What actions should be performed post-administration of cancer therapy to maximise safety?

From Cancer Guidelines Wiki

Introduction

Patient care post cancer therapy administration is an important aspect of cancer treatment whether the patient is treated as an inpatient or is being discharged home after day therapy. It is important that patients have all required information and all medications are prescribed. Many protocols require the administration of medication post therapy and these medications form an essential part of the cancer therapy. Omissions or errors in administration and provision of medication and information can lead to adverse effects for the patient.


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Evidence Summary

Patients being discharged home require information on treatment that has been administered and actions to be taken in the case of a severe event or feeling unwell. Providing the name and phone number of a healthcare professional as a 24 hour contact for advice and emergencies (e.g. on-call practitioner, emergency department) minimises delays in the assessment of side-effects from treatment.[1][2][3]

Omissions or errors in patient information and administration of important post therapy medications and supportive therapy can have a significant impact on patient outcomes and toxicities. Many medications are required as prophylaxis for symptoms and side effects and include (but are not restricted to) antiemetics, growth colony stimulating factor support, anti-diarrhoeals, hydration and electrolyte support (oral and intravenous), antivirals, antibiotics, antifungals, allopurinol, mesna, folinic acid (leucovorin), mouthwashes and eye drops. Some protocols combine oral and parenteral cancer therapy and require that oral chemotherapy is taken post parenteral chemotherapy (e.g. intravenous oxaliplatin with oral capecitabine in the CAPOX [XELOX] protocol for colorectal cancer or subcutaneous bortezomib with oral cyclophosphamide and oral dexamethasone in the CyBorD protocol for multiple myeloma). Nursing staff must ensure in conjunction with the pharmacist that these medications are prescribed and administered according to the protocol, or that arrangements are in place for supply from the pharmacy on discharge.


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Recommendations

Note: Section 8 of these guidelines (General Information, "Patient Information") provides additional recommendations on information to be provided to patients.


Consensus-based recommendationQuestion mark transparent.png

Nursing staff must ensure that all medications required post-administration of the cancer therapy are prescribed and administered according to the protocol and treatment plan (e.g. mesna, folinic acid, intravenous fluids). Requirements may differ according to whether the patient is receiving treatment as an inpatient or day patient.


After administration the nurse must ensure that cytotoxic chemotherapy precautions are observed when handling patient waste. The period of time can vary depending on the route of administration, dose and half-life. Generally precautions should be observed for 48 to 72 hours following parental administration or up to 7 days following oral therapy. These times may be longer according to the protocol or local policy.


Prior to discharge from hospital the nurse should ensure that the patient has the following:

  • Written information on the treatment administered including expected side effects, precautions to be taken and what to do in the case of an adverse effect (e.g. uncontrolled nausea and vomiting, a febrile episode or diarrhoea).
  • Arrangements made for laboratory tests and other tests relevant to the disease and treatment.
  • An appointment for medical review and the next cycle of treatment.
  • The name and phone number of a healthcare professional who is available as a 24 hour contact for advice and emergencies (e.g. on-call practitioner, emergency department).

The nurse should ensure in conjunction with the pharmacist that arrangements are in place for the supply of all required discharge and take home medications e.g. antiemetics, anti-diarrhoeals, colony stimulating factors.

Written and verbal information should be provided by the pharmacist on the medication including instructions on how and when the medication should be taken, expected side effects, precautions to be taken and what to do in the event of an adverse effect.


All post-administration care and actions must be documented in the patient’s healthcare record including care of the patient during and after administration of chemotherapy, discharge medication and the education and information provided to the patient.

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References

  1. Goldspiel B, Hoffman JM, Griffith NL, Goodin S, DeChristoforo R, Montello CM, et al. ASHP guidelines on preventing medication errors with chemotherapy and biotherapy. Am J Health Syst Pharm 2015 Apr 15;72(8):e6-e35 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25825193.
  2. Carrington C, Stone L, Koczwara B, Searle C, Siderov J, Stevenson B, et al. The Clinical Oncological Society of Australia (COSA) guidelines for the safe prescribing, dispensing and administration of cancer chemotherapy. Asia Pac J Clin Oncol 2010 Sep;6(3):220-37 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20887505.
  3. Neuss MN, Gilmore TR, Belderson KM, Billett AL, Conti-Kalchik T, Harvet BE, 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 Jan 6;44(1):31-43 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/28067033.

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