Improving Safety in Handling Cytotoxic Drugs: Quality Assurance Project

Abstract

Selection of Opportunities for Improvement
Cytotoxic drugs commonly prescribed for the treatment of cancer and auto-immune disorders. Many of these drugs have carcinogenic, mutagenic and teratogenic properties. Absence of or non-adherence to control measures may pose detrimental health effects to healthcare professionals through occupational exposure.

Key Measures for Improvement
There were several incidence of cytotoxic spillage reported in Miri Hospital in 2015. This study aimed at improving the adherence rate to safe handling of cytotoxic drugs checklist with the standard set at 100% adherence.

Process of Gathering Information
A cross-sectional study was conducted from April to May 2016 to assess the adherence rate of 7 wards in Miri Hospital that provide chemotherapy service. Data collection was carried out based on a safe handling of cytotoxic drugs checklist compiled according to Ampang Protocol. Implementations of remedial measures were carried out from June 2016 to March 2018. The adherence rate reassessed from April to May 2018.

Analysis and Interpretation
Pre-remedial mean adherence rate was 64.3%, which was below the standard value. The ABNA was 35.7%. Shortfalls in the adherence to safe handling of cytotoxic drugs were identified in the aspects of chemotherapy protocol availability, transport and storage, administration as well as disposal of cytotoxic preparations.

Strategies for Change
Regular seminars and continuous medical educations (CMEs) conducted and designed a protocol on the management of chemo-spillage. We appointed chemo-link nurses and doctors in each ward and made recommendation to each ward to purchase leak-proof container with larger capacity.

Effects of Change
The mean adherence rate was improved from 64.3% to 84.8% following remedial actions.

The Next Step
There is a need for continuous monitoring of adherence to safe handling of handling cytotoxic drug measures, and regular audits should be carried out to ensure sustainability of improvement.