Question for hospital peeps about stocking cytotoxic agents in Pyxis

[justademigod]

I wondered if anyone would be willing to share their policies or informal practices regarding the loading of cytotoxic/chemotherapeutic agents into their automated dispensing cabinets? I am talking about unit dose tabs/caps/cups like methotrexate, bicalutamide, dutasteride, megestrol acetate liquid, etc. We have had these items on our ADCs for years but a staff member has recently suggested removing them, citing concerns of contamination of the machines as well as excessive exposure of personnel to these agents. This would seem to my thinking to be a bit of a specious argument, since any contamination would have long-since occurred, and I'm not aware of any contamination concern with prepackaged oral dosage forms (only IV formulations). So does anyone here keep cytotoxic agents out of their ADCs entirely or keep them only in a certain drawer? TIA.

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[PharmDstudent]

We just label the pocket with a hazardous drug warning sticker. Nurses who can not handle such medications should already know what they can and can not touch. Other than that, we haven't had any problems. ADM are meant to aid in medication delivery, not hinder it. So it seems like someone is trying to circumvent the system that's already in place instead of trying to improve and expand upon it.

Here's what I think you should do. Keep all hazardous meds contained in closed pockets like Cubies. Label the pockets as hazardous. Do not allow nursing to return those meds into the general return bin. Have a separate container for hazardous returns. Done.

 

[cnicolef08]

^^^ that's what we do at my hospital. We keep separate hazardous waste bins on the floors for the nursing to dispose but whether or not they use them correctly is a different story. We don't really keep cytotoxic agents in a special bin, they are stocked in our Omnicell carousel just like all the other drugs. We use the stickers and require the nurses to come to the pharmacy to pick them up though. They are very skeptical about sending those things thru the tube system and getting jolted around and possibly leaking out.

 

[confettiflyer]

Anything on the NIOSH list gets bagged/tagged separately and sits in a separate bin in the ADC. Comments on the MAR indicate the medication is cytotoxic/hazardous and that cues the RN to look in that particular bin.

 

[Dred Pirate]

Anything on the NIOSH list gets bagged/tagged separately and sits in a separate bin in the ADC. Comments on the MAR indicate the medication is cytotoxic/hazardous and that cues the RN to look in that particular bin.

we do what pharmdstudent does

Confettiflyer - with the NIOSH list you technically have three different disposal methods depending on the drug, so we decided to put all meds in one bin that gets handled and disposed of the most strigent way you need to. We figured the fine for one instance of non-compliance would be more than the increased cost of disposal.

 

[knight on horse]

If they are indeed prepackaged and sealed then you will have to ensure, off the top of my head

1. That they are indeed sealed i.e. the seal is good
2. Nurses and other personnel handling the machine don't leave residue that builds up over time
3. Production of these packages is clean with no contamination

 

[zelman]

Anything on the NIOSH list gets bagged/tagged separately and sits in a separate bin in the ADC. Comments on the MAR indicate the medication is cytotoxic/hazardous and that cues the RN to look in that particular bin.

Including clonazepam?

 

[confettiflyer]

I was talking out of my ass apparently. I'll pay attention at work on Monday and tell you all what we actually do.

 

[Dred Pirate]

Including clonazepam?

sorry - all meds minus controlled substances