Pr

1
Work with cytotoxic drugs overview of different
hospitals wards in Valais, Switzerland
Buchmann S 1, Obrist R 2, Marty S 1 Institut
Central des Hôpitaux Valaisans, SION,
Switzerland 1Division of Pharmacy 2Division of
Oncology sophie.buchmann_at_ichv.ch
32nd European Symposium on Clinical Pharmacy
VALENCIA 29.10 1.11.2003
ICHV Division of Pharmacy Division of Oncology
Background and objective Evaluation of the work
with cytotoxic drugs in different hospitals
wards in Valais, Switzerland. Because of the
geographic dissemination of those hospitals
(fig.1), all depending on the Central Pharmacy,
which is halfway located, there is no centralised
cytotoxics preparation existing yet. The aim of
this study is to identify sources of errors
(fig.2) and try to reduce potential for
chemotherapy-related mistakes.
Design Initially literature's review and
guidelines on the subject and visits in two
Universitary Hospitals working with a centralised
cytotoxics preparation at the Pharmacy. Then,
local evaluation with a check-list (fig.3)
concerning prescription, drugs order at the
Central Pharmacy, preparation and finally
treatments administration. Setting 10 wards
working with cytotoxic drugs in different
hospitals in Valais, Switzerland.
Main outcome measures Comparison of the different
wards results with the literature's
recommendations, guidelines and with the way of
work in the two visited Universitary Hospitals.
(fig.4)
50 km
Fig. 1 Location of the six regional hospitals
in Valais
Fig. 2 Example of dangerous drugs order
received at the Central Pharmacy
Fig. 3 Check-lists first page
Results Most of the divergences from the
literature's recommendations have been found at
the stages of prescription and preparation of
cytotoxic drugs. The prescriptions are not
necessarily given in a procedure form and are not
always clear enough for the nursing staff. Safety
precautions during the preparation of cytotoxic
drugs are not always applied in optimal way.
Contaminations risks for both the nursing staff
and the prepared drugs exist. Medicines orders
at the Pharmacy and treatments administration
are the stages with a lower risk of problems.
Fig. 4 Example of results analysis table
Conclusions The study shows problems within the
process which could generate serious
complications for patients and for the nursing
staff. The improvements that a Central Pharmacy
can propose, in order to decrease the risk of
mistakes are standardization of procedures for
chemotherapy for all the prescribers, including
all informations that the nursing staff needs,
plus local support for the preparation of
cytotoxic drugs. Eventually centralisation of
cytotoxic drugs preparation at the Central
Pharmacy, considering difficulties ensuing
geographical distribution of hospitals. The
implication of the clinical pharmacist in such a
process may be essential to reduce risks with the
cytotoxic drugs.