SUMMARY: WORKPLACE SAFETY IN ONCOLOGY SETTINGS


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Risk In today’s cancer care settings, safety as it relates to antineoplastic drugs primarily addresses patient safety. Beardwood and Kainer contend that “professional risk in nursing practice is seldom discussed” and has yet to be recognized as a problem.21 The American Nurses Association Code of Ethics for Nurses Provision 5 maintains that nurses owe “the same duties to self as to others,” including the responsibility to promote health and safety.22 Minimizing risk to health care workers is nurses’ responsibility.22 Further, “nurses should model …[avoidance of] unnecessary risks to health or safety in the course of their professional and personal activities.”22 Put simply, minimizing risks associated with exposure to antineoplastic drugs is a nursing duty.

State-of-the-science protection Hazardous drug containment and worker safety must be a primary concern in cancer care settings. Although nurses have not always been involved in product evaluation, selection, and purchasing decisions, nurses must demand an official seat at the table when hazardous drug safety devices are considered. Some experts indicate that use of CSTDs in compounding and administration processes is no longer optional. Instead, organizational resources should be directed toward identifying the CSTD best suited for that setting, and developing, implementing, and monitoring of safety devices to ensure workplace safety.

Medical surveillance Health care workers exposed to infectious diseases and radiation are routinely monitored in the workplace. Although NIOSH recommends medical surveillance of health care workers who prepare, administer, transport, and dispose of hazardous drugs, these measures are not required or practiced in most health care settings. Recommended elements of a medical surveillance program include collection of workers’ medical, reproductive, and occupational history, physical examination, laboratory studies, and biological monitoring.13 Polovich and Clark advocate implementation of a registry of data connecting nurses’ exposure history and health outcomes.16 Without data on occupational exposure to hazardous drugs, its true impact remains unknown.16


Pamela Haylock is an adjunct faculty for the Online RN to BSN Program at Schreiner University in Kerrville, Texas, and chairs Equashield‘s Nurse Advisory Council, which seeks to develop strategies to increases nurses’ awareness of issues around occupational exposure to hazardous drugs. She is a past president of the Oncology Nursing Society. 


REFERENCES

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18. Berdi F, Powell MF, Sanz C, et al. Assessing the efficiency of CSTDs for compounding. 2015;12(7):4. Pharm Purchasing Prod. 2015;12(7):4. http://www.pppmag.com/article/1717/July_2015_Hazardous_Drug_Handling/Assessing_the_Efficiency_of_CSTDs_for_Compounding/. Accessed September 2, 2015.

19.  Clark BA, Sessink PJ. Use of a closed system drug-transfer device eliminates surface contamination with antineoplastic agents. J Oncol Pharm Pract. 2013;19(2):99-104.

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22. American Nurses Association. Code of Ethics for Nurses with Interpretive Statements. Silver Spring, MD: American Nurses Association; 2015.