Safe Use of Chemotherapy; Safe Administration and Patient Safety Flashcards
What does the NHS Quality Triangle entail, and how does it relate to managing healthcare risk? Why does it exist?
- Safety
- Effectiveness
- Experience
> Keep me safe
Make me better
Treat me with respect
» Patients and public expect total certainty and safety.
Is legislation or regulation better for managing risk?
- Mixture of both
- Move away from legislation to regulatory expectations and ‘fitness to practice’
How can risk be managed, prevented?
- Expect unexpected, assume the worst.
- Categorise seriousness, impact and consequences of harm if it were to occur.
What chemotherapy hazards are there WRT exposure?
Exposure:
- Absorption (spillage, splashing, needle-stick injuries)
- Inhalation (over-pressurising vials during preparation)
- Ingestion (eating, drinking, smoking in contaminated areas/poor hygiene)
What is the risk of exposure to chemotherapy?
- Cytotoxics interfere w/cell division; normal cells damaged too.
- Acute (serious irritation of skin, eyes, mucous membranes e.g. methotrexate) and chronic health effects (mutagenic/teratogenic)
- Acute vs prolonged occupational exposure (not as much of a risk due to PPE etc.)
What legislation and guidance govern chemotherapy exposure risk?
- Health and Safety at Work Act 1974
- Management of Health and Safety at Work Regulations 1999
- COSHH 2002
- Employers’ responsibility under H&S legislation/COSHH
What does Health Surveillance entail for chemotherapy risk?
- System of ongoing health check for people exposed to risk from cytotoxic drugs etc.
- Can measure concentration on skin, body fluids etc.
- HSE recommend accident records to keep a health record
What is extravasation in terms of cytotoxic chemotherapy? When could it occur?
- Leakage of IV drugs from vein into surrounding tissue
- When IV medication passes into tissue around a blood vessel, resulting in minor discomfort to severe damage
What do the types of injury extravasation can cause depend on?
- Drug
- Volume
- Site
- Duration of exposure
- Reaction
How are chemotherapy drugs classified WRT their extravasation risk?
- Non-vesicant; no damage, mild pain e.g. cyclophosphamide, 5FU (sx SC fluid etc)
- Irritant; pain and phlebitis (inflammation at site or along vein) e.g. cisplatin, etoposide, methotrexate
- Vesicant; blistering, ulceration and necrosis (destroying muscle, nerves, tendons etc.) e.g. carmustine, anthracycline antibiotics, paclitaxel and vinca alkaloids.
What are the risk factors for extravasation?
- Frailty
- Age (elderly/children)
- Confused and sedates patients
- Peripheral neuropathy (reduced sensation)
- Repeated IV infusion/injections
What are the steps taken to prevent extravasation?
- Staff proficiently trained
- Avoid cannulae in the dorsum of the hand, foot, ankle, near joints/joint spaces (limited soft tissue protection), ante cubital fossa etc, use muscley/fatty sites.
- Use smallest 22/24 gauge polyurethane cannula and warm water soak/hot pack to promote vasodilation
- Cannulated area covered with transparent dressing, no bandaging to allow observation.
- Nurse sits at patient level facing patient, administers slowly, asking patient to report pain/burning at site during or after.
What is the treatment for severe extravasation?
Severe extravasation; surgical debridement (removal of dead/damaged tissue), reconstruction w/skin grafts.
Outline the principles of the BOPA 4 phase approach to treating extravasation.
- Phase 1 (cool and calm); apply cold pack to reduce dispersion and cellular uptake etc
- Phase 2 (localise and neutralise); intermittent cold treatment, syringe to remove it
- Phase 3 (dilute and disperse); S/C hyaluronidase 1500 U
- Phase 4 (report and learn); document w/photos, incident reporting.
How can the symptoms of extravasation be treated?
- Topical/oral/parenteral antihistamine
- NSAID, paracetamol or opioid
