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                                                                                                              home pageHome June 15, 2000

NURSE ALERT

Cytotoxic (Antineoplastic) Drugs Are Being
Administered Outside of OSHA Guidelines

The CNA Professional Performance Committees (PPCs) and Quality Liaisons (QLs) have recently discovered that these drugs are being handled and administered improperly in many Kaiser facilities. The drugs are administered both IM and IV, but without proper mixing precautions, safety precautions during administration, disposal precautions, medical surveillance of personnel, or education of personnel and patients about the potential risks of the drugs.

OSHA guidelines need to be in place for any and all administration of these drugs, no matter what the usage, the dosage or the route of administration. The effect is cumulative.

Methotrexate, an agent normally used as a chemo drug, is often administered in reduced dosages for other purposes. However, it does not matter for what purpose the medication is given, it retains its antineoplastic characteristics and can pose a danger to the staff handling the drug unless certain safety precautions are maintained. Many Kaiser staff are not aware of the proper handling procedures and safety precautions required by OSHA. For example:

  • The Gilroy clinic was administering it IM for rheumatoid arthritis for 6 years without protocols, protective     clothing, annual health evaluations, training in administration of the drug or warnings to all staff of the dangers.     After the PPC met with Gilroy management, corrections were made and proper training procedures instituted.

  • In Napa/Solano, it was drawn up by the RNs and administered in the clinic for years without proper precautions.     The CNA Labor Rep intervened and had Kaiser management immediately cancel and reschedule the patients     until the pharmacy was able to prepare the proper dosages for delivery to the RNs and a new policy for     protective clothing implemented.

  • The South San Francisco Infusion Clinic had been admixing and administering chemotheraputic agents for     years without knowledge of or adherence to OSHA guidelines. The efforts of the QLs got management to work     with CNA to ensure that the pharmacy does all drug preparation and regular medical surveillance is done.

    OSHA has numerous guidelines for safe handling of these drugs, the most notable are:

  • Annual health testing of staff who work in areas where they are exposed to this drug

  • Adequate protective clothing, including gloves, gowns, masks and goggles.

  • Workers must be informed of the carcinogenic potential and reproductive hazards of these drugs and should     "avoid exposure, especially early in pregnancy."

  • Education and training of all staff involved in handing any aspect of antineoplastic medication, including     preparation, administration and disposal.

    Please contact your PPC, Quality Liaison or CNA Labor Rep if you have questions or concerns about the safe handling of drugs you are administering. If you have information or questions please contact CNA Labor Rep Morton Newman at fax number 510-663-1681. Include your name and phone number so we can contact you.