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Pan London Guidelines for the Safe Prescribing, …

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.

Pan London Guidelines for Safe Prescribing, Handling and Administration of Cytotoxic Drugs Version 1.0 Page 1 of 107 Pan London Guidelines for the Safe

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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.

2 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. 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.

3 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.

4 2009 extravasation and administration sections. 28th May Incorporate Out of Hours section 2009. 13th July Incorporate purchasing, preparation, supply, CA, JT, KD and LC. 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.

5 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. 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.

6 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.

7 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. 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.

8 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.

9 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.

10 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. 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.


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