ISMP Survey on Administration of IV Vincristine
(
All Respondants)

Total: 418

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? 23% 71% 5%
b. Are doses of IV vincristine diluted and dispensed/ administered in a syringe? 52% 43% 5%
c. Are intrathecal medications packaged in a distinctive container not used for any other purpose to prevent confusion with IV medications, including vincristine? 55% 41% 4%
d. Do doses of IV vincristine include warning labels stating: “Fatal if given intrathecally. For IV use only.” (or similar labeling)? 54% 7% 1%
e. Are vincristine injections placed in an overwrap with a second warning label affixed? 77% 20% 3%
f. Does a pharmacist independently double-check IV vincristine doses, even if another pharmacist initially prepared the dose? 76% 17% 7%
g. Is IV vincristine delivered from the pharmacy to a location where intrathecal drugs are prohibited? 24% 71% 5%
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)? 43% 54% 3%
i. Do two health professionals independently check IV vincristine doses before administration? 94% 4% 2%
j. Are doses of IV vincristine prohibited from being administered in the same location where intrathecal medications are given? 39% 58% 4%
k. Is IV vincristine banned from rooms where lumbar punctures are performed? 40% 58% 2%
l. Are those who prescribe, prepare, dispense, and administer chemotherapy educated about published case reports of fatal intrathecal administration of IV vincristine? 90% 3% 7%

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?   25 mL
18%
50 mL
44%
Other

38%
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
96%
No
4%
Yes
80%
No
20%

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?

Yes
5%
No
95%
Mild:11
Moderate:
7
Severe:

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:16
Moderate:
1
Severe:
2
Yes 3% No
97%
3. Please provide the following information about your facility:
a. Category that best describes your facility:
General 67%
Specialty: non-oncologic 2%
Specialty: oncology 31%
b. Category that best describes your services:
Both 67%
Inpatients 16%
Outpatients 17%
c. Category that best describes your oncology patients:
Adults and pediatric 24%
All adults 64%
All pediatrics 12%

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