There was no extra training for the staff regarding chemotherapy. The nurses giving it had to rely on personal experience for precautions. Sally frequently administered chemotherapy. Around 1993 she developed cancer and died. Before she died, she initiated an investigation through Worker’s Compensation Board (WCB) to prove her cancer was a result of being exposed to chemotherapy that she administered to patients. Her husband continued the case after her death. They were successful in establishing a link. It was Sally's quest to prevent another incident happening to someone else, a fellow nurse. I thought about her quest, and decided I could help her at this time.

Home Nursing Care here was recently accepting more clients on chemotherapy. The staff has varied backgrounds, but the majority has been working for Home Care for over ten years. Therefore, any chemotherapy experience they would have would be over ten years ago. When I was giving chemotherapy to one client, who was receiving it twice a day for four weeks, the client often remarked on how I was the only one to wear a mask, gown, gloves and goggles. She said most of the nurses just wore gloves. At first I thought I was being overly cautious because I had worked with Sally, and I had been diagnosed with cancer myself in 1995. However, those thoughts faded and the client's comments prompted me to inquire about our precaution practices. I did a mini survey of an office that has not had any chemotherapy patients. Nine out of fourteen nurses thought gloves were all that was necessary. Four nurses thought a gown would be necessary as well, and only one suggested masks and goggles as well. For disposal precautions five nurses did not know if there were special precautions, six thought tubing/syringes were safely disposed of in a separate garbage bag, while three nurses stated the equipment should be double bagged. I myself was unsure of how much precaution equipment was necessary. Now what to do. I concluded that our precautions varied greatly and were perhaps not good enough. We would need more education about chemotherapy precautions.

Next question, was how to we get the education and in what form does it come in. I called the Clinical Resource Nurse from Oncology at the Royal Jubilee Hospital. She offered to lend me the self-directed learning modules they use to certify their staff. I also called the Cancer Clinic, and they sent me a copy of their policy/procedures for chemotherapy administration. At this point I also attempted to get a copy of Sally’s case through WCB and the British Columbia Nurses’ Union (BCNU), but I was unsuccessful to date.

At this point I decided I needed to approach the Occupational Health and Safety Committee. I called the BCNU committee member and explained what was happening. I asked if she could address this issue at the next meeting. This person said they would mention this at their next meeting.

I then called WCB and got their regulations. They stated that each worker be given additional orientation/education prior to administering chemotherapy. The regulations also stated that a record be kept on each employee regarding how much chemotherapy agents they give and when. These records must also be kept ten years following the employee terminating with the employer.

Following the O.H&S meeting, I called the member back to see what was said. She said the group would look into the WCB regulations themselves. In the meantime, at our office we got another patient that required intravenous chemotherapy. Things were not moving fast enough for me. I then called the Manager that sits on the Occupational Health & Safety Committee. I told her my concerns, and asked if I could make a presentation to the group. She readily agreed.

Since the nursing did not seem to understand the need for extra precautions, the focus of my presentation would be the need for adequate precautions. Where to start with it. Since I am not an authority on the subject I needed something to make my presentation more credible. I decided I would present some research supporting the need for adequate precautions.

I did a CINAHL search for research based articles. I also did a Pmed search which produced much the same, only not as nursing focused. I was hoping for recent articles, however, most research was done in the 1980’s. I was further limited by the availability of the journals. The two I selected, Self Protective Practices Of Nurses Handling Antineoplastic Drugs, and Occupational Exposure of Nursing Personnel to Antineoplastic Agents were the most recent available to me.