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Chemo surveillance

  • 1.  Chemo surveillance

    Posted 09-03-2019 16:39
    Hello!
    Our facility is looking at revamping our medical surveillance prior to working with HD agents.
    Currently we are performing a baseline lab/ physical prior to employment to those that are working in oncology and administering hazardous drugs.
    What are other facilities doing in regards to medical surveillance and what staff is included in this?
    We have inpatient and outpatient units. (Med surg, IR, Urology, OB, etc) and we are wondering who should all be included in this?

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    Lisa Nordick RN BSN OCN
    Lake Region Health Care
    Rothsay MN
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  • 2.  RE: Chemo surveillance

    Posted 09-05-2019 13:24
    Hi. If it helps to see a published survey of what institutions are doing for medical surveillance, earlier this year there was "Medical Surveillance Programs for Workers Exposed to Hazardous Medications: A Survey of Current Practices in Health Care Institutions" https://www.ncbi.nlm.nih.gov/pubmed/30475315 -- "A cross-sectional survey was distributed to members of the American College of Occupational and Environmental Medicine and the National Comprehensive Cancer Network. Forty-six of the 91 survey respondents indicated that their institution had a hazardous medication surveillance program. We identified the most frequent laboratory (complete blood count) and physical (skin) examination components. A health history was frequently used."

    ONS has "What are medical surveillance recommendations for those who administer chemotherapy and biotherapy?" https://www.ons.org/faq/medical-surveillance -- it links to the "Sample Medical History Questionnaire for Hazardous Drug Handlers" https://www.ons.org/sites/default/files/Safe%20Handling%20Medical%20Surveillance%20Questionnaire.pdf

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    Mark Vrabel
    INFORMATION RESOURCES SUPERVISOR
    Oncology Nursing Society
    Pittsburgh PA
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  • 3.  RE: Chemo surveillance

    Posted 10-22-2019 14:30
    I was unable to find the Frequently asked questions regarding medical surveillance for working for HD agents.

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    Vicky Portwood RN MSN MSN OCN
    Coffeyville Regional Medical Center
    Coffeyville KS
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  • 4.  RE: Chemo surveillance

    Posted 10-24-2019 10:25

    The page at https://www.ons.org/faq/medical-surveillance is no longer there, only the sample questionnaire at https://www.ons.org/sites/default/files/Safe%20Handling%20Medical%20Surveillance%20Questionnaire.pdf


    I couldn't retrieve it via the Wayback Machine. There was an older version (the following) but it refers to the 2011 ONS Safe Handling edition which has since been updated to the 2017 edition (that has the chapter "Medical Surveillance of Healthcare Workers Handling Hazardous Drugs") at https://ebooks.ons.org/book/safe-handling-hazardous-drugs-third-edition 


    What are the medical surveillance recommendations for handlers of hazardous drugs?
     

    The ONS Safe Handling of Hazardous Drugs (2011) text outlines the recommended components of a medical surveillance program including a thorough medical, reproductive and work history, physical exam, and laboratory studies including the following: CBC, reticulocyte count, AST, ALT and Alkaline phosphatase, urine microscopy or dipstick for blood. It also discusses biologic monitoring if specific exposures are being monitoring for. There is rationale included for each component of the surveillance process. 

    • Maintain a list of all workers who are exposed to HDs on the job
    • HD handlers complete periodic questionnaires to track drug exposure and adverse health events
    • Educate all staff members in safe handling procedures and reinforce education as needed
    • Observe safe handling precautions in practice, use of PPE, following safety procedures during drug preparation and administration
    • Document HD spills, cleanup activities and accidental exposure
    • Share results of medical surveillance confidentially with employees handling HDs
    • Develop policies which provide guidance for healthcare workers handling HDs to pursue surveillance through primary care providers if needed

    The National Institute for Occupational Safety and Health (NIOSH), which is within the Centers for Disease Control (CDC) published recommendations entitled Medical Surveillance for Healthcare Workers Exposed to Hazardous Drugs (http://www.cdc.gov/niosh/docs/wp-solutions/2013-103/pdfs/2013-103.pdf). Within this document are a listing job titles that may involve exposure to hazardous drugs and the steps included in a medical surveillance program. Each healthcare organization should determine who would be included in the surveillance based upon their interaction with hazardous drugs. 



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    Mark Vrabel
    INFORMATION RESOURCES SUPERVISOR
    Oncology Nursing Society
    Pittsburgh PA
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