Chemotherapy Preparation Research Articles

Virtual reality teaching in chemotherapy administration: Randomised controlled trial.

This study examined the effect of virtual reality (VR)-based documents (VRdocs) on knowledge and attitude towards chemotherapy administration in nursing students. Chemotherapeutic drugs in cancer patients are a complicated and dangerous process. However, despite the high toxicity of the chemotherapeutic drugs, the compulsory or internship courses in nursing schools do not include training in operational chemotherapeutics and its associated safety measures. A randomised controlled trial based on the CONSORT 2010 guidelines (registry number: NCT03707210). A total of 77 students were randomised to an experimental (VRdocs, n=38) or a control group (n=39). Pre- and posttest data were collected. After the pretest, the control group received the education documents, whereas, the experimental group used VR software consisting of an application about chemotherapy administration. Finally, the effectiveness of the intervention was self-evaluated using questionnaires after 7days. The posttest scores for knowledge (F=6.412, p=.013) and attitude in the experimental group were significantly different from those in the control group (F=8.469, p=.005). Compared with the control group, a significant number of students in the experimental group indicated their higher recommendation score for the VRdocs (p=.0001). Schools must provide a variety of handouts and teaching methods to educate nursing students about high-risk nursing techniques. Methods using VR can address the shortcomings of the traditional documents, and the use of both methods simultaneously can produce better learning results. Virtual reality based documents were provided to the participants to understand the preparation, implementation, and safety of chemotherapy. VRdocs allow students to re-learn high-risk care techniques without the influence of time and space and may prove useful for other nursing courses.

Pediatric blinatumomab preparation: Risk assessment on SmPC for software compliance

Blinatumomab is an anticancer drug used in the treatment of Acute Lymphoblastic Leukaemia (ALL) in both adults and children. ALL is the most common form of cancer in children and patients who are refractory to standard treatments have poor prognosis. The preparation of blinatumomab is unique and extremely complex. It's important to carry out any information to identify all the critical issues related to the preparation of blinatumomab: sharing procedure between prescribers, staff of the Centralized Chemotherapy Preparation Unit [Unità Farmaci Antiblastici (UFA)] and administering nurses aimed at reducing the clinical risk related to the management of the drug blinatumomab and to obtain correct prescriptions on the real dose to be prepared, safe worksheets with computer processing of all variables (volumes to be added and corresponding dose of drug) and complete labels containing all the information necessary for the control of the preparation and its correct infusion. A computerized process involves the use of specific software to which precise instructions must be given. This study is divided into two phases, the first one focused on the analysis of Summary of Product Characteristics (SmPC) and the extrapolation of any unclear part of SmPC. The second phase involved the manufacturer to answer a questionnaire. This comparison with the company allowed to perfect the blinatumomab preparation process leading to: 1. allow the patient to be discharged and return a few times for infusions and consequently reduce the number of medical prescriptions; 2. set up the drug for each patient every 4 days; 3. reduce costs related to devices, staff employed. Computerizing the preparation of anti-blastic drugs is a necessary path for the safety of the patient and all the operators involved, however it may be necessary to make changes in the preparation process to allow the software to work correctly. The comparison between pharmacist, clinician and, where necessary, the manufacturer of the drug, was effective in the preparation of this drug.

Healthcare failure mode and effect analysis in the chemotherapy preparation process.

To conduct a Health Care Failure Mode and Effects Analysis (HFMEA) of the chemotherapy preparation process to identify the steps with the potential to cause errors, and to develop further strategies to improve the process and thus minimize the risk of errors. An HFMEA was conducted to identify and reduce preparation errors during the chemotherapy preparation process. A multidisciplinary team mapped the preparation process, formally identified all the steps, and then conducted a brainstorming session to determine potential failure modes and their potential effects. A severity and probability score for each failure mode, a hazard score (HS) and a total HS were calculated. A hazard analysis was conducted for each HS equal to or more than 8. Finally, an action plan was identified for each failure mode. After the action plan was implemented, failure modes were revaluated and a new HS score was calculated as well as the percentage decrease in risk. The team identified five main steps in the chemotherapy preparation process and nine potential failure modes. After implementing the control measures, all the HSs decreased. The total HS associated with the chemotherapy preparation process decreased from 54 to 26 (-52%). This reduction in the total HS was mainly achieved by updating the Standard Operating Procedures (SOPs) and implementing bar code and gravimetric control system. The application of HFMEA to the chemotherapy preparation process in centralized chemotherapy units can be very useful in identifying actions aimed at reducing errors in the healthcare setting.

