USP <800> Answers Some Difficult Questions About Hazardous Drug Safety
Exposure to hazardous drugs puts healthcare workers at risk for myriad adverse effects. Until recently, consistent safety information for HD administration and disposal has been lacking. However, with USP Chapter <800> going into effect in December 2019, U.S. Pharmacopeia has changed the landscape of HD safety guidelines.
Should You Wear a Gown to Disconnect Chemo?
The short answer is yes—guidelines from ONS, National Institute of Occupational Safety and Health, Occupational Safety and Health Administration, and U.S. Pharmacopia all call for nurses to always wear appropriate personal protective equipment (PPE) when at risk for exposure, including disconnecting a patient’s chemotherapy. Wearing a gown and other PPE isn’t just good practice—it protects nurses at one of many touchpoints during chemotherapy administration and patient care where healthcare providers are at risk for exposure to hazardous drugs.
Why Aren’t Nurses Adhering to PPE Requirements?
Oncology nurses are dedicated to providing the best, safest cancer care to their patients—protecting them from medical harm and prolonging life. But when it comes to protecting themselves, nurses sometimes take shortcuts in wearing personal protective equipment (PPE) that guards them against exposure to hazardous drugs.
Evidence Supports Strategies for Better Safe Handling Practice
The evidence is clear: for more than 40 years, reports have confirmed that hazardous drug exposure poses significant safety risks to providers who handle many agents related to cancer treatments. Healthcare professionals experience several substantial health threats, including reproductive problems, airway and skin irritation, and cancers. Despite the potential health risks, the data are also clear: nurses routinely do not wear personal protective equipment as recommended when handling hazardous drugs.
USP <800> Brings Change, Collaboration to Pharmacy and Nursing
U.S. Pharmacopeia (USP) chapter <800> provides safety measures for all healthcare workers in any setting where hazardous drugs (HDs) are used in the health system. For situations from the initial delivery of the drug to the institution through administration and disposal, USP <800> provides a vast number of safety measures intended to minimize risk and potential exposure to HDs. To meet the new requirements, medical institutions and pharmacies have had to make significant changes in various systems.
Handle With Care: How USP <800> Will Affect Nursing Practice
Police officers wear body armor and construction workers wear hard hats. Why? Because these professions carry inherent dangers in the line of duty—and oncology nursing does too. Statistically, healthcare workers face more workplace-related dangers than both law enforcement and construction, yet attention to safety and personal protection isn’t always a central focus. This can be especially true in cancer care, where nurses are required to administer hazardous drugs (HDs) and handle dangerous medications on a daily basis. Although safety recommendations exist, few enforceable standards are protecting nurses handling HDs.
HOPA and ONS Collaborate on Safe Handling Guidelines Consistent With National Recommendations
The Hematology/Oncology Pharmacy Association (HOPA) and Oncology Nursing Society (ONS) have partnered to develop a joint position statement in advance of an upcoming compliance deadline for U.S. Pharmacopeia Chapter 800 (USP <800>).
The Case of the Safety Session
Doug is a 48-year-old triathlete who was recently diagnosed with chronic myeloid leukemia (CML) after a routine blood test showed an increase in white blood cells and a subsequent bone marrow biopsy showed greater than 20% blast cells. The medical oncologist prescribed the oral drug dasatinib. Doug and his wife meet with Staci, RN, to receive oral therapy education. During the teaching, Doug says his wife will have no trouble dispensing the dasatinib because she already prepares all of their meals and nutritional supplements.
The Case of the Explicit Exposure
Mr. Larsen presents to the clinic for his first dose of R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone) for a diagnosis of diffuse large B-cell lymphoma. Elizabeth, his oncology nurse, just started the cyclophosphamide when she is paged to the desk for a call from Mr. Larsen’s oncologist. She quickly removes her face shield and gloves as she hurriedly leaves the room to take the call. After completing the call, she returns to Mr. Larsen’s room to remove her gown.
What USP Means for Safe Oncology Nursing Practice
Nurses in oncology who compound hazardous drugs may be familiar with the U.S. Pharmacopeial Convention (USP) because of chapter <795> related to compounding nonsterile medications and chapter <797> addressing compounding sterile medications. But what is USP really, and why does it have an impact on oncology nursing practice?
Safe Handling of Hazardous Drugs Is No Accident
Oncology nurses must remain vigilant to protect patients and themselves from chemotherapy exposure. During a session on Friday, April 12, 2019, at the ONS 44th Annual Congress in Anaheim, CA, Martha Polovich, PhD, RN, AOCN®, of Georgia State University in Atlanta, and MiKaela Olsen, APRN-CNS, MS, AOCNS®, FAAN, of Sidney Kimmel Comprehensive Cancer Center in Baltimore, MD, instructed nurses on how to ensure safe handling of hazardous drugs (HDs) in their practice settings.
Do Cytotoxic Agents Impact Ground Soil or Well Water?
