Background and importance The 2016 National Institute for Occupational Safety and Health (NIOSH) update classified hazardous drugs (HD) with a risk to healthcare staff into three lists. NIOSH criteria included: carcinogenicity, teratogenicity, reproductive toxicity, organ toxicity at low doses, genotoxicity and drugs that mimic existing drugs in structure or toxicity. The Spanish National Institute of Occupational Safety and Hygiene then published a national adaptation of the NIOSH lists.

Aim and objectives To analyse the HD included in the hospital formulary and the safe handling measures implemented. The second objective was to quantify the prescriptions of HD and the pharmaceutical interventions required.

Material and methods The hospital formulary was revised in January 2019 to classify HD according to risk level. Antineoplastic intravenous drugs were excluded. We considered antineoplastic drugs (list 1), non-antineoplastic drugs that meet NIOSH criteria (list 2) and drugs with a reproductive risk (list 3). A safe work procedure to handle HD in hospital was developed and the pharmacy procedures were revised. To assess the impact of HD in medical orders, a prospective study from January to June 2019 was conducted. Data collection included HD, classification group, number of inpatient prescriptions and pharmaceutical interventions.

Results In the hospital formulary, there were 78 medications included in the NIOSH lists: 29.5% in list 1, 38.5% in list 2 and 32% in list 3. A comprehensive safety programme of three measures was carried out. Firstly, the hospital formulary was modified, five new formulations were purchased and one magistral formula was created. Secondly, changes in labelling, repackaging or preparation in a biological safety cabinet occurred for 10 medications. Thirdly, staff training was provided. According to the analysis of medical orders, in a 130 day period, there were 4093 daily HD prescriptions (66.1% in list 3, 32.4% in list 2 and 1.5% in list 1) and 229 pharmaceutical interventions proposing a better formulation.

Conclusion and relevance There were a large number of drugs classified as hazardous in the hospital, most belonging to list 3 of the NIOSH classification. This means additional effort for the pharmacy department is required. Working procedures for safe handling should be revised.

References and/or acknowledgements No conflict of interest.