The article that I chose to discuss is an article about a study that determined the exposure of Oncology nurses to hazardous drugs in an ambulatory setting. This study was performed using 12 different ambulatory centers. 378 nurses were studied. I wanted to read and study this article because this is exactly related to what I do. I am always trying to look at ways to reduce our exposure to hazardous drugs in our office. When we are administering chemo, we wear disposable gowns. We also wear chemo-tested and approved gloves. We are suppose to wear 2 pairs of gloves when administering chemo. I will not swear to you that we always wear 2 pair. We do have a spill kit for any chemo spills that may happen. I have only had 2 to happen in the 10 1/2 years I have worked there. We also used a closed system transfer device (CSTD). We implemented the CSTD last year. We started using one brand but it leaked. So after multiple attempts with this type, we switched to another brand. So far, we have not had any issues with this brand. I am open to any advice you may have on how we can decrease our chances of exposure to these hazardous drugs.
I have very little experience with oncology and this topic is not something I’ve ever thought about, thanks for bringing it to my attention! Have you considered using two different colors of gloves to give a visual indicator if someone isn’t wearing both? It could help staff keep each other accountable if it’s obvious that someone isn’t being compliant with the double glove policy.
Thank you for your response! That is a good idea. I have not thought about that before. I will look into that and see if our materials management keeps a different color. I can probably order a different brand and I bet it would be a different color. Thank you!
I am not a chemotherapy nurse, but as a new grad worked on a GYN/ONC floor and vaguely remember administering chemotherapy drugs. In the PACU there were some drugs that we had to use chemo precautions with. It was always a big deal, however, I imagine it is of more importance when you are being exposed multiple times during the day. I really liked the previous post suggestion of using different colored gloves.
I found this article that studied compliance of oncology nurses regarding safety and 8/10 nurses reported that they did not double glove. The reasons they found seemed to be that they felt exposure was rare or wouldn’t really matter, so education was recommended.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4568815/
I have not read this article until now. It is a great article! I am going to print this out and take it with me to the office. This is something I have been trying to work on for a while now. We do not have a very good medical surveillance program and I am wanting to create one for our Oncology nurses. Thank you so much again for sharing this article!
I did not realize so many spills were occurring with medications in oncology practice. I found the link to the direct study. What was interesting was that even after the PPE education given to the nurses, they still didn’t see any significant change in the use of PPE (Friese, et al., 2020). Is it a time factor? I have never worked an oncology unit, but I imagine all the extra steps and double gloving/ etc does slow down the process of administration.
With this recent COVID-19 shortages, access to PPE may also be limited (Pagan, 2020). At our facility, all RN’s are now required to do training on handling hazardous medications and spills. What is amazing in this article is that there were 2 nurses who had no PPE on at all during a spill! Maybe monitoring is needed? Maybe they need a check off system for a few months until they start improving their use of PPE? Maybe even having an annoying pop-up dialog box they have to click through and “sign” that they had all the correct PPE on before medication removal/ administration?
Friese, C. R., Yang, J., Mendelsohn-Victor, K., & McCullagh, M. (2019). Randomized Controlled Trial of an Intervention to Improve Nurses’ Hazardous Drug Handling. Oncology nursing forum, 46(2), 248–256. https://doi.org/10.1188/19.ONF.248-256
Pagan, J. (2020, April 3). PPE Use During COVID-19: A Double Challenge. https://www.oncologynurseadvisor.com/home/cancer-types/general-oncology/ppe-use-during-covid-19-a-double-challenge/.
I am not familiar with Oncology practices but we do training annually of drug safety, including chemotherapy drugs. I can completely understand how lax nurses can be after a while, but don’t realize how detrimental to our health it can be. I found an interesting research article on patients perspective with chemotherapy administration and potential errors or even lax of safety standards from nursing.
“Approximately 16% of patients experienced an error in their care, and 11% were worried about errors. Patients felt the risk of each of the four errors was low, while risk for potential harm from error was high” (Sankaranarayanan, 2010).
It’s interesting when a patient provides their perspective in the care they receive.
Sankaranarayanan, J. (2010). Patient-reported perceptions and safety behaviors in chemotherapy administration. Expert Review of Pharmacoeconomics & Outcomes Research, 10(5), 509-512. doi:10.1586/erp.10.64
This is a good topic. We do annual training on different chemicals and spills that include chemo as someone previously mentioned. I like the thought of using different colored gloves as a visual aide to remind yourself and others to wear two gloves to protect yourself.