Study of tasks interruptions during the production of chemotherapies

Context
Control of the chemotherapy preparation circuit is a major element in the fight against the risk of drug errors and exposure of personnel to cytotoxic products. The HAS task interruptions Guide 2016 is a security tool that can be applied to the different stages of the drug circuit, especially in the chemotherapy preparation area.

Objectives
Study of impact of tasks interruptions on the risk of avoidable error during the preparation of chemotherapies within a cytotoxic production unit.

Materials and methods
The team of the chemotherapy preparation unit (UPC) is composed of 3.5 FTE preparers, 1.5 internal FTE, and 1 external FTE. Through a prospective quantitative observational study, we assessed task interruptions of various team members in February 2019 during 6 mornings. The observer followed the professional for 1.5 hours with an evaluation grid and collected the characteristics of each task interruptions: circumstances, members concerned, reason, severity and duration of each tasks interruptions.

Results
One hundred and seventy-eight task interruptions were recorded during 13 observation times (20 hours) with an average of 9.4 interruptions per hour [4-17]. It was during pharmaceutical validations and printing of manufacturing sheets for interns and during the manufacture of chemotherapy bags by pharmacy technicians that we report the largest number of task interruptions. The main source was a physical interruption (84%), in order to search additional informations (56%), of non-urgent gravity (50%), mainly of short duration (less than 1 minute in 90% of cases) and for the most part induced by a member of the team. In parallel, a daily record of nonconformities was made.

Discussion / Conclusion
Task interruptions within the chemotherapy production area are common, especially during the validation of prescriptions and during the preparation of chemotherapy bags. Over the years, they have become a habit for health professionals and can be contributory factors for the occurrence of iatrogenic accidents. A first feedback was made to the team to raise staff awareness of the risks of error and some practical measures were discussed and implemented. A working group was formed to continue to reflect on these task interruptions. This study will be extended to other areas of pharmaceutical technology.

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