Download Safe Adminstration of Vinca Alkaloid Drugs

SAFE
ADMINISTRATION OF
VINCA ALKALOID
DRUGS
health.wa.gov.au
Contents
Page
1.
Background
2
2.
Scope
2
3.
Definitions
3
4.
Policy statement
3
5.
4.1
Prescribing
3
4.2
Preparation and dispensing
3
4.3
Administration
4
4.4
Staff training
4
Roles and responsibilities
5.1
5
Health service managers and clinical directors
5
5.2 Clinical staff involved in the prescribing, dispensing, preparation or administration
of vinca alkaloid drugs
5
6.
Evaluation and Monitoring
5
7.
References
5
8.
Relevant legislation
6
9.
Related documents
6
10. Authority
6
1
Effective: Nov 2015
Title:
Safe Administration of Vinca Alkaloid Drugs
1. Background
Vinca alkaloids must NEVER be administered intrathecally.
Fatalities have occurred when vinca alkaloids have been administered intrathecally.1
This policy was initially developed in response to the National Medication Safety Alert
arising from a fatal incident due to the incorrect administration of vincristine (a vinca
alkaloid drug) by the intrathecal route.2
While any medication administered via the incorrect route can result in harm, the
inadvertent intrathecal administration of vinca alkaloids results in death or permanent
disability in the majority of cases.3,4
The inadvertent intrathecal administration of intravenous chemotherapy, including
vinca alkaloids, remains a potential risk.1 This policy aims to ensure the safe
administration of vinca alkaloid drugs outlining the minimum standards for the
prescribing, dispensing, preparation, administration and transport of vinca alkaloid
drugs.
This guideline should be used in conjunction with existing cytotoxic chemotherapy
policies and the related policy for the Safe Administration of Intrathecal
Chemotherapy and High Risk Medications.
2. Scope
This policy applies to all Western Australian public health services and private
healthcare facilities contracted to provide care to public patients where vinca alkaloid
drugs are prescribed, dispensed and administered. This policy is strongly
recommended to all private healthcare providers in WA.
Health Service Managers and Clinical Directors are advised to bring this revised policy
to the attention of staff to ensure its prompt implementation within their jurisdiction.
All Department of Health clinicians (medical, nursing and pharmacy) providing health
services on behalf of the Department of Health must comply with this policy in
prescribing, dispensing, preparing and administering vinca alkaloid drugs within the
Department of Health or Department of Health funded services.
2
3. Definitions
Vinca alkaloids
Minibag
Extravasation
A class of anticancer drugs which includes
vinblastine, vincristine, vinflunine and vinorelbine.
A small volume intravenous infusion bag, usually
containing 50mL or 100mL of sterile fluid.
Accidental leakage of an intravenous solution from the
vein into the surrounding tissue space resulting in
injury.
4. Policy statement
4.1 Prescribing

In accordance with the Clinical Oncological Society of Australia guidelines,
vinca alkaloids must only be prescribed by medical practitioners with
appropriate skills, training and qualifications in the management of cancer. 3

Dosing of vinca alkaloids must be calculated by a medical practitioner skilled in
this task.

The total milligram dose of vinca alkaloid to be added to the minibag must be
verified by a chemotherapy competent pharmacist and the chemotherapy
competent registered nurse administering the dose.
4.2 Preparation and dispensing

Vinca alkaloid drugs must be prepared in a minibag of compatible solution, NOT
IN A SYRINGE.1

Vinca alkaloids must be prepared and supplied in a minibag containing a total
volume of 50mL or more.

All vinca alkaloids should be labelled clearly with the warning ‘FOR
INTRAVENOUS USE ONLY – Fatal if given by other routes.1

Vinca alkaloids should NOT be prepared at the same time in the same location
as medicines that are intended for intrathecal administration.

Vinca alkaloids must only be prepared and dispensed by appropriately trained
staff who have been assessed as competent to prepare and dispense
chemotherapy.
3
4.3 Administration

Vinca alkaloids must never be administered intrathecally.

Vinca alkaloids must only be administered by appropriately trained staff who
have been assessed as competent to administer chemotherapy.

Staff administering vinca alkaloids must be aware of the risk of extravasation
and ensure procedures for preventing, monitoring for, and treating extravasation
are followed.

Immediately prior to the administration of a vinca alkaloid the patient’s name,
name of the medication, dose, route of administration, date and time of
administration, expiration date of the medication and patient allergies must be
checked by two registered nurses with appropriate training and skills. Where a
second nurse is not available then a pharmacist or medical practitioner with
appropriate knowledge and skills should perform this function.

Vinca alkaloids must NEVER be administered using a motorised pump. They
should be administered using gravity to reduce the chance of extravasation
injuries.