Successful use of problem-solving methodology to reduce pharmacy chemotherapy processing time

ObjectivesThe primary objectives of this study were to (1) reduce pharmacy turnaround time (TAT) without compromising safety and quality and (2) reduce compounding order overload during peak hours (8:00 AM-5:00 PM). The secondary objective was to decrease patient wait time pertinent to pharmacy services. SettingThe setting was a hospital-based pharmacy. Practice descriptionPharmacy dispensing more than 1800 doses daily, 30% of which goes to outpatient cancer treatment. Patients usually receive multiple compounded medications; thus, compounding numbers are several folds higher than patient number. High compounded chemotherapy order volume overloaded pharmacy staff during peak hours and was a major contributor to patient wait time. Practice innovationUsing Define Measure Analyze Improve Control Six Sigma and intelligent risk-taking strategies, a dedicated team identified root causes of problems and designed long-lasting solutions that would not compromise quality. EvaluationThe most effective initiative was the advanced preparation of chemotherapy for select patients (Concierge), which addressed pharmacy TAT, patient wait time, and chemotherapy order overload, all without affecting safety or quality of dispensed medications. ResultsPharmacy TAT decreased by 77% for Concierge patients and 31% for standard patients. Comparable decreases were observed for patient wait time: 67% for Concierge and 27% for standard patients. Safety and quality were maintained for all dispensations during and after implementation of Concierge. A concurrent 8% increase in patient number was observed despite no changes in physical capacity. ConclusionThe implementation of Concierge initiatives: markedly reduced pharmacy TAT without compromising safety checks performed by pharmacists; decreased chemotherapy order overload during peak hours; improved distribution of assignments for pharmacy staffand statistically significant decreased wait time for all patients, especially those selected for Concierge. Effective selection of Concierge patients minimized additional costs associated with wasted premixed chemotherapy. Improving workflow for a subset of patients affected a greater patient population, allowing additional patients to be treated daily.

Optimisation of the preparation of chemotherapy based on 5-fluorouracil by the use of peristaltic pumps

Abstract ObjectivesPreparation of 5-FU elastomeric pumps is a time-consuming activity inducing musculoskeletal disorders (MSDs). Our unit has developed an automated filling system consisting of two peristaltic pumps (one for the diluent, one for the cytotoxic drug). The objective was to validate the accuracy of the assembly and evaluate the impact of automation on the compounding time, occurrence of MSDs and cost of preparation.MethodsAccuracy was determined by calculating the total error on the volumes injected by the pumps. Measurements were made for 2 brands (AMF, Baxter), 3 different volumes; repeated 3 times at 3 times of the day. The time-saving study compared 24 measurements in manual filling and 24 in automated mode. Impact of automation on the occurrence of MSDs was evaluated by a self-assessment questionnaire. Finally, a comparison between the price of a manually prepared elastomeric pump and an automated prepared elastomeric pump was performed.ResultsVolumes administered by the pumps were accurate (total error < 2.5%). Preparation time was divided by 2. Occurrence of MSD decreased (8.7 manual filling vs. 23.5/28 automated filling). Overcost was moderate (14.7% for AMF; 10.3% for Baxter).ConclusionsUsing peristaltic pumps, 5FU preparation was optimized for moderate additional cost.

The Chicago Consensus on peritoneal surface malignancies: Standards.

The Chicago Consensus Working Group provides the following multidisciplinary recommendations for the care of patients with peritoneal surface malignancies. This article focuses on the standards of a peritoneal surface malignancy center, standards of billing and coding, standards of operative reports for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, standards of cytoreductive surgery training, and standards of intraoperative chemotherapy preparation. These guidelines are developed with input from leading experts, including surgical oncologists, medical oncologists, pathologists, radiologists, palliative care physicians, and pharmacists. These guidelines recognize and address the emerging need for increased awareness in the appropriate management of peritoneal surface disease. They are not intended to replace the quest for higher levels of evidence.

