What governance processes, policies and procedures should be in place for the safe provision of cancer therapy?

From Cancer Guidelines Wiki


An effective system of clinical governance in the delivery of cancer therapy is essential to ensure the safety and quality of care.[1][2][3][4][5] Governance defines clear lines of accountability and responsibility, ensures appropriate oversight of policy and procedures and provides a mechanism to continuously improve safety.

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Evidence Summary

Episodes of errors and incorrect dosing in cancer chemotherapy have been attributed, at least in part, to poor governance processes in Australia and overseas.[6][7][8][9][10][11][12]

Consumer participation in the governance process can improve the design of systems and procedures that are followed.[1]

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Consensus-based recommendationQuestion mark transparent.png

Each healthcare facility should have its own governance committee and framework to provide direction and clear instruction on working practices for all team members involved in the delivery of cancer medications. The clinical governance committee should include consumer input.

Policies and procedures should be approved by a relevant governance committee, which may include the facilities Drug and Therapeutics Committee. All documents must include a specified review date and mechanisms must be in place to update procedures and policies regularly.

All team members should have access to and be familiar with the content of the policies and procedures including updated versions.

A mechanism should be in place that enables regular review and audit of practices and encourages a culture of continuous safety and quality improvement.

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Policies and procedures should be stored electronically in a read-only format to avoid unapproved or undetectable alterations.

Printing copies of procedures and protocols that are available electronically should be minimised with staff encouraged to use electronic sources. This avoids the possible use of superseded documents when a newer version is issued. Any printed material should be annotated with the date of printing. A useful statement to add as a footnote is: All printed copies of this document are considered uncontrolled copies. Printed copies are only valid for the day printed.

When policies and procedures are being circulated for update or review the document should be annotated with a watermark to clearly identify that it has not been approved.

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  1. 1.0 1.1 Australian Commission on Safety and Quality in Health Care. The National Safety and Quality Health Service (NSQHS) Standards. [homepage on the internet]; 2014 [cited 2016 Sep]. Available from: https://www.safetyandquality.gov.au/our-work/assessment-to-the-nsqhs-standards/.
  2. 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.
  3. Leape LL, Bates DW, Cullen DJ, Cooper J, Demonaco HJ, Gallivan T, et al. Systems analysis of adverse drug events. ADE Prevention Study Group. JAMA 1995 Jul 5;274(1):35-43 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/7791256.
  4. Goldspiel BR, DeChristoforo R, Daniels CE. A continuous-improvement approach for reducing the number of chemotherapy-related medication errors. Am J Health Syst Pharm 2000 Dec 15;57 Suppl 4:S4-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11148943.
  5. 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.
  6. Roush W. Dana-Farber death sends a warning to research hospitals. Science 1995 Jul 21;269(5222):295-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/7618095.
  7. O'Brien ME, Borthwick A, Rigg A, Leary A, Assersohn L, Last K, et al. Mortality within 30 days of chemotherapy: a clinical governance benchmarking issue for oncology patients. Br J Cancer 2006 Dec 18;95(12):1632-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17160081.
  8. Dyer C. Doctors suspended after injecting wrong drug into spine. BMJ 2001 Feb 3;322(7281):257 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11157519.
  9. NSW Health Department. Off-protocol prescribing of chemotherapy for head and neck cancers. Inquiry under section 122 of the Health Services Act 1997.; 2016 [cited 2016 Sep] Available from: http://www.health.nsw.gov.au/Hospitals/Documents/section-122-final-report.pdf.
  10. 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.
  11. Department of Health. A Report by the Chief Pharmaceutical Officer. Building a safer NHS for patients: Improving Medication Safety.; 2004 [cited 2016 Sep] Available from: http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4084961.pdf.
  12. Vowels M. Review of Etoposide Phosphate dosing in the Oncology Unit. [homepage on the internet] Women’s and Children’s Hospital (WCH) Children, Youth and Women’s Health Service, Adelaide, South Australia.; 2008 [cited 2016 Sep]. Available from: http://www.health.sa.gov.au/Default.aspx?tabid=52&mid=449&ctl=ViewDetails&ItemID=1820&PageIndex=0.

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