Chapter 23: Administration of systemic anticancer therapies
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Legal and professional issues
The hazards of handling cytotoxic drugs are well recognized, along with the requirement to adhere to safety measures recommended to protect all staff who prepare, administer and handle cytotoxic drugs or waste products. The Control of Substances Hazardous to Health (COSHH) Regulations (HM Government [100]) were updated in 2017. The Health and Safety Executive (HSE [104]) has provided a document on the safe handling of cytotoxic drugs. National evidence‐based guidelines have been implemented to reduce exposure, provide adequate protective equipment, ensure regular staff monitoring and provide effective written procedures for dealing with preparation, administration, disposal and dealing with spills and accidents. To limit exposure, cytotoxic drugs should be prepared only by skilled, knowledgeable and experienced healthcare professionals (Polovich et al. [194], RCN [201]). A full risk assessment under the COSHH Regulations must be made by all departments and wards handling, preparing or administering cytotoxics (HSE [104]). The assessment should identify all appropriate procedures for the safety of staff.
Health surveillance
It has been suggested that organizations should provide health surveillance programmes for staff exposed to hazardous drugs and that they should be an integral part of health and safety in the workplace (European Policy Recommendations [73], Nixon and Schulmeister [176]). Some organizations offer yearly health surveillance for staff directly involved in handling cytotoxics on a regular basis, for example certain staff working in pharmacy reconstitution units. Surveillance normally includes physical examinations, blood samples and history of exposure (HSE [104]). If no surveillance is offered, a risk assessment focusing upon exposure should be initiated (Box 23.1).
Box 23.1
Employers’ obligations regarding safe handling of cytotoxic medications (HSE [104])
Employers are obliged to:
- identify substances that are a hazard to staff and others who may be exposed
- manage how the drugs should be handled and what to do in the event of a spill or accident
- ensure that healthcare personnel have access to the ideal environment, protective clothing, policies and procedures, a system of monitoring and recording effects, and any necessary equipment such as spill kits.
