What You Need to Know About Chemotherapy in Your Everyday Practice

by: Dawn Dexter RN, CMSRN

Chemotherapy, hormone therapy and biotherapy are common treatments for cancer. According to the National Institute for Occupational Safety and Health (NIOSH), hazardous drugs is now the term used to encompass traditional chemotherapy as well as novel agents called biotherapy.

As nurses in all areas, we may be caring for patients receiving hazardous drugs. It is unknown what ill effects, if any, come from continued exposure. Special knowledge and precautions are needed to protect yourself and the patient (Lester, 2012).

What do you need to know about caring for your patient receiving chemotherapy?

The best practice is to minimize your exposure to hazardous drugs and their metabolite.

When a patient has just received chemotherapy or forty-eight hours after the completion of the medication, you should wear personal protection equipment (PPE), to prevent accidental exposure to hazardous drugs and its metabolites (Walton et al., 2012).

The safety equipment includes approved gowns, gloves, goggles, and face shield. At our health system it is available on the unit or can be obtained from the central supply area.

This should be done prior to starting a treatment. Your patient will secrete the hazardous drug metabolite within sputum, tears, semen, vaginal secretions, urine and stool for an average of forty-eight hours after the therapy is complete (Polovich & Gieseker, 2011).

If the bed needs to be changed a gown should be worn, along with gloves. The linen can be put in the linen bag. If the patient is incontinent and wearing a diaper, it should be placed in a plastic bag prior to placing into the yellow chemotherapy waste container.

When handling urine, remember to wear goggles, gloves and gown, along with a face shield because of the risk of splashing (NIOSH, 2014).

Who can administer chemotherapy and take down completed chemotherapy bags and tubing?

At Memorial Hospital West, you need to be an ONS Chemotherapy/Biotherapy provider to initiate therapy. TWO chemotherapy provider nurses need to review the original doctor’s order, check the protocol, dose calculations and critical lab results, cosign and verify the rate on the IV pump.

In addition, the two nurses need to complete a critical check at the bedside by verifying two patient identifiers (JACHO, 2014). You, as the patient’s nurse, at the discretion of the chemotherapy nurse who is going to hang the hazardous drug, can administer the premedication.

The drug is hung by the chemotherapy certified nurse and can be taken down upon completion by the nurse that is responsible for the patient. Again, it is important to wear the PPE. If any questions arise during time of monitoring the patient or before taking down the IV bag and tubing, the primary nurse should call the clinical manager or charge nurse.

Oral chemotherapy used for non-cancerous conditions such as IV ganciclovir, are also known as hazardous agents. You are required to attend a four hour safe handling class in order to give the medications by mouth as well as a potent antiviral agent called IV ganciclovir.

The order should be checked by two nurses and cosigned before being administered. A small yellow chemotherapy bucket should be placed in the patient’s room (Walton et al., 2012).

All packaging, medication cups and gloves should be placed in the yellow bucket after use. As a reminder to the staff, a chemotherapy sign should be placed over the patient’s head or bed.

Protect yourself, the patient and others; be knowledgeable about the safe handling of all hazardous drugs in your work setting.


References

  • NIOSH [2014]. NIOSH list of antineoplastic and other hazardous drugs in healthcare settings 2014. By Connor TH, MacKenzie BA, DeBord DG, Trout DB, O’Callaghan JP. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2014-138 (Supersedes 2012-150).
  • The Joint Commission. Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation. Oakbrook Terrace, IL: The Joint Commission, Nov 2012. Retrieved from http://www.jointcommission.org/.
  • Lester, J. (2012). Safe Handling and Administration Considerations of Oral Anticancer Agent in the Clinical and Home Setting. Clinical Journal of Oncology Nursing, 16, 192-197.
  • Polovich, M., & Gieseker, K. (2011). Occupational Hazardous Drug Exposure Among Non-Oncology Nurses. MEDSURG Nursing, 20, 79-97.
  • Walton, A., Mason, S., Busshart, M., Spruill, A., Cheek, S., Lane, A., Sabo, K., Taylor, A. (2012). Safe Handling: Implementing Hazardous Drug Precautions. Clinical Journal of Oncology Nursing, 16, 251-253.

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