Risk management of extravasation of cytostatic drugs at the Adult Chemotherapy Outpatient Clinic of a university hospital

• Published in: Journal of clinical nursing Vol. 14; no. 7; pp. 876 - 882
• Main Authors: Adami, Nilce Piva, De Gutiérrez, Maria Gaby Rivero, Da Fonseca, Selma Montosa, De Almeida, Elizabeth Pinto Magalhães
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.08.2005; Wiley Subscription Services, Inc
• Subjects: Administration; Adult; adverse events; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - adverse effects; Brazil; Cancer; Chemotherapy; Extravasation; Extravasation of Diagnostic and Therapeutic Materials - epidemiology; guarantee of health care quality; Hospitals, University - standards; Humans; Incidence; Medication Systems, Hospital; Neoplasms - drug therapy; Neoplasms - nursing; Nursing; oncology nursing; Oncology Nursing - standards; Outpatient Clinics, Hospital - standards; Outpatient treatment; Patients; Quality of Health Care; Risk Management; Side effects; Brazil
• ISSN: 0962-1067; 1365-2702
• DOI: 10.1111/j.1365-2702.2005.01124.x

Aims and objectives.  To verify the incidence of extravasation of cytostatic drugs in patients treated on an outpatient basis at a university hospital in the city of São Paulo, Brazil, during the period from 1998 to 2002, and to assess the quality of care provided by the nursing team using a protocol adopted for the treatment of this adverse event as a parameter. Background.  The movement for quality in healthcare services has been a recent event in Brazil, mainly as the result of the Brazilian Program of Hospital Accreditation instituted in 1998. Considering the emphasis on risk management, it is important to mention the monitoring of the occurrence of extravasations of cytostatic drugs in order to improve the quality of nursing care provided to cancer patients. Design and methods.  An evaluative study with a descriptive, prospective and longitudinal design was conducted, based on the documentary analysis of the notification of 216 extravasations of vesicant and irritant drugs that occurred between 1998 and 2002 and the corresponding prescriptions of cold or hot compresses. Results.  The mean incidence of extravasations ranged from 0·2 to 1·4% over the five years of the study. Incorrect prescription of the type of compress was observed for three patients. Undesired effects were ulcers caused by the extravasation of vinblastine and dacarbazine in two cases. Conclusions.  The low incidence of both extravasation and tissue damage demonstrates the adequate quality of nursing care provided to cancer patients at the outpatient clinic studied. However, the identification of the lack of 12 records of thermal treatment and of three erroneous prescriptions requires the implementation of educational measures to prevent these types of incident. Relevance to clinical practice.  The relevance of this study to clinical practice is to increase the awareness and involvement of the nursing team in the maintenance of a continuous surveillance system of the process and results of chemotherapy administration in order to increase the quality of care and the safety of the patient.