HealthApril 22, 2016

USP 800: Performing an assessment of risk

USP 800 Hazardous Drugs – Handling in Healthcare Settings was published on February 1, 2016. 

Patricia C. Kienle, RPh, MPA, FASHP is a member of the USP Compounding Expert Committee, however, the information in this blog is not endorsed by or affiliated with USP.

The hazardous drugs of concern to USP 800 are medications that are hazardous to people; this differs from EPA hazardous materials that are hazardous to the environment. Some drugs are on both lists, but the list to reference for USP 800 is the NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings. An updated list is expected later this year. The NIOSH list sorts drugs into three categories:

  • Antineoplastics
  • Non-antineoplastics
  • Reproductive hazards only

Once you have identified the drugs and the dosage forms that you handle, you need to assess how you will protect personnel from exposure to these agents. USP 800 allows two approaches:

  • Handle all dosage forms of all agents on the list with all the containment precautions and work practices listed in 800, or
  • Perform an assessment of risk for drugs that are not Active Pharmaceutical Ingredient (API) or are not antineoplastics that need to be manipulated and determine alternative containment strategies and/or work practices that protect personnel

Some drugs must be handled with all the containment strategies and work practices listed in 800:

  • API of any three categories of hazardous drugs
  • Antineoplastics that need to be manipulated

Other agents may be considered for your assessment of risk. These agents include:

  • Antineoplastics that only need to be counted or packaged
  • Non-antineoplastics
  • Reproductive hazards only

Start this process by reviewing the NIOSH list and identifying those drugs you handle, and which dosage forms of those drugs you handle. Determine if you will handle all of those with all the requirements in 800, or if you will perform an assessment of risk for some of the dosage forms.

Most organizations will take the assessment of risk approach. The dosage form and packaging that you handle will drive a lot of the decision points you need to make.

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