The Chicago Consensus on Peritoneal Surface Malignancies: Standards.

The Chicago Consensus Working Group provides the following multidisciplinary recommendations for the care of patients with peritoneal surface malignancies. This article focuses on the standards of a peritoneal surface malignancy center, standards of billing and coding, standards of operative reports for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, standards of cytoreductive surgery training, and standards of intraoperative chemotherapy preparation. These guidelines are developed with input from leading experts including surgical oncologists, medical oncologists, pathologists, radiologists, palliative care physicians, and pharmacists. These guidelines recognize and address the emerging need for increased awareness in the appropriate management of peritoneal surface disease. They are not intended to replace the quest for higher levels of evidence.

Proposal of a simple and rapid method for the chemotherapy preparations analytical control by spectrophotometry UV-Vis method.

The preparation of anticancer chemotherapy in a hospital must meet several objectives; the first main is the quality, which can be provided by setting up a surveillance system and a quality control of each preparations. The aim of this work is to present a simple, fast and accurate spectrophotometric method for the routine control of cytotoxic preparations. This is a study carried out in the cytotoxic preparation unit of the university center of Rabat-Sale children's hospital in Morocco. All samples of preparations were collected and analyzed daily on the site. After validation of the analytical method with respect to many parameters such as: linearity, accuracy and precision according to ICH Q2 guidelines, samples of cytotoxic preparations collected were assayed. The results are satisfactory with good level of exactitude, and high precision. Compared to other techniques, this method can be considered as a useful alternative in the routine quality control of preparations. It can quickly obtain qualitative and quantitative information with instrumentation and inexpensive reagents.

Clinical, economic and organizational impact of pharmacist interventions on injectable antineoplastic prescriptions: a prospective observational study

BackgroundPharmacists play a key role in ensuring the safe use of injectable antineoplastics, which are considered as high-alert medications. Pharmaceutical analysis of injectable antineoplastic prescriptions aims to detect and prevent drug related problems by proposing pharmacist interventions (PI). The impact of this activity for patients, healthcare facilities and other health professionals is not completely known. This study aimed at describing the clinical, economic, and organizational impacts of PIs performed by pharmacists in a chemotherapy preparation unit.MethodsA prospective 10-week study was conducted on PIs involving injectable antineoplastic prescriptions. Each PI was assessed by one of the four multidisciplinary expert committees using a multidimensional tool with three independent dimensions: clinical, economic and organizational. An ancillary quantitative evaluation of drug cost savings was conducted.ResultsOverall, 185 patients were included (mean age: 63.5 ± 13.7 years; 54.1% were male) and 237 PIs concerning 10.1% prescriptions were recorded. Twenty one PIs (8.9%) had major clinical impact (ie: prevented hospitalization or permanent disability), 49 PIs (20.7%) had moderate clinical impact (ie: prevented harm that would have required further monitoring/treatment), 62 PIs (26.2%) had minor clinical impact, 95 PIs (40.0%) had no clinical impact, and 9 PIs (3.8%) had a negative clinical impact. For one PI (0.4%) the clinical impact was not determined due to insufficient information. Regarding organizational impact, 67.5% PIs had a positive impact on patient management from the healthcare providers’ perspective. A positive economic impact was observed for 105 PIs (44.3%), leading to a saving in direct drug costs of 15,096 €; 38 PIs (16.0%) had a negative economic impact, increasing the direct drug cost by 11,878 €. Overall cost saving was 3218€.ConclusionsPIs are associated with positive clinical, economic and organizational impacts. This study confirms the benefit of pharmacist analysis of injectable antineoplastic prescriptions for patient safety with an overall benefit to the healthcare system.

Centralization impact and cost-saving study in a Moroccan hospital's centralized unit of chemotherapy preparation.

