Subcontracting of the reconstitution of anti-cancer drugs: feedback from the principal 2 years after implementation

Introduction
A subcontracting of the reconstitution of anti-cancer drugs was initiated in 2019 with the support establishment of our regional hospital grouping. The subcontracting involved organisational changes in the pharmacy and in the care services. Two years after the implementation of this cooperation, it seemed appropriate to evaluate our current organisation and to collect the satisfaction of the different actors.
The aim is to carry out an inventory of the current organisation of subcontracting of anti-cancer drugs in order to improve practices.

Materials and methods
Satisfaction questionnaires were distributed to all those involved in the circuit: pharmacists and hospital pharmacy assistants from the provider establishment, pharmacists and PPH from the establishment, logistics, nursing and oncology teams, and patients.
In order to obtain an exhaustive list of the organisational malfunctions that may have occurred, a retrospective analysis of the non-conformities reported since the beginning of the cooperation was carried out.

Results
58 non-conformities related to the subcontracting circuit were reported, mainly by the 2 pharmacies. Only 1 non-conformity was declared by our oncology hospital service. Many stages of the subcontracting process are concerned: prescription (7), pharmaceutical validation (13), transport (10), reception (7), dispensation (1), invoicing (6), information systems (14).
72 responses to the satisfaction questionnaires were obtained. 97% of respondents considered the current organisation to be satisfactory. 94% of patients were also satisfied with their care. The main comments for improvement concern the management of time constraints for medical validation: 66% of the pharmacists in the provider establishment are dissatisfied with the respect of deadlines; training in the new computer software: 40% of the respondents do not feel comfortable with it; and the updating or redistribution of certain procedures: 30% of them are unfamiliar to the nurses.

Discussion
The organisation in place is satisfactory for the staff but also for the patients. Points of attention were highlighted and will be monitored to maintain the necessary requirements for this activity. Improvement actions will be implemented taking into account the various responses. A pharmaceutical validation schedule will be initiated in order to avoid delays. Additional training on the computer software is also planned. It will be interesting to carry out a new evaluation in a few months to assess the effectiveness of these actions.

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