International Journal for Quality in Health Care Advance Access originally published online on December 10, 2008
International Journal for Quality in Health Care 2009 21(1):44-50; doi:10.1093/intqhc/mzn052
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Published by Oxford University Press 2008
The application of hazard analysis and critical control points and risk management in the preparation of anti-cancer drugs
Department of Pharmacy, Hopital Européen Georges Pompidou, Paris, France
Objective. To apply the Hazard Analysis and Critical Control Points method to the preparation of anti-cancer drugs. To identify critical control points in our cancer chemotherapy process and to propose control measures and corrective actions to manage these processes.
Setting. The Hazard Analysis and Critical Control Points application began in January 2004 in our centralized chemotherapy compounding unit. From October 2004 to August 2005, monitoring of the process nonconformities was performed to assess the method.
Methods. According to the Hazard Analysis and Critical Control Points method, a multidisciplinary team was formed to describe and assess the cancer chemotherapy process. This team listed all of the critical points and calculated their risk indexes according to their frequency of occurrence, their severity and their detectability. The team defined monitoring, control measures and corrective actions for each identified risk. Finally, over a 10-month period, pharmacists reported each non-conformity of the process in a follow-up document.
Results. Our team described 11 steps in the cancer chemotherapy process. The team identified 39 critical control points, including 11 of higher importance with a high-risk index. Over 10 months, 16 647 preparations were performed; 1225 nonconformities were reported during this same period.
Conclusions. The Hazard Analysis and Critical Control Points method is relevant when it is used to target a specific process such as the preparation of anti-cancer drugs. This method helped us to focus on the production steps, which can have a critical influence on product quality, and led us to improve our process.
Keywords: Hazard Analysis and Critical Control Points method, anti-cancer drugs, risk management, quality management
Address reprint requests to: Nicolas Martelli, Department of Pharmacy, Hopital Européen Georges Pompidou, 20 rue Leblanc, Paris, France. Tel: +33-156-093-244; Fax: +33-156-093-247; E-mail: ph.upio{at}egp.aphp.fr
Accepted for publication October 30, 2008.