Download CHEMOTHERAPY INJECTABLE ADMINISTRATATION

PROCEDURE TITLE: CHEMOTHERAPY Oral ADMINISTRATION
DEPARTMENT: Patient Care Departments
USE WITH POLICY:
APPROVED:
DOCUMENT NUMBER:
EFFECTIVE DATE:
KEY WORDS: OSHA, ASHP, Chemo, Spill,
Hazardous drug
REVIEWED:
REPLACES DOCUMENT DATED:
SCOPE:
This policy applies to all nursing, pharmacy, and environmental Services
PURPOSE:
To provide a standard for the safe handling, manipulation (crushing, splitting, opening
capsules, or dissolving/mixing with food or water), and administration of oral chemotherapy/hazardous drugs.
Definitions:
A. Class B hazardous drugs: Any oral drug identified by at least one of the following six
criteria:
a. Cacinogenicity (risk of developing cancer)
b. Teratogenicity (risk of adverse reproductive outcomes) or developmental toxicity
c. Reproductive toxicity in humans
d. Organ toxicity at low doses in human or animals
e. Genotoxicity (risk for chromosomal changes)
f. New drugs that mimic existing hazardous drugs in structure or toxicity, or their mechanism
of action is such that the agent could be potentially toxic to healthy cells.
B. Chemotherapy drugs: A harzardous agent whose primary purpose is to inhibit or prevent
the proliferation of malignant cell populations or cause destruction of these cells; also called
cytotoxic drugs or antineoplastic drugs.
FORMS:
Chemotherapy Administration Checklist
EQUIPMENT:
Chemotherapy Spill Kit
Gloves - disposable, exam latex or non- latex
Gloves – Thick, disposable, powder free, long cuffed chemotherapy gloves. Latex is preferred but
non-latex is acceptable (i.e.: Patient/staff allergy or per drug-product manufacturer
recommendation)
Gown – Single use disposable, impermeable, closed front, lint-free, long sleeved, knitted cuffs
Eye shield goggles
Absorbent paper towel
Plastic back liner
Yellow biohazard container
Knowledge of closest eye wash apparatus
Chemotherapy Precaution sign
Reference books, supports as available
REQUIREMENTS:
1.
Population Specific Considerations: If a pediatric patient should require chemotherapy: the
Physician, Nurse manager of the Pediatric unit and Nurse manager of the Oncology unit will
meet prior to the admission of the patient.
2.
Nursing and Pharmacy personnel mixing or administering chemotherapy agents must be
have completed the St. Joseph Hospital orientation and training for safely preparing and /or
administering chemotherapy agents.
3.
Any staff that is pregnant, breastfeeding, actively attempting to conceive in the near future
(both male or female), or who have other medical reasons prohibiting exposure to
chemotherapy may elect to refrain from administering these agents or caring for these
patients during their treatment (up to 72 hours after completion of therapy). Staff with
concerns should contact their Manager or Occupational Health.
4. An accurate height and weight will be obtained on each admission to determine the current
BSA. If the current BSA indicates a significant variation (greater 10%) from the previous
admission or the standard recommended dose range, the MD should be contacted to verify
the need for any dose adjustments.
5. Obtain values of CBC (within last 3 days), liver and kidney functions (within last 7 days), and
any other clinical assessment appropriate for the prescribed chemotherapy regimen.
6. All antineoplastic agents shall be prepared in a satellite pharmacy in accordance with
pharmacy policies and procedures.
7. All manipulations of hazardous drugs will be done in the satellite pharmacy with a biological
safety hood. This includes crushing or oral medications, opening of capsules, or
mixing/dissolving medications with food or fluid (see attached for oral chemotherapy agents
that may be manipulated).
8. Nursing to place a Spill Kit in the room where the chemotherapy is to be administered.
9. No verbal or phone orders for chemotherapy will be accepted.
10. All chemotherapy agents will be marked “Hazardous Agents” and transported by pharmacy
and placed in the designated area (not into the patient bin in pyxis).
PROCEDURE:
1.
Patient Teaching to include (if applicable):
a.
b.
c.
d.
e.
Side effects
Symptom management (i.e. nausea)
Risks and benefits
Use of equipment
Discharge teaching
2.
Complete Chemotherapy Administration Checklist
3.
Place spill kit in the room where chemotherapy is to be administered.
4.
Wash hands before and after each glove use.
5.
Nurse will verify the delivery time with the chemotherapy pharmacist when the chemotherapy
agents(s) will be sent to the floor.
6.
Pre-medicate as ordered. Note if the drug is scheduled or PRN.
7.
Chemotherapy drug preparation is done only in the Chemotherapy Satellite Pharmacy with
appropriate safety precautions and equipment
8.
Chemotherapy drugs are delivered to the nursing module in zip-lock bags marked "Biologic
Hazard Cytotoxic Drug". The empty bag should be kept and used to contain the spoon,
container, pill cup, mask, gown, and gloves when empty.
9.
