ISMP Survey on Administration of IV Vincristine

If you work in an inpatient and/or outpatient healthcare facility that provides both IV and intrathecal chemotherapy, please have the person most knowledgeable about this practice complete this survey about the administration of IV vincristine. Please note: Only one survey response should be submitted per healthcare facility. (If inpatient and outpatient practices differ, please complete one survey for each setting.) Results must be submitted to ISMP by January 27, 2006. We appreciate your participation!

1. Please tell us whether these error-reduction strategies are employed when dispensing and/or administering IV vincristine.

Error-Reduction Strategies	Yes	No	Sometimes
a. Are doses of IV vincristine diluted and dispensed/administered in a minibag?
b. Are doses of IV vincristine diluted and dispensed/ administered in a syringe?
c. Are intrathecal medications packaged in a distinctive container not used for any other purpose to prevent confusion with IV medications, including vincristine?
d. Do doses of IV vincristine include warning labels stating: “Fatal if given intrathecally. For IV use only.” (or similar labeling)?
e. Are vincristine injections placed in an overwrap with a second warning label affixed?
f. Does a pharmacist independently double-check IV vincristine doses, even if another pharmacist initially prepared the dose?
g. Is IV vincristine delivered from the pharmacy to a location where intrathecal drugs are prohibited?
h. If a patient is receiving IV vincristine and an intrathecal medication, does the organization have a process to verify that the intrathecal injection has been completed before dispensing IV vincristine (or vice versa)?
i. Do two health professionals independently check IV vincristine doses before administration?
j. Are doses of IV vincristine prohibited from being administered in the same location where intrathecal medications are given?
k. Is IV vincristine banned from rooms where lumbar punctures are performed?
l. Are those who prescribe, prepare, dispense, and administer chemotherapy educated about published case reports of fatal intrathecal administration of IV vincristine?

2. Please answer the following questions by placing checkmarks in the appropriate column. Use column A if referring to your experiences with administering undiluted IV vincristine from a syringe. Use column B if referring to your experiences with administering diluted IV vincristine via a bag or syringe. Do not use column B if you have no experience with administering diluted IV vincristine.

Questions	Column A: Undiluted		Column B: Diluted
a. What is the typical volume of solution administered for each dose of IV vincristine in your facility?	Not Applicable		25 mL	50 mL	Other
b. During administration of IV vincristine, does a trained licensed practitioner remain at the bedside to continually monitor the patient and assess IV patency and signs of extravasation?	Yes	No	Yes	No
c. Are you aware of any extravasations that have occurred within the past 2 years related to administration of undiluted IV vincristine? If yes, how many were mild, moderate, or severe? Mild Moderate Severe	Yes	No	Not Applicable
d. Are you aware of any extravasations that have occurred within the past 2 years related to administration of diluted IV vincristine? If yes, how many were mild, moderate, or severe? Mild Moderate Severe	Not Applicable		Yes	No

3. Please provide the following information about your facility:

a. Category that best describes your facility:
b. Category that best describes your services:
c. Category that best describes your oncology patients: