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Structures and processes of care in ambulatory oncology settings and nurse-reported exposure to chemotherapy
  1. Christopher R Friese1,
  2. Laurel Himes-Ferris2,
  3. Megan N Frasier3,
  4. Marjorie C McCullagh4,
  5. Jennifer J Griggs2,5
  1. 1Division of Nursing Business and Health Systems, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
  2. 2University of Michigan School of Public Health, Ann Arbor, Michigan, USA
  3. 3University of Michigan College of Literature, Science, and Arts, Ann Arbor, Michigan, USA
  4. 4Division of Health Promotion and Risk Reduction, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
  5. 5Division of Haematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Christopher R Friese, Nursing Business and Health Systems, University of Michigan School of Nursing, 400 N. Ingalls 4162, Ann Arbor, MI 48109-5482, USA; cfriese{at}


Purpose Oncology nurses in ambulatory settings are at increased risk for unintentional chemotherapy exposure due to the large volumes of agents delivered and the absence of regulatory enforcement. Given the limited data regarding the correlates of exposure, the authors sought to identify the relationship between the organisational structures and processes of care in ambulatory oncology settings associated with increased risk of unintentional chemotherapy.

Methods Between April 2010 and June 2010, a state-wide sample of oncology nurses were surveyed who reported their employment outside of hospital inpatient units (n=1339). The survey examined the likelihood of self-reported exposure to chemotherapy as a function of perceived quality of the practice environment, nursing workload, and seven ambulatory chemotherapy administration safety standards.

Results The response rate was 30.4%, with minimal demographic differences observed between respondents and non-respondents. The overall rate of exposure to the skin or eyes in the past year was 16.9%. In multivariable logistic regression models that controlled for demographic characteristics and clustering of nurses in practices, the likelihood of exposure decreased when nurses reported adequate staffing and resources (OR 0.35, 95% CI 0.17 to 0.73; p=0.001), and when nurses reported that chemotherapy doses were verified by two nurses frequently or very frequently (OR 0.17, 95% CI 0.05 to 0.59; p=0.001).

Conclusions Oncology nurses in the ambulatory setting report substantial unintentional skin and eye exposure to chemotherapy. Ensuring adequate staffing and resources and adherence to recognised practice standards may protect oncology nurses from harm.

  • Occupational exposure
  • nursing
  • antineoplastic agents
  • safety
  • outcomes assessment (healthcare)
  • health services research
  • healthcare quality improvement
  • nurses
  • organisational theory

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  • An additional appendix is published online only. To view this file please visit the journal online (

  • Funding This research was supported by a Pathway to Independence Award (R00 NR 010750) from the National Institute of Nursing Research, National Institutes of Health, and in part from the University of Michigan Comprehensive Cancer Centre Support Grant (P30 CA46592).

  • Competing interests None.

  • Ethics approval University of Michigan—IRBMED.

  • Provenance and peer review Not commissioned; externally peer reviewed.