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.
The Impact of Practice Environments on HD Safety
Polovich discussed how standards for HD handling are needed to reduce occupational exposure, which continues to be a risk for nurses. Exposure is linked to increases in several types of malignancies, and evidence from the literature has identified sources including contaminated external vial surfaces, excretion in healthcare providers’ urine, and workplace surface contamination.
Because nurses and pharmacists are employees, they may not feel empowered to make practice changes. In addition, administrative leadership may not fully appreciate the need for different personal protective equipment (PPE) based on the hazard (e.g., isolation gowns versus chemical-resistant gowns).
“When one person fails to follow recommended safe handling precautions, it potentially harms not only that person, but also their coworkers,” Polovich said. “When nurses recognize less-than-safe practices, they have a responsibility to communicate that to their supervisor or employer.
“One strategy is to focus on what the standards describe as safe practice, and how the practice in their setting compares. Most healthcare administrators understand this quality-improvement perspective, and failure to comply with standards is usually taken seriously,” Polovich said.
The U.S. Pharmacopeia (USP) is a nonprofit organization that sets standards for medicines that are enforceable by the U.S. Food and Drug Administration. Its chapter on safe handling is available for free with registration.
Implementation Challenges in the Practice Settings
Olsen discussed how healthcare providers need to be trained before handling HDs, with competency reassessed at least annually. Education may include online modules, spill training videos, online reporting for exposure and spills, and policies and procedures that address labeling, packaging, and transportation of HDs. Practices may consider using an employee safe handling agreement.
Because HD handling may cause reproductive risk, male and female healthcare workers who are pregnant, breastfeeding, or trying to conceive must notify their employers, and alternate duty that does not require HD handling should be provided.
Inpatient oncology nurses should be alert for unsafe PPE practices because domino effects may occur when, for example, gloves are not tested for use with HDs. Other unsafe practices include wearing contaminated gloves while using the phone or typing and reusing gowns. In the outpatient setting, nurses should educate family members who share bathrooms with patients to reduce risk of exposure.
Polovich and Olsen emphasized that an organization’s culture is the most important factor in protecting nurses and patients. “A single influential person, whether a formal or informal leader, can do a lot to promote safe handling,” Polovich said.
“Nurses should model the appropriate use of precautions during HD handling,” Polovich added. “They can provide positive feedback to colleagues who practice safely, and gently remind others if they fail to do so. Talking about safety regularly serves as a reminder that safety is valued.”