Download Chemotherapy Safety

10/19/2015
Learning Objectives
Chemotherapy Safety:
How YOU Can Make a Difference
Cathy Letton, PharmD, BCOP
Clinical Pharmacy Specialist, Hematology/Oncology
Medical University of South Carolina, Charleston, SC
Disclosure Statement
I have nothing to disclose.
Upon completion of this activity, pharmacy technician
attendees should be able to:
►Describe the chemotherapy process and the technician’s
role in that process
►Recognize the classification of chemotherapy and safety
precautions to prevent exposure
►Identify safe practices specific to oral chemotherapy
►Define the role of the pharmacy technician in preventing
chemotherapy preparation & dispensing errors
Definitions
Chemotherapy:
►A chemical agent that inhibits the maturation and proliferation of
malignant cells.
►This term refers to a medication used to treat cancer.
►The majority of chemotherapy medications are hazardous.
►Not all chemotherapeutic agents are considered hazardous.
► Hormonal agents used for the treatment of oncologic diseases are not
considered chemotherapy but may be deemed hazardous.
Hazardous Medication:
►A medication that may be carcinogenic, teratogenic, genotoxic, or may
cause reproductive toxicity or organ toxicity at low doses.
►Not all hazardous medications are classified as chemotherapy.
Definitions
Carcinogenic:
►capable of or has potential to cause cancer or promote cancer in living
tissues.
Teratogenic:
► capable of producing genetic malformations
Chemotherapy Process
The purpose of establishing a chemotherapy process is to outline
the precautions necessary to optimize safety during order
processing, preparation, and handling of chemotherapy and other
hazardous medications that are administered in a hospital and
clinic settings.
Genotoxic:
►capable of damaging DNA and leading to mutations
Mutagenic:
►capable of increasing the spontaneous mutation rate by causing
changes in DNA.
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10/19/2015
Chemotherapy Process
Includes:
1. Training of pharmacy personnel in handling, preparation,
and disposal of chemotherapy
2. Storage of hazardous medications
3. Order processing specific to chemotherapy
4. Preparation, dispensing, and delivery of chemotherapy
and hazardous substances
Training of Pharmacy Personnel
Pharmacy personnel who have contact with chemotherapy or hazardous
medications should undergo annual training and competency
requirements. (Verified by visual observation, environmental testing)
Training must occur before pharmacy personnel independently handle
hazardous drugs.
Pharmacy personnel should demonstrate competence, knowledge, and
proficiency in techniques and procedures for safely handling (preventing
exposure to oneself, other persons, and the environment, and managing
accidental exposure) and disposing of hazardous drugs.
All training and competency assessment must be documented.
http://www.usp.org/usp-nf/notices/general-chapter-hazardous-drugshandling-healthcare-settings
ASHP guidelines on handling hazardous drugs. Am J Health-Syst
Pharm 2006; 71: 95-114.
Training of Pharmacy Personnel
Test Question # 1
Training must include the following:
Which statement is false regarding the chemotherapy process?
►Overview of list of hazardous drugs and their risks
►Review of standard operating procedures (SOP) related to the
handling of hazardous drugs
►Proper use of PPE
►Proper use of equipment and devices (e.g., engineering
controls)
►Spill management
►Response to known or suspected hazardous drug exposure
1. Pharmacy personnel must wash hands, nails, and arms to
elbow for 30 seconds with antiseptic soap.
2. Garbing should occur in the ante area and is sequenced from
“cleanest” to “dirtiest”.
3. Personal electronic devices are not allowed in the sterile
compounding area.
4. Everything entering the buffer area should be sanitized with
alcohol.
http://www.usp.org/usp-nf/notices/general-chapter-hazardous-drugshandling-healthcare-settings
ASHP guidelines on handling hazardous drugs. Am J Health-Syst
Pharm 2006; 71: 95-114.
Training of Pharmacy Personnel
Training of Pharmacy Personnel
Must perform antiseptic hand cleansing and disinfection of nonsterile compounding surfaces
Select and appropriately don protective garb. Garbing occurs in
ante area and is sequenced from “dirtiest” to “cleanest”.
