Necessary Drugs, Unnecessary Exposures: An Examination of Chemotherapy Safe Handling Among Oncology Healthcare Workers

Purpose:
The goal of the project was to use the quality improvement process to develop and test a worksite intervention to protect oncology nurses and pharmacists from unnecessary exposures to chemotherapy, decreasing their risk of negative acute and chronic health effects such as skin rashes and cancer.

Relevance/Significance:
This project is directly related to the conference theme as it translates best practices in chemotherapy safety into solutions that have been tested by nurses and pharmacists in their work environment. It works to optimize safety culture in healthcare organizations, reducing unnecessary exposures and adverse health effects caused by chemotherapy to patients, families and staff. These findings can translate to other work environments and provide a framework to improve safety in other areas.

Strategy and Implementation:
This was a mixed methods intervention study. Oncology staff (N=163) from inpatient and outpatient areas that work with chemotherapy were asked to participate. The survey investigated how workers' perceptions of risk, self-efficacy, barriers, workplace safety climate, and co-worker influence might predict the use of personal protective equipment (PPE) to prevent chemotherapy exposure. Contamination of worksite surfaces was evaluated with a wipe sampling kit designed to measure chemotherapy residue on surfaces. Findings from the employee survey and sampling were used to establish baseline values and to develop an intervention to improve safe handling techniques among nurses and pharmacy staff. The intervention used staff feedback to create and implement sustainable changes on each unit. The employee survey and surface contamination was assessed again, after the intervention, to assess changes from baseline in potential employee exposures, knowledge and work practices.

Evaluation:
Findings showed personal protective equipment use was significantly lower than recommended and workplace safety climate significantly affected use (b = 0.38, p less than 0.0001). Environmental sampling from 62 unique sites showed chemotherapy exposure occurring in 5 areas. Changes made to the work environment showed 97% found the changes successful in improved use of chemotherapy precautions.

Implications for Practice:
This study is among the first to contribute to the research on effective interventions to maximize safety and prevent unnecessary chemotherapy exposure to oncology nurses. With replication of the study in other institutions, it may also inform clinical practice and policy decisions in the field.