Practice Issues

Unlike radiation exposure, exposure to hazardous drugs cannot be measured with a badge or device. Instead, healthcare workers must strive to minimize exposure to these drugs.
In "Neutropenia: State of the Knowledge," a two-part ONS white paper, the authors identify what currently is known and, importantly, not known about the most common dose-limiting toxicity of cancer chemotherapy: chemotherapy-induced neutropenia (CIN).
Following is "Practice Safe Nursing With Oral Hazardous Drugs," an article featured in the January 2010 issue of ONS Connect. 
Oral formulations of chemotherapy and hormonal therapies have been used for decades and include many familiar agents, such as cyclophosphamide, melphalan, and tamoxifen.
"Oncology Nurses' Use of National Comprehensive Cancer Network Clinical Practice Guidelines for Chemotherapy-Induced and Febrile Neutropenia," available as a journal article and podcast, summarizes findings fr
Vincristine sulfate is a vesicant. Therefore, it is extremely critical that the IV needle or catheter is properly inserted prior to the vincristine injection or infusion. Any leakage into surrounding tissues during the infusion may cause substantial injury.
Despite vincristine labeling requirements and increased awareness of harm that occurs when vincristine is accidentally administered intrathecally, wrong-route vincristine errors continue to occur.
In 2005, the Joint Commission issued a Sentinel Alert regarding the prevention of administration errors associated with vincristine.
There are several very critical points to be aware of when administering vincristine sulfate, also commonly known as Vincasar PFS and Oncovin.
Nurses can minimize exposure to hazardous drugs with the use personal protective equipment and careful technique. Spill kits should be available wherever chemotherapy is located. Although they are commercially available, clinicians can assemble their own kits (American Society of Health-System Pharmacists, 2006).
Because many biotherapy agents are still relatively new in the treatment of cancer, there is still quite a bit of variability in how these agents are handled. However, it is important to note that some biologic agents are considered hazardous while others are not.
Recommendations for what personal protective equipment (PPE) to wear when handling chemotherapy or contaminated materials are consistent across several groups, including the National Institute for Occupational Safety and Health (NIOSH), Occupational Safety and Health Administration (OSHA), American Public Health Association, and ONS.
Albeit controversial, mandating nurse staffing ratios is one way of approaching staffing in patient care areas. The American Nurses Association (ANA) has been outspoken on this issue, calling for legislation mandating staffing plans and ratios.
If you are seeking resources related to determining nurse staffing in radiation oncology, the following organizations can help guide you.
More work has been done looking at staffing in ambulatory care settings. This work has focused on nursing workload models and adequate staffing based upon these measures. In 2005, Gaits identified four categories of questions that can be used to guide staff allocation decisions. The questions focus on