Administration lines used for the intravenous administration of vinca alkaloid
chemotherapy should be clearly labelled in accordance with the Australian
Commission on Safety and Quality in Healthcare, National Recommendations
for User-applied Labelling of Injectable Medicines, Fluids and Lines.
o The route of administration must be identified on all administration lines. 5
o The date and time that the line is required to be changed must be
identified.5
4.4 Staff training

The prescribing, dispensing, preparation or administration of vinca alkaloids
should only be carried out by staff with appropriate training, knowledge and
skills in cancer chemotherapy.3

Every health care facility should have a procedure in place to ensure that all
staff involved in the prescribing, dispensing, preparation or administration of
vinca alkaloids are trained, accredited and authorised to manage
chemotherapy.3

Every health care facility should have a procedure in place to ensure all
inexperienced staff that will be involved in the prescribing, dispensing,
4
preparation or administration of vinca alkaloids receive appropriate training and
supervision before being left to carry out these tasks.3
5. Roles and responsibilities
5.1 Health service managers and clinical directors

To bring this document to the attention of all medical, pharmacy and nursing
staff.

To ensure that local policies and procedures comply with the requirements of
this policy.
5.2 Clinical staff involved in the prescribing, dispensing, preparation or
administration of vinca alkaloid drugs

To comply with the requirements of this policy.

To follow local protocol/guidelines relating to the prescribing, dispensing,
preparation or administration of vinca alkaloid drugs.

To maintain an appropriate knowledge and competency relevant to area of
practice.
6. Evaluation and Monitoring

Health service managers and clinical directors are responsible for ensuring that
regular audits are carried out and evaluated to verify compliance with the policy.

Results from auditing and evaluation should be relayed back to staff, to assist in
promoting successful change management.
7. References
1. Gilbar PJ. Intrathecal chemotherapy: potential for medication error. Cancer
Nursing. 2014 [cited 2015 April 29]; Jul-Aug; 37(4):299-309. Available from:
http://journals.lww.com/cancernursingonline/Abstract/2014/07000/Intrathecal_Che
motherapy__Potential_for_Medication.8.aspx
2. Australian Council for Safety and Quality in Healthcare. Safety and Quality Council
Medication Alert. Vincristine. Alert 2, December 2005 [cited 2015 April 29];
Available from: http://www.safetyandquality.gov.au/wpcontent/uploads/2013/12/National-Medication-Alert-Vincristine-administrationPDF-376KB.pdf
3. Guidelines for the Safe Prescribing, Dispensing and Administration of Cancer
Chemotherapy. Clinical Oncological Society of Australia 2008 [cited 2015 April
29]; Available from:
https://www.cosa.org.au/media/1093/cosa_guidelines_safeprescribingchemo2008.
pdf
5
4. 2014-15 Targeted Medication Safety Best Practices for Hospitals. Institute for Safe
Medication Practices; [cited 2015 April 29]; Available from:
http://www.ismp.org/tools/bestpractices/TMSBP-for-Hospitals.pdf
5. National Recommendations for User-applied Labelling of Injectable Medicines,
Fluids and Lines. Australian Commission on Safety and Quality in Health Care
2012; [cited 2015 April 29]; Available from: http://www.safetyandquality.gov.au/wpcontent/uploads/2012/03/Labelling-Recommendations-2nd-edition-February2012.pdf
8. Relevant legislation

Health Practitioner Regulation National Law (WA) Act 2010.

Medicines and Poisons Act 2014.

Poisons Regulations 1965.
9. Related documents

Consent to Treatment Policy for the Western Australian Health System 2011
(OD 0324/11)
http://www.health.wa.gov.au/CircularsNew/circular.cfm?Circ_ID=12789

National Recommendations for User-Applied Labelling of Injectable Medicines,
Fluids and Lines (OD 0385/12)
http://www.health.wa.gov.au/CircularsNew/circular.cfm?Circ_ID=12887

Policy for the Safe Administration of Intrathecal Chemotherapy (OD 0629/15)
http://www.health.wa.gov.au/circularsnew/circular.cfm?Circ_ID=13260

Safe Handling of Cytotoxic Drugs (OP 1961/05)
http://www.health.wa.gov.au/CircularsNew/circular.cfm?Circ_ID=11950

Standardisation of terminology, abbreviations and symbols on the prescribing
and administration of medicines (OD 0184/09)
http://www.health.wa.gov.au/CircularsNew/circular.cfm?Circ_ID=12476

WA High Risk Medication Policy (OD 0561/14)
http://www.health.wa.gov.au/CircularsNew/circular.cfm?Circ_ID=13149
10. Authority
Title:
Safe Administration of Vinca Alkaloid Drugs
Contact:
Office of the Chief Medical Officer: Project Coordinator- Western Australian
Medication Safety Group
Directorate:
Office of the Chief Medical Officer | Clinical Services and Research
Version:
Version 2
Date Published:
05/11/2015
Date of Last Review:
04/11/2015
Date Next Review:
05/11/2020
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© Department of Health 2015
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