Aims
Numerous anti-cancer drugs have been identified as hazardous by the National Institute for Occupational Safety and Health (NIOSH) for posing a risk to health from occupational exposure. Whilst global guidance calls for additional personal protective equipment (PPE), organisations must consider practical implications. Collaboration between nursing and pharmacy is essential to assess feasibility and promote workplace safety.
Policy development and implementation
A multidisciplinary panel reviewed evidence for three categories of hazardous drugs (cytotoxic, monoclonal antibodies, hazardous non-cytotoxic drugs). Handling requirements were evaluated against international and state guidance to inform an organisational approach. Organisational processes were assessed for safety from occupational exposure of cytotoxic drugs, including the use of respiratory masks and closed system transfer devices. Drugs were considered on an individual basis to ensure alignment with handling recommendations by clinical risk. In particular, targeted oral anti-cancer drugs not listed by NIOSH were assessed for inclusion. Recommendations were approved by consensus vote of multidisciplinary panel with partner organisations.
Results
Voluntary overuse of PPE and confusion about institutional nurse credentialing requirements were early barriers to adherence. Concerns arose on the risk from previous exposure to hazardous drugs, particularly by nursing staff. Whilst it was generally accepted that the procedure aimed to mitigate occupational risk, information was given to patients about new workflows incorporating PPE. Post implementation audits assessed adherence to new PPE requirements (nursing) and medical chart annotations (pharmacy) – outcomes forthcoming.
Conclusion
Staff safety is paramount in cancer care delivery. Timely compliance with best practice on safe handling is needed in cancer services as anti-cancer drugs represent a large portion of hazardous drugs. Through collaborative and consensus approach practice change was achieved with impact on safety of staff and functional operations. Practice changes were widely accepted by pharmacy and nursing staff.