Quality-assurance testing of staff pharmacists handling cytotoxic agents

Competency-based simulation testing was used to improve staff pharmacists' handling of cytotoxic agents. Pharmacists were asked to prepare a simulated liquid cytotoxic agent (fluorescein sodium 0.5 mg/ml.) according to the pharmacy service standard operating procedures. Participants were observed throughout the preparation to assess proper safety and aseptic technique, waste disposal, and labeling. Ultraviolet light was used to assess surface contamination. After the test, errors were discussed with each participant. All participants then received scheduled annual training on preparation of cytotoxic agents, and they took the simulation test again three months later. Thirteen staff members completed all testing. Simulation test scores improved from 61% to 84%. Evidence of surface contamination was found for 92% of these pharmacists during the pretest and only 23% during the posttest. Written test scores improved, but not significantly, from 85% to 89%. Each simulation and feedback session took 30 minutes. Simulation testing significantly improved competence in preparation of cytotoxic agents.