Nurses who administer cancer therapy and related therapy to patients with cancer need to be equipped with the appropriate skills and competencies to ensure the safe administration of these medicines. Maintaining the competency of healthcare professionals is a key principle of clinical governance and risk management and contributes to overall risk reduction in administration errors.
Adequate training and skills assessments are necessary to ensure nurses attain and maintain these skills to deliver optimal care to patients with cancer.
Nursing staff should complete education and achieve competency in chemotherapy administration prior to administering any chemotherapy medication. The eviQ Antineoplastic Drug Administration Course (ADAC) supports health professionals to develop the necessary knowledge and clinical skills to administer cancer medications via different routes and handle related waste safely. The National Professional Development Framework for Cancer Nursing (EdCaN) provides a professional development model for nurses working in cancer.
Nursing staff administering parenteral therapy must be proficient in intravenous cannulation or be supported by staff who have cannulation skills. In addition, they must be competent in the management and maintenance of central venous access devices or be supported by staff who have these skills. eviQ Cancer Education Online  hosts the Central Venous Access Device (CVAD) course. This comprehensive, evidence-based course consists of three modules with associated competency assessment tools.
Nursing staff administering parenteral therapy must complete training and undertake relevant competency assessments with regard to infusional devices used at their institution. Nursing staff required to administer chemotherapy via routes other than parenteral are to be provided with evidence-based education to facilitate the acquisition of knowledge and skills. Local policies and procedures may differ in relation to educational requirements for the administration of oral cancer agents. Procedures to be followed should be placed clearly in patient care plans and notes.
Note: Section 1 of these guidelines (General Information, "Competency and Skills") provides additional recommendations on competency and skills relevant to cancer treatment.
Nurses administering cancer therapies should be competent in age-appropriate basic life support (Neuss et al, 2017; Belderson and Billett, 2017).
All nurses administering chemotherapy, targeted therapy, monoclonal therapy for cancer and related treatments should have access to appropriate educational resources and relevant standards and legislation (Vioral, 2014).
Education programs must have clear and unambiguous learning objectives underpinned by relevant aspects of The National Cancer Nursing Education Project (EdCaN, 2009). Education programs must include strategies to ensure staff are kept up-to-date with new therapies, new protocols and new devices that are introduced into clinical practice and can access relevant information. With the increasing number of new non-chemotherapy medicines (e.g. monoclonal immunotherapies) being introduced into clinical practice, nursing staff must ensure understanding and competency to administer these therapies and provide patient support.
Nurses must demonstrate competence, knowledge and proficiency in the administration of cancer therapy and related aspects of cancer care. Competencies to be completed include:
Nurses should maintain their competency and skills in the administration of chemotherapy through ongoing learning and regular competence based assessment. Staff who are competent in the administration of cancer therapy and management of cancer patients should support and facilitate training. Nurses with a role in cancer should attend specialist cancer conferences, seminars and educational meetings to maintain and update specialist knowledge and skills. Competencies to be completed include:
- Cancer Institute NSW. eviQ Cancer Treatments Online. [homepage on the internet]; 2018 Feb 25 [cited 2016 Sep]. Available from: https://www.eviq.org.au.
- The National Cancer Nursing Education Project (EdCaN). A national professional development framework for cancer nursing.; 2009 Available from: http://edcan.org.au/assets/edcan/files/docs/EdCanWeb_2nded.pdf.
- Cancer Institute NSW. eviQ Cancer Education Online. [homepage on the internet]; 2018 Feb 25 Available from: https://education.eviq.org.au/.
- 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.
- 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.
- Belderson KM, Billett AL. Chemotherapy safety standards: A pediatric perspective. Pediatr Blood Cancer 2017 Jun;64(6) Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/28306217.
- 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.