title: Improving safety-related knowledge, attitude and practices of nurses handling cytotoxic anticancer drug: pharmacists' experience in a general hospital, Malaysia.
abstract: BACKGROUND
  An increasing trend of cytotoxic drug use, mainly in cancer treatment, has increased the occupational exposure among the nurses. This study aimed to assess the change of nurses' safety-related knowledge as well as attitude levels and subsequently to assess the change of cytotoxic drug handling practices in wards after a series of pharmacist-based interventions.
  
  
  METHODS
  This prospective interventional study with a before and after design requested a single group of 96 nurses in 15 wards actively providing chemotherapy to answer a self-administered questionnaire. A performance checklist was then used to determine the compliance of all these wards with the recommended safety measures. The first and second assessments took 2 months respectively with a 9-month intervention period. Pharmacist-based interventions included a series of technical, educational and administrative support measures consisting of the initiation of closed-system cytotoxic drug reconstitution (CDR) services, courses, training workshops and guideline updates.
  
  
  RESULTS
  The mean age of nurses was 32.2∓6.19 years. Most of them were female (93.8%) and married (72.9%). The mean knowledge score of nurses was significantly increased from 45.5∓10.52 to 73.4∓8.88 out of 100 (p<0.001) at the end of the second assessment. Overall, the mean practice score among the wards was improved from 7.6∓5.51 to 15.3∓2.55 out of 20 (p<0.001).
  
  
  CONCLUSIONS
  The pharmacist-based interventions improved the knowledge, attitude and safe practices of nurses in cytotoxic drug handling. Further assessment may help to confirm the sustainability of the improved practices.
authors.affiliation: Department of Pharmacy, Sultanah Bahiyah Hospital, Alor Setar, Kedah, Malaysia. huankeat123@yahoo.com
authors.forename: Chan Huan
authors.initials: CH
authors.lastname: Keat
authors.forename: Nor Suhada
authors.initials: NS
authors.lastname: Sooaid
authors.forename: Cheng Yi
authors.initials: CY
authors.lastname: Yun
authors.forename: Malathi
authors.initials: M
authors.lastname: Sriraman
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000633:toxicity*; D001291:Attitude of Health Personnel; D005260:Female; D019983:Guideline Adherence; D015386:Hazardous Substances / Q000633:toxicity*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008296:Malaysia; D008297:Male; D009369:Neoplasms / Q000188:drug therapy / Q000451:nursing*; D016273:Occupational Exposure / Q000009:adverse effects / Q000517:prevention & control*; D016272:Occupational Health; D009859:Oncology Nursing / Q000193:education* / Q000592:standards; D010607:Pharmacy Service, Hospital; D017410:Practice Guidelines as Topic; D057184:Practice Patterns, Nurses'; D018709:Statistics, Nonparametric; D017132:Workplace / Q000592:standards
chemical_list: D000970:Antineoplastic Agents; D015386:Hazardous Substances