Episode 349: ONS 50th Anniversary: Evolution of Safe Handling and ONS’s Legacy in Developing Safe Handling Guidelines
Release Date: 02/07/2025
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“You also want to deal with patient preferences. We do want to get their disease under control. We want to make them live a long, good quality of life. But do they want to come to the clinic once a week? Is it a far distance? Is geography a problem? Do they prefer not taking oral chemotherapies at home? We have to think about what the patient’s preferences are to some degree and kind of incorporate that in our decision-making plan for treatments for relapsed and refractory myeloma,” Ann McNeill, RN, MSN, APN, nurse practitioner at the John Theurer Cancer Center at Jersey Shore University...
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“Radioimmunoconjugates work through a dual mechanism that combines immunologic targeting with localized radiation delivery. The monoclonal antibody components bind to specific tumor-associated antigens such as CD20, expressed on malignant B cells. Once found, the attached radioisotope delivers beta radiation directly to the tumor, causing DNA damage and cell death,” Sabrina Enoch, MSN, RN, OCN®, CNMT, NMTCB (CT), theranostics clinical specialist at Highlands Oncology in Rogers, AR, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a...
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“The United States does not have a national cancer registry. We have a bunch of state registries. Some of those registries do collaborate and share information, but the issue is the registries that do exist typically do not report cancer by occupation. So, we cannot get our arms around the potential work-relatedness of the health outcome given the current way the state registries collect information. What we’re trying to set up, is a way to make what is currently an invisible risk, visible,” ONS member Melissa McDiarmid, MD, MPH, DABT, professor of medicine and epidemiology and public...
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“[Multiple myeloma] is very treatable, very manageable, but right now it is still considered an incurable disease. So, patients are on this journey with myeloma for the long term. It’s very important for us to realize that during their journey, we will see them repeatedly. They are going to be part of our work family. They will be with us for a while. I think it’s our job to be their advocate. To be really focused on not just the disease, but periodically assessing that financial burden and psychosocial aspect,” Ann McNeill, RN, MSN, APN, nurse practitioner at the John Theurer Cancer...
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“Referring patients to audiology early on has shown dramatic reduction in hearing loss or complications because the audiologist can really see where were they at before they started chemotherapy, where were they at during, if they get an audiogram during their treatment. And then after treatment, it’s really important for them to see an audiologist because this is really a survivorship journey for them. And as nurses, the ‘so what’: We are the first line of defense,” ONS member Jennessa Rooker, PhD, RN, OCN®, director of nursing excellence at the Tampa General Hospital Cancer...
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“We proposed a concept to the American Society of Clinical Oncology (ASCO), recognizing that extravasation management requires significant interdisciplinary collaboration and rapid action. There can occasionally be uncertainty or lack of clear guidance when an extravasation event occurs, and our objective was to look at this evidence with the expert panel to create a resource to support oncology teams overall. We hope that the guideline can help mitigate harm and improve patient outcomes,” Caroline Clark, MSN, APRN, AGCNS-BC, OCN®, EBP-C, director of guidelines and quality at ONS, told...
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“They [monoclonal antibodies] are able to cause tumor cell death by binding to and blocking to necessary growth factor signaling pathways for tumor cell survival. That’s going to be dependent on the target of the antibody, but I’ll give an example of epidermal growth factor, or EGFR. This is overexpressed in several different kinds of cancers where activation of this growth factor increases the amount of proliferation and migration of cancer cells. So, if we bind to it and block to it, then that would help halt these pathways and stop cancer cell growth,” Carissa Ganihong, PharmD,...
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“The thought of recurrence is also a psychosocial issue for our patients. They’re being monitored very closely for five years, so there’s always that thought in the back of their head, ‘What if the cancer comes back? What are the next steps? What am I going to do next?’ It’s really important that we have conversations with patients and their families about where they’re at, what we’re looking for, and reassure them that we’ll be with them during this journey and help them through whatever next steps happen,” ONS member Clara Beaver, DNP, RN, AOCNS®, ACNS-BC, manager...
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“I’ll go back to the backpack analogy. When your kids come home with a backpack, all of a sudden their homework is not on the desk where it’s supposed to be. It’s in the kitchen; it kind of spreads all over the place, but it’s still in the house. When we give antibody–drug conjugates (ADCs), the chemotherapy does go in, but then it can kind of permeate out of the cell membrane and something right next to it—another cancer cell that might not look exactly like the cancer cell that the chemotherapy was delivered into—is affected and the chemotherapy goes over to that cancer cell...
