Transitions of care between pediatric onco-hematology and intensive care units: An exploratory study of healthcare professionals’ perceptions and practices in medication management

As in adult care, pediatric patients experience transitions in their care trajectory, such as transfers to intensive care units (ICUs) during episodes of clinical deterioration. In pediatric onco-hematology, the administration of Chimeric Antigen Receptor (CAR) T-cell therapy often necessitates several days of ICU admission for post-infusion monitoring. As a result, systematic collaboration between pediatric onco-hematology and intensive care teams is becoming standard for these advanced therapies. This study aimed to explore healthcare professionals' perceptions, experiences, and practices related to medication management during transitions of care between pediatric onco-hematology and ICU settings. Semi-structured interviews were conducted with healthcare professionals from both specialties. Transcripts were analyzed using a manual inductive approach. Twenty-four healthcare professionals participated (14 ICU, 10 onco-hematology). Themes emerged: (1) the clinical complexity of onco-hematology patients, (2) technical and logistical barriers (e.g., software incompatibility, clinical transfers, medication transfer), (3) the specific involvement of parents in pediatric care. Emergency ICU admissions were identified as the highest-risk transfer for medication-related adverse events. Improvements included three essential areas: information diffusion especially improving written one and verbal nursing transmissions, implementing trainings and practices standardization by instance for intravenous medications. Clinical pharmacists can help in those improvement areas and so need to be implemented in pediatric ICU and work on those transitions to reduce medication errors. These findings underscore the need to optimize medication safety during care transitions. Strategic efforts such as interdisciplinary collaboration, standardized protocols, and pharmacist involvement can help reduce risks and improve outcomes.