Implementing a formal cytotoxic agent program at an overseas medical treatment facility.

United States Naval Hospital (USNH), Okinawa, Japan, is the Navy's largest outside continental U.S. hospital, with 104 inpatient beds. An historical vision for the hospital has been to become the military's medical referral center for the Western Pacific. In keeping with this version the hospital has sought to expand, upgrade, or initiate certain health care services. One service that has been pursued over the last decade has been implementation of a formal cytotoxic agent program. This was finally accomplished in August 1995 with the signing by the Commanding Officer of USNH Okinawa Instruction 6570.1. The purpose of this paper is to explain how the program was implemented; described the services of the program sought to provide; discuss the key players involved with the implementation process; describe hindrances to program implementation; and, finally, to describe USNH Okinawa's experience with the program.