[MCOH-EH] [EXTERNAL] hazardous drug administration

[Amy Behrman]

Thank you Warner; fantastic summary 

Amy Behrman,MD
University of Pennsylvania



> On Sep 1, 2017, at 11:11 AM, Hudson, T. Warner <TWHudson at mednet.ucla.edu> wrote:
> 
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> At AOHC 2017 in Denver there was a long session on this with several excellent speakers. And several of the UC OH Medical directors attended, me among them, and so with 5 of the  UCs having medical centers we too are all interested in doing the right thing.  Mark Russi, MD Medical Director of Occupational Health at Yale Hospitals presented a fantastic segment of the Denver sessions on this and among other things reviewed the published data on what you find if you do lab tests (CBC, U/A, BUN/creat, AST/ALT) on 1000 healthy non exposed individuals, and you will have over 900 abnormal results to chase down.  So consensus among the medical directors all trained in USPSTF and first do not harm is that doing physicals and labs as part of this surveillance will generate so much chasing of incidental personal health findings like the lab tests just noted at significant time, expense and hazard to these individual with no evidence based medicine evidence of benefit, that we at UC are going on the minimalist end of this “surveillance” spectrum; education, review of use of PPE and exposure history and potentially more if exposure occurs depending on the exposure.  Warner
>  
> T. Warner Hudson, MD FACOEM, FAAFP
> Medical Director, Occupational and Employee Health
> UCLA Health System and Campus
> Office 310.825.9146
> Fax 310.206.4585
> Pager 800.233.7231  ID 27132
> E-mail twhudson at mednet.ucla.edu
> Website www.ohs.uclahealth.org
>  
> From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Morelli, Karen J
> Sent: Friday, September 01, 2017 5:39 AM
> To: MCOH/EH <mcoh-eh at mylist.net>
> Subject: Re: [MCOH-EH] [EXTERNAL] hazardous drug administration
>  
> I, too, would love to see if anyone has a hazardous drug surveillance program in place as our system is looking at this as well.
>  
> Karen Morelli RN, BSN
> Clinical Manager
> WorkHealth LLC
> Eastern Maine Healthcare Systems
>  
> From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Angeli Mancuso
> Sent: Thursday, August 31, 2017 4:59 PM
> To: MCOH/EH
> Subject: Re: [MCOH-EH] [EXTERNAL] hazardous drug administration
>  
>  
>  
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>  
> Hi all,
>  
> 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? Are you asking them to complete the questionnaire and lab work (CBC, metabolic panel, UA) now and considering this a baseline?
> 
> 2)     What are you doing with abnormal lab results for these current employees? Referring to their own physician? Doing follow up and more extensive testing through Occupational Medicine to determine other underlying health conditions and then referring to PCPs?
> 
> I’ve really appreciated the shared policies and forms from everyone! Thanks for being such a great community!
>  
>  
> Angeli Mancuso, RN, COHN-S/CM
> Manager, Employee Health & Safety | Cottage Health
> P.O Box 689 | 400 W. Pueblo St | Santa Barbara, CA 93102-0689
> Office: (805) 569-7866 |  Fax: (805) 569-8271
> a1mancus at sbch.org | cottagehealth.org
> www.lifewhereyouloveit.org
>  
> From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Allen-Hardy, Blythe
> Sent: Tuesday, August 01, 2017 3:39 PM
> To: MCOH/EH
> Subject: Re: [MCOH-EH] [EXTERNAL] hazardous drug administration
>  
> I’m fairly new to the organization so still learning how it is determined who’s in the program. I’m assuming that a list is giving to occur health by the director of oncology nursing. I can respond back once I get further clarification.
>  
> <image002.jpg>
>  
> Blythe Allen-Hardy, MD, FACOEM
> Medical Director, Employee Health
> Texas Medical Center
> 6411 Fannin, JB500
> Houston, Texas, 77030
> W: 713-704-2792
> C: 720-840-9593
> F: 713-704-6350
> Blythe.allen-hardy at memorialhermann.org
>  
> From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Thrasher, Terri
> Sent: Tuesday, August 01, 2017 1:34 PM
> To: MCOH/EH
> Subject: Re: [MCOH-EH] [EXTERNAL] hazardous drug administration
>  
> How do you determine who to place in surveillance and how many employees are you running through the surveillance labs?
> Terri
>  
> Kindest regards,
>  
> Terri
>  
> Terri L. Thrasher RN MSN
> Sr. Director HR
> Employee Health, Occupational Safety, Environmental Health, Employee Relations, Leave Management  HR Compliance/Policy, Workers Compensation, 803-SAFE, Injury Management, Non CCHMC Badging, Early Education and Childcare Center
> 3333 Burnet Ave
> Cincinnati Ohio 45229  MLC 9006
> 513-636-6240
>  
>  
>  
> From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Allen-Hardy, Blythe
> Sent: Tuesday, August 01, 2017 2:22 PM
> To: 'MCOH/EH' <mcoh-eh at mylist.net>
> Subject: Re: [MCOH-EH] [EXTERNAL] hazardous drug administration
>  
> Cathy,
>  
> At Memorial Hermann we have a surveillance program that I am in the process of updating due to the USP 800 requirements. We have a policy in place in our hospitals on how the drugs are handled etc and it is fairly comprehensive. The medical surveillance I believe as involved checking a CBC, UA and completing an annual questionnaire. I am developing a medical surveillance guideline that will addl laboratory tests such as LFT’s, BUN/Cr to the CBC w/diff and UA. Will also add a focused exam component for post exposures.
>  
> That may be overkill but I want to make sure we have a comprehensive program. Feel free to contact me for further questions.
>  
> <image002.jpg>
>  
> Blythe Allen-Hardy, MD, FACOEM
> Medical Director, Employee Health
> Texas Medical Center
> 6411 Fannin, JB500
> Houston, Texas, 77030
> W: 713-704-2792
> C: 720-840-9593
> F: 713-704-6350
> Blythe.allen-hardy at memorialhermann.org
>  
> From: MCOH-EH [mailto:mcoh-eh-bounces+blythe.allen-hardy=memorialhermann.org at mylist.net] On Behalf Of Senior, Cathy (Employee Health)
> Sent: Tuesday, August 01, 2017 11:42 AM
> To: 'MCOH/EH'
> Subject: [EXTERNAL] [MCOH-EH] hazardous drug administration
>  
>  
>  
> Does anyone have a medical surveillance plan for employees who handle hazardous drugs. We are seeing more administration of these hazardous drugs between starting the intravesical therapy and the biologics that are administered. We follow the ONS guidelines for safe handling of hazardous drugs as outlined in our policy. We already have the appropriate work practice in place including proper use of PPE and education for the staff that handle these drugs. There has been a concern voiced by one of our educators that institutions such as NIOSH have recommendations for medical surveillance to make it a comprehensive prevention program that we do not have in place.  Some of the drugs we administer is  Carboplatin, VP-16, Taxol, Cisplatin, Cytoxan, Erbitux, 5-FU, Abraxane, Gemzar, Herceptin, Parieto and Rituxan to name a few. We also give biologics to out-patients in our short stay unit. Any help would be much appreciated.  Thanks
>  
>  
> Cathy Senior RN BSN CDE
> Employee Health Director
> Penn Highlands DuBois
> 100 Hospital Avenue
> P.O. Box 447
> DuBois Pa 15801
> Phone 814-375-3392
> Fax 814-372-2610
> cesenior at phhealthcare.org
> www.phhealthcare.org
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