The Case of the Safety Session

August 20, 2019 by Deborah Christensen MSN, APRN, AOCNS®

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.

Oral Therapy Safety

Storage and Handling
- Check medication storage instructions. Some medication can be stored at room temperature whereas others need to be refrigerated.
- Keep medication in original package until use.
- If using a medication container, keep oral therapy separate from other medications.
- Wash your hands with soap and water prior to and after dispensing medications, even if gloves were used.
Disposal
- Gloves used to handle medication cups can be disposed of in household trash.
- Any leftover medication should be disposed of in accordance with Drug Enforcement Agency (DEA) policy. Patients can check with their local health department or access the DEA website.
- Do not recycle or reuse empty medication medication containers. Remove medication labels, rinse, and dispose in household garbage.

What Would You Do?

Staci recognizes the importance of teaching patients and caregivers safe handling, storage, and disposal of oral medications. In addition to safety measures, potential drug and food interactions are crucial components of oral therapy education.

Oral anticancer medications, like all medications, should be kept out of reach of children and pets. In the home setting, patients should dispense their own medications; if assistance is needed, the support person should avoid touching the medication and wear gloves for added safety (https://www.ons.org/toolkits/toolkit-safe-handling-hazardous-drugs-nurses-oncology). Patients and caregivers also need to understand the importance of following the additional safe handing and disposal precautions listed in the sidebar.

To prevent drug-drug interactions, patients should be told to notify their oncologist before taking any new medication or supplement. For example, oral dexamethasone and St. John’s wort, a supplement used to enhance mood, can lower the effectiveness of tyrosine kinase inhibitors (https://doi.org/10.18773/austprescr.2015.060) such as dasatinib, imatinib, and pazopanib. Certain foods can also interact with oral chemotherapy and targeted therapy. In addition to grapefruit, consuming starfruit- and pomegranate-containing products can lead to higher concentrations of certain anticancer medication (https://www.nationalcmlsociety.org/faq) in the bloodstream and increase side effects.

Staci reinforces patient education by using printed medication teaching sheets from Oral Chemotherapy Education (OCE), a resource library of drug specific oral therapy education teaching sheets. ONS partnered with three other national organizations to create the OCE resource. In addition to safety issues, the teaching documents (https://www.oralchemoedsheets.com/index.php/sheet-library) list known drug, food, and supplement interactions for each medication.

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