Safe Handling Practices in Oncology With Jacqueline Redeemer

Welcome to Onc Nurse On Call, the new podcast from Oncology Nursing News, hosted by editors-in-chief Patricia Jakel, MN, RN, AOCN, and Stephanie Desrosiers, DNP, MSN, RN, AOCNS, BMTCN, delivering maximum impact in minimum time.

This week, Jakel and Desrosiers are joined by Jacqueline Redeemer, RN, MN, AOCNS, a clinical nurse specialist (CNS) in solid tumor oncology at The University of California, Los Angeles, who shared her experience integrating safe handling practices into her clinic.

Redeemer’s career path came full circle when she returned to the inpatient setting after 20 years in ambulatory breast cancer care. This transition exposed her to rapid innovations in oncology, including cellular therapies and complex procedural treatments. Her background as a CNS allowed her to view care through a systems-oriented lens, leading her to identify critical safety gaps in nontraditional oncology settings, particularly in the safe handling of antineoplastic agents.

While observing a hepatic arterial infusion procedure in interventional radiology (IR), Redeemer noted that the staff were not consistently applying oncology nursing standards. Because the IR department did not frequently administer chemotherapy, there was a misconception that the high-dose melphalan used in the procedure posed minimal risk due to the way it was perfused. Redeemer utilized her CNS training to emphasize that even a small percentage of a highly concentrated dose remaining in systemic circulation required rigorous protection. She noted that the dose being administered was nearly 10 times the typical intravenous level, making the 10% residue a significant safety concern.

To address these gaps, Redeemer initiated a collaborative performance improvement project involving pharmacy, environmental services, and IR leadership. A primary challenge was the introduction of closed system transfer devices, which were unfamiliar to the IR team.

“All staff that would manage or engage with either administering or handling body excreta or anything after...they needed to be in service and receive education,” Redeemer explained, noting that the training extended to technologists, perfusionists, anesthesiologists, and physicians.

Logistics also required tight coordination because the team had a strict 1-hour window from the time the drug was compounded in the pharmacy to the completion of the infusion to ensure drug stability.

Implementation involved grassroots just-in-time training and simulations to ensure the team could maintain a sterile field while utilizing chemotherapy-approved personal protective equipment. These efforts gained full organizational support following a logistical mishap involving a tubing shortage, which highlighted the vulnerability of staff and patients during the procedure. Following this event, adherence to safety protocols increased significantly across the interdisciplinary team. Unexpectedly, these standardized operating procedures and improved preparation also enhanced clinical efficiency, reducing the total procedure time from 3 hours to approximately 2 hours.

Reflecting on the initiative, Redeemer stressed the need to move away from fragmented care models toward integrated interdisciplinary collaboration. She argued that oncology nursing expertise must be included in organizational decision-making across all clinical areas.

“An oncology nurse needs to be at the table at all times when there are decisions about how to administer, handle, or [introduce] new drugs,” she stated. By involving specialized nursing leadership, health care systems can ensure that safety standards remain consistent and evidence-based across clinical settings and routes of administration.