Pan London Guidelines for the Safe Prescribing, …

1 Pan London Guidelines for the safe prescribing , handling and administration of Systemic Anti Cancer Treatment Drugs Document Detail Document Type Operational Policy Pan London Guidelines for the safe prescribing , handling and Document name administration of Systemic Anti Cancer Treatment Drugs Document location Version V Effective from April 2011. Review date No later than April 2013. Owner London Cancer Networks Prepared by Jacky Turner and Pauline McCalla Approved by, date London Cancer New Drugs Group, March 2011. Relevant external law, Manual for Cancer Services 2004. regulation, standards Department of Health Guidance National Confidential Enquiry into Patient Outcome and Death (NCEPOD) 2008. National Chemotherapy Advisory Group (NCAG). Cancer Reform Strategy Medicines and Healthcare products Regulatory Authority (MHRA). National Patient Safety Agency (NPSA). EU Directives Health & Safety Executive directives COSHH.

2 British Oncology Pharmacists Association (BOPA) Standards Pan London Guidelines for safe prescribing , handling and administration of Cytotoxic Drugs Version Page 1 of 107. Change History Date Change details Approved by 11th March First Draft 2008. 18th March Draft Consultation Pan 2008 Introduction, Scope and Sections , , , , , London Network , , reviewed and comments incorporated. Pharmacists 16th July Draft Consultation Pan Incorporated comments on Sections 14,15 & 16 & London Network Appendix I & H Pharmacists & Lead Chemo nurses, N &. NE London 11th Health & Safety Section added. September 1st October Wastage & Spillage sections added (prior to comments). 2008. 27th April Inc. Non-medical prescribing responsibilities JT. 2009. 14th May Incorporate clinical governance, oral chemotherapy, JT. 2009 extravasation and administration sections. 28th May Incorporate Out of Hours section 2009. 13th July Incorporate purchasing, preparation, supply, CA, JT, KD and LC.

3 2009 transportation and storage section, the Education and Training section 30th July Incorporate commentsfrom14th July JT. 2009. 31st July IV administration section updated JT. 11th Jan Comments from AC Newham, contact details for NLCN, JT. 2010 NELCN and KCH added, community section added 23rd Nov Comments from RMH added, extravasation section PMc 2010 revised, Contacts from NWLCN added 21st Dec Comments from ,RFH and , SMH PMc 2010 added 25th Jan Revised extravasation section, comments from all PMc 2011 networks and updated contacts list. 17th Feb Final revisions PMc 2011. 31st Mar Addition of final comments PMc 2011. Pan London Guidelines for safe prescribing , handling and administration of Cytotoxic Drugs Version Page 2 of 107. CONTENTS. page Introduction 7. Scope of the document 8. 1 Health & Safety 9. Staff monitoring 9. Personnel records 10. Pregnancy and breastfeeding 10. Monoclonal Antibodies 11.

4 Gene Therapy 11. Control of exposure to cytotoxic drugs 11. Recommended good practice 11. Minimising exposure 12. Personal protective equipment to be used when handling cytotoxic drugs 12. Hand protection 12. Eye protection 13. Torso protection 13. Gowns 13. Respiratory protection 14. Recommendations for Personal Protective Equipment in handling activities 14. 2 Clinical Governance 15. Senior management with Cancer Networks and Individual Trusts 15. Department managers and supervisory staff 15. Employees and medical staff 15. 3 Staff responsibilities and standards 16. Prescribers responsibility (including non-Medical prescribers) 16. All prescribers are responsible for; 17. Pharmacists responsibility 19. Nurses responsibility 20. Prescriptions 21. Consent for treatment 23. Chemotherapy off-protocol prescribing 23. 4 Purchasing, preparation, supply, transportation and storage of 25. chemotherapy Purchasing, receipt and storage in pharmacy 25.

5 Preparation of cytotoxic drugs 25. Supply of cytotoxic drugs 26. Transportation of cytotoxic drugs 26. Storage in clinical areas 27. 5 Preparation of cytotoxic drugs 28. Pharmacy cytotoxic preparation services 28. page 6 Out of hours initiation and administration of chemotherapy 29. Pan London Guidelines for safe prescribing , handling and administration of Cytotoxic Drugs Version Page 3 of 107. Exceptional circumstances 29. Out to hours preparation of chemotherapy doses 29. Out of hours preparation in clinical areas 30. Protective clothing 30. 7 administration of cytotoxic drugs 31. Facilities 31. Equipment 32. 8 prescribing . Dispensing and administration of oral anti cancer 33. treatments Principles of safe practice 33. prescribing 33. Prescription verification 34. Dispensing and labelling 34. General Guidelines for handling and administration of oral formulations 35. Spillage 35. Patient education and information 36.