The purpose of this study was to assess the cost saved and the amount of drug wasted when compounding anticancer drugs in the centralized unit for chemotherapy preparation. A secondary objective was to estimate the centralization impact of activities related to the preparation of chemotherapies. This was a two-month, single-centre, prospective study conducted at the National Oncology Institute in Rabat. The cost saved and the amount of drug wasted were calculated using a standardized data collection sheet (the prescribed dose, the amount of drug deployed, the amount remaining after compounding, the amount of drug saved and the drug wastage). The centralization impact was calculated using the amount of drug wasted in the centralized unit for chemotherapy preparation and a theoretical amount of drug wasted without centralization of preparation. During the study period, the total amount of drug saved was 249,959.5 mg (7.2% of drug used), which represented 96,657 USD. The amount of drug wasted was 89,290.5 mg or 42275.5 USD. The drug waste per dilution and per drug was 6.4 mg [1.6-16.1]. While the potential savings over one year (580,000 USD) reached 13.9% of the cytostatic drugs budget for 2018, the potential drug waste cost reached 6.1%. The centralization impact is estimated at an average of 79.5% ± 13.7% waste reduction. The outcome of our study showed that the grouping of prescriptions in centralized unit for chemotherapy preparation could result in significant savings on the amount of drugs deployed. The centralization of cytostatic preparations is of economic interest.

Improving the Timeliness of Chemotherapy Administration in the Bone Marrow Transplant Unit.

Patients undergoing hematopoietic stem cell transplantation (HSCT) are often admitted to the hospital the day they are due to begin their conditioning regimen. Timely initiation of chemotherapy during regular work hours is important for patient safety, because during the night shift fewer physicians and pharmacists are available for urgent or unexpected matters. A review of the data at our institution from October 2017 to August 2018 showed that approximately one-third of our chemotherapy was started during the night shift (after 19:00), and the average time from admission to start of chemotherapy was over 8 hours. There are currently no well-defined benchmarks for timeliness of chemotherapy initiation. The aim of this quality improvement initiative was to increase the percentage of patients who start chemotherapy in the bone marrow transplant unit before 19:00 from 65% to >80% by March 31, 2019. We identified barriers to timely initiation of chemotherapy through process mapping and analysis of failures. The primary barriers were late admissions (after 12:00 pm) and time from admission to preparation of chemotherapy. We addressed mechanisms to mitigate these barriers through Plan-Do-Study-Act testing. Interventions included providing families specific admission times and their rationales and process for notifying pharmacy of admissions immediately on arrival. We used standardized control charts to measure the impact of the interventions on change. We also monitored medication errors before and during the intervention. From September 2018 to March 2019 the percentage of patients who started preparative chemotherapy before 19:00 increased from 65% to 85%, the percentage of patients who were admitted after 12:00 remained similar before (31%) and after the interventions (33%), and the average time from admission to start of chemotherapy decreased from 8.6 hours (513 minutes) to 6.4 hours (382 minutes). Medication errors were similar before (n = 50) and after the interventions (n = 43). Using standardized processes, we demonstrated a substantial decrease in the percentage of HSCT patients starting their preparative regimen after 19:00 without a concurrent increase in errors. We believe these interventions and measurements can be used in all transplant centers and have the potential to influence patient safety and outcomes.

A quality improvement approach to optimizing infusion wait times.

61 Background: Long wait times are a common and occasionally unavoidable experience for patients receiving chemotherapy infusions. It unfavorably impacts patient satisfaction and clinic efficiency. Our primary objective was to evaluate the impact of infusion clinic process changes on patient wait times within a Plan, Do, Study, Act (PSDA) framework. Methods: A multi-disciplinary team, consisting of oncology, nursing, pharmacy, quality improvement, and support staff, met to have brainstorming sessions, make surveys, and conduct time studies to analyze our current process (Plan). A Pareto chart created using survey results showed communication issues were likely causing the largest modifiable impact on our wait times. A common source of miscommunication was whether patients are waiting on labs results for treatment. Beginning March 2019, patients not requiring labs on the day of treatment were assigned to a separate scheduling title to designate them as priority for vital signs and review by pharmacy (Do). Upon clinic check-in, these patients now have vitals signs collected immediately and pharmacy is notified of their arrival to begin chemotherapy preparation. Results: Baseline as well as prospective wait time data was collected from 30 clinic days (360 patient wait times) from chart reviews and timestamp data available in the electronic medical record (EMR). Results were analyzed (Study) using Statistical Process Control (SPC) charts to allow for early detection of improvement. Pre-implementation wait times averaged 1 hour and 37 minutes. Post implementation wait times average 1 hour and 16 minutes (Act). This change was significant based on a shift visible on the SPC chart. Our balancing measure of wait times for all patients did not increase compared to baseline (2 hours and 15 minutes). No significant correlation was observed between average daily wait times and the day of the week or the number of patients treated that day at baseline. Conclusions: Implementation of a new clinic scheduling title and workflow reduced wait times for patients not requiring labs on the day of treatment without increasing wait times for patients requiring labs. Additional PDSA cycles will be conducted for further reductions in wait times for all patients at our site.

