Veterans Administration medical center policies and procedures for handling injectable antineoplastic drugs

Policies and procedures for handling injectable antineoplastic agents in Veterans Administration medical centers ( VAMCs ) were surveyed. The chiefs of pharmacy of 158 VAMCs received a questionnaire that covered (1) methods of preparation, administration, and disposal of injectable antineoplastic medications, (2) precautions in the handling of these drugs, and (3) general information about the institutions. Representatives of 136 (86.1%) of the VAMCs responded, representing more than 72,000 hospital beds with 1203 designated as oncology beds. Approximately half of these institutions had written policies and procedures for the preparation, administration, and disposal of the agents. Only 22 VAMCs had a formal training program for their employees. Sixty-two percent indicated that the pharmacy had complete responsibility for the preparation of injectable antineoplastics, while 33% still claimed nursing involvement. Only five institutions stated tests were performed to evaluate harmful effects. Only half used vertical laminar-airflow hoods exclusively for the preparation of these agents. Two thirds of the VAMCs stated that they had special methods for segregating antineoplastic waste; 81% employed incineration. The survey identified areas involving the handling of injectable antineoplastics in which hospitals need to develop policies.