Wash hands, nails, arms to elbow for 30 seconds with
antiseptic soap (use nail picks)
Remove all outer jackets, makeup, jewelry
No visible jewelry, artificial nails, makeup
Personal electronic devices not allowed in sterile
compounding area. Remove prior to hand hygiene.
Nails no longer than ¼ inch; no exposed skin
Don shoe covers, hair & beard covers, and mask.
Once gloved, sanitize often with alcohol
Perform hand hygiene.
Hoods cleaned/documented beginning of each shift
Everything entering buffer area sanitized with alcohol
Sterile isopropyl alcohol for hood & hands cleaning in buffer area
Non-shedding, disposable towels/electronic hand dryer for hand
drying
Non-shedding sterile wipes for hood
Am J Health-Syst Pharm 2014; 71: 145-166.
ASHP guidelines on handling hazardous drugs. Am J Health-Syst
Pharm 2006; 71: 95-114.
Don gown, fastened securely at neck and wrists
Sanitize hands with alcohol & allow to dry.
Enter buffer area & apply sterile, powder-free gloves.
Sanitize gloves with 70% sterile alcohol & allow gloves to
dry.
Am J Health-Syst Pharm 2014; 71: 145-166.
ASHP guidelines on handling hazardous drugs. Am J Health-Syst
Pharm 2006; 71: 95-114.
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Training of Pharmacy Personnel:
Personal Protective Equipment (PPE)
Katrina Rivers, CPhT
Test Question # 2
Personal Protective Equipment (PPE)
Which statement is true regarding safety precautions to prevent
exposure?
Gloves:
►Worn at all times when handling hazardous drugs (HD)
►Sterile, powder free, nitrile or neoprene rubber & polyurethane
1. One set of chemotherapy gloves should be worn while
compounding hazardous drugs.
2. Gloves should be changed every 30 minutes during batch
compounding.
3. Gowns may be worn for longer than 3 hours as long as they are
not torn or contaminated.
4. Shoe and hair coverings may be discarded in the regular trash
after compounding hazardous drugs.
(successfully tested & meet ASTM standard of “chemotherapy gloves”)
►Double chemo gloves should be worn while compounding HD
►One set of gloves under gown cuff; the other over gown cuff
►Gloves should be changed every 30 minutes during batch
compounding
►Outer glove removed after prep & decontamination of product
and before removing garb
►Inner glove remains on while removing garb
►Wash hands before donning and after removing gloves
ASHP guidelines on handling hazardous drugs. Am J Health-Syst
Pharm 2006; 71: 95-114.
Personal Protective Equipment (PPE)
Personal Protective Equipment (PPE)
Gowns:
►Disposable with polyethylene or vinyl coatings (provides
adequate splash protection and prevents drug permeation)
►Worn no longer than 3 hours during compounding and changed
immediately if damaged or contaminated
►Remove gowns with care using inner gloves and dispose of as
contaminated waste
►Wash hands after removing and disposing of gowns
Additional PPE (Eye and Face protection):
►Worn when possibility of exposure to splashing or uncontrolled
aerosolization of HD (e.g., spills, cleaning, decontaminating)
►Face shield, safety glasses, OSHA certified fit-tested respirator
(N-95 mask)
ASHP guidelines on handling hazardous drugs. Am J Health-Syst
Pharm 2006; 71: 95-114.
ASHP guidelines on handling hazardous drugs. Am J Health-Syst
Pharm 2006; 71: 95-114.
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Personal Protective Equipment (PPE)
Personnel Compounding Competency
Shoe and hair covering:
Touch contamination remains the primary cause of microbial
contamination in sterile compounding and personnel training and
assessment are required to ensure lowest possible risk for
contamination due to human error.
►Removed with inner gloves
►Discarded as contaminated waste when used in HD handling
areas
►Written test required to assess knowledge about proper compounding
►Hands-on observation required to assess proper technique
ASHP guidelines on handling hazardous drugs. Am J Health-Syst
Pharm 2006; 71: 95-114.
Am J Health-Syst Pharm 2014; 71: 145-166.
ASHP guidelines on handling hazardous drugs. Am J
Health-Syst Pharm 2006; 71: 95-114.