Student confidence with oncology pharmacy competencies

ObjectiveThe purpose of this study was to assess the change in student confidence to perform oncology pharmacy competencies before and after completing oncology didactic instruction using a flipped classroom approach. MethodsFirst year doctor of pharmacy students completed a survey prior to the Applied Science and Therapeutics (AST) oncology module (pre-survey) and the same survey following the completion of the oncology module (post-survey). The survey consisted of questions addressing prior oncology pharmacy experience related to employment (research or patient care) and education, level of interest in oncology pharmacy, and level of confidence to perform thirteen oncology pharmacy competencies. ResultsOne-hundred sixteen students completed the pre-survey and 35 completed the post-survey. Students completing both surveys reported greater confidence in all oncology pharmacy competencies (p < 0.0001) after instruction. The greatest increases in student confidence were related to chemotherapy dose calculations, patient education, and drug-drug interactions. ConclusionsThe delivery of oncology content using flipped classroom instruction in the AST course successfully increased student confidence in ability to perform oncology pharmacy competencies. Cancer screening, cancer risk factors, and the preparation and dispensing of chemotherapy were competencies identified as needing greater emphasis in classroom instruction. Future studies are needed to assess student's knowledge and application of oncology pharmacy competencies in both the experiential and classroom settings.

Simulation to assess intelligent video camera system's actual production performance during chemotherapy preparation

Abstract Introduction: DRUGCAM is a new approach to control the chemotherapy preparations with an intelligent video system to assist the pharmacy technician during compounding process. This tool is able to control all of our production (except for colored and dark anticancer drugs) with an in-process control and a posteriori inspection. We first aimed to estimate DRUGCAM's performance in real-life production by simulation and to compare it with the double human control. Furthermore, factors influencing the performance of both controls were observed and preventive solutions will be envisaged to optimize our activity. Equipment and methods: Each day during 30 days, between 11:30 am and 12:30 am, we controlled 20 different volumes contained in syringes, in real production conditions (clean room) both by human visual inspection then by automated video control. Working conditions have been observed and tasks disturbances and interruptions have been noted. A set of information has been collected: the syringe's model, the volume of product and the disturbances. A statistical analysis has been conducted to interpret results. Results: With 24 errors throughout the 600 volume controls, the error rate for the visual human control is 4%. Seven checked volumes were superior to the expected volume (overdosing) and 17 were inferior (underdosing). The error rate for DRUGCAM is 0.17%. Among the disturbance factors, the type of syringe used is responsible for errors: 13 errors have been noticed with the 1 mL syringe and 8 errors with the 10 mL syringe which represent higher error rates than with the other syringes. The “permanent” staff members of the unit present an error rate of 5.3%, more important than the “non-permanent” ones (1.8%). More mistakes are done in the presence of a pharmacist than in its absence (13% against 4%). Conclusion: Our studies justify the superiority of the DRUGCAM system toward double human control. Moreover, the double human control could possibly be disturbed by external factors whereas DRUGCAM is not. Using DRUGCAM is to be considered to establish preventive measures and reduce tasks interruptions or disturbance factors thanks to video analysis.

