Joint Commission Recommends Strategies for Eliminating Vincristine Administration Adverse Events
In their Quick Safety Issue #37, The Joint Commission (TJC) highlights the risk of improperly administering Vincristine, a chemotherapy drug. TJC has been cautioning health care providers about risks associated with vincristine for years, includes issuing a Sentinel Event Alert in 2005. When given intrathecally, vinca alkaloids (vinblastine, vinorelbine, vincristine, and vincristine liposomal) cause destruction of the central nervous system. There are few survivors of this type of adverse event.
According to TJC, even though the serious consequences of giving the chemotherapy drug vincristine intrathecally are widely known, adverse events still occur because some organizations continue to administer vincristine via syringe.
Some progress has been seen in preventing vincristine adverse events because several national organizations have been promoting an effective prevention strategy that creates a mechanical barrier to intrathecal administration (into the subarachnoid space).
The Institute for Safe Medication Practices (ISMP), The Joint Commission, Oncology Nursing Society (ONS), World Health Organization (WHO), National Comprehensive Cancer Network® (NCCN®), American Society of Clinical Oncology (ASCO) and Oncology Nursing Society (ONS) all support using minibags to administer vincristine and other vinca alkaloids.
Diluting intravenous vincristine or other vinca alkaloids in a minibag that contains a volume that is too large for intrathecal administration (e.g., 25 mL for pediatric patients and 50 mL for adults), makes it mechanically difficult to accidentally administer intrathecally.
In Quick Safety Issue #37, TJC suggestions the following safety actions:
- Organizations should ensure that intravenous vincristine is never dispensed to a location where intrathecal chemotherapy medications, such as cytarabine or methotrexate, are being administered.
- Organizations should implementing policies that provides for the dilution of intravenous vincristine and other vinca alkaloids in a minibag that contains a volume that is too large for intrathecal administration (e.g., 25 mL for pediatric patients and 50 mL for adults).
- Organizations should ensure adherence to established medication safety processes, such as medication double-checks and labeling medications that are not immediately used.
Providers should also consider the following:
- Vincristine must only be administered intravenously.
- Prepare vincristine in minibags for intravenous administration
- Syringes containing vincristine should be clearly labeled with the warning "FATAL IF GIVEN INTRATHECALLY. FOR IV USE ONLY. DO NOT REMOVE COVERING UNITL MOMENT OF INJECTION"
- The overwrap for the syringe containing vincristine should also have the above warning printed on it
- Do not administer vincristine when and where intrathecal administration of medications is being performed.
- A "time out" should be conducted by two (2) qualified healthcare professionals to verify and document the drug, dose and route at the time of pharmacy preparation of intravenous vincristine and before each administration of intravenous vincristine
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