Personnel Compounding Competency
Storage of Hazardous Medications
Pharmacy personnel should be able to demonstrate the following:
►Hazardous medications should be segregated (e.g., separate bin or location on
shelf) from other drug inventory.
Proper hand hygiene technique
Proper gloving & garbing, including successful glove fingertip test
Proper aseptic technique, including successful media-fill test
Proper cleaning & disinfecting procedures, including successful
surface sample test
Competency in compounding hazardous drugs
►Drug packages, bins, shelves, and storage areas for hazardous drugs must have
distinctive labels to identify them as requiring special handling precautions.
►Hazardous drugs should be stored in area with sufficient exhaust ventilation to
remove any airborne contaminants.
►Pharmacy personnel must wear double gloves when stocking and inventorying
hazardous drugs.
Competency in use of sterile devices (closed system transfer
devices(CSTD), connectors
►Hazardous drug packages must be placed in sealed containers and labeled with
unique identifier.
Competency in use of pharmacy compounding devices and
equipment
►Chemotherapy spill kits should be available in all areas where hazardous drugs are
stored and handled.
Competency to perform end-product testing and sterilization
Am J Health-Syst Pharm 2014; 71: 145-166.
ASHP guidelines on handling hazardous drugs. Am J
Health-Syst Pharm 2006; 71: 95-114.
ASHP guidelines on handling hazardous
drugs. Am J Health-Syst Pharm 2006; 63:
1172-93
Order processing specific to Chemotherapy
Preparation of Chemotherapy
1. PLT, SCr, T. Bili)
2. Check chemotherapy references for specific monitoring
►Compounded medications should be prepared one at a time, using
standardized techniques whenever possible.
parameters.
3. Verify treatment plan or protocol.
4. Verify accuracy of treatment dates. Order is received by
pharmacist.
5. Start time verified with treatment RN.
6. Verify that order is signed by appropriate provider.
7. Verify appropriate antiemetics and hydration are ordered.
8. Verify patient's height, weight, and BSA.
9. Check labs (WBC, ANC,
10.Verify stability of diluent and the final concentration.
►The chemotherapy preparation process should include an independent
double check by two separate individuals of the correct drug, diluents,
administration containers, and volume measurements before the
solutions are transferred to the final administration container.
►Verification may be done by direct visual inspection; remote monitoring
through telepharmacy applications with pictures; or by weighing syringes,
other transfer devices, and immediate product containers before fluid
transfer is complete.
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Preparation of Chemotherapy
Preparation of Chemotherapy-Aseptic Technique
Gather all items for compounding prior to beginning work in BSC
For HDs in vials, avoid pressurizing contents of vial (may cause
drug to spray).
Use Luer-Lok syringes & connections for manipulating HDs
Attach & prime IV administration set to final container in BSC prior to
adding HD
Use CSTD to achieve dry connection between administration set and
HD’s final container
Final prep must be surface decontaminated after compounding is
complete
Clean inner gloves must be worn in BSC when labeling & placing final
product in transport bag.
Avoid pressurization by creating a slight negative pressure in vial.
Syringes should be no more than ¾ full when filled with solution from
HD vial or ampule
For HDs in ampules, gently tap neck of ampule & wipe with alcohol.
Use filter needle to withdraw contents and exchange with needle of
similar gauge and length. Excess drug should be discarded in sterile
vial.
Transport bags must never be placed in the BSC or isolator work
chamber
ASHP guidelines on handling hazardous drugs. Am J Health-Syst Pharm
2006; 63: 1172-93
ASHP guidelines on handling hazardous drugs. Am J Health-Syst Pharm
2006; 63: 1172-93
Hazardous Waste Containment and Disposal
Hazardous Waste Containment and Disposal
In 1976, Resource Conservation and Recovery Act (RCRA) was
enacted to provide a mechanism for tracking hazardous waste
from its generation to disposal. Regulations are enforced by the
Environmental Protection Agency (EPA).
►Hazardous products and wipes used for cleaning and
decontamination are disposed of in black sharps containers
►Hazardous waste is collected and stored in properly labeled,
leak-proof, and spill-proof containers of nonreactive plastic and
are required for areas where hazardous waste is generated.
