title: Safe handling of cytotoxic drugs in the physician's office: a procedure manual model.
abstract: OBJECTIVE
  To present a model of an adapted manual of safety procedures designed for education and implementation of standardized cytotoxic drug handling in the private oncology office setting.
  
  
  METHODS
  Published articles, textbook chapters, published technical bulletins and guidelines, research studies identifying risks of occupational exposure and procedural guideline sources for reducing these risks.
  
  
  RESULTS
  Most published guidelines on safe handling of cytotoxic drugs address the hospital setting but lack practical guidelines for use within an oncology office. The procedures presented in this model are a composite of several current guidelines offering recommendations for minimizing chronic low-level exposure to cytotoxic drugs. The recommendations are compiled into a procedure manual for office settings.
  
  
  CONCLUSIONS
  The mere provision of laminar flow hood equipment in a physician's office is insufficient without a consistent policy for nursing personnel to follow. Such a policy should be established through the development of a standardized manual appropriate for the office that includes procedures required for the equipment. Adapting safety guidelines into an office procedural manual provides a practical and consistent approach to enhancing personal safety for oncology nurses within community office settings.
  
  
  CONCLUSIONS
  With today's rapid expansion of ambulatory chemotherapy services, the need for specialized instruction in the safe handling of cytotoxic drugs has become increasingly apparent. In the course of their duties, private office oncology nurses endure daily exposure to toxic agents, which poses a concern for occupational safety. An established procedure manual standardizes safe work practices for use in training new personnel and evaluating staff exposure to cytotoxic drugs.
authors.affiliation: College of Pharmacy, University of New Mexico, Albuquerque, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Carmignani
authors.forename: G G
authors.initials: GG
authors.lastname: Raymond
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D003299:Cooperative Behavior; D004339:Drug Compounding; D004780:Environment, Controlled; D005374:Filtration / Q000295:instrumentation; D006801:Humans; D008370:Manuals as Topic; D009784:Occupational Diseases / Q000139:chemically induced / Q000517:prevention & control; D009818:Office Nursing; D014481:United States; D014489:United States Occupational Safety and Health Administration
chemical_list: D000970:Antineoplastic Agents