When patients go home after receiving their regimen of powerful cytotoxic agents, oncology nurses routinely encourage them to double flush after using the bathroom to ensure that trace amounts of hazardous medication are eliminated from the environment to prevent other members of the household from being exposed. But what happens with chemotherapy chemicals found in human waste as they enter a patient’s septic system—and eventually the water supply?
ONS Safe Handling Guidelines Are Consistent With National Recommendations
Last week, the American Society of Clinical Oncology (ASCO) released its 2019 safe handling standards. Although oncology nurses contributed to the expert panel, ONS does not endorse the ASCO standards because they differ from and guidelines from national and governmental organizations in several key ways. As an oncology nurse administering hazardous drugs, here’s what you need to know to keep yourself, your colleagues, and your patients safe.
Monitoring Surface Contamination of Hazardous Drugs and Considerations for Remediation
Hazardous drugs are medications known to cause adverse health effects because of exposure in the workplace, according to the National Institute for Occupational Safety and Health. Examples of such agents include chemotherapy drugs, antivirals, hormones, and bioengineered drugs.
Which of the Following Drug Spills Doesn’t Require a Full-Facepiece, Chemical Cartridge-Type Respirator or PAPR?
Which of the following drug spills doesn’t require a full-facepiece, chemical cartridge-type respirator or PAPR during clean up?
D. Nitrogen mustard
What ONS Does When the Question Can’t Be Answered Definitively
How frustrating it can be not to have enough evidence to answer a question definitively. That happens often in clinical practice, even as we build evidence for it. Expert opinion can help when the body of research does not. This spring, we have continued work in two areas in which answers are not definitive.
ONS Shares Chemotherapy Education in Sub-Saharan Africa
For sub-Saharan African (SSA) countries, cancer incidence is on the rise. The increase in cancer rates can be attributed to several factors, including economic and social development and infectious disease rates. In that part of the world, many healthcare professionals don’t have access to up-to-date information regarding safe chemotherapy handling and administration. The American Cancer Society (ACS) and Clinton Health Access Initiative (CHAI) developed the ChemoSafe program to share critical information and resource acquisition focused on safe chemotherapy administration and cancer treatments with healthcare providers in SSA. ONS provided specific nursing content to support the ChemoSafe initiative, including educational materials and courses.
What Are ONS’s Recommendations for Gowns When Handling Hazardous Drugs?
Although USP Chapter <800> implementation has been delayed, ONS experts are receiving questions about clarifications and specifics for wearing gowns when handling hazardous drugs (HDs). Questions include topics such as hanging gowns and reusing, length of time gowns can be worn, the need for gowns with oral chemotherapy agents, and materials requirements of gowns.
USP <800> Implementation Delayed to December 2019
The U.S. Pharmacopeia (USP) announced on September 29, 2017, it would delay the implementation of USP General Chapter <800> Hazardous Drugs—Handling in Healthcare Settings to coordinate its implementation with chapter <797> Pharmaceutical Compounding—Sterile Preparations. According to USP, chapter <797> is still undergoing revisions and will be available for public comment in fall 2018. UPS <800> was set for implementation by July 1, 2018, but both chapters are now expected to become official on December 1, 2019.
What Oncology Nurses Need to Know About USP <800>
Because of the risks and dangers associated with hazardous drugs, guidelines surrounding their use and handling have been issued since 1981. Since then, several organizations, including ONS (in tandem with the American Society of Clinical Oncology), the American Society of Health-System Pharmacists, the Occupational Safety and Health Administration, and the National Institute of Occupational Safety and Health, have released guidelines for various providers who handle the drugs.
What Safe Handling and Administration Requirements Apply to Immunotherapy?
In a supplement to the April 2017 issue of the Clinical Journal of Oncology Nursing, ONS released its first set of recommendations for nurse education and safe handling principles regarding immunotherapy administration. ONS recommendations are based on best-available evidence and the anecdotal experiences of professionals at cancer centers with varied experiences in immunotherapy administration.
What Are ONS’s Recommendations for Safe Handling of Hazardous Drugs?
Research suggests that healthcare workers who handle hazardous drugs may experience acute effects such as skin rashes or more chronic effects including adverse reproductive events and malignancy. This has led numerous government agencies to make recommendations regarding the safe handling of hazardous drugs.
Do You Know the Best Practices for Targeted Medication Safety?
The Institute for Safe Medication Practices (ISMP) has added five new best practices and revised two existing ones for safe medication administration in its recent release of the 2016-2017 Targeted Medication Safety Best Practices for Hospitals.
What Is ONS’s Stance on Handling Chemotherapy While Pregnant, Breastfeeding, or Trying to Conceive?
One of the questions that ONS commonly receives in the clinical inbox is whether nurses who are pregnant, breastfeeding, or trying to conceive can safely administer or handle chemotherapy and other hazardous drugs.