What resources are required for the safe provision of cancer therapy?

From Cancer Guidelines Wiki

Introduction

Resources include staffing and non-labour resources such as equipment and reference sources. Resources need to be appropriate and sufficient to ensure the delivery of cancer therapy aligns with safe practices at all times during the patient’s treatment journey.[1]


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Evidence Summary

Labour resources

Cancer therapy is delivered across a variety of settings and tumour groups. There are limited bodies of work that accurately describe optimal skill mix, numbers and discipline of staffing needed to support the safe delivery of all cancer therapy.

The Society of Hospital Pharmacists of Australia (SHPA) provides recommendations on staffing levels for pharmacists across a range of specialties and patient admitted status including cancer.[2] The British Oncology Pharmacy Association (BOPA) makes pharmacy workforce recommendations on numbers of pharmacists required to ensure the mandated verification of chemotherapy prescribing occurs.[3]

Nurse-to-patient ratios are mandated in Queensland which define a minimum number of nurses required on a ward according to the number of admitted patients.[4] This is not cancer specific.

Non labour resources

The use of electronic programs to facilitate the prescribing, dispensing and administration of cancer therapy has been demonstrated to improve safety.[5][6][7][8][9][10][11][12] Electronic prescribing systems require careful implementation and ongoing monitoring to be effective in reducing risk. The need to duplicate data entry into multiple systems requires additional staff resources and can contribute significantly to medication errors.


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Recommendations

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Staff numbers and skill mix must be suitable for the activity and cancer type. Staffing resources should take into account the range of tumour groups treated, the complexity of the treatment, the case mix and number of patients that attend the facility for treatment and/or management of side effects from cancer therapy.


Electronic information management systems should be in place to support the provision of cancer therapy. Systems for prescribing, dispensing and administration should provide seamless data entry or be linked to minimise the need to duplicate data entry.


Up-to-date information resources that support the delivery of cancer therapy must be available to all staff at the point of care. With the frequency that new cancer treatments and protocols evolve it is recommended that electronic reference resources be utilised to inform day-to-day practice.


All staff should have access to up-to-date and well maintained equipment (e.g. computers, infusion pumps) to support the delivery of cancer therapy.


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Labour resources


A process should be in place for capacity management to ensure staffing resources match patient activity and treatment complexity.


A structured peer support or mentoring program should be available to all staff new to cancer or new to the facility (Ashley et al, 2011).


Specialist populations (e.g. geriatrics, paediatrics and patients undergoing stem cell transplant) require a reduced staff-to-patient ratio to ensure safe practices can be maintained. It is recommended that transplant facilities follow the 'Foundation for the Accreditation of Cellular Therapy' (FACT) accreditation standards.


Staffing resources should include skilled Information Technology (IT) support to manage implementation and maintenance of electronic prescribing systems.


Non labour resources


All staff must have easy access to up-to-date information resources to support their role. Minimum resources that should be available include:

  • Online resources and medication information that provides specialist information on chemotherapy administration, compatibilities, toxicities and monitoring and supportive care.
  • Up-to-date protocols and journal articles relating to treatment, e.g. eviQ Cancer Treatments Online (Cancer Institute NSW).
  • Out-of-date text books and printed resources can compromise patient safety where information has been superseded. It is recognised that some older text books and protocols may be useful in specific cases and for educational purposes. They should be kept in a designated area and clearly annotated where the information has been superseded.

(Ashley et al, 2011)[13] ;(Cancer Institute NSW)[14]


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References

  1. 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.
  2. The Society of Hospital Pharmacists of Australia - Committee of Specialty Practice. Standards of Practice for Clinical Pharmacy Services. Chapter 9; Staffing levels and structure for the provision of services. J Pharm Pract Res 2013;43, S32-34.
  3. British Oncology Pharmacy Association (BOPA). Chemotherapy Service Specification. Medicines Optimisation, Safety and Clinical Pharmacy workforce plan. [homepage on the internet]; 2015 [cited 2016 Sep]. Available from: www.bopawebsite.org (Members only section).
  4. Queensland Health. Office of the Chief Nursing and Midwifery Officer. Nurse-to-patient ratios. [homepage on the internet]; 2016 Jul [cited 2016 Sep]. Available from: https://www.health.qld.gov.au/nmoq/optimisingnursing/nurse-to-patient-ratios.asp.
  5. Womer RB, Tracy E, Soo-Hoo W, Bickert B, DiTaranto S, Barnsteiner JH. Multidisciplinary systems approach to chemotherapy safety: rebuilding processes and holding the gains. J Clin Oncol 2002 Dec 15;20(24):4705-12 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12488417.
  6. Schulmeister L. Preventing chemotherapy errors. Oncologist 2006 May;11(5):463-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16720846.
  7. Kozakiewicz JM, Benis LJ, Fisher SM, Marseglia JB. Safe chemotherapy administration: using failure mode and effects analysis in computerized prescriber order entry. Am J Health Syst Pharm 2005 Sep 1;62(17):1813-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16120742.
  8. Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE, et al. Role of computerized physician order entry systems in facilitating medication errors. JAMA 2005 Mar 9;293(10):1197-203 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15755942.
  9. Gandhi TK, Bartel SB, Shulman LN, Verrier D, Burdick E, Cleary A, et al. Medication safety in the ambulatory chemotherapy setting. Cancer 2005 Dec 1;104(11):2477-83 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16245353.
  10. Dubeshter B, Walsh CJ, Altobelli K, Loughner J, Angel C. Experience with computerized chemotherapy order entry. J Oncol Pract 2006 Mar;2(2):49-52 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20871716.
  11. Bates DW, Teich JM, Lee J, Seger D, Kuperman GJ, Ma'Luf N, et al. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc 1999 Jul;6(4):313-21 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/10428004.
  12. Adelson KB, Qiu YC, Evangelista M, Spencer-Cisek P, Whipple C, Holcombe RF. Implementation of electronic chemotherapy ordering: an opportunity to improve evidence-based oncology care. J Oncol Pract 2014 Mar;10(2):e113-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/24371301.
  13. Ashley L, Dexter R, Marshall F, McKenzie B, Ryan M, Armitage G. Improving the safety of chemotherapy administration: an oncology nurse-led failure mode and effects analysis. Oncol Nurs Forum 2011 Nov;38(6):E436-44 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22037343.
  14. Cancer Institute NSW. eviQ Cancer Treatments Online. [homepage on the internet]; 2017 Nov 18 [cited 2016 Sep]. Available from: https://www.eviq.org.au.

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