The American Society of Clinical Oncology (ASCO) and Oncology Nursing Society (ONS) jointly delineated chemotherapy administration safety standards in 2009. Those standards were created in response to the need for standardization in chemotherapy administration and subsequently have been used in clinical practice and ASCO’s Quality Oncology Practice Initiative certification program. The standards were updated in 2011, 2013, and 2016.
The 2016 standards update (published in January 2017) 1 was led by a working group from ASCO and ONS. Representatives from the American Society of Pediatric Hematology/Oncology and the Association of Pediatric Hematology Oncology Nurses were added when the group decided that the standards should apply to pediatric oncology. A literature review was performed and updated standards were drafted and posted for public comments.
The ASCO/ONS chemotherapy administration safety standards were reordered to better reflect the sequential process of chemotherapy ordering, preparation, and administration. The first section of the standards contains standards for a safe healthcare environment, including staff qualifications and education. Other sections focus on treatment planning, patient education, and consent to treatment. There are now updated standards on patient monitoring, including adherence, toxicities, and complications.
A Focus on Pediatric Oncology
Pediatric considerations, such as measuring a child’s height with each treatment cycle as well as having a licensed pharmacist review chemotherapy orders for patients under age 18, are new standards. Additional chemotherapy labeling requirements were added, including specific items to be included on medications dispensed from the healthcare setting that are to be taken at home.
Sequencing of administration when applicable and total number of products to be given when medication is provided in divided doses, represent new labeling standards. Each product should be labeled with the total number of products to be administered and the individual products sequence within that total grouping; for example, 1 of 5, 2 of 2, etc.
Another new standard is that upon chemotherapy preparation, a second person approved by the healthcare setting to prepare parenteral chemotherapy verifies the drug vial(s), concentration, drug volume or weight, diluent type and volume (when applicable), and administration fluid type, volume, and tubing.
The standard on treatment goals has been clarified to provide examples. Goals of treatment need to be included in treatment plans and/or orders and state treatment intent (eg, cure disease, prolong life, or reduce symptoms). Clearly stating the goal of treatment not only guides treatment decisions and care planning, but also helps guide conversations with the patient and family.
Multichannel Drug Safety Education
A patient education standard has been expanded to state that patients are provided with verbal and written or electronic information as part of an education process prior to the first administration of chemotherapy. Previously, written patient education materials were print only; however, as electronic materials have proliferated, the standards were updated to reflect their use.
Although ASCO/ONS standards on intrathecal chemotherapy preparation and labeling were a component of the earlier standards, a new standard on vincristine administration has been added. Vincristine, when inadvertently administrated intrathecally, can cause paralysis and oftentimes is a lethal medication error.
To reduce the likelihood of this happening, vinca alkaloids need to be administered by intravenous infusion (via minibags) in facilities in which intrathecal medications are administered. Intrathecal medications should be administered immediately after a timeout, double-check procedure that involves 2 licensed practitioners or other personnel approved by the healthcare setting to prepare or administer chemotherapy.
The ASCO/ONS chemotherapy administration safety standards are minimum expectations for ordering, preparing, and administering chemotherapy. They are applicable to a variety of settings and across treatment populations, including pediatric oncology. Some or all of the standards can be incorporated into practice. For some healthcare settings, such as small office practices, the standards may be aspirational, whereas in other settings, they guide day-to-day practice.
- Neuss MN, Gilmore TR, Belderson KM, et al. 2016 Updated American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards, Including Standards for Pediatric Oncology. Oncol Nurs Forum. 2017;44(1):1-13.
Lisa Schulmeister, MN, RN, ACNS-BC, FAAN, is an oncology nursing consultant and editor-in-chief of Oncology Nursing News.