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