Preparing Non-Oncology Ambulatory Care Practices for USP 800 Compliance

Published studies have shown that workplace exposures to hazardous drugs can cause both acute and chronic health effects such as skin rashes, adverse reproductive outcomes (including infertility, spontaneous abortions, and congenital malformations), and possibly leukemia and other cancers.

The USP 800-chapter revises standards that require all healthcare personnel who handle hazardous drugs (HDs) to understand and implement specific practice and quality standards for handling these HDs including the receipt, storage, compounding, dispensing, administration, and disposal of sterile and nonsterile products and preparations.

The focus for this poster is on how our organization is preparing the non-oncology practices whose staff who may not belong to the Oncology Nursing Society (ONS), have oncology nursing certification, or have the depth of knowledge and resources related to HDs. The inpatient and ambulatory care oncology nurses at our organization developed an educational program to prepare for USP 800 compliance that incorporated many existing practices related to HD handling, PPE, and spill management. The non-oncology practices will incorporate some of the materials they developed, but with more in-depth education about the hazardous nature of the drugs they give and the need for precautions they may not have ever practiced or even be aware of.

Unlike oncology ambulatory care practice nurses, some of our ambulatory care specialty practices give NIOSH group 1 HDs (antineoplastic drugs, including those with the manufacturer’s safe-handling guidance) to people who may or may not have a cancer diagnosis. These specialty practices are also giving these group 1 drugs via non-intravenous routes (e.g. intravesical, intramuscular, subcutaneous, and topical).
Other ambulatory primary care practices are also administering HDs from group 2 (non-antineoplastic drugs that meet one or more of the NIOSH criteria for a hazardous drug, including those with the manufacturer’s safe-handling guidance) and group 3 (non-antineoplastic drugs that primarily have adverse reproductive effects). The staff in these practices were often unaware of the NIOSH grouping of HDs and the number of drugs they give that are considered HDs.

This poster will describe the process used to identify USP 800 compliance gaps and the implementation of safe work practices in the non-oncology ambulatory care practices administering HDs. This will include descriptions of the workflow to address those gaps in areas such as PPE compliance, closed system transfer devices (CTSDs), and the spill clean-up process. It will also outline the education content and competencies developed for nursing staff to prepare them for handling HDs.