ASHP guidelines on handling hazardous drugs. Am J Health-Syst
Pharm 2006; 71: 95-114.
►Paper disposables used in compounding HDs are disposed of
in yellow plastic or cardboard bins.
ASHP guidelines on handling hazardous drugs. Am J Health-Syst
Pharm 2006; 71: 95-114.
Test Question # 3
Which of the following is considered an advantage of oral
chemotherapeutic agents?
a. Oral chemotherapeutic agents are more affordable for patients
than intravenous agents.
b. Oral agents are less likely to interact with other medications
than intravenous agents.
Oral Chemotherapy
Safe Handling
c. Oral agents can provide a better quality of life for patients.
d. Adherence with oral agents is not an issue for patients
compared to intravenous agents.
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Oral Chemotherapy
Over the past decade, self-administration of oral chemotherapy
has increased.
►Availability of oral agents
►Increased control and convenience for patients
►Increased quality of life
►Reduction in travel costs & healthcare resources
Safe handling of oral chemotherapeutic agents in clinical practice. 2011
jop.ascopubs.org.
ASHP guidelines on handling hazardous drugs. Am J Health-Syst Pharm
2006; 71: 95-114.
Oral Chemotherapy-Disadvantages
►May compromise patient safety
►Contribute to medication errors
►Contamination
►Inadvertent exposure to other individuals
►Associated with greater risk of adverse events
►Patient or caregiver responsible for administration
►More susceptible to errors- Incorrect dosing
►Nonadherence
▪Can be significant problem
▪Less of a concern with parenteral therapy in a monitored institutional
setting
►Increased adverse events due to lack of coordinated care
►Limited monitoring- leading to possible morbidity and mortality
▪Difficult to monitor home administration
▪Fewer clinic visits needed for drug administration
▪Must inform patient of known AE profile with the medication
Safe handling of oral chemotherapeutic agents in clinical practice.
2011 jop.ascopubs.org.
ASHP guidelines on handling hazardous drugs. Am J Health-Syst
Pharm 2006; 71: 95-114.
Recommendations for Safe Handling for
Manufacturers and Distributors
Recommendations for Safe Handling for
Manufacturers and Distributors
►Appropriate Packaging And Segregation
▪Effective packaging and segregation techniques should be used to
►Minimize handling of oral chemotherapeutic agents
avoid contamination prior to distribution.
▪Packaging should clearly state that segregation techniques have been
used, so that additional precautions can be utilized during unpacking of
medications.
▪Packaging material should be durable, contain any accidental
leakage during transport, and be tamper-proof.
▪Package label should indicate that agent is "Cytotoxic."
▪Labeling on package should be intact, and cytotoxic agents are stored
and transported separately from non cytotoxic agents.
Safe handling of oral chemotherapeutic agents in clinical
practice. 2011 jop.ascopubs.org.
ASHP guidelines on handling hazardous drugs. Am J HealthSyst Pharm 2006; 71: 95-114.
▪Package only the amount of tablets/capsules needed for
one cycle of therapy
▪Use unit-of-use packaging (reducing the need for
packaging based on cycle of therapy)
▪Develop liquid formulations or provide information on
compounding liquid formulations of their products for
patients who have difficulty swallowing
Safe handling of oral chemotherapeutic agents in clinical
practice. 2011 jop.ascopubs.org.
ASHP guidelines on handling hazardous drugs. Am J HealthSyst Pharm 2006; 71: 95-114.
Recommendations for Safe Handling for
Manufacturers and Distributors
Recommendations for Safe Handling for
Health Care Providers
►Educational materials
►Training and competencies for safe handling
▪Attend orientation programs and routine training courses
approved by an oncology organization, specific to their
roles
▪Complete competencies associated with training
programs, along with an accompanying assessment for
licensing qualification if applicable
▪Establish a primary educator within healthcare institution
as a source of referral and continued education on oral
chemotherapy for healthcare professionals, allowing for
consistent education, training, and monitoring
▪Provide educational material to physicians, RNs,
pharmacy personnel, patients, and caregivers regarding
safe handling
▪Update patient educational material as new information
becomes available
Safe handling of oral chemotherapeutic agents in clinical practice.
