The American Society of Clinical Oncology (ASCO) and ONS are conducting an ongoing collaborative project to use a rigorous, consensus-based process to develop standards for safe administration of chemotherapy. Current ASCO/ONS standards address safety of all routes of chemotherapy administration to adult patients in the outpatient setting and inpatient setting.
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 addition to engineering controls, safer work practices, and the use of personal protective equipment (PPE), healthcare workers should be routinely monitored in a medical surveillance program. ONS, the Occupational Safety and Health Administration (OSHA), and the American Society of Health-System Pharmacists (ASHP) all have recommendations related to employee medical surveillance.
Following is "Practice Safe Nursing With Oral Hazardous Drugs," an article featured in the January 2010 issue of ONS Connect. The number of currently available hazardous oral drugs is increasing and now includes small molecules and hormones in addition to traditional agents such as cyclophosphamide. Nurses are presented with unique safety challenges in handling these medications.
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. It is crucial that extravasation precautions are employed when administering vincristine. These include
Despite vincristine labeling requirements and increased awareness of harm that occurs when vincristine is accidentally administered intrathecally, wrong-route vincristine errors continue to occur. See the journal article “Preventing Vincristine Administration Errors: Does Evidence Support Minibag Infusions?” for a discussion on risk-reduction strategies using minibag infusions to reduce potential errors in vincristine administration.
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). A hazardous drug spill kit should include the following contents.
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. These recommendations don’t differentiate between high- and low-risk situations, as there is no known minimum safe exposure and always the potential for contamination.
Guidelines for the safe handling of hazardous wastes have existed for 20 years or more, but with nearly six million healthcare workers handling these wastes as of 2009, the importance of maintaining safety guidelines has never been greater.