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“Working as an oncology infusion nurse, being oncology certified, attending chapter meetings, going to ONS Congress® has really taught me plenty. But being an oncology patient taught me way more. I know firsthand the fears ‘you have cancer’ brings. Then going through further testing, CT scans, MRIs, genetics, the whole preparation for surgery was something I never considered when I treated a breast cancer patient,” ONS member Catherine Parsons, RN, OCN®, told Valerie Burger, MA, MS, RN, OCN®, CPN, member of the ONS 50th anniversary planning committee, during a conversation about...
info_outline“What I find most rewarding is connecting with nurses, who now understand the risks of exposure and are committed to minimizing their personal exposure. When I first started speaking about safe handling, there were a lot of nurses who were skeptical about the need for self-protection. I rarely see that now. Nurses are concerned for their own safety and more open to protective behaviors,” ONS member Martha Polovich, PhD, RN, AOCN®-Emeritus, adjunct professor in the School of Medicine at the University of Maryland, told Liz Rodriguez, DNP, RN, OCN®, CENP, ONS member and 50th anniversary committee member, during a conversation about the evolution of safe handling of hazardous drugs and ONS’s role in shaping safe handling policies.
Music Credit: “Fireflies and Stardust” by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.
Learning outcome: Learners will report an increase in knowledge related to the evolution of safe handling guidelines.
Episode Notes
- The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast episodes. Find a full list of opportunities.
- ONS Podcast™ episodes:
- ONS Voice articles:
- ONS books:
- Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition)
- Safe Handling of Hazardous Drugs (fourth edition)
- ONS courses:
- Clinical Journal of Oncology Nursing articles:
- Huddle Card: Introduction to Safe Handling
- ONS Safe Handling Learning Library
- Joint ONS and Hematology/Oncology Pharmacy Association (HOPA) position statement: Ensuring Healthcare Worker Safety When Handling Hazardous Drugs
- National Institute for Occupational Safety and Health: Managing Hazardous Drug Exposures: Information for Healthcare Settings
- American Society of Health-System Pharmacists Guidelines on Handling Hazardous Drugs
- USP <800> FAQs
- Connie Henke Yarbro Oncology Nursing History Center
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
“PPE has always been recommended to reduce exposure because gloves and gowns provide physical barrier to protect against dermal absorption. But what we didn’t know back then was what gloves and gowns were made of mattered. So PVC gloves were often used just because they were readily available in all our clinical settings. Gowns were rarely worn for drug administration, even though they had been recommended since early on, and many considered gowns back then as optional because the wording in the [Occupational Safety and Health Administration] guidelines said ‘recommended’ and not ‘required.’” TS 3:19
“Those early chemo gloves were a bit like wearing gloves you might use to clean your oven. They were so thick and got in the way of taking care of patients or mixing drugs or administering drugs. So the biggest change, I think, is that gloves that are currently available are very thin, and they provide the necessary protection for those who are handling hazardous drugs. We now have a gloves standard that requires permeation studies to demonstrate the protective ability of the gloves before they can be labeled for use with hazardous drugs.” TS 11:56
“ONS and HOPA developed a position statement on safe handling of hazardous drugs. … This came because our two organizations were unable to support some of the other proposed guidelines from another organization. So we got together, and through our cooperation, resulted in language about the importance of safe handling, about supporting safe handling for practitioners, pharmacists, and nurses. Also, I feel really good about this—our cooperation resulted in language about protecting the rights of staff who are trying to conceive or who are pregnant or who are breastfeeding to engage in alternative duty that doesn’t require them to handle hazardous drugs.” TS 17:12
“If there’s no worker safety, then who’s going to take care of the patients?” TS 21:52
“What I find most rewarding is connecting with nurses, who now understand the risks of exposure and are committed to minimizing their personal exposure. When I first started speaking about safe handling, and that’s going back a long way, there were a lot of nurses who were skeptical about the need for self-protection. They had been handling hazardous drugs for years and had no signs of ill effects, and so they assumed that we weren't overreacting with all of the recommendations. They saw the use of precautions and PPE as a speed bump in their busy day and also thought that was unnecessary. I rarely see that now. Nurses are concerned for their own safety and more open to protective behaviors.” TS 23:50