Reconditioning solid oral doses of hazardous drugs: Quebec experience

Introduction

There are risks to the health of workers who are occupationally exposed to hazardous drugs.

Objectives

The objective is to identify hazardous drugs available in solid oral forms, available and optimal reconditioning methods for oral doses of hazardous drugs and to discuss the precautions and personal protection equipment to be used by pharmacy and wards’ staff in handling these doses.

Methods

Literature review and descriptive study.

Results

The most recent list of the National Institute for Occupational Safety and Health (NIOSH) published in 2014 contains 184 of which 87 are not antineoplastic drugs. In Canada, drug commercialization falls under a federal competence while professional practices fall under provincial jurisdiction. Although there is no legal status for hazardous drugs in Canada, several provinces have adopted guidelines surrounding the handling of hazardous drugs, targeting mostly antineoplastic. In Quebec, the Association pour la santé et la sécurité au travail (ASSTSAS) and the Ordre des pharmaciens du Québec published respectively in 2008 and 2015 their guidelines. Generally, recommendations include proper training of staff, the use of personal protective equipment and appropriate management, exclusion of these products from robots and automated packagers, maintenance procedures and destruction. In health facilities, the solid oral forms of hazardous drugs are repackaged via manual supply trays of packaging robots with targeted maintenance or packaged manually.

Discussion

If the application of these recommendations is increasingly widespread across pharmacy departments and retail pharmacies, more progress is expected in patient care units, outpatient clinics and patients’ homes. A survey to assess the implementation of the progress of these recommendations is desirable.

Conclusion
Quebec’s guidelines offer general recommendations surrounding the repackaging of solid oral doses of hazardous drugs. More specific recommendations, taking into account risks, the needs of the institutions and validation of optimal scenarios are under discussion.