In the medical-surgical ICU where I work, we frequently provide care for oncology patients who are receiving chemotherapy. We are not trained in chemotherapy administration and management, therefore it is a biochemical health hazard for the untrained nursing staff. Using the hierarchy of controls, this is how I would propose to address the issue:
PPE: Protect the Worker with Personal Protective Equipment
- Implement education and training to newly hired nursing staff and annually to all patient care staff on proper use of personal protective equipment when providing care to ICU patients receiving chemotherapy
Administrative Controls: Change the Way People Work
- Facilitate easier access to PPE by ensuring that the unit is well stocked and that it is easy to find
- Provide supportive education and training that is not punitive to all patient care staff (no question is a dumb question type of attitude)
Engineering Controls: Isolate People From Hazard
- Design chemowaste management systems to be more accessible, convenient and user friendly to patient care staff
- Design at least one room in the ICU to be appropriate for chemotherapy
Substitution: Replace the Hazard
- Optimal intervention is to reduce exposure or minimize the effects of exposure through staff education and training
Elimination: Physically Remove the Hazard
- Have appropriate and secure disposal systems accessible to patient care staff
In my ICU unit, the main barrier of patient care staff to exercising their rights to a healthy and safe workplace is lack of knowledge and training. It is the responsibility of management to provide this training, yet they do not see it as a priority, because we are a "medical-surgical ICU," despite the fact that 50% of our patients have cancer and receive some form of anti-cancer treatment.
Hi Allyssa,
ReplyDeleteYou presented a very well thought out approach to addressing the biochemical hazard of chemotherapy administration and management due to untrained nursing staff. I wanted to especially note your recommendation for engineering controls, which is an an appropriate method of isolating patients to specialized rooms for chemotherapy administration and providing a method of chemowaste management to ensure a reduction in exposure to these specific biohazards.
I am surprised to hear that there is no training on best practices for handling biochemical hazards such as chemotherapy. However, it makes sense that you would assume most ICUs do not handle chemotherapy. Is it true for all ICUs that a large amount of patients receive chemotherapy?
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