Occupational Exposure to Antineoplastic Drugs: Identification of Job Categories Potentially Exposed throughout the Hospital Medication System

OBJECTIVES: Studies examining healthcare workers' exposure to antineoplastic drugs have focused on the drug preparation or drug administration areas. However, such an approach has probably underestimated the overall exposure risk as the drugs need to be delivered to the facility, transported internally and then disposed. The objective of this study is to determine whether drug contamination occurs throughout a facility and, simultaneously, to identify those job categories that are potentially exposed. METHODS: This was a multi-site study based in Vancouver, British Columbia. Interviews were conducted to determine the departments where the drugs travel. Subsequent site observations were performed to ascertain those surfaces which frequently came into contact with antineoplastic drugs and to determine the job categories which are likely to contact these surfaces. Wipe samples were collected to quantify surface contamination. RESULTS: Surface contamination was found in all six stages of the hospital medication system. Job categories consistently found to be at risk of exposure were nurses, pharmacists, pharmacy technicians, and pharmacy receivers. Up to 11 job categories per site may be at risk of exposure at some point during the hospital medication system. CONCLUSION: We found drug contamination on select surfaces at every stage of the medication system, which indicates the existence of an exposure potential throughout the facility. Our results suggest that a broader range of workers are potentially exposed than has been previously examined. These results will allow us to develop a more inclusive exposure assessment encompassing all healthcare workers that are at risk throughout the hospital medication system.

Patient Safety in Drug Therapy and the Influence of the Prescription in Dose Errors / Segurança do paciente na terapêutica medicamentosa e a influência da prescrição médica nos erros de dose / Seguridad del paciente en la terapéutica medicamentosa y la influencia de la prescripción médica en los errores de dosis

The aims of this study were to analyze the redaction of the prescription in dose errors that occurred in general medical units of five Brazilian hospitals and to identify the pharmacological classes involved in these errors. This was a descriptive study that used secondary data obtained from a multicenter study conducted in 2005. The population consisted of 1,425 medication errors and the sample of 215 dose errors. Of these, 44.2 percent occurred in hospital E. The presence of acronyms and/or abbreviations was verified in 96.3 percent of prescriptions; absence of the patient registration in 54.4 percent; absence of posology in 18.1 percent; and omission of date of 0.9 percent. With respect to medication type, 16.8 percent were bronchodilators; 16.3 percent were analgesics; 12.1 percent, antihypertensives; and 8.4 percent were antibiotics. The absence of posology in the prescriptions may facilitate the administration of the wrong dose, resulting in inefficiency of the treatment, compromising the quality of care provided to hospitalized patients.

Os objetivos foram analisar a redação da prescrição médica nos erros de doses, ocorridos em unidades de clínica médica de cinco hospitais brasileiros, e identificar as classes farmacológicas envolvidas nesses erros. Este é estudo descritivo que utilizou dados secundários, obtidos de pesquisa multicêntrica, realizada em 2005. A população foi composta por 1425 erros de medicação e a amostra por 215 erros de doses. Desses, 44,2 por cento ocorreram no hospital E. Verificou-se presença de siglas e/ou abreviaturas em 96,3 por cento das prescrições, ausência do registro do paciente em 54,4 por cento, falta de posologia em 18,1 por cento e omissão da data em 0,9 por cento. Com relação ao tipo de medicamento, 16,8 por cento eram broncodilatadores, 16,3 por cento eram analgésicos, 12,1 por cento, anti-hipertensivos e 8,4 por cento eram antimicrobianos. A ausência da posologia nas prescrições pode favorecer a administração de doses erradas, resultando em ineficiência do tratamento, comprometendo a qualidade da assistência prestada aos pacientes hospitalizados.

Los objetivos fueron analizar la redacción de la prescripción médica en los errores de dosis ocurridos en unidades de clínica médica de cinco hospitales brasileños e identificar las clases farmacológicas envueltas en esos errores. Se trata de estudio descriptivo que utilizó datos secundarios obtenidos de en una investigación multicéntrica realizada en 2005. La población fue compuesta de 1.425 errores de medicación y la muestra por 215 errores de dosis. De estos, 44,2 por ciento ocurrieron en el hospital E. Se verificó: presencia de siglas y/o abreviaturas en 96,3 por ciento de las prescripciones; ausencia del registro del paciente en 54,4 por ciento; falta de posología en 18,1 por ciento, y omisión de la fecha en 0,9 por ciento. Con relación al tipo de medicamento, 16,8 por ciento eran broncodilatadores; 16,3 por ciento eran analgésicos; 12,1 por ciento, antihipertensivos y 8,4 por ciento eran antimicrobianos. La ausencia de la posología en las prescripciones puede favorecer la administración de dosis equivocadas, resultando en ineficiencia del tratamiento, comprometiendo así, la calidad de la asistencia prestada a los pacientes hospitalizados.