NEWS
Stronger safeguards needed to protect patients and healthcare providers in hospital oncology
By Eva Baginska n Canadian hospital oncology settings, current procedures around chemotherapy medications can pose risks to both patients and healthcare workers. For patients, errors in preparation methods can be catastrophic, while the risk of exposure to medications presents serious risks to healthcare workers. While the dangers associated with drug exposure have been known for decades, chemotherapy compounding errors have gained more recent attention due to high profile incidents and subsequent awareness efforts. Rachel E. Gilbert and Dr. Chun-Yip Hon, and their respective collaborators, published research illustrating these risks in several recently published Canadian studies. Gilbert and Hon’s work demonstrates that Canadian hospitals have additional safeguards they can employ to protect both patients and healthcare workers from harms associated with hazardous oncology drugs. To protect the health and safety of Canadians, stronger control measures are needed to minimize risks associated with chemotherapy treatments throughout hospital medication systems. In “Intravenous Chemotherapy Compounding Errors in a Follow-Up Pan-Canadian Observational Study,” Gilbert and colleagues observed chemotherapy preparation practices at four cancer centre pharmacies, each in different Canadian provinces. In her paper, Gilbert differentiates between latent errors and actual errors: while a latent error represents an opportunity for an error to occur (e.g., similar treatments placed together), an actual error would represent an error actually taking place (e.g., the wrong treatment being selected). In the study, 11 latent errors were discovered. While no actual errors were observed, the high-risk practices noted could have led to catastrophic results for the patient. The latent errors observed included manual transcription into pharmacy systems; more than one mix being staged per bin; and reusing the same syringe to create a total dose; among others. Chemotherapy compounding is a high-risk activity; errors in preparation
I
www.hospitalnews.com
could result in death or permanent loss of function for patients. Gilbert notes that relevant Canadian guidelines do not address the 11 latent errors uncovered by the study: no current guidelines address all of the issues; some guidelines address certain issues; and some other issues were not addressed by any current guidelines. While Gilbert’s research addressed risks to patients in manual compounding processes, Hon investigated risk of exposure to antineoplastic treatments to Canadian healthcare workers. While awareness about this topic has increased in recent decades, Canadian-based research on antineoplastic drug contamination has remained limited. Occupational exposure to antineoplastic drugs can cause health risks including genetic damage, adverse reproductive effects, or increased risk of cancer. In “Antineoplastic Drug Contamination of Surfaces Throughout the Hospital Medication System in Canadian Hospitals,” Hon and team found detectable levels of drug residue on surfaces at all stages of the Canadian hospital medication system. While safe handling guidelines for these drugs do exist, the study showed drug contamination still occurs. Since dermal contact is understood to be the primary route of occupational exposure for healthcare workers, Hon also investigated dermal contamination levels on the hands of healthcare workers. Hon’s “Antineoplastic Drug Contamination on the Hands of Employees Working Throughout the Hospital Medication System,” observed healthcare workers in six Canadian hospitals. Workers from all job categories in the study had some level of contamination, suggesting the range of employees at risk of exposure is higher than previously believed. Following the investigations into external exposure, Hon noted that urine samples could account for other routes of exposure, including ingestions and inhalation. In “Antineoplastic drug contamination in the urine of Canadian healthcare workers,” Hon found that, despite control measures in hospitals, a range of Canadian healthcare workers
are at risk of antineoplastic drug exposure – not only nurses and pharmacy personnel. As the research shows, there is an urgent need for improvement to protect healthcare providers and patients from risks associated with hospital oncology. Gilbert’s research shows current practice standards do not address many opportunities for error, while Hon found dramatic rates of contamination on surfaces, hands and in the bodies of healthcare workers throughout Canadian hospital systems. Gilbert makes recommendations for how potential risks could be mitigated, including automating compounding processes; live quality control mechanisms; and interfaced pharmacy and information technology systems. Hon recommends a review of existing
control measures and recommends considering all at-risk healthcare workers when designing new measures. Both researchers also call for further investigations, so additional trends can be observed to inform interventions. These conclusions are aligned with a framework published by authors at the Institute for Safe Medication Practices Canada, which suggests that system-based prevention strategies that employ automation and computerization, as well as forcing functions and constraints, are the most likely to create lasting changes for safe medication use. In Canada, stronger system safeguards should be developed and widely adopted, in order to protect patients and healthcare workers from risks associated H with chemotherapy medications. ■
Eva Baginska is a health services researcher and is the vice president of Health Economics and Outcomes Research (HEOR) at BD - Canada.
WITH BD® HD CHECK, THE REVOLUTIONARY 10-MINUTE HAZARDOUS DRUG TESTING SYSTEM. Discover the confidence of test results in minutes, not weeks. Discover the new BD.
Identify surface contamination in LESS THAN 10 MINUTES.*
Contact your BD representative or visit bd.com/HospitalNews *For select hazardous drugs. BD and the BD Logo are trademarks of Becton, Dickinson and Company or its affiliates. © 2019 BD. All rights reserved. 1910001945 (0419)
MAY 2019 HOSPITAL NEWS 13