A recent study, published in August 2011 by Friese and colleagues, correlates the incidence of accidental chemotherapy exposure in outpatient infusion centers to several factors.1 Appearing first online in BMJ Quality and Safety, the article discusses staffing and resource availability, as well as adherence to safety practice standards and their contribution to higher chemotherapy exposure event reporting. In summary, when the nurses sampled reported adequate staffing and resource availability, the reported incidence of accidental exposure to chemotherapy was lower. Similarly, when sampled nurses reported performing a 2-nurse check of chemotherapy doses frequently or very frequently, the reported rate of accidental exposure was also lower. This information leads the authors to suggest that these 2 particular practice issues, if attended to, may actually “protect oncology nurses from harm” and leads this author to wonder: can safety practices be, at least to some degree, contagious? Can we hope that safety improvements in any aspect of practice may improve the safety culture of the work environment overall? This would be an exciting concept to clinicians who work to overcome obstacles to evidence-based practice changes, only to see little progress made over long periods. There may be progress in related aspects of practice that has not been correlated, and a thorough analysis of associated factors, as was done in this study, could help to validate those. Though the above study did not draw any specific conclusions outside of the mentioned results, evidence on how training and practice guideline adherence impact exposure rates would be interesting and could be helpful in encouraging healthcare facilities to standardize staff education and more closely track compliance with standards. Perhaps a nurse who is trained in the standardized ONS Chemotherapy Biotherapy Provider course is more attentive to the technical aspects of drug administration that can lead to exposure, such as failure to wear proper personal protective equipment, and experiences fewer or no exposures. Maybe a nurse who is trained to always perform a 2-nurse check of chemotherapy doses, and always does so, will also be inclined to ensure she always uses 2 patient identifiers at the bedside, thereby reducing the risk of “wrong patient” errors. Will an outpatient clinic manager, who carefully monitors nurse-to-patient ratio and staffing adequacy, be more committed to safe handling guidelines in his or her department and promote medical surveillance for staff? Considering that various barriers exist to making safety-related practice changes, it is exciting to believe that when barriers are removed, the overall safety culture of a department can be improved incrementally with each change. Further studies will be needed to support this idea, but as the focus narrows on patient safety, worker safety should be similarly prioritized and studied. Though safe practice recommendations have existed since the 1980s, there is little regulatory monitoring or enforcement of these standards, and compliance varies widely in outpatient and office settings.2 Hopefully studies like Friese’s will further persuade organizations to take increased steps toward ensuring the safety of healthcare workers handling chemotherapy and other hazardous drugs. For clinicians like myself who champion safe, evidence-based chemotherapy practices, this is an exciting study. Unfortunately, it supports that nurses are still becoming exposed to chemotherapy in their work environment at alarming rates. It also demonstrates that there is something we can do about it! Oncology nurses and oncology administrators committed to the goal of improving the safety in their chemotherapy treatment areas may find even the small successes of their efforts to be contagious! References
To sign up for our newsletter or print publications, please enter your contact information below.
