Working With Hazardous Medications in Long-term Care Pharmacy

Staff at long-term care facilities, including providers of LTC pharmacy services, may be exposed to hazardous medications at various points throughout the day. It is likely that staff will be involved in activities that have the potential for contact with uncontained medications. Exposure to these medications in the workplace has been associated with acute and short-term reactions (such as nausea, rash, and mucosal irritation), as well as long-term effects (such as congenital abnormalities). Staff safety is paramount, and it’s important for long-term care pharmacy providers to inform other staff of the risk and how to avoid or reduce risk. While hazardous medications are most commonly thought of in association with chemotherapy (antineoplastic agents), there are many other medications that are officially classified as hazardous. Hazardous medications are organized into three groups—antineoplastic agents, non-antineoplastic agents that meet one or more NIOSH criteria, and medications with reproductive risk for those who are pregnant, breastfeeding or actively trying to conceive.  Examples of non-antineoplastic hazardous medications include hormonal products, antibiotics, and immunosuppressant medications. A complete list of medications that are considered to be hazardous can be located in the Grane Rx Policy and Procedure Manual.

How to Handle Hazardous Medications

When handling hazardous medications, good work practice includes: Hazardous medications should be prepared by post-acute care pharmacy providers, not by nurses or physicians without proper PPE and engineering controls. The risk of exposure to hazardous medication through inhalation or direct skin contact is present in procedures such as:
  • Transferring hazardous drugs from one container to another, reconstituting, or manipulating medications
  • Withdrawal of needles from drug vials
  • Expulsion of air from a drug-filled syringe. Expelling air from syringes should be done in the biological safety cabinet, not by the healthcare worker giving the injection.
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How Long-term Care Pharmacy Can Mitigate the Risks of Hazardous Medications During Administration

Exposure to a hazardous medication is potentially likely during administration. Good work practices include:
  • When administering medications, look for stickers or labeling which indicates that the medication in the container is hazardous.
  • Personnel administering oral hazardous medications wear latex gloves.
  • Only those trained to administer hazardous medications should be allowed to perform this function.
  • Until the reproductive risks associated with handling hazardous medications have been substantiated, staff members who are pregnant or breastfeeding should avoid contact with these medications.

How Long-term Care Pharmacy Can Mitigate the Risks of Hazardous Medications During Caregiving

Exposure to hazardous medications during care giving can occur when dealing with excreta that may contain high concentrates of hazardous medications. Special precaution need to be taken by personnel while caring for a resident who has been taking hazardous medications. These include:
  • If personnel are unable to differentiate between body fluid types, care should be given in accordance with the Bloodborne Pathogens Standard. Universal precautions must be observed to prevent contact with blood or other potentially infectious materials.
  • Personnel, including nursing and housekeeping, who deal with excreta, primarily urine, from patients who have received hazardous medications in the last 48 hours, should wear PPE, gloves, and gowns.
  • Gloves be discarded after each use or immediately if contaminated.
  • Gowns should be discarded after leaving the patient-care area or immediately if contaminated.
  • Hands must be washed thoroughly after hazardous medications are handled.
  • Disposable linen or protective pads should be used for incontinent or vomiting patients.
  • Contaminated non-disposable linen or protective pads require prewashing.
While it’s important to use appropriate precautions when coming into direct contact with hazardous medications and body fluids, it’s also important to keep in mind there is potential for there to be particulate matter on the outer container of the hazardous medication products. It’s difficult to stay up-to-date on the latest in pharmacy best practices. Our Grane Rx long-term care pharmacy services team is here to advise your SNF on all aspects of medication usage. Discover the Grane Rx difference today by calling (866) 824-MEDS (6337).]]>

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