• The Control of Substances Hazardous to Health (COSHH) Regulations require employers to control substances that are hazardous to health
  • Assessments and subsequent actions reduce the risks associated with working with hazardous substances
  • If five or more staff are employed, risk assessments must be written down
  • Medicines can be classified as low, medium or high risk (high-risk medicines require individual, detailed assessments)
  • The information in summary of product characteristics (SPC) or safety datasheets should be used to perform risk assessments

Health and safety in the dispensary requires the identification of hazards and risks.

  • A hazard is anything that may cause harm (e.g. chemicals, electricity, working from ladders, an open drawer)
  • The risk is the chance, high or low, that somebody could be harmed by these and other hazards, together with an indication of how serious the harm could be.

Control of Substances Hazardous to Health (COSHH)

The COSHH Regulations require employers to control substances that are hazardous to health. Exposure to hazardous substances can be prevented or reduced by:

  • Finding out what the health hazards are
  • Deciding how to prevent harm to health (risk assessment)
  • Providing control measures to reduce harm to health
  • Making sure they are used
  • Keeping all control measures in good working order
  • Providing information, instruction and training for employees and others
  • Providing monitoring and health surveillance in appropriate cases
  • Planning for emergencies.

Every employer or self-employed person is legally required to make an assessment of the health and safety risks arising from their work. The purpose of the assessment is to identify what needs to be done to control health and safety risks. If a practice employs five or more people, the assessment(s) must be recorded in writing.  Failure to adequately control hazards can lead to prosecution under the COSHH Regulations and civil action from injured or ill employees.

Hazardous substances include:

  • Substances used directly in work activities (e.g. cleaning agents and medicines)
  • Substances generated during work activities (e.g. waste fumes from anaesthesia equipment)
  • Naturally occurring substances (e.g. dust from litters)
  • Biological agents such as bacteria and other microorganisms.

To comply with COSHH Regulations, the following eight steps must be followed:

  1. Assess the risks.
  2. Decide what precautions are needed.
  3. Prevent or adequately control exposure.
  4. Ensure that control measures are used and maintained.
  5. Monitor the exposure.
  6. Carry out appropriate health surveillance.
  7. Prepare plans and procedures to deal with accidents, incidents and emergencies.
  8. Ensure employees are properly informed, trained and supervised.

Substances regarded as hazardous to health include:

  • Substances classified as dangerous to health under the Registration, Evaluation, Authorisation and restriction of Chemicals (REACH) legislation 2007 (recognizable by their warning symbols)
  • Biological agents
  • Any kind of dust if concentrations in the air exceed levels specified in the COSHH Regulations
  • Other substances that may pose a risk to health but are not covered by the Chemicals (Hazard Information and Packaging for Supply) Regulations (CHIP) for technical reasons (e.g. medicines).

For further information on COSHH Regulations 2002 see the Health and Safety Executive (HSE) website.

Risk assessment

Risk assessment involves five steps:

  1. Identify the hazards.
  2. Decide who might be harmed and how.
  3. Evaluate the risks and decide on precautions.
  4. Record significant findings.
  5. Review assessment and update if necessary.

Areas of work in the dispensary requiring risk assessment include:

  • General medicines handling
  • Handling cytotoxic medicines
  • Spillage of medicines
  • Manual handling (e.g. accessing high shelves and moving medicine orders)
  • Trip hazards
  • Waste disposal.

Risk assessments should be carried out for all these tasks and reviewed annually. Standard operating procedures (SOPs) should be written detailing the required control methods, and all staff should be required to sign to acknowledge the SOPs have been read and understood.

See also Correct storage, dispensary management and standard operating procedures.

See also Cytotoxic drugs.

For further information on risk assessments see the Health and Safety Executive (HSE) website.

Low- and medium-risk substances

When working with veterinary medicines, there is a wide variation in risk. Many medicines can be classified as low or medium risk, but others pose a very serious risk to health.

Risks associated with handling low- and medium-risk medicines can be adequately controlled by performing assessments by therapeutic group/type/route of administration. For example, the practice can produce standard methods for the control of exposure to:

  • Injectable anaesthetics
  • Inhalation anaesthetics
  • Pour-on anthelmintics
  • Steroidal compounds
  • Vaccines
  • Antibiotics
  • Disinfectants.

Within these groups, practices must identify specific risks such as penicillin allergy.

High-risk substances

Specific and detailed assessments, along with the resulting control methods, should be made for high-risk substances such as:

  • Cytotoxic medicines
  • Micotil® (tilmicosin)
  • Hormones
  • Oil-based vaccines
  • Gluteraldehyde disinfectants
  • Large animal Immobilon (etorphine).

General guidelines for handling medicines

In general, when handling medicines, a member of staff must:

  • Treat all medicinal products as potentially harmful
  • Be aware of the hazards associated with medicines and know the results of the Control of Substances Hazardous to Health (COSHH) and risk assessments
  • Wear disposable gloves when handling any open or loose products
  • Be familiar with the practice SOP for handling medicines and use additional protective clothing and equipment as and when specified
  • Inform the health and safety officer if they are or expect to become pregnant. In the case of pregnancy, be aware of and avoid handling teratogenic medicines (see the BSAVA Small Animal Formulary for a listing) likely to harm the unborn child or medicines likely to cause miscarriage
  • Inform the health and safety officer if they experience any allergies or adverse effects thought to be caused or made worse by the handling of, or exposure to, veterinary medicinal products
  • Wash their hands after handling medicines, even if disposable gloves have been worn.

Summaries of product characteristics

To perform risk assessments, employers require information on the safe use of medicines, chemicals and disinfectants.

Manufacturers are no longer required to produce safety datasheets for medicines. Information of the safe use of each medicine can be found in the SPC. The VMD product information database has a full list of veterinary SPCs for:

  • Currently authorized products
  • Expired products
  • Suspended products
  • Registered homeopathic products
  • Specified feed additives.

For non-veterinary authorized medicines (e.g. human prescription-only medicines) used under the prescribing cascade, SPCs can be found online at the electronic Medicines Compendium (eMC).

Chemicals and disinfectants are required under REACH regulations 2007 to have a safety datasheet and appropriate warning symbols on the product packaging.

Health and safety in the dispensary quiz

1. Risk assessments that should be carried out for the dispensary include:

2. Specific and detailed COSHH assessments must be performed for which one of the following?

3. The VMD website does not hold SPCs for which one of the following?

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