In response to QHC’s commitment to enhance the quality and safety of care for our patients and health care workers, oncology, pharmacy and nursing staff are now using a new system that provides an added protection while preparing and administering hazardous drugs.
In September, QHC implemented the use of BD PhaSeal; a closed system transfer device (CSTD) that not only prevents drug exposure but also reduces surface contamination and provides ergonomic benefits for those who prepare and administer hazardous drugs.
Prior to the implementation of the closed system at QHC, hazardous drugs were being prepared in a biohazard safety cabinet using a standard needle and syringe technique, which is referred to as an “open system”. Open system manufacturing carries the potential risk of aerosolizing or splattering/spraying hazardous drugs from pressurized vials within the hood and possibly exposing staff to vapors or needle stick injury. According to Karen Smith, Director of Pharmacy at QHC, the original request for a CSTD product came from the pharmacists in Oncology. However, because CSTDs are an additional cost and the fact that the use of closed systems for hazardous products are recommended but not mandated, it was a lengthy process to receive approval to purchase BD PhaSeal. The staff cited not only the potential risk of contamination as a concern but also the issues that the open system technique caused when drawing up medications. “There’s a lot of push and pulling while mixing chemo drugs and the drugs are getting viscous (thicker) so there’s a lot more potential for arm and wrist injuries for staff.” Smith said that BD PhaSeal has a balloon to equalize pressure within the vial so there is a lot less manipulating and minimizing the need to use the “milking” technique to avoid aerosolization of the product.
Smith said that although the staff have always used safe practices while drawing up medications, there was still a potential risk involved while using the open system technique. “When you add liquid to a powder in a vial, for example, you can create an imbalance in pressure so you have to “milk it” so that you don’t get overpressure in the vial. If there is overpressure, it can lead to inadvertent aerosolization whereby the product comes out of the hole made from the tip of the needle.” Because most of the drugs that are used in Oncology are cytotoxic (used primarily to treat cancer) the drugs kill not only cancer cells but normal cells as well. “If you’re exposed to it, you run the risk of having some cell death,” Smith added. She said although there is potential that aerosolization could occur while mixing hazardous drugs using the open technique, the staff are very careful to avoid it from happening. “We’ve always had measures in place to protect those who are mixing drugs in oncology. This is just an added protection.”
BD PhaSeal not only provides ergonomic benefits and protects staff from potential contamination while preparing hazardous drugs, it is also added protection for the nurses in Oncology who are administering the medications. Jane Palmateer, Oncology Team Leader said that staff now have the option to apply a transfer device to the patient’s medication lines when intravenous therapy is required. “In the past and prior to the implementation of PhaSeal, there was a potential that a drop of IV fluid could occur when the line was removed. Having this new system in place makes us feel safer because it’s a closed system and there’s now no potential for ‘a drop of any fluid to escape’.
Shaena Dearman, Occupational Health & Safety Consultant with QHC said that along with the concern for hazardous drug exposure, there had been reports of repetitive strain from the pharmacy staff who performed the task of mixing chemotherapy drugs and BD PhaSeal presented as a good option to reduce these types of injures. “We were looking for any way of trying to reduce this hazard because we not only want our staff to be safe, but it is also costly to have those types of workplace incidents,” she said.
Smith said that because there is an added cost for every time the CSTD product is used, staff continue to use the open system technique when drawing up and administering non-hazardous medication. “We don’t use it (Phaseal) for everything we mix. We have certain drugs that are not cytotoxic and we don’t use the product when we’re mixing those.” She said that when intravenous therapy is required, they leave it up to the nursing staff to determine whether or not they add the device to the line. “That has worked really well. They like being able to decide whether or not they use it,” she added.
BD, the manufacturer of BD PhaSeal, returned to QHC in early December to host lunch and learns with staff and offered tips and tricks for safe handling and proper ergonomics while using the system. During the sessions, staff reported that the system has made their processes easier, they now feel safer and protected, and feel their workflow is more efficient. Those who prepare the medications are also experiencing less pain and strain on their joints.
BD is an international medical technology company with offices in more than 50 countries. Although a CSTD is not yet mandatory for healthcare workers in Ontario who prepare and administer hazardous drugs, approximately 35% percent of hospitals in Ontario are using BD PhaSeal.