Evidence-Based Practice Poster Session (Posters #11-#20)
20 - Implementing Anti-neoplastic Precautions in Perioperative for USP 800 Readiness
Description: Problem Statement: Perioperative staff lack knowledge and training regarding safe handling of antineoplastic drugs used in the OR. Our OR does not have a policy and procedures in place regarding hazardous drugs (HD) precautions and safe handling. Significance: Use of chemotherapy in periop is considered a critical procedure which requires staff knowledge and competency on handling the drugs safely. USP 800 chapter ensures that organizations institute protocols based on the standards which will take effect on December 2018. The USP 800 standard is enforceable by the state designated body and will be tied to CMS and reimbursement.
Background: Chemotherapeutic drugs are being administered intravesically in the OR but there has been no formal education and training provided to the periop staff on orientation and annually; and there are safety risks to both patients and staff regarding its use. There was an incident in our OR which involved leakage of the chemotherapy agent from the Foley catheter and none of the staff involved (OR circulator, surgical tech, perioperative nursing assistants, charge nurse, and manager) knew how to handle the situation. Clinical Questions: Are the perioperative staff knowledgeable on the hazards of anti-neoplastic drugs used in the OR? Are the perioperative staff competent and compliant on the latest practices in safe handling of anti-neoplastic drugs used in the OR? Description of EBP: USP 800 standards require use of chemotherapy appropriate PPE (chemo-rated gloves, chemo gown), spill training, use of N95 mask or respirator, and the use of closed-system transfer device (CSTD). OSHA and NIOSH recommend:a. implementation of HD safe handling programb. develop procedures for minimizing exposure using personal protective equipmentImplementation : Formed a multi-disciplinary anti-neoplastic task force. Sent task force members to a formal 6-hr. chemo training for non-chemo nurse to learn about the guidelines and standards of handling HD in the OR. Reviewed hospital chemo policy. Educated staff on the latest chemo agents used in the OR and safe handling. Created chemo workflow process in periop.Collaborated with pharmacy in using CSTD, with housekeeping for appropriate HD waste disposal and spill training for RN's
Results: Some OR nurses are now chemo trained. HD safe handling is part of onboarding education and will be included annually. Implemented a chemo workflow in the OR which minimized staff risks of exposure and implemented a closed system intravesical administration of chemo.
Discussion: OSHA recommends that anyone handling HD receive information and training initially and annually thereafter regarding the hazards and ways to minimize exposure. NIOSH states that organizations implement a program for safe handling of HDs and developing procedures that reduce the exposure of staff. Implications: Periop staff are aware on the hazards of chemo drugs. They are knowledgeable on minimizing risk and its safe handling.