2011 jop.ascopubs.org.
ASHP guidelines on handling hazardous drugs. Am J Health-Syst
Pharm 2006; 71: 95-114.
Safe handling of oral chemotherapeutic agents in clinical practice. 2011
jop.ascopubs.org.
ASHP guidelines on handling hazardous drugs. Am J Health-Syst Pharm
2006; 71: 95-114.
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10/19/2015
Recommendations for Safe Handling for
Healthcare Providers
Recommendations for Safe Handling for
Healthcare Providers
►Training and competencies for safe handling
►Storage
▪Cytotoxic agents should be stored in a designated area in
the pharmacy per the manufacturer's instructions.
▪ Healthcare workers handling oral chemotherapeutic
agents should be trained and competent to treat
individuals accidentally exposed to these agents and on
proper disposal of cytotoxic medications.
▪Non-health care professional staff who may come in
contact with waste from patients who have received
cytotoxic agents (clerks, hygiene and sanitation workers)
should undergo appropriate training.
Safe handling of oral chemotherapeutic agents in clinical practice.
2011 jop.ascopubs.org.
ASHP guidelines on handling hazardous drugs. Am J Health-Syst
Pharm 2006; 71: 95-114.
▪Cytotoxic agents should be separated from noncytotoxic
agents.
Proper storage and handling or oral chemotherapeutic agents
should be ensured by healthcare professionals in order to prevent
accidental exposure and to ensure the integrity of these
medications.
Safe handling of oral chemotherapeutic agents in clinical practice. 2011
jop.ascopubs.org.
ASHP guidelines on handling hazardous drugs. Am J Health-Syst Pharm
2006; 71: 95-114.
Recommendations for Safe Handling for
Healthcare Providers
Recommendations for Safe Handling for
Healthcare Providers
►Handling
1. Correct use of personal protective clothing and equipment
should be instituted to minimize exposure.
2. Oral chemotherapeutic agents should not be dispensed in
automated counting machines.
3. Disposable gloves should be used for dispensing. Hands
should be washed before and after glove application.
4. Compounding, crushing, or splitting oral chemotherapeutic
agents should be performed in BSC and should involve use of
personal protective equipment.
5. Separate equipment should be used for cytotoxic and
noncytotoxic agents
►Handling
6. Pharmacy personnel should attempt to limit additional handling
of hazardous medications by other HC professionals (unit dose
medications and powders reconstituted in pharmacy and
dispensed in its "ready to administer" form).
7. HC professionals should have a written emergency plan in the
event of a spill or accidental exposure
8. An updated list of hazardous medications should be readily
accessible to all HC personnel involved in handling of oral
chemotherapeutic agents.
Safe handling of oral chemotherapeutic agents in clinical
practice. 2011 jop.ascopubs.org.
ASHP guidelines on handling hazardous drugs. Am J HealthSyst Pharm 2006; 71: 95-114.
Safe handling of oral chemotherapeutic agents in clinical
practice. 2011 jop.ascopubs.org.
ASHP guidelines on handling hazardous drugs. Am J
Health-Syst Pharm 2006; 71: 95-114.
Recommendations for Safe Handling for
Healthcare Providers
Recommendations for Safe Handling for
Healthcare Providers
►Disposal and cleaning of contaminated materials
For pregnant personnel handling oral chemotherapy:
1. No consensus by the panel was reached regarding a
recommendation.
2. Panel members agreed the goal should be to minimize or
eliminate any role of pregnant staff in handling chemotherapy
agents (oral or IV).
3. In practice settings where this goal is not feasible, pregnant
personnel should wear appropriate protection (e.g., gown,
gloves).
▪All disposable protective clothing and materials used
while handling oral cytotoxic agents should be disposed of
as cytotoxic waste according to the local waste disposal
regulatory guidelines.
▪All nondisposable materials exposed to chemotherapeutic
agents (e.g., counting trays, tools, surfaces) should be
washed or decontaminated thoroughly after use.
Safe handling of oral chemotherapeutic agents in clinical
practice. 2011 jop.ascopubs.org.
