Voluntary questionnaire tracks chemo effects
No abnormal findings in medical surveillance
Hospitals are using questionnaires as a way to monitor the possible health effects on employees who work with chemotherapeutic agents. But there are no guidelines that tell hospitals what to ask or how to implement the program.
At St. Luke’s Hospital in Bethlehem, PA, Stephanie Dillman, RN, employee health coordinator, developed a voluntary program with a questionnaire, physical exam, and lab tests that focus on possible areas of concern.
She worked with the inpatient nurse manager of the oncology unit, the outpatient infusion center manager and others in the oncology department to develop the program. (See copy of questionnaire)
About 200 people handle chemotherapeutic agents at the health system’s three hospitals, but fewer than 10 employees have participated in the surveillance. No abnormal findings have been uncovered.
"My impression is that [the employees] are comfortable with what they’re doing and don’t feel there’s a real concern," Dillman notes.
Yet the hospital felt it was important to offer the screening, based on recommendations from the National Institute for Occupational Safety and Health (NIOSH) and the Oncology Nursing Society in Pittsburgh.
A 2004 NIOSH alert recommended medical surveillance of employees, among other practices, for safe handling of hazardous drugs.
"A questionnaire is the place to start to identify people who have the potential for exposure and see if they’re having any problems," says Thomas Connor, PhD, a research biologist with NIOSH in Cincinnati and author of the alert.
The Oncology Nursing Society (ONS) provides a web-based course of safe handling of hazardous drugs, as well as a text. Both include information on medical surveillance. The web course includes live on-line chats to allow for interactive sessions. (More information is available at www.ons.org.)
Surveillance for effects related to hazardous drug exposure is not unlike surveillance of bloodborne pathogen exposure or tuberculosis screening, says Martha Polovich, MN, RN, AOCN, an oncology clinical nurse specialist at Southern Regional Medical Center in Riverdale, GA, and a member of the NIOSH working group on antineoplastic and other hazardous drugs. She also was an author of the ONS guidelines, Safe Handling of Hazardous Drugs.
"It’s the backdoor way of looking at the effectiveness of your [safe handling] program," adds Polovich. "If your program is working the way it should, you shouldn’t see any health effects. But that doesn’t mean you shouldn’t look for them.
"The minimum someone has to do is to be able to identify the people who are at risk, based on employment activities. Then they do need to do some baseline assessment at hire, and some form of periodic assessment, whether that’s a questionnaire to look for health effects or a questionnaire plus some lab work. Then they have to have a plan for monitoring an employee who has an acute exposure from a spill, including follow-up," she says.
The surveillance program at St. Luke’s includes questions about reproductive health history, the use of personal protective equipment, and a list of symptoms. The lab work includes a liver function test, a complete blood count with differential, creatinine level, and urinalysis.
It is reassuring when the results come back negative, Dillman adds. "It’s not something that’s easily monitored. When you do nuclear medicine, they can sweep the room to see if there’s been any exposure, but they can’t do that with chemo. You’re just assuming that your personal protective equipment is working and your work practice is good."
Hospitals are using questionnaires as a way to monitor the possible health effects on employees who work with chemotherapeutic agents. But there are no guidelines that tell hospitals what to ask or how to implement the program.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content. TESTING
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