Development of a Regional Safe Handling of Hazardous … · Regional Safe Handling of Hazardous Drugs Program ... Define a process for pharmacy staff ... Many medications may pose

Development of a Regional Safe Handling of Hazardous Drugs Program

Barbara SprollWRHA Medication Safety Pharmacist15 June 2011

Safe Handling of Hazardous Drugs

Most hospitals have policies & procedures for the handling of cytotoxic drugs (chemotherapy)

But what about those other drugs….Other medications that have been acknowledged as potentially hazardous


In 2004 set out to develop and implement a regional program for the safe handling of those “other drugs”…

Collaboration between multiple sites of the Winnipeg Regional Health Authority and CancerCare Manitoba


Define a process for pharmacy staff to identify medications that may pose a hazard

Provide procedures for every stage of handling within the pharmacy


Reviewed literature and existing policies & guidelines

National Institute for Occupational Safety & Health (NIOSH)Other Canadian & select American hospitalsAnd associations like CSHP, etc.


Definitions were developed and hazardous medications were divided into 2 categories:

Cytotoxic

Non-Cytotoxic Hazardous


If clear classification is not available; used definitions along with the classification of similar drugs and consideration of the pharmacology, pharmaceutics, toxicology and pharmacokinetics of the drug to assess hazardous properties.


Procedures for the handling of both categories of drugs were developed

Procedures for the handling of cytotoxic drugs were taken directly from the WRHA cytotoxic policy


Procedures for the handling of non-cytotoxic hazardous drugs were also based on information in the policy but modified to ensure safety & practicality

Safe Handling of Hazardous DrugsProcedures developed for every stage of handling:

ReceivingStoragePreparationDistributionAdministrationDisposal


Also considered the handling risk associated with different types of dosage forms:

InjectablesOral Intact Dosage FormsCompromised Dosage Forms


Procedures are summarized on a wall chart & detailed information was published in a resource manual

All information is posted on the regional web site

PHARMACYSAFE HANDLING OF DRUGS

Cytotoxic & Non-Cytotoxic Hazardous Drugs

For the most recent version of the drug table, go to

http://home.wrha.mb.ca/prog/pharmacy/drugs_safehandling.php

Purpose

Prepared by WRHA Regional Pharmacy Program and Pharmacy Department, Cancer Care Manitoba January 2009

4. Nursing staff should not alter (i.e. crush, further dilute) any cytotoxic or non-cytotoxic hazardous medication requiring special handling precautions. Contact Pharmacy. Exception: dissolve and dose techniques.

5. Refer to WRHA Cytotoxic Handling Policy or site specific policy on spill management for antineoplastic drugs. 6. No “spill report” required. For spill volumes over 25 mL, staff should wear a gown during spill management.

1. Refer to “Cytotoxic and Non-Cytotoxic Hazardous Drugs” table (attached, left) and Definitions (above). 2. Oral cytotoxic drugs and all non-cytotoxic hazardous drugs require special handling for receipt, preparation and

transport. Refer to WRHA INSITE Pharmacy Program website or site specific procedures (http://home.wrha.mb.ca/prog/pharmacy/drugs_safehandling.php).

3. Handling precautions for cytotoxic drugs developed by Nursing Safe Handling of Antineoplastic Agents Task Force (June 2003).

4. Nursing staff should not alter (i.e. crush, further dilute) any cytotoxic or non-cytotoxic hazardous medication requiring special handling precautions. Contact Pharmacy. Exception: dissolve and dose techniques.

5. Refer to WRHA Cytotoxic Handling Policy or site specific policy on spill management for antineoplastic drugs. 6. No “spill report” required. For spill volumes over 25 mL, staff should wear a gown during spill management.

1. Refer to “Cytotoxic and Non-Cytotoxic Hazardous Drugs” table (attached, left) and Definitions (above). 2. Oral cytotoxic drugs and all non-cytotoxic hazardous drugs require special handling for receipt, preparation and

transport. Refer to WRHA INSITE Pharmacy Program website or site specific procedures (http://home.wrha.mb.ca/prog/pharmacy/drugs_safehandling.php).

3. Handling precautions for cytotoxic drugs developed by Nursing Safe Handling of Antineoplastic Agents Task Force (June 2003).

This chart is adapted from the National Institute for Occupational Safety and Health (NIOSH) Health Alert, “Preventing Occupational Exposures to Antineoplastic and other Hazardous Drugs in Healthcare Settings (Prepublication March, 2004)” and the ASHP Guidelines on Handling Hazardous Drugs, January 12, 2006 for use in WRHA facilities* and CancerCare ManitobaACKNOWLEDGEMENT This chart is adapted from the National Institute for Occupational Safety and Health (NIOSH) Health Alert, “Preventing Occupational Exposures to Antineoplastic and other Hazardous Drugs in Healthcare Settings (Prepublication March, 2004)” and the ASHP Guidelines on Handling Hazardous Drugs, January 12, 2006 for use in WRHA facilities* and CancerCare ManitobaACKNOWLEDGEMENT

