[MCOH-EH] MCOH-EH Digest, Vol 252, Issue 271 Hazardous Drug Administration

Sharon Petersen Sharon.Petersen at imail.org
Sun Sep 10 13:38:13 PDT 2017
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We are a large integrated healthcare organization with many locations. Compliance was a nightmare for many years, so we had to mandate compliance by policy for employee Health (EH) requirements.  Surveillance programs are among the EH requirements and if people do not comply they are held to the sanctions of the policy. We have the support of HR and leadership, which is critical to holding people to the policy. Negative reinforcement isn't ideal by any means, but our efforts to achieve compliance through non-compulsory means were resource-intensive and in vain.

Sharon Petersen, MHA, BSN, RN, COHN/CM
Director Employee Health Operations
Intermountain Healthcare

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On Sep 9, 2017, at 1:00 PM, "mcoh-eh-request at mylist.net<mailto:mcoh-eh-request at mylist.net>" <mcoh-eh-request at mylist.net<mailto:mcoh-eh-request at mylist.net>> wrote:

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Today's Topics:

  1.  hazardous drug administration (Dr Joe Fanucchi)


----------------------------------------------------------------------

Message: 1
Date: Fri, 8 Sep 2017 23:07:40 -0700
From: Dr Joe Fanucchi <drjoe at meditrax.com<mailto:drjoe at meditrax.com>>
To: mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>
Subject: [MCOH-EH] hazardous drug administration
Message-ID: <b0ba37f6-9947-5d7e-7982-94bfb6a25edc at meditrax.com<mailto:b0ba37f6-9947-5d7e-7982-94bfb6a25edc at meditrax.com>>
Content-Type: text/plain; charset="windows-1252"; Format="flowed"

On 8/31/2017 1:59 PM, Angeli Mancuso wrote:
I sincerely appreciate the input and perspectives from this group. I
have some follow up questions that I?m curious how others are handling:
1)For current employees, how are you getting folks into compliance
with this regulation?
------------------------------------------------------------------------

Colleagues,

After seeing a number of references to "Pharma 800 requirements" and
"the new hazardous drug administration regulation." I made several
inquiries to the NIOSH and OSHA folks at the AOHP Conference in Denver.
None of them recognized the term "Pharma 800", and they were unable to
find any references to that specific term online.

They were also puzzled by references to "USP 800 _regulations_" or "USP
800 _ru__les_".

 * USP is a non-governmental agency which is not authorized to issue
   regulations, and which charges a fee to obtain a copy of their "best
   practices" recommendations. USP 797, and now 800(2016), provide the
   national professional standard for pharmacy processes to protect the
   safety and health of employees, not only patients. USP 800 addresses
   drug preparation, administration, disposal and spill management
   procedures that minimize worker and environmental exposure. It
   should be noted that these documents provide guidance from USP
   related to worker protection. However, they are _not_ OSHA regulations.
 * I was informed that although _OSHA has no explicit standard_, USP
   800 focuses explicitly on protecting workers from exposures to
   hazardous drugs. USP 797 and 800, then, represent "best practices"
   in healthcare that incorporate national consensus standards on
   infrastructure maintenance (ASTM).
 * Since 2008, the Oncology Nursing Society/American Society of
   Clinical Oncology
   <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.ons.org_practice-2Dresources_standards-2Dreports_chemotherapy&d=DwICAg&c=II16XUCNF0uj2WHDMBdftpHZzyfqZU4E6o4J8m7Yfh-XF5deecOtjPXuMFvj1uWy&r=OMiruqkyeeRPiGKsXq9uKWtTLoMNZ3bMACcvvCq4FNU&m=-nB3YUknGYMj_6SVhoRor45Nia97ONRdfkLqDZk4klw&s=ts9FpU3gx6KtDpU7WteqrX85d_jbBciQHntEokMn9MA&e= >
   have developed a joint program with best practices and
   implementation guidance
   <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.ons.org_practice-2Dresources_standards-2Dreports_chemotherapy&d=DwICAg&c=II16XUCNF0uj2WHDMBdftpHZzyfqZU4E6o4J8m7Yfh-XF5deecOtjPXuMFvj1uWy&r=OMiruqkyeeRPiGKsXq9uKWtTLoMNZ3bMACcvvCq4FNU&m=-nB3YUknGYMj_6SVhoRor45Nia97ONRdfkLqDZk4klw&s=ts9FpU3gx6KtDpU7WteqrX85d_jbBciQHntEokMn9MA&e= >
   now available without charge.

NIOSH has compiled an updated list of antineoplastic and other hazardous
drugs (NIOSH List of Antineoplastic and Other Hazardous Drugs in
Healthcare Settings, 2014 <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.cdc.gov_niosh_docs_2014-2D138_&d=DwICAg&c=II16XUCNF0uj2WHDMBdftpHZzyfqZU4E6o4J8m7Yfh-XF5deecOtjPXuMFvj1uWy&r=OMiruqkyeeRPiGKsXq9uKWtTLoMNZ3bMACcvvCq4FNU&m=-nB3YUknGYMj_6SVhoRor45Nia97ONRdfkLqDZk4klw&s=ItIoguTFaiZDSbXerGPiUYKBOI1nFkDOOCjoAKxMFQ4&e= >).

