Antineoplastic admixture service in a tertiary-care hospital

The rationale and decision-making processes involved in the development and implementation of an antineoplastic admixture service in a 1027-bed teaching hospital are described. Because of concerns expressed by nurses about the potential health hazards of handling antineoplastic drug products, the department of pharmacy was asked to prepare all injectable antineoplastic agents within the institution. At the time of the request, the pharmacy department operated 12 decentralized pharmacies and one central pharmacy; no i.v. admixture services were provided, except for total parenteral nutrient solutions. In developing the service, the pharmacy department considered the advantages and disadvantages of (1) a centralized versus decentralized organization, (2) various physical facilities, and (3) various staffing patterns. An ad hoc committee of the P & T committee was formed to develop multidisciplinary guidelines for the appropriate handling of these products. A centralized service open from 0800 to 1600 daily was established. A supervisor was hired to train and manage the rotation of the entire pharmacy staff through the area. A vertical laminar-airflow biologic safety cabinet and exhaust adapter were purchased, and policies and procedures for handling the antineoplastic agents were developed for all involved personnel. Since opening in July 1983, the antineoplastic admixture service has been positively received by health-care providers in this institution, and no major problems have been associated with the program.