Careful adherence to safety guidelines for administering chemotherapy is not only critical in the inpatient setting but also in ambulatory facilities and increasingly in the home with a growing number of oral agents in use now and in the oncology drug pipeline.
The Oncology Nursing Society (ONS) recently published an update of its chemotherapy and biotherapy practice guidelines,1
which recognizes these developments and also includes specific advice to assist patients in managing chemotherapy in the home setting, covering such issues as safe storage, disposal, what to do in the event of a spill, and how to protect family members from exposure.2
Oral Chemotherapy Considerations
At the recent ONS Congress, Stephanie Lee, BSN, RN, ONC, and Sarah Mendez, MA, RN, AOCNS, both from the New York University Langone Medical Center (NYULMC), presented their research on the development of standardized instructions for educating nurses about managing patients receiving oral chemotherapy.3
The protocol they developed included delivering brief, inservice training to other units at NYULMC, focusing on patient medication verification, consent, treatment planning, as well as emphasizing the need to involve two nurses in this process. Nurses were also educated on the proper use of personal protective equipment when handling oral chemotherapy, the correct disposal of medication packaging, and body waste.
“Many nurses are not familiar with the safety precautions and protocols regarding oral chemotherapy, often consulting the nurses on the hematology/oncology unit for assistance,” the researchers explained.
“Providing this type of education throughout the hospital helped nurses become familiar and confident when caring for patients receiving oral chemotherapy,” they continued. “Overall, it improved quality of care and safety to both patients and nurses.
Need for Ongoing Vigilance
“Luckily, we do have guidelines from ONS, as well as OSHA and other places, which are all in sync,” said Colleen O’Leary, RN, MSN, AOCNS, during a recent interview. She is a clinical nurse specialist at the Ohio State University Comprehensive Cancer Center James Cancer Hospital and Solove Research Institute in Columbus.
O’Leary, who also coordinates Nursing Evidence-Based Practice at her institution, stressed the need to engage nurses experienced in administering chemotherapy. “You don’t want to have a brand new person doing that, and you have to have that independent double check,” so that there is more than one person looking at it and checking, for example if the dose and body surface area calculation is correct.
She stressed that these guidelines apply in both the inpatient and the ambulatory setting. Sometimes, she added, processes have not been as rigorous in ambulatory areas, but now there is a growing understanding that these precautions must be applied and guidelines adhered to across the board.
“Obviously, we do not want to do anything to harm our patients,” O’Leary said, “putting them at risk for extravasation or wrong doses, but we need to protect ourselves, too, from exposures. Nobody wants to have a mistake in the medication, especially with chemotherapy. Vigilance really is the key.”
Polovich M, Olsen M, LeFebvre K, eds. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. 4th ed. Pittsburgh, PA: Oncology Nursing Society; 2014
Mayer DK. Safe management of chemotherapy in the home. Clin J Oncol Nurse. 2014;18(2):161-162.
Lee S, Mendez S. Educating Nurses on safe administration and management of oral chemotherapy. Oncol Nurs Forum. 2014;41(2):E114.