Cancer therapy and associated treatment can be administered by several routes including oral, intravenous infusion, intravenous bolus, intraventricular, subcutaneous and intradermal. Many of these routes require administration by an appropriately credentialed cancer nurse or an appropriately informed patient, where the medication is being self-administered. Administration via more specialised routes such as intrathecal and intraperitoneal may require a medical practitioner with specialist or surgical experience. There are a number of safety checks required to ensure safe administration of cancer therapy.
Policies, procedures and equipment for safe administration and handling of cancer therapy must be easily accessible, understood and adhered to by all nurses involved in the administration of cancer therapy.
Administering cancer treatment in an area that is suitable for the process and equipped to manage any reasonably foreseeable adverse events associated with the medication or route of administration is an essential part of medication safety. The environment should be free from unnecessary noise and activity. The patient conditions (e.g. seating, lighting) should enable the patient to comfortably receive therapy and encourage easy communication with nursing staff.
The availability of local procedures, medical assistance and medications to manage any complications that may arise during administration ensure adverse events are managed appropriately and in a timely manner.
The chemotherapy, targeted therapy and related medications must be checked at the point of administration by two registered nurses with the appropriate training and skills. All dosage and administration rate-related calculations should be independently verified (White et al, 2010a; White et al, 2010b).
At least one staff member with current, age appropriate training in basic life support should be present during chemotherapy administration (Neuss et al, 2017; Belderson and Billett, 2017).
Only healthcare professionals who have obtained competence in the administration of cancer therapy by the specific administration route should administer cancer therapy via that route.
Cancer therapy should be administered in an area that is equipped to manage any reasonably foreseeable adverse events that may be associated with the medication or route of administration.
Local occupational health and safety workplace guidelines must be followed when handling hazardous medications (NIOSH, 2014; Clinical Oncology Society of Australia and Cancer Pharmacists Group of Australia, 2013).
Policies and procedures for safe medication administration, management of extravasation and emergency procedure protocols must be followed when administering cancer therapy (Polovich et al, 2014; Goldspiel et al, 2015a).
All administrations, observations and actions related to the patient during administration must be documented in the patient’s healthcare records including vital signs, adverse events and patient reported concerns (Polovich et al, 2014). The entry must be made at the time and point of delivery of patient care and be signed and dated.
Nursing staff involved in the administration of therapy in the home should ensure that appropriate procedures are in place to manage any complications and be able to access medical assistance and medications for the management of an adverse event (Evans et al, 2016). Procedures must maximise patient safety and minimise the risk of errors.
(White et al, 2010a) ;(White et al, 2010b) ;(Neuss et al, 2017) ;(Belderson and Billett, 2017) ;(NIOSH, 2014) ;(Clinical Oncology Society of Australia and Cancer Pharmacists Group of Australia, 2013) ;(Polovich et al, 2014) ;(Goldspiel et al, 2015a) ;(Evans et al, 2016)
Administration of cancer treatments closer to home for people with cancer from rural and remote locations is currently being implemented in some Australian states (Sabesan et al, 2012; Clinical Oncology Society of Australia, 2015; SA Cancer Clinical Network Steering Committee, 2010). Under these service models nursing staff should ensure that procedures for administration are followed that maximise patient safety and minimise the risk of errors.
Preparations for parenteral administration must be checked for leaks, precipitation or any other visual signs of problems with the solution. Seek advice from the providing Pharmacist if any concerns or if advice is required.
Table 16: Administration of cancer therapy by specified routes
| ADMINISTRATION VIA THE INTRAVENOUS ROUTE
|ADMINISTRATION VIA THE INTRAMUSCULAR AND SUBCUTANEOUS ROUTE
| ADMINISTRATION VIA THE INTRATHECAL ROUTE
Note: Further recommendations on intrathecal cancer therapy are provided under the General Information section of these guidelines.
| ADMINISTRATION VIA THE ORAL ROUTE
Note: Further recommendations on oral cancer therapy are provided under the General Information section of these guidelines.
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