‘Oral Chemo Starter Kits’ Boosted Safe Handling on Non-Oncology Units

At the 43rd Oncology Nursing Society Congress in Washington, DC, from May 17–20, Betsy St. Germain, MN, RN, AOCN, from Maine Medical Center, Portland, presented the poster “‘Oral Chemo Starter Kits’: Promoting Safe Handling of Hazardous Drugs for Non-Oncology Units.”

As St. Germain’s poster notes, Maine Medical Center has been Magnet-designated by the American Nurses Credentialing Center since 2006. It is part of MaineHealth, the largest healthcare organization in Maine and a leading healthcare provider serving Maine and northern New England. MaineHealth is a 12-member health system that is recognized as one of the foremost integrated healthcare delivery networks in the US.

In her poster, St. Germain emphasized that it is critical to provide nursing and support staff education regarding safe handling of hazardous drugs (HDs) for the treatment of both malignant and nonmalignant conditions. Unintended occupational exposure to HDs can be minimized through the adoption of safe-handling practices such as the use of personal protective equipment (PPE), not only when administering HDs but also when disposing of and handling a treated patient’s bodily fluids.

The goal of St. Germain’s initiative was to provide nursing and support staff with the education and tools needed to protect themselves from HD exposure.

While patients with noncancerous conditions are increasingly being treated with HDs such as antineoplastics and biologics/targeted therapies, many non-oncology hospital units do not have routine safe-handling practices in place for nursing and other support staff caring for treated patients.

During a 60-day observational period, St. Germain uncovered several potentially concerning issues, including:

• Unverified oral HDs were being brought by patients from their homes to hospital units.
• Nonformulary oral HDs were prescribed by providers other than oncologists, and were labeled “continue home meds.”
• Nonformulary HDs were manually entered into the EMR (electronic medical record) and did not have an attached “Hazardous Drug, Use Safe Handling” warning label.
• Administration schedules for many HD oral agents varied.
• Oral HDs were used for immune suppression in patients without a malignant condition.

Antineoplastic agents and biologics/targeted therapies were prescribed for a variety of malignant and nonmalignant conditions. Antineoplastic agents were used to treat a range of disorders, such as certain autoimmune conditions, myeloproliferative disorders, sickle cell disease, and colorectal cancer. Biologics/targeted therapies were used to treat conditions including renal cell carcinoma, mantle cell lymphoma, breast cancer, myelofibrosis, CML (chronic myeloid leukemia), CLL (chronic lymphocytic leukemia), cancer of the appendix, polycythemia vera, prostate cancer, SCLC (small cell lung cancer), and NSCLC (non–small-cell lung cancer).

In the non-oncology setting, safety issues observed included PPE accessibility and use concerns, both during administration and when hospital staff were handling bodily fluids. While St. Germain found formulary oral HDs were appropriately labeled and stored, safe handling procedures were lacking. There was also room for improvement in the safe handling of nonformulary oral HDs, including the need for appropriate HD labeling and handling.

Oral Chemo Starter Kits provided to non-oncology units include chemotherapy gloves, gowns, protective face masks with eye shields, chemotherapy symbol signs to display on the doors of patients’ rooms, chemo travel bags, special chemo trash bags in which to discard soiled linen and other materials, and a chemotherapy spill kit. The starter kits also contain policy information (written and approved in 2016 and revised in 2017) on ordering, preparing, administering, safe handling, and disposal of oral chemotherapy/biotherapy for both children and adults with cancer and noncancer conditions; and an Oral Chemo Skills Checklist [for] Safe Handling, for use by RNs and CNAs.

Importantly, after non-oncology units received these special HD safety kits-which St. Germain noted “were demonstrated at multiple unit-based skill fairs and house wide educational forums”-there was a significant increase in chemotherapy handling precautions, with the need for replenishment of kits in patient care areas throughout Maine Medical Center.