Pharmacy will deliver the chemotherapy, in a zip-lock bag, to the "YELLOW colored
Chemotherapy Bucket", if being administered on the Oncology floor, and inform the
administering RN that it has been delivered. Otherwise they will deliver the chemotherapy
agent(s) to the nurse and will also deliver a Chemotherapy Spill Kit, if the drug is being
administered in an area that does not contain such kit.
10. Use safe handling and disposal practices:
Gowning Procedure
 Place one pair of exam gloves (latex or non-latex) on hands
 Gown with a disposable, impermeable chemotherapy gown.
 Place on a second pair of gloves that is thick, disposable, powder free and long
cuffed. Latex is preferred but non-latex is acceptable.
 Tuck gloves over gown cuffs
b. Gloves should be changed when leaving the patient room, sustaining a tear or
puncture, after a drug spill, or after 30 minutes of continuous wear.
c. A high efficiency filter respirator should be worn when administering aerosolized
drug or the potential for the aerosolization of a drug, and when cleaning up a spill.
11.
12.
13.
14.
15.
16.
17.
18.
Open package of medication
Place in medicine cup
Administer medication cup
Put ALL material used in preparation and administration including gown, gloves, cup
and packing in a re-sealable plastic bag
Dispose of bag in puncture proof hazard waste container
Observe for immediate adverse reaction (i.e. extravasation, anaphylaxis)
Contact pharmacist and MD immediately if any adverse reaction occurs.
Reassess the patient at least hourly unless indicated otherwise.
19. Use safe disposal practices:
a. When handling blood, vomit, or other excreta of patients who are receiving or have
received chemotherapy within the past 72 hours, wear thick, disposable, powder free and
long cuffed gloves. Latex is preferred but non-latex is acceptable
b. Flush toilet after use. Leave area immediately flushing to avoid aerosolization.
c. Single use disposable, impermeable gowns are available as necessary.
d. Eyewear available as necessary.
e. Dispose of any chemotherapy bags, tubing, protective barriers, protective equipment, and
linen by placing them in a red biohazard bag and putting that into the yellow biohazard
container.
f. Alert mortuary, pathologist, and/or coroner, at time of expiration, that the patient has
received chemotherapeutic agents within previous 72 hours.
 Document "Chemotherapy Precautions" on Release of Body Record.
22. For eye and/or skin contamination
Remove contaminated clothing and place in red biohazard bag.
Place red bag in yellow biohazard container.
Immediately wash skin x 3 with soap and water.
Immediately flush eyes at sink with water or use liter bags of NS (Normal Saline) to irrigate
eyes for at least 5 minutes. Contact Occupation Health
e. Complete Employee Injury Report
a.
b.
c.
d.
REFERENCES:
JCAHO:
RI 2.30, RI 2.90, PC 2.150, PC 3.230, PC 5.60
PROCEDURE:
St. Joseph Hospital HIPP: view Chemotherapy Spill.
St. Joseph Hospital HIPP: view Pain Assessment and Management
OTHER:
OSHA Technical Manual
a. Section VI, Chapter 2, Controlling Occupational Exposure to Hazardous
Drugs.
b. Section VIII, Chapter 1 Chemical Protective Clothing.
American Society of Health-Systems Pharmacists. ASHP Technical Assistance Bulletin
on Handling Cytotoxic and Hazardous Drugs 2007, p.47-62.
Chemotherapy and Biotherapy: Guidelines and Recommendations for Practice, Oncology
Nursing Society, 2009.
Infusion Therapy in Clinical Practice 2nd Edition, Hankins, et al., 2001.
Policies and Procedures for Infusion Nursing, 2nd Ed., Infusion Nurses Society,
2002.
Pediatric Nursing 3rd Ed., Ruth C. Binder et al, 2003.
Infusion Nursing Standards of Practice, Revised 2000 (Latest edition as of
9/8/04), Intravenous Nurses Society.
HELP: MCU Nursing Team Leader or Oncology Pharmacist.
Medication
Aromasin
Arimidex
Busulfan
Casodex
Chlorambucil
Cytadrem
Dasatinib
Erlotinib
Faresten
Femara
Imatinib
Mesylate
Hexalen
Lapatinib
ditosylate
Lenalidomide
Melphalan
Methotrexate
Nexavar
Nilotinib
Revlamid
Sanitinib
Malate
Targretin
Temodar
Thalimid
Tasigna
Tabloid
Tarceva
Tykerb
Xeloda
Zolinza
Do not
crush
Can be
crushed
Unknown
X
Administration Considerations
Take after meals
X
X
Take on empty stomach if experiencing
nausea and vomiting
X
Take 1 hour before, 2 hours after evening
meal or at bedtime
X
X
X
Take 1 hour before or 2 hours after eating
X
X
Take with a large glass of water
X
Take at bedtime
Take 1 hour before or 2 hours after
X
Take on an empty stomach
X
Take 1 hour before or 2 hours after eating
Take 1 hour before or 2 hours after eating,
consume only water for 1 hour after taking
X
Avoid Grapefruit
X
X
X
Take on an empty stomach at bedtime
Take with water 1 hour after meal
X
X
X
X
Take 30 minutes after a meal