Enhancing Chemotherapy Drug Administration Safety Through Nurse Self-Assessment

Introduction

Chemotherapy drug administration places nurses at a high risk for workplace exposure. Unsafe exposure to chemotherapy drugs has been known to cause “Increased cancer occurrence; adverse reproductive outcomes, including infertility and miscarriage; fetal defects when exposed during pregnancy” (Colvin et al., 2016, p. 1). The study discussed in this paper was aimed to determine if nursing staff followed their hospital’s policy and procedure for proper handling and disposal of chemotherapy drugs. The purpose of this paper is to highlight the importance of strict adherence to safe handling practices of chemotherapy drugs to reduce exposure.

Research Question and Objective

The research question for the article is, Do nurses adhere to “PPE recommendations and hospital policies for safe handling when administering and disposing of IV chemotherapy” (Colvin et al., 2016, p. 2)? The article describes that evidence was collected by evaluating the nurse’s self-assessment on whether PPE recommendations and hospital policies for safe handling were followed. As well as direct observation of the nurses to determine adherence to PPE recommendations and hospital policies for safe handling.

The article explains that the study was “A prospective, comparative mixed-methods study” (Colvin et al., 2016, p. 1). The study was observational and quantitative in nature, which allowed the researchers to observe nursing staff perform chemotherapy administration and handling as well as collect subjective data through the use of questionnaires. The study utilized “Micro-ethnography and questionnaires” (Colvin et al., 2016, p. 1).

This type of research has both strengths and weaknesses. The study’s strengths lie in the ability to access nurses in real-time. This allowed the researchers to gather immediate object data. The weakness of the research design is related to “The role of the observer and what effect he or she has on the people and situations observed” (University of Portsmouth, 2012). There is also the possibility of encountering ethical dilemmas, which can occur when “Observing real-life situations for research purposes” (University of Portsmouth, 2012). The researchers may choose this particular research design because the design is flexible and easy to implement in a medical center.

Sample and Data Collection

The sample included three observers and thirty-three nurses. The “Observers made 22 confidential observations on 13 different days and involving 12 of the 20 nurses who met inclusion criteria” (Colvin et al., 2016, p. 3). Also, twelve of the thirty-three nurses observed also completed the self-assessment questionnaire. The entire study was conducted at a single center. The study sample size is too small, and the study seems to lack enough participation from the nursing staff. The number of observations and self-assessment data is not adequate and, therefore, limits the study.

The data collected was collected by three researchers through direct observation and questionnaires. In order “To assess observations of handling, administering, and disposing of chemotherapy, a 15-item “yes or no” nurse skill checklist was developed by investigators” (Colvin et al., 2016, p. 2). The self-assessment questionnaire consisted of “A nine-item questionnaire that used a five-point Likert-type response set ranging from 0 (never) to 4 (always), plus a “not applicable” option.” (Colvin et al., 2016, p. 2). The researchers were sure to maintain the confidentiality of the nurses being observed and did not collect nurse characteristics. There was no mention of patient confidentiality and considerations or patient privacy.

Limitations of the Study

The limitations of the study are related to the sample size and the number of responses to the self-assessment questionnaire. Also, the researchers reported that “One nurse may have been observed more than one time on different days by different observers” (Colvin et al., 2016). It was also reported that there was a lack of consistency in the assessment wording, therefore potentially causing differences in reported frequencies in adherence to PPE recommendations. The limitations noted in the study could be overcome by conducting the study at more than one medical center and utilizing standardized assessments.

Listing limitations within a study is important because it allows the reader to better interpret the validity of the findings. It allows the reader to determine the quality of the research. It will also help the reader determine if the findings are credible and reliable.

Findings and Implications

The study found that of all the observed practices, nurses only completed three behaviors 100% of the time. The three items were “Disposing of gloves in a chemotherapy-approved container after initiating chemotherapy, discarding the chemotherapy bag and tubing after disconnecting chemotherapy infusions, and washing hands after chemotherapy was administered” (Colvin et al., 2016, p. 1).

The researchers also identified that three behaviors were completed with a higher frequency than what was reported on the questionnaires. The items were “Double gloving and gowning when disconnecting chemotherapy and properly discarding chemotherapy” (Colvin et al., 2016, p. 1). The researchers also concluded that two behaviors were completed with lower frequency than what was reported on the questionnaires. The items were “Double gloving and protecting work surfaces during administration” (Colvin et al., 2016, p. 1).

The study’s findings did help to answer the research question of whether or not nurses adhere to “PPE recommendations and hospital policies for safe handling when administering and disposing of IV chemotherapy” (Colvin et al., 2016, p. 2).

Conclusion

The study highlights the importance of safe chemotherapy drug administration. Unsafe exposure to chemotherapy drugs comes at a cost to the nurses providing its administration. The results of the study provide new information about nursing adherence to safe-handling policies and procedures. It is recommended that to maintain strict adherence to safe handling practices, nurses should be educated more frequently than once per year. It was also found that if even one person does not practice safe handling procedures, they place everyone at risk of exposure.

References

1. Colvin, C., Karius, D., & Albert, N. (2016). Nurse Adherence to Safe-Handling Practices:. Clinical Journal of Oncology Nursing, pp. 1–7.
2. University of Portsmouth. (2012). Primary Data Collection – Observations. Retrieved from http://compass.port.ac.uk/UoP/file/664e8001-f121-4e5d-aa06-6c95c797e8af/1/Observations_IMSLRN.zip/page_04.htm