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Recommendation 5: planning the oncology pharmacy

It is strongly recommended that the oncology pharmacy be in compliance with relevant guidelines from the Canadian Society of Hospital Pharmacists and Accreditation Canada standards. Although the specific details of oncology pharmacy planning are beyond the scope of this document, details and some important considerations may be found in the National Association of Pharmacy Regulatory Authorities (NAPRA) guideline and CSA document CSA Z8000-11.3,18,20

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It is strongly recommended that special requirements for heating, ventilation and air-conditioning systems in healthcare facilities be taken into consideration.3,19

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A class II type B BSC is required with a preference for the type B2 because it ensures that there is no recirculation of air within the cabinet.3,18,20

There is emerging evidence suggesting some robotic devices that prepare hazardous drugs improve the accuracy of medication preparation and reduce potentially harmful staff safety events. Further studies are required to establish the cost-effectiveness of these robotic implementations. Each healthcare facility will need to assess the need for such devices in their environment.20-24

It is strongly recommended that all mixing and preparation of administration sets with a hazardous drug be performed in one centralized area in a specially designated class II type B BSC21 that:

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It is recommended that airlocks be considered if there are particular concerns about the propagation of airborne hazardous drugs.

It is strongly recommended that the priming of administration sets be prepared in the manner mentioned above.

It is strongly recommended that the layout allow and facilitate the unimpeded cleaning of all surfaces (walls, floors, ceilings, doors, diffusers, windows). It is strongly recommended that the furniture and equipment in the sterile preparation room be kept to a bare minimum. It is strongly recommended that there be a visual link; for example, a sealed window and a way to communicate between the sterile preparation room and the pharmacy, to view the work in progress. It is strongly recommended that access to the sterile room be limited to trained and authorized workers.2 A pass-through window can be installed to minimize the risk of contamination when transferring products into and out of the clean room. The pass-through should be equipped with an interlocking system or procedure that prevents both doors from being open at the same time.3

Limit worker traffic, particularly near unpacking and storage areas (to avoid accidental breakage) and near preparation cabinets (to avoid interfering with their proper operation).

It is legislated that the facilities include an emergency eyewash that may or may not be hooked up to the airlock sink.10 As a minimum, it is strongly recommended that an emergency eyewash be able to provide 15 min of flushing to both eyes.23 It is strongly recommended that a full shower be accessible nearby (e.g., in the oncology units/clinics).

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Closed system drug-transfer devices are not a substitute for class II type B BSC. There is evidence from studies24-48 that closed-system drug-transfer devices can reduce contamination during preparation and increase or extend the beyond-use date of a drug. Further emerging evidence suggests that when these devices are not used as specified, they could become open to the environment. Further research is needed to evaluate this possibility.

In the non-sterile drug preparation process (e.g., oral preparations), it is strongly recommended that the same level of worker protection be adhered to.

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