Safe handling of hazardous drugs.

Background: This evidence-based practice guideline was developed to update and address new issues in the handling of hazardous drugs including being compliant with NAPRA (National Association of Pharmacy Regulatory Authorities) and USP 800 (United States Pharmacopeia) standards, the use of personal protective equipment and treatment in diverse settings including in the home setting. Methods: This guideline was developed from an adaptation and endorsement of existing guidelines and from three systematic reviews. Prior to publication, this guideline underwent a series of peer, patient, methodological and external reviews to gather feedback. All comments were addressed and the guideline was amended when required. This guideline applies to and is intended for all health care workers who may come into contact with hazardous drugs at any point in the medication circuit. Results: The recommendations represent a reasonable and practical set of procedures that the intended users of this guideline should implement to minimize the opportunity for accidental exposure. These recommendations are not limited to just the point of care, but cover the entire chain of handling of cytotoxics from the time they enter the institution until they leave in the patient or as waste. Conclusions: Decreasing the likelihood of accidental exposure to cytotoxic agents within the medication circuit is the main objective of this evidenced-based guideline. The recommendations differ slightly from previous guidelines due to new evidence.

Evaluating the outcomes of complex nursing initiatives: Insights from the CANO/ACIO National Strategy for Chemotherapy Administration Project.

Because nursing interventions are typically complex and dynamic, evaluating their impact upon care and care systems is a notoriously daunting challenge. Nursing organizations seeking to evaluate the impact of their efforts are frequently frustrated by the gap between the evaluation research ideal and their available resources. In this paper, we describe a practical and manageable process developed to address such an evaluation challenge. Using a three-step inquiry approach, supported by modest organizational funding and a realistic level of voluntary member time, we were able to generate a meaningful understanding of intersecting outcomes arising from the implementation of CANO/ACIO's National Strategy for Chemotherapy Administration. On the basis of our experience, we see considerable merit in both process and outcomes of this form of targeted evaluation.