Cyberattack or IT system failure: a survival kit for a sterile compounding production unit

Introduction
Cyberattacks are becoming increasingly frequent in healthcare settings, with more than 400 incidents reported in France in 2023 according to the French National Cybersecurity Agency (ANSSI). In addition to cyberattacks, hospitals may also face major disruptions caused by IT, network, or power failures.
After a 4-hour general network outage at our institution, we identified missing or outdated tools required to maintain activity within our anticancer drug compounding unit (UPAC) under degraded conditions. The aim of this project was therefore to develop and implement a business continuity plan (BCP) dedicated to the UPAC.

Materials and methods
A multidisciplinary working group including pharmacy technicians and a pharmacist was set up. The group reviewed the tools that had been unavailable during the outage, assessed the need for IT resources, equipment and documentation, and updated the degraded-mode operating procedure. Documents were mainly produced using Microsoft Office^®. Data were extracted from the CHIMIO^® and Copilote^® professional software systems.

Results
Three working group meetings were held, allowing two critical scenarios to be examined: failure of the Chimio^® professional software and complete network failure. The group defined the tools to be developed by pharmacy technicians, including ready-to-use production worksheets, administration plans, a prescription register, protocols, and associated documents.
Ready-to-use production worksheets were designed for standardised doses of the 10 most frequently used drugs and for the 8 drugs administered at fixed doses. A blank production worksheet and a calculation support file covering all other drugs were also created.
Six key documents were generated and archived in paper format: a prescription register, a standard checklist for equipment and product release, a supplier contact list with dedicated contacts, a list of ordering recommendations, and a monitoring document for drugs not covered by activity-based hospital funding.
Essential IT resources were identified, including an offline computer, a printer and connection cable, and a USB flash drive containing all tools. A physical survival kit was also assembled, comprising printed documents, blank production worksheets, the degraded-mode procedure, and associated materials.

Discussion/Conclusion
This project revealed limited team preparedness for major IT disruption scenarios and led to the development of practical continuity tools by pharmacy technicians. A simulation exercise is planned in the near future. The working group should be maintained and meet regularly to ensure that the tools are updated and optimised, to assess team familiarity with the kits, and to conduct periodic simulations. Degraded-mode procedures can no longer be considered optional: implementing and continuously improving a BCP in an anticancer drug compounding unit is essential to maintain the safety and quality of patient care. The activity recovery plan still needs to be defined according to the duration and scope of any future outage.

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