HAZARDOUS DRUGS (INCLUDING ANTINEOPLASTIC and CHEMOTHERAPY)

Hazardous Drug Handling

Hazardous drugs, although therapeutic to the patient, are known to or suspected to pose a health risk to health care workers exposed to them in the workplace due to the medication's inherent toxicity. According to the National Institute for Occupational Safety and Health (NIOSH) they exhibit one or more of the following characteristics in humans or animals:

• Carcinogenicity – capable of causing or promoting the development of cancer or a lesion which could be the starting point of a cancer
• Teratogenicity or other developmental toxicity – capable of causing congenital malformations due to an action on the embryo
• Genotoxicity – capable of damaging genetic material (DNA) to cause mutations
• Reproductive toxicity – capable of affecting fertility (i.e. miscarriages, late fetal death, infertility)
• Organ toxicity at low doses – capable of causing serious organ or other toxic effects at a low dose (i.e. liver damage, local necrosis of exposed tissue)
• Structure and toxicity profiles of medication that mimic existing medication determined hazardous by the above criteria

The B.C. Provincial Hazardous Drugs List is divided into two groups:  Group 1 and Group 2 based on the potential harmful effects.

Staff involved in the handling and administration of hazardous drugs must follow organizational procedures to avoid undue exposure and environmental contamination.  Precautions must also be taken when handling blood or body fluids from patients receiving Hazardous Drugs Group 1 within the 48-hour precautionary period.

For detailed information on hazardous drug precautions, spill management or accidental exposure, visit your organization's Occupational Health and Safety site:

PHC:  Hazardous Drugs

Hazardous Drug Preparation

All Group 1 and Group 2 hazardous drugs will be prepared in Pharmacy in a biological safety cabinet (BSC) and dispensed in a ready to administer format. If urgently required and a BSC is not available, refer to approved safe work procedures for preparation outside of a BSC.

All hazardous drugs will be transported to the units in two bags that are sealed. Medications to be administered as IV direct will be dispensed from Pharmacy in syringes. Medications for administration as IV infusions will be prepared and dispensed in a mini-bag or large volume infusion solution. Medications identified to be given by physicians will be labeled by pharmacy as "MD only" or "to be administered by physician."

Pharmacy can only prepare parenteral hazardous drugs during the day. Check with your site pharmacy when medications are needed for the same day, or if a hazardous drug (Group 1 or Group 2) is urgently needed after hours.

Hazardous Drug Administration 

Refer to the PDTM drug monographs for drug specific information.

For chemotherapy medications not found in the PDTM, refer to the BC Cancer Drug Monographs. 

Please refer to organization specific guidelines on SHOP for information on safe administration of hazardous drugs and chemotherapy medications, including education and competency requirements. 

Revised: February 2022