No safety net in pharmaceutical technology: How the absence of continuous service affects hospital practice?

Introduction
The preparation of sterile and non-sterile medicinal products within hospital settings—particularly under emergency conditions—may necessitate a structured continuity of service (CoS) in pharmaceutical compounding units. Nevertheless, many French healthcare institutions operate without such continuity, relying on alternative mechanisms to ensure the timely availability of critical medications outside of standard operating hours.

Objective
To characterize organizational models for hospital pharmaceutical compounding in the absence of CoS and to identify mitigation strategies implemented to maintain therapeutic continuity.

Methods
A national, multicenter descriptive survey was conducted over a one-month period in 2025. Data were collected from hospital institutions regarding the existence or absence of CoS, hospital classification (general vs. university), and alternative systems deployed to compensate for the lack of pharmaceutical service continuity.

Results
Among the responding institutions, 17 reported the absence of CoS (2 general hospitals [12%], 15 university hospitals [88%]). In such settings, several compensatory strategies were identified—often used in combination—depending on institutional resources and organizational structure:
• Dispensing of standard doses by the on-call pharmacy resident from the chemotherapy reconstitution unit (1 institution; 6%)
• Provision of emergency kits for intrathecal syringe preparations (e.g., cytarabine, methotrexate) (2 institutions; 12%)
• Scheduled compounding involving a pharmacy technician and activation of an on-call pharmacist upon clinical request or for preparations with limited stability (2 institutions; 12%)
• Use of closed-system transfer devices dispensed by on-call pharmacy staff for secure preparation and administration of chemotherapy (4 institutions; 24%)
• Pre-prepared, ready-to-use hospital formulations (e.g., spironolactone 5 mg/mL) (2 institutions; 12%)
In three institutions (18%) not involved in chemotherapy compounding, no replacement measures were reported; non-urgent preparations were deferred to regular working hours.

Discussion and Conclusion
These findings reveal a marked heterogeneity in the organizational responses to the absence of CoS, reflecting locally adapted practices. While certain institutions have implemented formalized and resilient frameworks, others remain vulnerable in out-of-hours emergency contexts. Standardization of protocols, development of national guidelines, and reinforcement of interdisciplinary coordination are recommended to enhance the safety and efficiency of the pharmaceutical supply chain in hospital settingss

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