Evidence-Based Practice Considerations In Facilitating The Risk Surveillance Of Occupational Exposure To Antineoplastic Agents

According to Martin and Larson (2003), healthcare professionals involved with handling antineoplastic drugs may be exposed inadvertently to these agents, placing them at potential risk for acute and long-term adverse effects. For example, cyclophosphamide one of the most frequently used antineoplastic agents in clinical treatment facilities, is a known human carcinogen (Larson, Khazaeli, & Dillon, 2003). While the health risks associated with cytotoxic use have been well established, there is little information available about how people perceive these risks, particularly among those most affected by it-chemotherapy nurses. Therefore, the purpose of this Evidence Based Practice (EBP) project was to develop a nurse practitioner knowledgebase regarding the impact of risk perception on the cytotoxic agent safety behaviors of oncology nurses. The research questions asked: (a) what is the level of healthcare knowledge regarding the role of the healthcare provider in facilitating risk surveillance of occupational exposure to antineoplastic agents? (b) according to the literature, how can healthcare providers contribute to cost-effective, high-quality care by facilitating risk surveillance of occupational hazards? and (c) according to the literature, how can healthcare providers contribute to cost-effective, high-quality care by facilitating risk surveillance of exposure to antineoplastic agents? A Boolean computer search of nursing and medical literature for theory-based, data-based, randomized controlled trials for citations utilizing CINAHL, MEDLINE, and the Cochrane Library was conducted for this systematic review. Becker’s Health Belief Model (1974) served as the theoretical foundation for this clinical project and guided the systematic review through data collection of the healthcare literature. Literature reviewed totaled 8 manuscripts, which represented reviews of another 122 references. Studies of healthcare workers have shown that occupational exposure to antineoplastic agents has caused acute adverse effects such as nausea, headache and dizziness (Valanis, Vollmer, Labuhn, & Glass, 1997). Exposure risk and its relationship to healthcare professionals’ compliance to established protocols for the safe handling and administration of chemotherapy agents continues to be a concern for health care institutions (Ritchie, McAdams, & Fritz, 2000). The literature reviewed for this study recommends compliance with established safety guidelines to ensure adequate protection to those involved in the handling, administration, and care of patients receiving antineoplastic agents. Yet despite the adoption of these guidelines in healthcare institutions, the current literature also suggests that many workers do not follow the standards established by their employers and current OSHA guidelines, putting themselves at risk for exposure to potential mutagenicity, alterations in fertility and long­ term effects from chemotherapy agents (Valanis, Vollmer, Labuhn, & Glass, 1997). Using an Evidence Based Medicine (EBM) approach, based on that of Sackett, Straus, Richardson, Rosenberg, and Haynes (2000), a knowledgebase was developed vi according to methods described by Davidson (2003) in which key findings from the systematic review of randomized control trials, data-based and theory-based literature were compared with current practice guidelines, resulting in a number of safe practice recommendations. These recommendations emphasize that safe levels of exposure to antineoplastic agents have not been determined therefore; it is essential to minimize exposure. The need for fiirther attention to risk surveillance of occupational exposure to antineoplastics in advanced practice nursing literature is critical. Evidence-based practice modalities that will utilize current guidelines in the risk surveillance of occupational exposure to antineoplastic agents are essential for nurse practitioner application in oncology settings. Implications for nursing theory, nursing research, advanced nursing practice, nurse practitioner education, and health policy are provided as they emerge from the concepts explored