboration contributed to the diversity of cases, though limited feedback from low-activity URCs affected inclusivity. The main challenge remains lack of time, due to workload in pharmaceutical technologies units. Some centers received PDF versions of the kakemonos for later use. A national rollout, supported by Regional Health Agencies (ARS), is being considered for the future.

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