Page 221 - Hospital Authority Convention 2018

Service Enhancement Presentations

F7.7 Committed and Happy Staff 13:15 Room 421

Cytotoxic Safety Programme for Nurses to Delivery Cytotoxic Drug in General Ward
Tam CH, Lui WK, Liu CW, Lo WH, Lam YK, Ng YB, Tan SK
Medical and Geriatrics Department, United Christian Hospital, Hong Kong
Introduction HOSPITAL AUTHORITY CONVENTION 2018
According to the Hong Kong Cancer Registry, the number of new cancer cases in Hong Kong rose at an average annual
rate of 2.9% over the past decade. In response to the increasing number of cancer patients, medical oncology service was
established since 2016. The missions of the service were to manage systemic cancer treatment, to optimise co-morbid
medical conditions before and during cancer treatment including chemotherapy, hormone therapy and immunotherapy, and
to manage the medical complications arisen from the cancer itself and therapy. Nurses require to handle cytotoxic drugs
frequently that can result in serious and even fatal outcomes if failure to deal properly and safely.

Objectives
(1) To provide a safe working environment to run the medical oncology service; and (2) to mitigate the risks of handling
cytotoxic drugs.

Methodology
To prepare a new medical oncology service in 2017, a series of strategies were set out such as staff recruitment, operation
guidelines review, staff training, competence assessments, and equipment preparation. (1) Staff recruitment: One advanced
practice nurse and two senior registered nurses who have completed Post-registration Certificate Course C related to
cytotoxic drug training were recruited in the medical oncology team. (2) Operation guideline review: We reviewed guidelines
for storage, handling and disposing of cytotoxic drugs. The procedures of safe handling cytotoxic drugs including drug
administration, disposal of cytotoxic waste and spill control were standardised. (3) Staff Training: According to the Hospital
Authority Safety Manual, any person with responsibility assigned in the work procedures involving cytotoxic drugs should
have received training. Therefore, lectures were provided by oncologist and medical oncology team members. Topics were
related to cytotoxic drug safety, spillage and extravasation management, and chemotherapy assessment. A scenario-based
spillage drill was implemented to enhance competence, knowledge and skills through practice. (4) Competence Assessment:
Compliance with practice standards is essential to protect all personnel from the harm of hazardous drugs. Chemotherapy
administration and spillage management audits were conducted regularly. (5) Equipment preparation: We designated a
lockable cupboard and refrigerator with warning signage where cytotoxic drugs are stored. -Chemotherapy trolley was
designed for administration of cytotoxic drug. It contains protective equipment, sharp box, and spillage kit to facilitate staff
to administer treatment. Healthcare Assistance working in night shift was assigned to check the trolley monthly to ensure
equipment available and functional. A warning label was designed to alert staff that all hazardous toxic waste should be
placed in a sharp box and red bag with warning label, then put in the designed area.

Results
20 patients were admitted to ward 9B receiving medical oncology treatment without sentinel and serious untoward event
reported. 100% compliance in chemotherapy audit was performed. All staff stated that they are more confident with
increased awareness to handle cytotoxic drug and protect themselves. Tuesday, 8 May 2018

219