It seems as though everyone has chemotherapy on the brain. The National Institute for Occupational Safety and Health (NIOSH) is in the process of updating their Alert on Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings. NIOSH already released a new list of hazardous drugs late last year. The U.S. Pharmacopeial Convention (USP) is busy finalizing General Chapter <800> Hazardous Drugs – Handling in Healthcare Settings. And now, ASHP has published updated chemotherapy guidelines.(1)
The updated guidelines can be found online in the electronic version of the April 15th issue of AJHP, but don’t try accessing them unless you have a subscription because there’s a paywall. According to the guidelines they are intended to “to define best practices for the safe use of chemotherapy and biotherapy agents and to assist practitioners in improving their medication-use systems to prevent medication errors and patient harm from these agents”.
The guidelines focus on improving best practice through:
- Educating staff
- Standardizing the ordering process, label contents, the preparation process, scheduling, and administration.
- Establishing dosage limits, acceptable routes of administration, etc .
- Eliminating verbal and “STAT” orders. This is definitely welcome. There’s just no place for a STAT or verbal chemotherapy order.
- Implementing CPOE and improving clinical decision support. Of note, chemotherapy entry via CPOE is messy. At least in my experience.
- Improving the medication use process from beginning to end. The new guidelines outline a “checkpoint” process that includes 10 checkpoints in total from prescribing all the way through post-administration and monitoring.
- Following a detailed chemotherapy drug preparation checklist. This concept has been around for a while. For what it’s worth, much of what is found on the drug preparation checklist in the guidelines can be automated with iv room technology.
While the guidelines mention “technologies to automate the preparation of sterile products, including chemotherapy”, the authors fall short of actually recommending its use. This is quite disappointing. The use of barcode scanning technology to verify medications used in compounding chemotherapy, the use of gravimetrics to verify drug amounts, and the use of photo-assisted documentation of the compounding process is a must in sterile compounding, especially when dealing with chemotherapy.
Every pharmacist that deals with chemotherapy – read that as all pharmacists – should read through the new guidelines and become familiar with the recommendations.
To that end, I would like to see ASHP make guidelines freely available to all in the future. It makes no sense to place them behind a paywall, especially if you want the recommendations to be adopted as best practice.
[UPDATE]: Thanks to Bruce Hawkins from ASHP, we now know that while most of ASHP’s policy and guidance documents are published in AJHP, all of those documents are available to the public at http://www.ashp.org/bestpractices. This is good information, so make use of it.
- Goldspiel, B. et al. ‘ASHP Guidelines On Preventing Medication Errors With Chemotherapy And Biotherapy’. American Journal of Health-System Pharmacy8 (2015): e6-e35. Web. 6 May 2015.