Communication and a Team Approach for Maintaining Patient, Visitor and Occupational Safety during Administration of Aerosolized Ribavirin

Abstract

Topic Significance & Study Purpose/Background/Rationale Ribavirin, a broad-spectrum antiviral agent, is used to treat hospitalized patients with severe lower respiratory tract infections due to respiratory syncytial virus (RSV). Immunocompromised patients are especially at risk. Aerosolized ribavirin is preferred over oral in order to minimize systemic effects such as hepatotoxicity and nephrotoxicity. However, aerosolized ribavirin presents administration challenges related to its hazardous and teratogenic effects, and its potential for environmental spread. There are many safety considerations for patient s receiving ribavirin, their visitors and the multidisciplinary team of providers caring for them. Even with the use of containment tents and aerosol scavenging devices during administration offering increased protection, a team approach with well-defined roles and clear communication is needed to ensure everyone s safety. Methods, Intervention, & Analysis Communication and coordination among care providers, and with the patient, is critical for safe administration. Providers, and the patient, should understand the indication for ribavirin and how it is administered, and along with their visitors must be aware of safety considerations. Nursing must be clear on interventions before, during and between administrations. Numerous challenges can contribute to poor communication and a reliance on individual action. A lack of clear structure and specific responsibilities in policies and procedures can lead to communication barriers. To overcome these barriers, the nursing clinical practice committee at our facility has created a nursing standard of practice (SOP) outlining the care of the patient receiving aerosolized ribavirin. Roles for nursing, respiratory therapy, and housekeeping are clearly defined and each discipline s role in reducing exposure is discussed. Findings & Interpretation The ribavirin SOP is designed to be used in tandem with our facility s nursing SOP for the safe handling of hazardous drugs. Working together with nursing, our medical leadership simultaneously updated the medical policy for the administration of ribavirin, ensuring hospital-wide consistency. As our discipline prepares for compliance with USP 800 and tighter safety requirements for the handling of hazardous drugs, the need for comprehensive policies and consistent safety standards is increasingly important. Discussion & Implications Aerosolized ribavirin has been in use for 30 years and is still the only FDA approved antiviral for RSV. This hazardous drug with teratogenic effects requires a coordinated effort among health care staff in order to ensure patient, visitor and occupational safety. The best way to accomplish this is through standardized procedures and communication. Sharing our facility s nursing SOP may encourage other facilities to create or revise their own SOP and thereby improve patient, family and occupational safety during the administration of aerosolized ribavirin.