Combining Soft Systems Methodology, ethnographic observation, and discrete-event simulation: A case study in cancer care

We describe a project where discrete-event simulation (DES) is combined with Soft Systems Methodology (SSM) and ethnographic observation to support the improvement of patient flows in an outpatient chemotherapy unit and a chemotherapy preparation pharmacy unit. The project combines three interesting characteristics. First, we rely on ethnographic observation to explore the problem situation and frame the problem, a technique rarely reported in operational research (OR). Second, this leads us to define several root definitions, an aspect that remains overlooked in studies combining SSM and DES. Finally, the project stands at the interface between two departments (outpatient oncology unit and chemotherapy preparation pharmacy unit), a situation seldom explored in healthcare OR but where SSM has arguably a lot to offer to help identify and accommodate diverging objectives. We framed the problem, developed a simulation model, explored scenarios and refined a preferred one into a new business process. However, the proposed changes were not implemented. We analyse the outcomes of the project, the contribution of each method and their integration into an intervention. The paper provides insights on how SSM and DES can be combined in practice, and how the potential of ethnographic observation can be leveraged in this context.

Traditional Chinese Medicine Preparation Combined Therapy May Improve Chemotherapy Efficacy: A Systematic Review and Meta-Analysis.

Background Whether traditional Chinese medicine preparation combined therapy can improve the efficacy of chemotherapy is controversial. This meta-analysis evaluates the efficacy of traditional Chinese medicine preparation combined with chemotherapy. MethodThree databases were searched from inception through August 2018. Eligible randomized controlled trials (RCTs) involving the combined treatment of chemotherapy and traditional Chinese medicine preparation compared to chemotherapy alone for treating cancer were retrieved. The methodological quality of the included RCTs was assessed with Cochrane Collaboration's risk of bias assessment tool. Meta-analysis was adopted to make comprehensive comparisons between the experimental and control groups. Results Four RCTs were included in this review, comprising 256 subjects. The majority of the RCTs were judged as being of poor methodological quality. Meta-analysis showed that the combination of traditional Chinese medicine preparation and chemotherapy appeared to be more effective than chemotherapy alone, for the treatment of cancer, as assessed by the disease control rate (RR: 1.41, 95% CI: 1.11 to 1.79) and the objective response rate (RR: 2.71, 95% CI: 1.28 to 5.77). There were no statistically significant differences between the groups in terms of bone marrow suppression (RR: 0.88, 95% CI: 0.57 to 1.37) or gastrointestinal reaction (RR: 1.12, 95% CI 0.75 to 1.69). Conclusions Traditional Chinese medicine preparation combined with chemotherapy may improve objective response rates and disease control rates more than chemotherapy alone. The evidence that combined traditional Chinese medicine preparation can reduce the side effects of chemotherapy is insufficient. More rigorous randomized controlled trials are needed to confirm these conclusions.

Work overload is related to increased risk of error during chemotherapy preparation.

Chemotherapy preparation units face peaks in activity leading to high workloads and increased stress. The present study evaluated the impact of work overloads on the safety and accuracy of manual preparations. Simulating overwork, operators were asked to produce increasing numbers of syringes (8, 16, and 24), with markers (phenylephrine or lidocaine), within 1 h, in an isolator, under aseptic conditions. Results were analyzed using qualitative and quantitative criteria. Concentration deviations of < 5%, 5%-10%, 10%-30%, and >30% from the expected concentration were considered as accurate, weakly accurate, inaccurate, and wrong concentrations, respectively. Twenty-one pharmacy technicians and pharmacists carried out 63 preparation sessions (n = 1007 syringes). A statistically significant decrease in the manufacturing time for one syringe was observed when workload increased (p < 0.0001). Thirty-nine preparation errors were recorded: 30 wrong concentrations (deviation > 30%), 6 mislabeling, 2 wrong diluents, and 1 wrong drug. There was no statistically significant difference in the mean concentration accuracy of final preparations across the three workloads. The overall error rate increased with the number of preparations made in 1 h: 1.8% for 8 preparations, 2.7% for 16 preparations, and 5.4% for 24 preparations (p < 0.05). Although pharmacy technicians and pharmacists were able to increase production speeds with no effect on mean concentration accuracy under stressful conditions, there were greater probability errors being made. These results should encourage actions to spread workloads out over the day to avoid peaks in activity.

