Abstract
BACKGROUND: Nowadays, there is an increasing concern about the exposure and safe-handling procedures of antineoplastics and other hazardous drugs. PURPOSE: Identify hazardous medications dispensed to outpatients from a hospital pharmacy service and propose measures to improve safety during drug handling. MATERIAL AND METHODS: Retrospective study of medications dispensed to outpatients from a hospital pharmacy service between 2013 and 2016. The lists of the National Institute for Occupational Safety and Health (NIOSH) and the Spanish Technical Document (STD: ‘Hazardous drugs: preventive measures for their preparation and administration’) published in 2016 were reviewed for the identification of hazardous drugs. When a drug was not classified in the lists, the product information document of the Spanish Agency of Medicines and Health Products (AEMPS) and of the Food and Drug Administration (FDA) were reviewed. We assessed the drug evidence of carcinogenesis, mutagenesis, impairment of fertility, effects in pregnancy and adverse reactions (malignancies). RESULTS: We identified 76 drugs dispensed to outpatients. According to the Anatomical Therapeutic Chemical classification, 72% belonged to group L, 16% to group J, 5% to group H, 4% to group B and 3% to other groups. According to STD, 38 drugs were classified as hazardous (84% group 1, 8% group 2% and 8% group 3) and 36 drugs according to NIOSH (86% group 1, 8% group 2% and 6% group 3). The rest of the medications (38) did not appear in the lists. Of them, 17 drugs (45%) had notified effects of carcinogenesis, mutagenesis and/or malignancies side-effects in their product information document and 26 drugs (68%) had documented impairment in fertility and pregnancy disorders. Only six drugs (16%) had no toxic effects or no studies were available. The measures established to improve safety on hazardous drugs handling were: the development of a list identifying the hazardous drugs and the development of a document with recommendations for safe handling addressed to healthcare professionals and to patients. CONCLUSION: A high proportion of drugs (50%) dispensed to outpatients lack classification in the hazardous drug lists and therefore have an increased risk of incorrect handling. It would be advisable to identify potential hazardous drugs (70 in this study) and to instruct patients and healthcare workers on safe drug handling. No conflict of interest