Many medications may pose a health hazard to hospital staff when receiving, mixing, dispensing or administering. This is true especially if the dosage form is altered (e.g. crushing tablets, preparing liquids, reconstituting powders for injection). The highest risk medications have been identified. This chart and supplemental table is intended for pharmacy use in the handling of the identified drugs below:

1. cytotoxic and other medications requiring special handling precautions in WRHA facilities* and CancerCare Manitoba 2. minimum handling precautions (from Shipping & Receiving to administration at the bedside) 3. labeling requirements

* These Precautions are applicable to the following facilities in the Winnipeg Regional Health Authority (WRHA): Concordia Hospital, Deer Lodge Centre, Grace Hospital, Health Sciences Centre, MisericordiaHealth Centre, Riverview Health Centre, St. Boniface General Hospital, Seven Oaks General Hospital, and Victoria General Hospital.

HANDLING, PREPARATION & ADMINISTRATION PRECAUTIONS

Glossary of Terms • Compromised Dosage Form – splitting or crushing a tablet, opening a capsule, or making a suspension, liquid, powder, topical preparation, etc. • Dissolve and Dose – a technique to dissolve an intact dosage form (e.g. tablet) in a closed container (e.g. syringe) immediately prior to administration • Crush (in syringe), Dissolve and Dose – a technique where an intact dosage form (e.g. tablet) is crushed inside a closed container (e.g. syringe) and dissolved immediately prior to use • Closed System – a commercial system of reconstituting and withdrawing a liquid medication from a vial without risk of aerosolization of the product or contamination of the worker or surroundings

Cytotoxic Drugs 1 Non-Cytotoxic Hazardous Drugs 1

Definitions Hazardous drugs deemed to have maximal risk from occupational exposure. The term cytotoxic is retained as health care workers can relate to the term, and recognize the symbol to reflect maximal precaution.

Drugs (other than cytotoxic drugs) that are deemed to have a reduced risk from occupational exposure, but where special handling precautions are required.

Precautions Injectable Oral Intact Dosage Form 2

Compromised Dosage Form 2 Injectable 2 Oral Intact

Dosage Form 2 Compromised

Dosage Form 2

Receiving

Protective wear for staff receiving stock from warehouse, manufacturer or external pharmacy

Exam Gloves Exam Gloves Exam Gloves No special requirements

No special requirements Exam Gloves

Protective wear for staff receiving stock that has been damaged (stock contents confirmed by packing slip information)

Chemo Gloves Mask Gown



Exam Gloves Mask Gown



Preparation and Transport

Prepared by Pharmacy Only Nurse

(or Pharmacy for specified drugs)

Pharmacy Pharmacy except Dissolve & Dose 4

Preparation area Class II biological safety cabinet or

alternate closed system

Designated cytotoxic packaging area


Ward or Pharmacy



Protective wear (for staff preparing the area)

Single Chemo Gloves Footwear NONE NONE NONE NONE NONE

Protective wear (for staff preparing drug doses)

Double Chemo GlovesMask

Chemo Gown Footwear

Single Chemo Gloves

Double Chemo Gloves Mask Gown

Exam Gloves Exam Gloves Chemo Gloves

Mask Gown

Packaging requirements (by Pharmacy for doses) Each dose packaged

separately Unit-dose 4 Unit-dose 4 No special requirements

SOLIDS unit dose 4

LIQUIDS unit dose or multi-dose

SOLIDS unit dose 4

LIQUIDS unit dose or multi-dose

Labeling requirements (for use in patient care area)

Packaging for transport (to patient care area, other pharmacy area or external pharmacy)

Sealed Container (e.g. ziplock bag)



No special requirements

No special requirements


Clean-up protective wear Double Chemo GlovesN95 Mask

Chemo Gown Footwear

Single Chemo Gloves

Single Chemo GlovesChemo Gown

Mask Exam Gloves Exam Gloves


Administration & Disposal

Nursing administration restrictions REFER TO SITE-SPECIFIC POLICIES REFER TO SITE-SPECIFIC POLICIES

Handling precautions YES 3,4 YES 3,4 YES 3,4 YES No special requirements 4

YES 4

Drug waste management YES YES YES NONE NONE NONE

Human waste management YES YES YES NONE (BCG precautions)

NONE NONE

Spill management YES 5 YES 5 YES 5 Chemo Gloves

Mask 6 Chemo Gloves

Mask 6 Chemo Gloves

Mask 6


Implementation PlanImplementation check lists for the managers to use at their sites

Template of a power point to be used for staff education

information specific to each site was added to the template


Ongoing developmentRevision of list, chart, and other resource materialTraining of new staff

Self learning package availableAnnual staff evaluationRoll out to other health care workers

Nursing!


For more information:

Barb SprollRegional Medication Safety [email protected](204) 833-1731

mailto:[email protected]

Documents

Development of a Regional Safe Handling of Hazardous … · Regional Safe Handling of Hazardous Drugs Program ... Define a process for pharmacy staff ... Many medications may pose