We’re back with our next edition of Rpharmy Rounds, and today we are talking toilets. An interesting question came up on one of our clients’ Rhazdrugs demo they conducted for nursing (you can read about some of the questions they asked here). One nurse asked how they know whether they need to isolate a patient from others or if they can use the same toilet.
In an article from the Oncology Nursing Society, they highlight why it is important to communicate these instructions to nurses because many hazardous drugs can lead to bathroom contamination. They conducted a project to examine contamination in both a patient and staff bathroom. You can read more about their testing here.
Their findings showed that 65% of the wipe samples from the patient bathroom floor and 35% of the wipe samples from the staff bathroom floor were positive for at least one hazardous drug.
How many health systems are thinking about this? I reached out to our only other client who has decided to include toileting instructions to ask why they decided to include this in patient care activities for nurses.
Their Director of Medication Policy and Regulatory Compliance expressed a similar sentiment. She said, “Our implementation of USP <800> regs was a system-wide initiative. Our workgroups included all disciplines to review current workflows, proposed workflows, and policy development. It was through those workgroup discussions that we explored processes and resources to safely handle medications and the excrete. So, in our build of the handling guidelines, we wanted to capture such guidance and provide that information to our nurse users to ensure safety for nursing, housekeeping, and facilities.”
How do you communicate to your nurses if a patient needs to be isolated or if they can share a toilet with another patient? How do you communicate to EVS staff if a room needs to be decontaminated? What is your policy for isolation? Do you have a policy? Below is an example of a client who chose to include toileting instructions on their Rhazdrugs site.
Without clear instructions, this is a judgment call that could result in inadvertently exposing patients, nurses, or EVS workers to hazardous waste. One comment we heard is that if there is ever any grey area, the default is to isolate. What does that mean for bed availability if the default is isolate when in doubt?
Another question this poses is about the safety of family members or caregivers of the patient. When you are educating them on how to care for the patient at home, are you sharing information about if they can share a toilet or if they should be isolated?
I’d also encourage you to listen to a recent podcast from ONS featuring AnnMarie Walton from Duke. She discusses the importance of toileting instructions even at home and her research she’s conducted on plastic-backed pads.
I’d love to hear if and how you are including toilet instructions in your hazardous drug handling plan. Please reach out to me here! If you’d like to be featured in Rpharmy rounds, please fill out this form linked here or via the QR code below.