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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 6 This document can be made available in alternative formats on request for a person with a disability. © Department of Health 2015 Copyright to this material is vested in the State of Western Australia unless otherwise indicated. Apart from any fair dealing for the purposes of private study, research, criticism or review, as permitted under the provisions of the Copyright Act 1968, no part may be reproduced or re-used for any purposes whatsoever without written permission of the State of Western Australia.