Relevant OSHA regulations include:

 * 1910.1020
   <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.osha.gov_pls_oshaweb_owadisp.show-5Fdocument-3Fp-5Ftable-3DSTANDARDS-26p-5Fid-3D10027&d=DwICAg&c=II16XUCNF0uj2WHDMBdftpHZzyfqZU4E6o4J8m7Yfh-XF5deecOtjPXuMFvj1uWy&r=OMiruqkyeeRPiGKsXq9uKWtTLoMNZ3bMACcvvCq4FNU&m=-nB3YUknGYMj_6SVhoRor45Nia97ONRdfkLqDZk4klw&s=WbGmhj3cd28YwQlgHZbw8M9WoiFZ_7vQsEiGjrmfxA8&e= >,
   Access to employee exposure and medical records. OSHA requires the
   reporting of employee exposure to hazardous medications, and allows
   access to these records by employees.
 * 1910.1200
   <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.osha.gov_pls_oshaweb_owadisp.show-5Fdocument-3Fp-5Ftable-3DSTANDARDS-26p-5Fid-3D10099&d=DwICAg&c=II16XUCNF0uj2WHDMBdftpHZzyfqZU4E6o4J8m7Yfh-XF5deecOtjPXuMFvj1uWy&r=OMiruqkyeeRPiGKsXq9uKWtTLoMNZ3bMACcvvCq4FNU&m=-nB3YUknGYMj_6SVhoRor45Nia97ONRdfkLqDZk4klw&s=EBBQUzgWpm9xo0ZjMfw4c4Tt4JsgSIXhcolEbRUtMSg&e= >,
   Hazard communication. Includes the coverage of drugs and
   pharmaceuticals in the non-manufacturing sector. Requires any drugs
   posing a health hazard (with the exception of those in solid, final
   form for direct administration to the patient, i.e., tablets or
   pills) be included on lists of hazardous chemicals to which
   employees are exposed. In compliance with this standard all
   personnel involved in any aspect of the handling of covered
   hazardous medications must receive information and training to
   appraise them of the hazards in the work area. [related topic page
   <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.osha.gov_dsg_hazcom_index.html&d=DwICAg&c=II16XUCNF0uj2WHDMBdftpHZzyfqZU4E6o4J8m7Yfh-XF5deecOtjPXuMFvj1uWy&r=OMiruqkyeeRPiGKsXq9uKWtTLoMNZ3bMACcvvCq4FNU&m=-nB3YUknGYMj_6SVhoRor45Nia97ONRdfkLqDZk4klw&s=-lmI5KHSbjXJasnhX0dDwvy-LUPS3aqwz7apQ6CjJb0&e= >]
 * 1910.1450
   <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.osha.gov_pls_oshaweb_owadisp.show-5Fdocument-3Fp-5Ftable-3DSTANDARDS-26p-5Fid-3D10106&d=DwICAg&c=II16XUCNF0uj2WHDMBdftpHZzyfqZU4E6o4J8m7Yfh-XF5deecOtjPXuMFvj1uWy&r=OMiruqkyeeRPiGKsXq9uKWtTLoMNZ3bMACcvvCq4FNU&m=-nB3YUknGYMj_6SVhoRor45Nia97ONRdfkLqDZk4klw&s=OxEILFQV16397zdruzMgTjU4oK7HMThvRElm7-y1dBk&e= >,
   Occupational exposure to hazardous chemicals in laboratories
 * OSHA has also published a document Controlling Occupational Exposure
   to Hazardous Drugs
   <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.osha.gov_SLTC_hazardousdrugs_controlling-5Foccex-5Fhazardousdrugs.html-23surveillance&d=DwICAg&c=II16XUCNF0uj2WHDMBdftpHZzyfqZU4E6o4J8m7Yfh-XF5deecOtjPXuMFvj1uWy&r=OMiruqkyeeRPiGKsXq9uKWtTLoMNZ3bMACcvvCq4FNU&m=-nB3YUknGYMj_6SVhoRor45Nia97ONRdfkLqDZk4klw&s=lUocnhs16NUpBsG5li0ayIzpah1S7XkHYgexLcr6cAA&e= >.

Can any list members provide a specific reference to the origin of the
term "Pharma 800" if it is something other than what the OSHA and NIOSH
representatives described, or if the term refers to a specific set of
regulations?

Your comments and recommendations are most welcome regarding the
development and implementation of policies which will promote
professionally-endorsed "best practices," but in the absence of specific
regulations the MCOH-EH List's principal role may well be supporting the
exchange of creative approaches to this issue.

Regards,

Joe Fanucchi

--
*Joe Fanucchi MD FACOEM*
President and Medical Director
MediTrax / OHS, Inc. <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.meditrax.com_&d=DwICAg&c=II16XUCNF0uj2WHDMBdftpHZzyfqZU4E6o4J8m7Yfh-XF5deecOtjPXuMFvj1uWy&r=OMiruqkyeeRPiGKsXq9uKWtTLoMNZ3bMACcvvCq4FNU&m=-nB3YUknGYMj_6SVhoRor45Nia97ONRdfkLqDZk4klw&s=miyX9IMLFCTaYPOvB9ZeHA-IKDSHLTzFFIaRLEy3i0w&e= >
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End of MCOH-EH Digest, Vol 252, Issue 271
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