6 9 administration of intravenous chemotherapy 37. Selection of device 37. Peripheral venous cannulation 37. Central venous catheters 38. Sequencing of drugs 38. Monitoring 39. Stop administering if 39. General principles of intravenous administration 39. administration of bolus chemotherapy for adults 41. administration of bolus chemotherapy for children 41. administration of vesicant drugs 41. administration of irritant drugs 42. administration of non-vesicant drugs 42. 10 administration via specific routes 43. Subcutaneous / Intramuscular chemotherapy 43. Specific additional equipment 43. Procedure 43. Intrapleural instillation 43. Specific additional equipment 44. Procedure 44. Intravesical instillation 45. Specific additional equipment 45. Procedure 45. Intraperitoneal instillation 46. Specific additional equipment 46. Procedure 46. administration of chemoembolisation 47. Specific additional equipment 47.

7 Procedure 48. administration of topical cytotoxic chemotherapy 48. Pan London Guidelines for safe prescribing , handling and administration of Cytotoxic Drugs Version Page 4 of 107. Specific additional equipment 48. Procedure 49. administration of cytotoxic solutions as ear drops 50. Carmustine implantation 50. 11 Extravasation 51. Definition 51. Prevention of extravasation 51. Cannulation 52. Education 52. Training 52. Signs and symptoms 52. Immediate management 53. Vesicant drugs 55. Plastic Surgery intervention including the Flush Out Technique 56. Subsequent treatment of extravasations 56. Peripheral cannulae 56. Irritant and non-vesicant drugs 56. Use of antidotes and hot/cold packs 57. Documentation 58. Classification of drugs 59. 12 Disposal of cytotoxic waste 61. Used disposable equipment 61. Contaminated non-disposable equipment/ items 61. Protective clothing and wipes 61. Part used doses 62. Unused oral doses 62.

8 Patient waste/body fluids 62. Soiled bedding/linen 62. Nappies 63. Disposal of waste in primary care/ community care 63. 13 Personal accidents 64. Skin 64. Eyes 64. Needlestick injuries 65. Clothing 65. 14 Cytotoxic spillages 66. Immediate action 66. Subsequent action 66. Liquid spillages 67. Powder spillages 67. Final clean up 67. page 15 Community chemotherapy 68. Pan London Guidelines for safe prescribing , handling and administration of Cytotoxic Drugs Version Page 5 of 107. Delivering intravenous chemotherapy closer to home 68. Selecting patient groups for community chemotherapy 69. Suitability of the environment for home chemotherapy 69. Delivering chemotherapy in a community setting 70. Support for patients 70. Administering subcutaneous, intramuscular, topical and continuous IV 71. chemotherapy by community and district nurses Patients administering oral chemotherapy at home 71. Information for patients producing cytotoxic waste at home 71.

9 16 Education and training 72. Training programmes for nursing and medical professionals 72. prescribing chemotherapy 73. Medical and nursing staff administering chemotherapy 73. Pharmacy staff 73. handling 73. Preparation 74. Clinical screening of chemotherapy prescriptions (including oral 74. chemotherapy). Domestic staff 74. Portering staff 74. Other staff in clinical areas 74. Multidisciplinary education and training 75. Appendices A Network and Trust Cancer Services contact names and numbers 76. B Pharmacy Cytotoxic reconstitution unit opening hours including 84. arrangements for Out of Hours chemotherapy in London and contact numbers C Guidelines for Nurses or Medical Staff Who May Be Reconstituting 89. Cytotoxic Drugs. D Sample of Cytotoxic Drug Extravasation Documentation Form 91. E Sample Patient Information sheet on extravasation 94. F Advice for patients and carers for the disposal of cytotoxic waste and 95.

10 Management of cytotoxic spillages in the home G Chemotherapy off protocol form 96. H Contents of in-house cytotoxic spillage kits for hospital use 97. I Example of spillage poster 98. J Glossary of terms 101. K Contributors to the Pan London Guidelines for the safe prescribing , 102. handling and administration of Systemic Anti Cancer Treatment Drugs References 103. Pan London Guidelines for safe prescribing , handling and administration of Cytotoxic Drugs Version Page 6 of 107. Introduction This document has been produced by collaborative working between the Network Chemotherapy Boards of North Central London & West Essex Cancer Commissioning Network and North East London Cancer Network, the Drugs and Therapeutics Advisory Committee of South East London Cancer Network, the North West London Cancer Network Drugs, Therapeutics and Chemotherapy Committee, and the South West London Cancer Network Chemotherapy Group.