Instituting Vincristine Minibag Administration

Abstract

The first fatal incident of wrong-route administration of vinca alkaloids occurred in 1968. Initial recommendations for practice change occurred in 2005. In 2012, 54% of oncology treatment sites had changed their practice. The authors' institution has developed a safe, adaptable, and consistent process to prepare, deliver, and administer vinca alkaloids by means of a minibag delivery. A multidisciplinary team, including representatives from the nursing and pharmacy departments, reviewed the literature and developed all processes, including staff education. Minibag administration began in August 2015, and more than 2063 doses have been administered without any extravasations. To date, the simulation strategy for education is effective, and the delivery system is safe.

Patient Safety in the Administration of Antineoplastic Chemotherapy and of Immunotherapics for Oncological Treatment: Scoping Review

“…The other studies were published in different health journals. 3,[13][14][15][16]19,21,[24][25]31,33,43,[36][37]39,42,47,[49][50] The safety of cancer drug administration in adults, children and young people in hospitals, [3][4][6][7][13][14][15][16][17][18][19][20][21][22]27,33,[35][36][40][41]44,[47][48][49][50]52 outpatient clinics, [3][4][5][16][17][18][19...…”

“…In order to avoid permanent sequelae and unnecessary tragic deaths as a result of intrathecal administration of vinca alkaloids, several procedures are recommended in institutions where intrathecal medications are administered: handling vincristine in an infusion bag (minibags), eliminating the risk of exchange with intrathecal syringes; labeling the infusion bags with vincristine preparations with an alert (for intrathecal use only); establishing a differentiated procedure for intrathecal drug administration, in another location and/or at times or days different from the intravenous medications (if this procedure is not possible, as for people receiving medication via both routes, a procedure must be performed so that intravenous vincristine is not dispensed until the confirmation of the end of intrathecal administration or vice versa); not using an infusion pump to infuse intrathecal vincristine (higher likelihood of leakage). 4,13 In the CTX administration phase, the following is recommended double-check by nurses for patient identification; check if the patient is wearing the identification bracelet with at least two identifiers; check for allergies to the drugs to be administered; identify drug name, dose, volume, route of administration, start and end date; check the appearance of the drug; put the signature and stamp on the prescription of all professionals (doctor, nurse and pharmacist); analyze if the CTX scheme was observed (adequate time since last cycle); identify treatment-related toxicity (if applicable); confirm if there are supportive medications; recalculate CTX doses; compare diluted drug labels with prescription and antineoplastic regimen; check for specific prescribed sequence; guide the patient verbally and deliver in writing (manual, folder); monitor the patient before, during and after drug administration; perform monitoring after CTX administration, including adherence, toxicity and complications. [4][5][15][16][17][18][19][20][21]24,26,32,[40][41][42]44,46,48,50 Studies have shown that the implementation of evidence-based care protocols improves care, organizes health services with the establishment of flows, and that they are imperative to improve the quality of care and patient safety.…”

“…The recommendations found in the studies to avoid them were the following: implement processes to verify CTX regimen prescriptions prior to administration; implement the double-check process, careful and standardized; promote training and continuing education of nurses working in oncology; provide guidelines for patients and families (educational materials appropriate to their level of literacy and understanding, validated by health professionals and target audience); encourage patients to question their treatment and empower them to be able to actively participate in their own care; standardize CTX and immunotherapy administration procedures; perform computerized prescription. [4][5][6][7]13,[19][20]22,[24][25][27][28][29][30][33][34]36,44,47,[49][50][51][52][53] Diverse studies stood out that signaled as essential the use of tools for managing risks related to drugs, such as the HFMEA (Healthcare Failure Mode and Effect Analysis) and Lean Sigma, methodologies used to map, evaluate and propose the control of incidents before they occur and to detect hidden incidents in the system, error reporting and surveillance systems; a checklist of items for safe administration of antineoplastic drugs. 22,25,28,30,37,42,44…”

“…31 Specific suggestions have been mentioned for vincristine dilution -such as the need for a cautionary phrase about its exclusive use intravenously -since its incorrect administration may lead to permanent sequelae or death. 4,13 It is also recommended to dispense vincristine in an infusion bag (minibag) and not in a syringe; administering intrathecal vinca alkaloid, at a different location and/or at times or days disposing of the intravenous medicinal products (if this procedure is not possible, intravenous vincristine should not be dispensed until the confirmation of the end of intrathecal administration or vice versa). 4,13 The published literature suggests that extravasation rates are not higher with the administration of a minibag than with syringes.…”

“…4,13 It is also recommended to dispense vincristine in an infusion bag (minibag) and not in a syringe; administering intrathecal vinca alkaloid, at a different location and/or at times or days disposing of the intravenous medicinal products (if this procedure is not possible, intravenous vincristine should not be dispensed until the confirmation of the end of intrathecal administration or vice versa). 4,13 The published literature suggests that extravasation rates are not higher with the administration of a minibag than with syringes. 13 Thus, the professional should be aware during its administration, as it is a vesicant drug with high potential for patient harm.…”