Standardizing Chemotherapy Safety: Navigating the Expansion of Non-Traditional Oncology Care Delivery

The landscape of cancer care delivery is undergoing a profound structural shift. Driven by clinical innovations and a push for operational efficiency, hazardous antineoplastic agents are increasingly moving beyond traditional infusion suites and into specialized procedural areas, including interventional radiology and urology suites.

While this decentralized approach optimizes patient throughput and expands access to localized therapies, it introduces unprecedented clinical risks by bringing complex oncology protocols into clinical environments less familiar with hazardous drug handling.

To ensure safety and procedural fidelity across these non-traditional care spaces, healthcare institutions must establish rigid operational boundaries. This requires standardizing dual-clinician medication verification and enforcing uniform personal protective equipment (PPE) protocols, regardless of the physical point of care. Furthermore, as nursing workflows vary vastly by department, clinical leadership is increasingly leveraging advanced practice providers (APPs) to bridge communication gaps, standardize competency training, and anchor multidisciplinary care teams.

In an interview with Oncology Nursing News, Jenn Pouliot, MSN, RN, OCN, senior director of oncology quality and safety at Mount Sinai Health System, discusses the operational complexities of administering oncology agents in non-traditional environments. Pouliot outlines Mount Sinai’s meticulous approach to tailored competency modeling, the non-negotiable safety standards required of procedural clinicians, and the pivotal role APPs play in maintaining clinical oversight across the health system.

Can you discuss the expansion of non-traditional administration in cancer treatment?

As far as non-traditional administrations, oncology is evolving, and we're giving chemotherapy in departments that we never really ventured into prior; for example, interventional radiology and urology–nurses who won't give chemotherapy otherwise, or wouldn't even be exposed to the idea of assessing patients coming in with symptoms or asking questions about certain drugs. So, we’re getting involved in departments that are taking care of oncology patients. They're not necessarily administering the chemotherapy, but they're handling the drug, or they're verifying the drug with the provider at the time of administration.

So, there's varying scenarios that can occur, depending on the department, and so we're really taking the time to listen to the workbook from the start to finish, as far as who's doing what, what kind of involvement everybody has, and then taking a step back and saying, “Okay, so based on this assessment, what do we think these nurses need to know? What do we think their involvement should be? What kind of training do they need competency wise?” And then we plan what that looks like from a nursing perspective and plan their competency training, and what that looks like maintaining moving forward.

It looks different in each space. It's not a one size fits all.

What are non-negotiables with the protocols associated with non-traditional administration?

The lack of written policy for PPE and chemotherapy is a non-negotiable, and just the verification process from start to finish. So, prior to prepping the drug, we do a 2-nurse verification, and that's a non-negotiable for us. And in some of these smaller areas, they didn't have 2 nurses to do it, so we hold the provider accountable to be that other clinician. [Providers] just need to be willing and able to adapt to that role to make sure that our standard doesn't get compromised and our process continues to get followed regardless of where we go. They have to be able to maintain their competency to do the verification processes prior to making the drug, and then at the administration time. We will not let that piece be taken out of our process.

How can leadership ensure consistency with these protocols as well?

We're able to provide the training, all the information that you need, set everything up in the EHR to where everyone's able to document the way they need to document. The process is seamless. There's no guessing as to what you need to do, but the provider needs to be hands on and able and willing to stick with the process. And then we do check-ins from time to time, just to see how the process is going. Are there any gaps that we need to fill? And then just making sure that [providers] have access to ask questions to the main hospital if they have any. And then keeping them in contact with someone from my team to keep them in line with making sure that they stay on top of their annual competencies. It was really just getting the buy-in and having meetings and just being willing to help them help themselves, I think was really important.

What role can an advanced practice providers (APP) play in bridging the gap between the medical oncology team and the procedural specialist?

They play a huge role. Our APPs are extremely independent as far as leading the charge with a lot of our procedural areas, especially with assuming these clinician/nursing roles. … They really do push things along, and in procedural areas like that, they do bridge a lot of the gaps. It's been a game changer as far as trying to find a nurse to do this and now they've assumed that role, which has been really helpful.