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Skip to 0 minutes and 15 seconds All containers should indicate that the drug is a cytotoxic. The primary container label should include the wording ‘cytotoxic’.

Skip to 0 minutes and 29 seconds The secondary packaging as well as transport containers, should have label with warning. Supply of cytotoxic drugs to a patient is by way of a medication order or prescription. Labelling content requirements are followed. User-applied labelling of medicines, fluids and lines should be followed, all injectable medicines and fluids removed from the manufacturer’s or hospital pharmacy’s original packaging prior to administration, or the labels should be on all containers for example, infusion bags, syringes, and basins containing medicines which leave the hands of the person preparing the medicine prior to administration that including flushes. all conduits, for example catheters and burettes and lines for parenteral administration.

Skip to 1 minute and 45 seconds Cytotoxic drugs for transportation, in this aspect, the following labels should be prominently displayed on the outer packaging and shipper, for example, ‘CYTOTOXIC — HANDLE WITH CARE’ label should be on. appropriate temperature and light conditions labels should be on. instructions in case of an emergency, particularly in regards to a spill or breakage. There should be clear contact details to source advice should this be required Cytotoxic drugs and related waste should be packaged and transported so as to provide adequate physical and chemical protection for the drug, and protection to handlers and the environment in the event of a spill. From a pharmacy to nursing stations, in terms of the Packaging.

Skip to 2 minutes and 57 seconds The Package in a sealed, leak-proof container, with outer bags heat-sealed where possible. Ensuring the container offers protection from light where required. Protect the drugs from breakage in transit. Containers used for transport should be hard walled, Contain leakage if breakage occurs, Childproof packaging. Containers should be appropriately labelled for the specified use, for example, intrathecal, oral or topical. Outer packaging to have ‘Cytotoxic’ label. Cytotoxic drug spill kits must be readily available to all workers involved in the transportation and receipt of cytotoxic drugs. Workers involved in the receiving and inventory control should be informed of the possibility of surface contamination.

Skip to 4 minutes and 23 seconds All workers, including contractors involved in the packaging, transportation, receiving and inventory control of the cytotoxic drug must receive appropriate training, for example, how to use a spill kit, what to do with contaminated waste following a spill cleanup, and what to do with packages that appear to be damaged, and health surveillance, monitoring as per risk assessment identification

Skip to 5 minutes and 3 seconds due to the potential of surface contamination, safe handling procedures such as wearing gloves, washing hands and cleaning surfaces must be undertaken. The supplier must provide the current safety data sheet when the cytotoxic drug is being supplied to the workplace for the first time or where the safety data sheet has been updated since the last supply. The transport could be a On-site waste transport.

Skip to 5 minutes and 49 seconds We need to be cautious about following matters do not overfill cytotoxic waste containers use dedicated, rigid walled, puncture-resistant containers, for example, wheelie bins, handcarts and trolleys, to move cytotoxic waste around the facility ensure such equipment for example, wheelie bins, handcarts and trolleys is appropriately labelled and kept clean, in accordance with infection control and other relevant standards schedule frequent waste collection rounds, that is the movement should be planned to avoid peak activity times for example, visiting hours, meal times and change of shifts. And avoid movement of cytotoxic waste through public areas or general staff thoroughfares

Skip to 7 minutes and 15 seconds ensure that waste disposal and linen chutes are not used for moving cytotoxic drug waste

Skip to 7 minutes and 27 seconds develop a cytotoxic spill management plan for spills occurring during transport where required, keep a record of waste movements. To ensure that cytotoxic drugs are safely administered, workplace design, use of specially designed equipment, safe work practices and personal protective equipment are essential. To ensure that risk control measures and safe work procedures and practices are developed, understood, implemented and maintained; education, training and supervision are crucial. Exposure while administering drugs may occur through following situation. handling cytotoxic drugs, spills, splashes to the skin or eyes, inhalation of airborne contaminants for example, which may be generated by the expulsion of air from a syringecontaining medicine, lastly sharps injuries. The following are examples of ways to ensure risk control measures implemented

Skip to 8 minutes and 53 seconds are the ‘best practice’: only undertake a drug administration service with risk control measures use closed system drug administration devices where possible drugs intended for administration are appropriately packaged, labelled and ready to use

Skip to 9 minutes and 21 seconds provide secure and labelled storage of waste and sharps containers to minimize exposure to cytotoxic waste provide information, training and education about side effects of cytotoxic drugs to the patient and cancer ensure that equipment used, such as infusion pumps as well maintenance and in good working order ensure access to emergency equipment is available at all times correct PPE is used for administration of all cytotoxic drugs.

Labeling, transporting and administration

After preparing and dispensing the cytotoxic drugs, it is important to safely transport to the patient location, which is usually at the nursing station.

In this video, Deputy Chiang will introduce the safety guidelines of it.

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This video is from the free online course:

Essentials of Good Pharmacy Practice: The Basics

Taipei Medical University