Risks and prevention associated with handling cytotoxics: setting up and running a continuing professional development training course

5 October 2023

A. Delavau, C. Nowak, I. Baudin
Centre Hospitalier d’Angoulême, France

Preparing cytotoxic injectables is a high-risk activity. These products are dangerous because they are toxic in cumulative doses for the person preparing and administering them, even in small, repeated doses. That’s why it’s vital to provide ongoing training to our teams, in order to limit the risks of exposure and promote the use of good preparation practices.

The aim was to create a Continuing Professional Development course for pharmacy assistants on the risks associated with handling cytotoxics and how to prevent them.

Training is defined according to the following points
* duration: 1 day, divided into 2 half-days (one for refresher courses and theory, and one for simulation workshops)
* Location: hospital simulation center
Several tools were created:
* Theoretical tools: 40-item pre-training test, open-ended questions to be answered as a group in the form of a meta-plan, theoretical reminder slide show, flyers handed out at the end of the training.
* Practical tools : Creation of falsified chemo test manufacturing sheets and inert bottles with falsified labels. Scenes were created around the isolator and captured on video. There was also a workshop on broken vials.
A satisfaction test was carried out at the end of the day.

The first training course was attended by 4 preparers with different backgrounds and locations. The results of the pre-test were 6.11/10 and post-test 7.57/10, i.e. an increase in scores of 14.6%. 2 of the 10 errors slipped into the isolator scenarios were not found by the participants. They were reviewed and corrected by post-processing. 100% of participants said they were satisfied with the survey. The handling part in the isolator was highly appreciated, as it simulated real-life conditions. 2 of the participants reported a desire to cover more theoretical points (reminders about the premises, "rules" for handling in a microbiological safety post).

The training seems to have been a success for both experienced and novice participants. However, there is still room for improvement : activities could be approached in a different way, such as a serials game or an escape game. Perhaps it would be legitimate to extend the training to other staff in contact with cytotoxics, such as nurses or interns who are just starting out. The course is in the process of being accepted for CPD certification.

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