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Hazardous Drugs
Jan 12, 2012
13:00-14:00
Pharmacy Conference Room, RJH
Plan
Hazardous Drug Definition •Stratification •Published list
POLICY: hazardous drug definition
Approval
Personal Protective Equipment •Separate committee • Published table •Cost-analysis •Practicality
Operating Procedures •6 areas
1) Administration
2) Receiving
3) Packaging
4)Disposal/Clean-up
5) Spills
6) Distribution
•Working committees •Policy •Procedure
Compile Policy and Procedures
Policy/Procedure Submission
Implementation
Hazardous Drug – Committee •Updates •Reviews •Feedback
Survey •12 surveys across Canada •Multiple attempts for numerous American Hospitals •Leaders
•Eastern Health •Winnipeg •Fraser Health
Results: Pharmacy Policy
30%
50%
20%
Yes
No
Draft
Results: Pharmacy Procedure
50%
40%
10%
Yes
No
Draft
Note: Many Hospitals and Health Authorities currently have procedure in place for cytotoxic medications
Results: Time Frame
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Site 1 Site 2 Site 3 Site 4 Site 5 Site 6 Site 7 Site 8 Site 9 Average
YEARS
Time Involved with Hazardous Drugs Policy/Procedure
•Ongoing for majority of sites •Most sites have been working on and off •One site not sure of duration
Results: NIOSH
90%
10%
Definition of Hazardous Drugs per NIOSH
Yes*
No
*Majority use NIOSH definition on paper and then modify for site
Results: References for Definition
•National Institute of Occupational Safety & Health (NIOSH) •Manufacture monographs •American Society of Hospital Pharmacists •Canadian Society of Hospital Pharmacists •Association for Health and Safety of Labor and Social Affairs Sector •Local formularies •Local cancer agencies •University HealthSystem Consortium Consensus Statement: Model hazardous drugs safety plan for institutions •Other provinces
Results: Medications of Interest
Note: some medications may not be listed as they or not on site specific formulary.
2
3
4
5
6
7
8
9
10
Sites (10 total)
Site Specific Hazardous Drug List: medications of interest
Results: Hazardous Drug Definition: Departments Involved
Site 1
Site 2
Site 3
Site 4
Site 5
Site 6
Site 7
Site 8
Site 9
Pharmacy
Nursing
OHS
Physician
Housekeeping
Other*
Other*: lab, materials management, environmental service
Results: Hazardous Drug Definition: Risk Stratification
70%
30%
Risk Stratification of Hazardous Drugs
Yes
No
Results: Hazardous Drug Definition: Risk Stratification
0
1
2
3
4
5
6
7
Single Tier Two Tier Three Tier Undecided
Risk Stratification Model
Results: Hazardous Drug Definition: Examples of Risk Stratification
Two Tier Three Tier
Group A oncology + non-carcinogens Group B others
High Hazard Medium Hazard Low Hazard
Hazardous cytotoxic Non-hazardous cytotoxic
Category 1 Category 2
IV/Oral Hazardous Reproductive Oral Hazardous
IV Hazardous Oral Hazardous
Pros and Cons for each system.
• Oral Hazardous
• Cytotoxic and Non-Cytotoxic
– Example 2
• Category 1 and 2
• Low, Medium, High Risk
• Group A and B
Results: Hazardous Drug Definition: Examples of Risk Stratification
Results: Hazardous Drug Definition: Decisions and Approvals
• Hazardous Drug Working Group • Regional committees for Hazardous Drugs • ± Physician (occupational health) • Pharmacy and Therapeutics Committee • Managing Medication Committee • Health and Safety Committee
These committees or groups then submitted to
regional, health authority or provincial councils for implementation/approval
• All sites thought it was necessary to have Canadian Guidelines that define and govern hazardous medications
Results: Hazardous Drug Definition
0
1
2
3
4
5
6
7
8
CHSP HC Manufactor OHS Other*
Site Selection(s)
What organization(s) would be the best to initiate, implement, maintain and regular hazardous drug guidelines?
Most challenging aspect(s) when developing a hospitals/health authorities definition of hazardous drugs:
• Developing policy and definition – NIOSH (broad, interpretation) – Personal Protective Equipment (compliance)
• Different members/opinions • Provincial Pressure • Lack of evidence (not black and white) • Economics (PPE, hoods, workload) • Implementation over region
– Buy-in
• Communication to employees • No consistency between sites (not efficient or safe)
Results: Hazardous Drug
Recommendations for hospitals/health authorities who are developing a definition for hazardous drugs?
• Involve nursing
• Balance between different departments and sites – Policy/procedure should be useful/practical for all sites
• Small working group – Authority
– Productive
– Meet on regular basis
• Have contact physician on standby if required
• Communication – sites, departments
Results: Hazardous Drug
Moving Forward
Multiple Steps: need to tackle individual portions of policy and procedure one at a time:
•Definition (Pharmacy/Occupational Health)
•PPE (Pharmacy/NURSING/Occupational Health)
•Packaging (Pharmacy/Occupational Health)
•Distributing (Pharmacy/Occupational Health)
•Administration (Nursing/Occupational Health)
•Disposal/clean-up/spills (committee)
Receiving Packaging
Distributing Administration
Disposal Spills Cleaning
0
1
2
3
4
5
6
7
8
9
10
Department Involvment at Site
Department
Departments Involved with Policy/Procedure Processes of Hazardous Drugs
Receiving
Packaging
Distributing
Administration
Disposal
Spills
Cleaning
Development
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