Hello,

For those involved in USP 800 program implementation/maintenance for your organization, especially larger institutions with a main cancer center and many community infusion centers:

What is your general approach to handling hazardous drug spills?

1. Do you have different processes for large centers vs. small community sites?

2. Who is involved in the hazardous drug spill response? What (if any) role do the following stakeholders play: pharmacy, nursing, chemical safety, environmental services, etc.?

USP 800 includes medical surveillance for healthcare workers who handle hazardous drugs as a regular part of their job assignment.
1. How are institutions defining "regular" for this? Staff that handles chemo/HD how frequently?
2. What personnel/departments will you be including in this medical surveillance program? EVS?

Do you allow nursing to crush one time doses of hazardous medications on the floor to administer via g-tube or do you require pharmacy to crush in a controlled environment per USP 800?

If you allow nursing to crush on the floor, what device do you use for crushing and what additional PPE requirements do you have for them?

We are struggling to determine if pharmacy needs to take over crushing activities for hazardous medications (non-antineoplastics and reproductive risk).

Thank you,
Madiha

Hello!

Our institution has started a discussion around what PPE and preparation precautions should be in place for monoclonal antibodies (in both the inpatient and ambulatory setting). We recognize that the only monoclonal antibodies that fall on the NIOSH hazardous drug list include those that are conjugated to an antineoplastic (eg, gemtuzumab)... whereas other commonly used mAbs (eg, infliximab, omalizumab-outpatient) are not present in the list. (I did attach two articles that leaned towards treating these agents as hazardous medications.)