Resumption of the downgraded circuit during a chemotherapy prescription software breakdown from A to Z

4 octobre 2023

C. Chabanol, M-L. Ducassou, M. Bay, J. Delrieu
Centre Hospitalier Universitaire de Poitiers, France

With the arrival of computing in the management of chemotherapy prescriptions as well as in the general organization of the health facility, a computer breakdown would lead to a paralysis of activity and medical treatment. Moreover, the alternative proposed by the software isn’t appropriated to our department work.

In order to restrict the breakdown’s impact, it’s important to set up a downgraded mode, easy to use in order to maintain the prescription’s security and to continue the patient care.
Materiel and Method : To fully resume the downgraded circuit of the chemotherapy prescription, it was carried out :
1-Achieve of a flowchart according to the duration of the software failure.
2-Record of all chemotherapy protocols and make them available even during the failure.
3-Daily record of manufacturing sheets and prescriptions on an external server.
4-Achieve a prescription help on a spreadsheet : physicians fill out the patient data as weight, size, molecule, ... The chart calculates : dosage adjudgment, proposes doses bending and volumes easily retrieved.
5-Achieve a global and secure manufacturing sheet on a spreadsheet : the chart is inspired by the daily used sheet, it checks the solvent-molecule compatibility, concentration, number of necessary vials…
6-Work situation on the prescription to the release of chemotherapy.
7-Validation of the new downgraded circuit by prescribing physicians.

The work situation showed a time to prescribe for physicians and to validate prescription for pharmacist two time longer than usual. No impact was founded on manufacturing time and a reduction in preparation release time, due to visual control.
The 54 most prescribed molecules were tested on the table prescription and manufacturing sheet then compared with software results :
- 5 molecules have a difference in final volume but this doesn’t affect the administered dose (no transfer).
- 1 preparation demonstrated the use a different formula to calculate body surface area in children, increasing the dosage by 3%.
- 4 molecules had differences of less than 4%, the rounding being different from that of the software.

The work situation revealed details that would allow, by adding data, to raise to the next level the security of the prescription and manufacture of chemotherapy.
After the review of the procedure by a pharmacist, it will be submitted to the medical validation of the chemotherapy prescribers.

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