Ensuring that the appropriate information, medication and equipment is available and the relevant patient assessments and/or checks have been completed is an essential part of the safety process of administration of cancer therapy.
The appropriate assessment of the patient and a review of healthcare records minimises the risk of incorrect administration of cancer therapy. Ensuring that all cancer therapy medication to be administered (including pre-medication, equipment and consumables) is available prior to administration commencing reduces delay and potential distractions during the administration process.
Policies, procedures and equipment for safe administration and handling of cancer therapy must be available. eviQ Cancer Education Online provides supporting information on the process for the safe administration of cancer therapy.
Note: Further information on the medication order can be found in the prescribing section of these guidelines and the steps that should be taken when verifying an order are covered in detail in the nursing section on pre-administration verification.
The following information should be made available prior to commencing the administration of cancer therapy (Polovich et al, 2014; Neuss et al, 2017; Belderson and Billett, 2017; Carrington et al, 2010):
The following assessments must be completed prior to commencing the administration of cancer therapy (Neuss et al, 2017; Polovich et al, 2014; Carrington et al, 2010):
The following medication and equipment must be available prior to commencing the administration of cancer therapy:
An appropriately qualified and trained registered nurse or nurse practitioner must be available during and after administration of cancer therapy. A medical officer with suitable experience must also be available in close proximity to respond to emergencies related to the administration of the therapy. The proximity and response time of the medical officer should be defined by local policy but should not compromise patient safety.
Administration of pre-medications must allow an appropriate time span to elapse before chemotherapy, targeted therapy and biological therapy is administered.
Pre-medication steroids such as dexamethasone may be self-administered by the patient at home prior to therapy. A check should always be performed with the patient to ascertain if the patient has self-administered prescribed pre-treatment medications.
Table 13: Information to be assessed and checked by the nurse prior to administration
| Patient’s medical and treatment history
A current diagnosis, treatment plan, documented protocol and medication history must be available and reviewed for current information.
|Patient's height, weight, body surface area and where appropriate, age|
| Pathology and laboratory results
Pathology and laboratory results should be documented and confirmation given by the prescriber that they are appropriate for treatment to proceed.
| Adherence to treatment
For oral chemotherapy an assessment for adherence should be performed.
| Response to previous treatment and previous toxicities that may impact on treatment
Ensure that existing conditions or toxicities do not prevent treatment from proceeding (e.g. nausea and vomiting, mucositis, neuropathy, diarrhoea, hypertension).
Additional medications that the patient may have commenced since the last treatment should be discussed with the pharmacists and medical officer.
| Psychosocial assessment
This should include the patient’s coping mechanisms, anxiety level and any cultural issues that may have an impact on the administration process. Where concerns are identified, referral to another healthcare professional should be considered according to local procedure. Ensure that identified issues do not preclude treatment from proceeding.
| Patient and carers (where appropriate) comprehension of the treatment plan, including chemotherapy and associated medications
This should be confirmed at each appointment and further education provided if assessment identifies inadequate understanding.
| Patient’s physical and performance status and vital signs
A physical assessment and subjective performance status assessment should be used: e.g. Eastern Cooperative Oncology Group (ECOG).
| Scans or investigations specific to the protocol
e.g. lung function tests, gated heart pool scan, echocardiogram.
| Pre-medication required at home has been taken by the patient as instructed
e.g. steroids, antiemetics.
|Access devices required for administration are in place and patent|
- 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.
- 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.
- Polovich M, Olsen M and LeFevre KB. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice (Fourth Edition). Pittsburg: Oncology Nursing Society; 2014.
- Cancer Institute NSW. eviQ Cancer Education Online. [homepage on the internet]; Available from: https://education.eviq.org.au/.
- 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.
- Clinical Oncology Society of Australia and Cancer Pharmacists Group of Australia. Position Statement: Safe handling of monoclonal antibodies in healthcare settings.; 2013 [cited 2016 Sep] Available from: https://www.cosa.org.au/media/173517/cosa-cpg-handling-mabs-position-statement_-november-2013_final.pdf.
- 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.
- Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982 Dec;5(6):649-55 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/7165009.