The availability of a competent and skilled workforce is essential to ensure safe medication practices are followed in the prescribing, dispensing and administration of systemic cancer therapies. Patient safety is optimised when staff possess the appropriate knowledge, skills and attitude towards medication safety and where a culture is embedded that supports a multidisciplinary approach to patient safety.
All medical, pharmacy and nursing staff involved in the provision of cancer therapy must maintain competency and meet continuing professional development (CPD) requirements as a condition of ongoing registration. The type of CPD must reflect the role and responsibilities of the staff member and be relevant to the current scope of practice.
New treatments and service models are continually evolving. All healthcare facilities have a responsibility to ensure staff delivering cancer therapy maintain their skills and competency relevant to the service and that the introduction of new services and treatments is supported by upskilling where needed. Insufficient training and education in new service models or new protocols can compromise safe delivery of treatment.
Each healthcare facility should establish a process to ensure that designated personnel have been trained and authorised to prescribe, dispense and administer cancer therapies as a treatment modality. Mechanisms should be in place to ensure appropriate training and supervision of inexperienced staff and trainees.
All staff involved in the management of cancer and cancer therapy must be competent to perform their relevant functions. In this context, competency should be measurable as an indicator of actual ability to perform defined duties and should be re-assessed at appropriate intervals.
All staff should maintain an appropriate knowledge and skill base with processes in place to ensure continuing professional education. Table 1 provides a suggested list of essential knowledge.
If a facility introduces a new model of service delivery, a new resource (e.g. electronic prescribing) or a new treatment protocol then a process should be in place to ensure upskilling and competency of staff to deliver the service or treatment.
Staff should have equitable access to education and training resources to develop and maintain their competency and skills.
Resources and training should ensure staff develop and maintain both clinical and behavioural skills relevant to cancer therapy (e.g. communication skills).
Experienced and senior staff who are competent in the management of cancer therapy should facilitate appropriate training and learning opportunities.
Education programs should have clear and unambiguous learning objectives, be useable and enable regular competency assessment. Programs should be discipline specific where appropriate (Goldspiel et al, 2015).
Training in electronic management systems used in cancer must be provided to all staff. An assessment of user competency should be performed before system access is granted to prescribe, dispense or administer cancer therapy.
Education and training should include applicable standards and legislation from local, state and national bodies (Vioral, 2014).
Members of the multidisciplinary team that are involved in the prescribing, dispensing and administration of cancer therapy should collaborate to identify the key characteristics of an assessor. For example; minimum years of experience, completion of a program related to conducting assessments, advanced communication skills.
Staff involved in the patient's care should be easily identifiable to the patient according to the discipline and speciality they represent (e.g. nursing, pharmacy, medical and pathology staff). This is to ensure the patient can direct questions about their cancer treatment to the most appropriately skilled person. Students and trainees must be identified to the patient.
Table 1: Suggested list of knowledge and skills applicable to healthcare professionals involved in the prescribing, dispensing and administration of cancer chemotherapy and targeted therapy.
|The principles involved in treating patients and carers.|
|The basic principles of chemotherapy and targeted therapy including mechanism of action, dosage methods, scheduling and administration.|
|Cancer therapy protocols commonly used within scope of clinical practice.|
|Electronic Prescribing Systems (where relevant to the facility).|
|Adverse effects and toxicities associated with chemotherapy and targeted therapy including early identification, ongoing monitoring, principles of prevention and management.|
|Principles of safe handling of cancer therapy in line with evidence-based best practice.|
|Preparation, storage and transportation processes related to chemotherapy.|
|Preparation, storage and transportation processes related to targeted therapy.|
|Information and support needs of patients and their families including psychological support for persons receiving treatment for cancer.|
|Ethical and legal issues associated with the use of chemotherapy and targeted therapy as a treatment modality for cancer.|
|Knowledge of available tools and processes to decrease errors in relation to chemotherapy delivery |
|Local policy and procedures as they relate to cancer treatment.|
- Mayer DK. First, do no harm. Clin J Oncol Nurs 2009 Feb;13(1):11 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19193542.
- Academy of Medical Royal College. Achieving safer prescription of cytotoxic agents: Academy Recommendations 2015. London, UK: Academy of Medical Royal College; 2015 Available from: http://www.aomrc.org.uk/wp-content/uploads/2016/05/Achieving_Safer_Prescription_Cytotoxic_Agents_0415.pdf.
- 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).
- Medical Board of Australia. Continuing professional development registration standard. [homepage on the internet]; 2010 Jul [cited 2016 Sep]. Available from: http://www.medicalboard.gov.au/Registration-Standards.aspx.
- Nursing and Midwifery Board of Australia. Continuing professional development registration standard. [homepage on the internet]; 2016 Jun [cited 2016 Sep]. Available from: http://www.nursingmidwiferyboard.gov.au/Registration-Standards.aspx.
- Pharmacy Board of Australia. Continuing professional development registration standard. [homepage on the internet]; 2015 Dec [cited 2016 Sep]. Available from: http://www.pharmacyboard.gov.au/Registration-Standards.aspx.
- Independent Review Panel for SA Health. Independent review into the incorrect dosing of cytarabine to ten patients with acute myeloid leukaemia at Royal Adelaide Hospital and Flinders Medical Centre.; 2015 [cited 2016 Sep] Available from: http://www.hcasa.asn.au/documents/211-full-report-independent-review-into-the-incorrect-dosing-of-cytarabine/file.
- Goldspiel BR, DeChristoforo R, Hoffman JM. Preventing chemotherapy errors: updating guidelines to meet new challenges. Am J Health Syst Pharm 2015 Apr 15;72(8):668-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25825190.
- Vioral AN. Standardization of chemotherapy administration: a multidisciplinary process utilizing electronic learning vignettes. J Nurses Prof Dev 2014 Mar;30(2):92-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/24658042.
- Fyhr A, Ternov S, Ek Å. From a reactive to a proactive safety approach. Analysis of medication errors in chemotherapy using general failure types. Eur J Cancer Care (Engl) 2015 Aug 4 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26239427.
- 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.