Cytotoxic Agents: Breaking to Manage Better!

Introduction/Objective
In the event of accidental exposure to cytotoxic agents, rapid intervention by trained personnel is essential. Healthcare simulation is a teaching method that enables professionals to practise managing high-risk situations in a safe environment. The aim of this project was to design and implement a simulation-based educational programme to improve the management of accidental cytotoxic spills in our hospital pharmacy.

Materials and Methods
1. Preliminary analysis: Assessment of current practices, existing procedures and available equipment for managing such situations.
2. Development of a simulation-based educational model in line with the French National Authority for Health’s best practices in healthcare simulation (March 2024).
3. Planning simulation sessions for all pharmacy staff who may handle cytotoxic drugs.
4. Evaluation of training effectiveness according to the Kirkpatrick model:
o Level 1 (satisfaction): measured using a 7-point Likert scale questionnaire.
o Level 2 (skills acquisition): assessed through a 15-question self-evaluation administered before and after the training.

Results
1. The procedure “Management of Accidental Cytotoxic Spills” was updated and the three decontamination kits available in the pharmacy were standardised.
2. Designed four different simulation scenarios (broken powder vial, broken liquid vial, leaking IV bag and direct product contact) along with a 27-item observation checklist. Each one-hour session, led by a pharmacist or pharmacy resident, consisted of four parts: self-assessment questionnaire (10 min), briefing (10 min), simulation (10 min), and debriefing using the R.A.S. (Reaction, Analysis, Synthesis) method (30 min).
3. Eleven sessions were conducted between 28/08/2024 and 20/09/2024, involving 15 pharmacy technicians, 3 storekeepers, 3 pharmacists, and 1 pharmacy resident (n=22).
4. Kirkpatrick Level 1: 100% of participants found the training very satisfactory and reported that their knowledge had been updated; 86% stated that they felt more confident in the event of such an incident.
Kirkpatrick Level 2: Improved skills, with a mean score of 7.1/15 (SD = 1.7) before training compared to 11.3/15 (SD = 1.2) after training.

Discussion/Conclusion
Implementing this programme significantly improved the management of accidental cytotoxic spills. Simulation proved an effective training method for pharmacy teams and could be extended to other high-risk situations, such as computer failure. However, broader implementation would require additional resources, particularly in terms of time for design and deployment.

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