ASHP guidelines on handling hazardous drugs. Am J
Health-Syst Pharm 2006; 71: 95-114.
Safe handling of oral chemotherapeutic agents in
clinical practice. 2011 jop.ascopubs.org.
ASHP guidelines on handling hazardous drugs. Am
J Health-Syst Pharm 2006; 71: 95-114.
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10/19/2015
Recommendations for Safe Handling for
Healthcare Providers
Recommendations for Safe Handling for
Healthcare Providers
Patient counseling:
1. HC professionals should provide patients and caregivers with
education and training to ensure understanding of safe
handling procedures and proper administration.
2. Patient educational materials should be monitored and
evaluated to ensure current and accurate information is being
delivered.
3. Patient consent for oral chemotherapy should be obtained.
4. Patients should be consulted and assessed for ability to take
oral chemotherapy and to comply with treatment plan.
Patient counseling:
5. All current medications should be reviewed with patient or
caregiver to identify potential drug interactions or interference with
dietary requirements.
6. Clear dosing instructions should be provided to patient,
including instructions on missed doses or if vomiting occurs.
7. During refill of prescriptions, potential drug and food
interactions should be reassessed and discussed with patient.
8. Patients should be made aware of any monitoring requirements
per their treatment plan.
9. Patients who are pregnant or breast-feeding should be
counseled on their risk-benefit profiles.
Safe handling of oral chemotherapeutic agents in clinical practice.
2011 jop.ascopubs.org.
ASHP guidelines on handling hazardous drugs. Am J Health-Syst
Pharm 2006; 71: 95-114.
Recommendations for Safe Handling for
Patients and Caregivers: DOs
►On
receiving your prescription, review the package label,
specifically checking medication name and dosage.
►Ensure that you completely understand when and how to
take the medication and ask questions if there is any
confusion.
►Transport and store medicine as instructed and as
outlined in the packaging label.
►Use gloves if possible and wash hands thoroughly before
and after glove application.* If gloves are not worn, tip
tablets and capsules from their container/blister pack directly
into a disposable medicine cup.
Safe handling of oral chemotherapeutic agents in clinical practice. 2011
jop.ascopubs.org.
ASHP guidelines on handling hazardous drugs. Am J Health-Syst Pharm
2006; 71: 95-114.
Safe handling of oral chemotherapeutic agents in clinical
practice. 2011 jop.ascopubs.org.
ASHP guidelines on handling hazardous drugs. Am J
Health-Syst Pharm 2006; 71: 95-114.
Recommendations for Safe Handling for
Patients and Caregivers: DOs
►Administer the medication as instructed.
►Keep a journal of adverse effects. Make a list of adverse
effects for which the healthcare professional has to be
contacted immediately.
►Consider using adherence devices. Use separate devices
for cytotoxic and noncytotoxic agents.
►Report any overdosing immediately.
Safe handling of oral chemotherapeutic agents in clinical practice. 2011
jop.ascopubs.org.
ASHP guidelines on handling hazardous drugs. Am J Health-Syst Pharm
2006; 71: 95-114.
Recommendations for Safe Handling for
Patients and Caregivers: DOs
Recommendations for Safe Handling for
Patients and Caregivers: DOs
►Keep information ready for necessary action in the event
of accidental exposure (including emesis and accidental
ingestion).
►Return wet, damaged, unused, discontinued, or expired
medications to the pharmacist or hospital for disposal.
►Report all medications (prescription and nonprescription
as well as complementary and alternative medicines) and
any specific dietary requirements to the healthcare
provider/prescriber, at the time of assessment and
consultation. Inform other healthcare professionals that you
are on oral chemotherapy (e.g., surgeons and dentists).
►Minimize the number of individuals coming in contact with
the cytotoxic medications.
►Wash the patient’s clothes and bed linen separately from
other items.
►Double-flush the toilet after use, during use of and 4 to 7 d
after discontinuing oral chemotherapy
Safe handling of oral chemotherapeutic agents in clinical
practice. 2011 jop.ascopubs.org.
ASHP guidelines on handling hazardous drugs. Am J
Health-Syst Pharm 2006; 71: 95-114.
Safe handling of oral chemotherapeutic agents in clinical
practice. 2011 jop.ascopubs.org.
