Safe Handling of Chemotherapy (Tom Gray) Flashcards
In managing risk, what are the main mistakes we hope to eliminate?
Surgery Toxicity Needles Administration erros Prescription administration errors
What is the basis of ‘The Human Error Theory’?
We can’t change human nature but we can nurture the environment that humans work in.
What is industry paves the way for better risk managed care?
The Aviation Industry
- improved reporting for learning purposes
In order to encourage positive reporting of near-miss events or errors, what needs rebalancing?
Blame culture, FtP, legislation, law etc
What is an example of the responsibility of Training and Staff Personal Safety Responsibility?
Pregnant members of staff (or women trying to conceive); shouldn’t be working directly with cytotoxic drugs and should also avoid exposure to potential needle stick injuries.
How can health surveillance improve safety of cytotoxic drug handling?
Monitoring trends and measuring contamination
Regular testing and discussion
What are the hazards that chemotherapy pose to workers/patients?
Exposure (mutagenic, carcinogenic); absorption, inhalation, ingestion
What are some of the historical problems associated with MTX preparation on wards?
Miscarriage, skin and eye problems in nurses
What are Never Events?
Never Events are serious incidents that are wholly preventable as guidance or safety recommendations that provide strong systemic protective barriers are available at a national level and should have been implemented by all healthcare providers.
What are generic problems that can lead to ‘Never Events’ / SI - Serious Incidents?
Wrongly prepared high risk injection Maladministration of K+ solution Wrong route oral/enteral administration IV administration of epidural Maladministration of insulin Overdose of midazolam in sedation Opioid oversode in naive patient
Even if no harm comes to the patient they should still be reported.
What drugs have had Safety Alerts raised?
Vincristine errors Cytarabine Oral chemo dose Vinca alkaloids Non-luer spinal devices
What is a Non-Vesicant drug?
No damage and mild pain upon administration
5- Fluorouracil
What is a Vesicant drug?
The leakage of certain drugs called vesicants out of a vein into the tissue around it. Vesicants cause blistering and other tissue injury that may be severe and can lead to tissue necrosis (tissue death).
Amascrine, Anthracycline antibiotics
What is an Irritant drug?
Acute pain and phlebitis (inflammation in vein)
Cisplatin and MTX
What is extravasation?
Leakage of IV drugs from the vein into the surrounding tissue
Where do recommendations for changes to practice come from?
Inquiry (Toft Report)
National Standards 2008
Patient Safety Alerts NPSA or NHS
How can the adverse effects of chemotherapy drugs be avoided via administration SOP?
Flush cannula with saline prior to use
Most vesicant drugs first when most clean
Nurse observes site for any signs of pain or reaction
If an adverse extravasation takes place what is the procedure to treat this?
BOPA - National Extravasation Protocol
- Cool and calm; cool bag to minimise dispersion
- Localise and neutralise; particular antidote and compass needle for removal from tissue
- Dilute and disperse
- Report and learn
What is an error?
Medication error
Errors in judgement
How should we respond to errors?
GPhC principle 6
Duty of Candour
Coping
Emotional Intelligence
