Table 1 Critical risks points and their main sources in the main working procedures of CIVAS centres.

Drug management

Drug beyond expiration date

1. No reasonable plans for purchasing medicine

2. Inattention to expiration date

3. “first expire, first out” principle unawareness

Therapeutic failure

1. Drug spoilage

2. Breakage of bag(s) or vial(s)

3. Medication selection error

1. Unfamiliar with drugs’ storage requirements

2. Careless warehouse entry check or sloppy shelf transfer

3. No distinguishable labels on shelves for similar medicines (e.g., name, appearance) or fatigued inattention

1. Unpredictable serious consequences

2. Air contamination, a waste of drugs

3. Error in drug preparation and intravenous admixture procedure

Prescription review

Failure to identify incorrect prescription

1. Obsolescence of prescription review software

2. No sufficient time for prescription review

3. Overdependence on the review software

Adverse reaction(e.g., allergy, physical impairment)/therapeutic failure/unpredictable serious consequences/death

Preprocessing step

1. Medication selection error

2. Incorrect label allocation for infusion bottle/bags

3. Drug preparations were allocated to incorrect batches

4. Refunded drugs were continually

prepared for original users

5. Drug container breakage

1. No distinguishable labels on shelves for similar medicines (e.g., name, appearance) or careless selection

2. Small label font lead to improper recognition or careless operation

3. Incorrect label allocation for different batches

4. Operators’ busyness and carelessness

5. Improper /fatigued operation

1–2. Incorrect medication for next step

3. Disruption of treatment plan/ therapeutic failure

4. A waste of drugs

5. Air contamination, a waste of drugs

Admixing step

1. Refunded drugs were continually produced for original users

2. Medications were mixed with diluent in incorrect batches

3. Diluent errors (wrong diluent or wrong volume usage)

4. Preparation of wrong drug dosage

5. Additive omission

6. Operation spill

7. Drug container breakage

1. Operators’ busyness and carelessness

2. Batch checks were not conducted before compounding

3–5, 7. Careless individual operation or excessive work pressure

6. Pharmacists were in a hurry to produce fluids

1. A waste of drugs

2. Disruption of treatment plan/therapeutic failure

3–4. Uncertain drug effects

5. Therapeutic failure

6–7. Air contamination, a waste of drugs

Packaging and delivery

1. Unusual changes in finished fluids (e.g., colour change, sediment, impurities, etc.) were not noticed

2. Leak-proof package was not sealed

3. Finished fluids were assigned to incorrect packages and delivered

4. Omission of finished fluids scan and delivery sheet printout

No sufficient time

1. Unpredictable serious consequences

2. Cytotoxic substances posed a threat to staff’s health

3–4. Transportation delay and therapy delay