Feedback: Is it useful to watch all DRUGCAM^® videos before delivery?

Introduction
The DRUGCAM^® control system (DC) has been operational in the antineoplasic drug preparation unit (ADPU) for 7 months. This system allows a per process control of key steps and a scenic video recording of the pharmacy technician’s gestures in order to fully secure the preparation steps. However, not all user centers view the video recording at the same time: before or after preparation delivery, systematically or in case of doubt/problem. During the delivery at the ADPU, some pharmacists (phm.) systematically watch the whole scenic video before dispensing while others only watch some steps (especially antineoplasic drug injections).
The objective is to determine if the verification of the entire DC video should be systematically performed before the preparation delivery.

Method
Between November 24, 2021 (DC installation date) and June 24, 2022, errors were identified by the phm. among the preparations recognized as compliant by DC:

• Errors stopped when reviewing the video at the delivery;
• Errors not stopped but could have been stopped if the video had been viewed in its entirety.

Results
During the analysis period, 10,912 preparations were made with DC.
Eight errors were stopped by the phm. before pharmaceutical delivery:

• Three cases of lack of double volume control by DC: injection before presentation to the camera and then duping the system by presentation of a syringe filled with air;
• Three cases of incomplete doses of antineoplasic drugs: removal of a syringe from the solvent bag instead of the cytotoxic vial and reinjection;
• One error in reconstitution of a lyophilisate: use of the dilution solvent instead of the reconstitution one;
• A final concentration error: withdrawal instead of addition of solvent.
  An error could have been detected before the delivery: absence of antineoplasic drug in the final bag (withdrawal of dilution solvent instead of the drug vial and then reinjection into the bag). The video was viewed after a residual error was detected.

Discussion - Conclusion
Based on these results and the heterogeneity of the delivery mode, it is possible that some non-compliant preparations are not always stopped, despite compliance according to DC. All critical steps of the preparation are concerned by these "human" errors, which is why the systematic examination of the entire DC video seems indispensable. From now on, a second pharmacist is in charge of reviewing the DC videos in real time. In addition, a flowchart standardizing the procedures to follow in case of forgotten volume presentation has been distributed.

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