From: Ian blenkharn@ianblenkharn.com
Category: Miscellaneous
Date: 29 Jul 2008
Time: 14:12:53 +0200
Remote Name: 86.133.234.230
Much is written about the safe handling of cytotoxics, mostly by those who have no experience though that doesn't necessarily make it incorrect. At least most of that guidance is clear, to avoid unnecessary exposure, to pay particular attention to avoid exposure of women of child-bearing age, to avoid repeat exposure no matter how slight, and to take care in the disposal of cytotoxic drug wastes that will include waste drug product and the items that have been used in their preparation and administration.
Some time ago, I was prescribed an ongoing course of methotrexate. The very first prescription was accompanied by severe warnings of toxicity. Keep the medicine safe; do not let anyone touch it; do not handle the tablets unnecessarily. I was even offered a pair of latex gloves to handle the tablets by a pharmacist who was herself wearing gloves (not quite sure about that, since I was going to put them in my mouth and swallow them using gloves to pick them up seemed a tad unnecessary!).
The pharmacy had a dedicated area for the storage and handling of all cytotoxics, complete with exhaust safety cabinets for the most toxic. All containers, including that given to me, were clearly marked with an additional red sticker 'CYTOTOXIC'. Never since has a community pharmacy taken such precautions.
But today I went to a local pharmacy for a further methotrexate and was concerned to watch the dispenser tip tablets from a bottle into the palm of one hand, count them out using a finger, and tip them from her hand into a bottle to be labelled for my use. A young woman, clearly of child-bearing age. No protection. No thoughts about the potential toxicity or the cumulative effects that might cause problems. And one must assume that the same casual attitude to the disposal and labelling or categorisation of wastes would be likely also.
That puts others at risk, and is totally unacceptable.
Perhaps the relevant professional bodies should get their act together and review guidance to their members.