Background and importance Preparation of chemotherapy treatment is a risky step. Therefore, the production circuit in the chemotherapy reconstitution unit (CRU) must be secured. The Drugcam digital tool is a preparation control system that guides the hospital pharmacy preparer (HPP) in their manufacturing process.

Aim and objectives A remote, multicentre and retrospective digital audit analysed qualitatively and quantitatively the practices of different CRU to find ways to optimise the preparation step for chemotherapy treatment.

Material and methods Over 1 year, data from 10 public and private healthcare institutions on three types of chemotherapy treatment, lyophilisate (pemetrexed), ready-to-use standard dose (nivolumab 240 mg) and dispenser (5-fluorouracil (5-FU)) were collected. This study analysed quantitative data extracted in Excel by pharmacists using local Drugcam data. Qualitative data obtained from audits made by pharmacists analysing 10 video recordings per chemotherapy preparation were also analysed.

Results 14 218 preparations made by 119 HPP were analysed: 2217 pemetrexed by 99 HPP, 1819 nivolumab by 90 HPP and 12827 5-FU by 110 HPP. The median preparation times for pemetrexed, nivolumab and 5-FU from all centres were 6.2, 4.2 and 4.9 min, respectively. Regardless of the three molecules, the results showed no significant difference between the experience of the Drugcam preparer and its productivity.

Qualitatively, analysis of the films showed heterogeneous practices between establishments: no compress for all stages, reconstitution by shaking of the lyophilisate as well as its mirage was not protocoled and rapid injections into the solvent were observed. The equipment used (infusion line or extension for infusion tree), the Drugcam practice (labelling of the preparation filmed or not, automatic or not automatic detection by the data matrix of the solvent/vial bags) and the organisation of each centre had a strong impact on the quality and productivity of the centres.

Conclusion and relevance If this study showed no correlation between time production, annual number of preparations and number of HPP, the analysis will allow us to recommend the practices of Drugcam for the preparation of chemotherapy treatment. Moreover, organisational modifications (series preparation, change of material reference) and practice harmonisation (standardised reconstitution of lyophilisates) will improve productivity and safety.

Conflict of interest No conflict of interest