Optimisation of chemotherapy prescription and preparation in an ambulatory unit: Validation of the OPTIMA program.

We implemented the two-step OPTIMA program to anticipate chemotherapy prescription which aims to assess the discrepancy rate between anticipated and real prescription and its impact on waiting time and quality of care. This prospective study included cancer patients receiving any intravenous chemotherapy. The OPTIMA program consists in a nurse phone call and a blood sample two days before the planned treatment. Collected information and biological results were used by a physician to issue a non-effective (step 1) or effective (step 2) anticipated prescription the day before the consultation. The real prescription was given as usual by another physician on the day of the consultation. Waiting time was collected, and patients' satisfaction with care was assessed with the OUT-PATSAT35 questionnaire. Respectively, 540 and 979 consultations (283 and 294 patients) were analysed in both steps. The discrepancy rate was 8.7% (step 1). In routine practice, the OPTIMA program (step 2) reduced patients' waiting time (median time 55 vs. 95min, p<0.001). A high general care satisfaction score was observed in both steps (80.7% and 80.2%). This anticipation program demonstrated the accuracy of chemotherapy prescription, whatever the regimen and cancer site, and its impact on waiting time optimisation.

A virtual centralized cytotoxic preparation unit simulation to evaluate the pharmacy staff knowledge.

The risk of medication errors related to drug preparation unit cannot be totally avoided because of human interference. The aim of this study is to investigate the background and knowledge of the pharmacy staff by replicating the cytotoxic preparation unit with potential errors. A 10-m2 room was provided to duplicate the centralized chemotherapy unit with three areas reproducing virtually the equipment preparation bench, the isolator, and the dispensing bench. The 14 situations selected by experts were integrated to each corresponded area. For each participant, a form was given and answers were analyzed by two independent experts. Statistical processing data were performed using GraphPad Prism® software. A total of 19 professionals participated in error simulation workshop over a one-month period. The overall rate of correct responses was 58 ± 19%. In five situations, correct responses rate was lower than 50%: wrong drug batch related to the preparation sheet (40%), inappropriate sterilizing conditions (15%), the time on the preparation sheet provides an expired expiry date for melphalan preparation (45%), a maximum drug dose exceeded (25%), the dispensing form not corresponds to the preparation sheet and final product label (30%). The rate of correct responses was 45 ± 25% for professionals not specifically dedicated to chemotherapy preparation. The overall satisfaction workshop rate was 8.7 ± 1.0 out of 10. This study showed the importance of training programs to sensitize personal staff to the risks of chemotherapy preparation and prevent errors.

Assessment of Nurse's Safe Behavior Towards Chemotherapy Management.

Introduction:The management of chemotherapy in the hospital environment has been associated with increased risk of exposure to harmful factors. The use of the designated protective area and equipment during the preparation and the administration of chemotherapy is considered the gold standard of prevention.Aim:The aim of the study was to assess nurse’s behavior in one public and one private hospital during the management of chemotherapy.Methods:A cross sectional study design, using a self-completing questionnaire was used to collect the data, the final sample consisted of n=82 nurses, employed in the oncology and haematology department of Limassol general hospital and the bank of Cyprus oncology center.Results:Most of the sample had a positive attitude towards the management and preparation of chemotherapy and kept the personal protection measures 52,4%. Inadequate aeration system was found to exist in both the health care centers 17,1%. The knowledge levels of the nurses employed in the bank of Cyprus oncology center was found to be statistically higher than the nurses employed in Limassol general hospital (84,4% Vs 23,4%, p<0,001).Conclusion:Educational programs need to be designed and implement to update nurses with the latest safety techniques and procedures, aiming at the protection of the employees from side effects as a result from the exposure to chemotherapy. The management of the healthcare institution need to ensure that the workplace environment fulfils all the safety standards and health regulations regarding the preparation of chemotherapy. Lastly more studies need to be conducted to monitor the knowledge and attitudes levels, and the implementation of safety and health regulation from the health care organizations regarding the safe management and preparation of chemotherapy.