ASHP guidelines on handling hazardous drugs. Am J
Health-Syst Pharm 2006; 71: 95-114.
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10/19/2015
Recommendations for Safe Handling for
Patients and Caregivers: DON'Ts
►Leave medication in open areas, near sources of water, direct
sunlight, or where they can be accessed by children or pets.
►Store medications in the areas where food or drinks are stored
or consumed. Crush, break, or chew tablets.
►Double-up on doses, unless instructed by a healthcare
professional.
►Share prescriptions or medication.
►Assume that oral chemotherapy is safer than intravenous
chemotherapy.
►Skip doses unless instructed by your physician. Discard
medication down the toilet or in the garbage.
Role of Pharmacy Technicians
In preventing chemotherapy preparation and dispensing errors
Safe handling of oral chemotherapeutic agents in clinical
practice. 2011 jop.ascopubs.org.
ASHP guidelines on handling hazardous drugs. Am J
Health-Syst Pharm 2006; 71: 95-114.
Chemotherapy Process
Manufacture
Preparation
Good Catches caught by Pharmacy Technicians
Administration
Incorrect total volume entered on IV chemotherapy product label
Incorrect administration set (secondary vs primary) applied to final
product
Incorrect drug concentration used to mix IV chemotherapy
Transport
Storage
Waste
Handling
Incorrect quantity entered on oral chemotherapy retail prescription
Incorrect instructions entered on oral chemotherapy retail prescription
Incorrect start date for chemotherapy
Distribution
Receipt
Equipment
maintenance
& repair
Incorrect chemotherapy drug prescribed through Patient Assistance
Program
Incorrect capsule size prescribed on oral chemotherapy retail
prescription
Incorrect patient on patient assistance prescription and application
Safe handling of oral chemotherapeutic agents in clinical
practice. 2011 jop.ascopubs.org.
ASHP guidelines on handling hazardous drugs. Am J
Health-Syst Pharm 2006; 71: 95-114.
Test Question # 4
Role for Technicians
What is the role of the pharmacy technician in preventing
chemotherapy preparation and dispensing errors?
► Provide extra layer of safety for pharmacists
►Voice concern and ask questions when processes do not
work
►Update and verify patient information at prescription dropoff
►Know medical/pharmacy terminology and drug names
►When entering prescriptions, notify pharmacist on drug
alerts involving medication interactions, allergies,
duplications, and other clinical warnings
a. Provide extra layer of safety for the pharmacist.
b. Voice concern and ask questions when processes do not
work.
c. Utilize and implement technology to help catch dispensing
errors.
d. All of the above.
ASHP guidelines on preventing medication errors. Am J Health-Syst Pharm
2014; 223-47.
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Role for Technicians
Pharmacy Technicians
►Use barcode technology and other technology to help
catch errors
►Use second identifier at point of sale (DOB, patient’s
address) to avoid dispensing to wrong patient
►Develop process to refer high-alert medications (HDs) to
pharmacist for counseling
►Share internal medication errors with work group and
discuss prevention strategies
Cassandra Whaley, CPhT, clarifies directions on Patient
Assistance Prescription with MD and RN prior to sending to drug
company.
ASHP guidelines on preventing medication errors. Am J Health-Syst Pharm
2014; 223-47.
Pharmacy Technicians
How can YOU make a difference
in chemotherapy safety?
References
American Society of Health-System Pharmacists. ASHP guidelines on handling
hazardous drugs. In: Drug distribution and control: preparation and handlingguidelines. Bethesda, Md: ASHP; 2006. p. 95-114.
ASHP guidelines on compounding sterile preparations. Am J Health-Syst Pharm.
2014; 71(2): 145-66.
American Society of Health-System Pharmacists. ASHP Guidelines on
Preventing Medication Errors with Chemotherapy and Biotherapy. In: Medication
Misadventures-Guidelines. Bethesda, Md: ASHP; 2014. p. 223-47.
Goodin S, et al. Safe handling of oral chemotherapeutic agents in clinical
practice: Recommendations from an international pharmacy panel. J of Onc
Practice. 2011.
http://www.jop.ascopubs.org
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