Promoting Behavior Change Self-monitoring As an Intervention Among Computer Users

ADVANCEMENTS IN PHARMACEUTICAL and biological technology have resulted in the introduction of an increasing number of hazardous drugs each year. NIOSH (2004) defines hazardous drug as “any drug identified by at least one of the following six criteria: carcinogenicity, teratogenicity or developmental toxicity, reproductive toxicity in humans, organ toxicity at low doses in humans or animals, genotoxicity, or new drugs that mimic existing hazardous drugs in structure or toxicity.” The increase in drug volume has increased the potential for occupational exposure, which has prompted many healthcare organizations to reevaluate current controls. In 2004, NIOSH published guidelines to prevent employee exposure to hazardous drugs during preparation, administration and disposal in healthcare facilities. These guidelines follow previously published guidelines from the Oncology Nursing Society (2003), the American Society of Healthcare Pharmacists (ASHP, 2000) and OSHA (1986). This article discusses howa largemedical center conducted a risk assessment relative to hazardous drugs and systematically established organizational best practices. Characterizing the Risk According to NIOSH (2004): [W]orkersmay be exposed to a drug throughout its life cycle—from manufacture to transport and distribution, to use in healthcare or home care settings, to waste disposal. These workers include shipping and receiving personnel, pharmacists, and pharmacy technicians, nursing personnel, physicians, operating room personnel, environmental services personnel and workers in veterinary practices where hazardous drugs are used. A growing body of scientific evidence indicates that exposures are occurring and being detected inside the bodies of healthcare workers. NIOSH (2004) cites a report by Harrison (2001) which states that six different drugs (cyclophosphamide, methotrexate, ifosfamide, epirubicin and cisplatin/ carboplatin) were detected in the urine of healthcare workers by 13 of 20 investigations. NIOSH also documents five additional case studies. Polovich, Blecher and Glynn-Tucker, et al. (2003) list 17 research studies on the occupational risks of healthcare workers with occupational exposure to hazardous drugs. Sessink and Bos (1999) report that long-standing control methods may be insufficient to protect healthcare workers from exposure to hazardous drugs. In response to these reports, Mayo Clinic formed a Hazardous DrugWorkgroup to evaluate the medical center's practices for handling hazardous drugs. Evaluation Process The evaluation process consisted of a three-step process: 1) Job hazard analyses (JHAs) in departments with potential exposure. These analyses led to recommendations and updates to the medical center's existing engineering, administrative and personal protection practices. 2) Systematic comparison of the medical center's internal control practices with the recommendations of NIOSH, OSHA, Oncology Nursing Society and ASHP. 3) Research, analysis and justification for instances where the medical center's internal control methods differ from the guidance documents. Job Hazard Analyses Each department in the medical center whose job functions involved potential employee exposure to hazardous drugs conducted a JHA. The departments included pharmacy, nursing, environmental services, linen and central services, facilities and monitoring tool, first at 2minutes, then extended to 15 minutes, in an effort to provide more opportunities to self-monitor throughout the session. Furthermore, in a similar study, Gravina, Loewy and Austin (manuscript in preparation) demonstrated that an intensive self-monitoring procedure coupled with self-monitoring accuracy training resulted in par