Resources include staffing and non-labour resources such as equipment and reference sources. Resources need to be appropriate and sufficient to ensure the delivery of cancer therapy aligns with safe practices at all times during the patient’s treatment journey.
Cancer therapy is delivered across a variety of settings and tumour groups. There are limited bodies of work that accurately describe optimal skill mix, numbers and discipline of staffing needed to support the safe delivery of all cancer therapy.
The Society of Hospital Pharmacists of Australia (SHPA) provides recommendations on staffing levels for pharmacists across a range of specialties and patient admitted status including cancer. The British Oncology Pharmacy Association (BOPA) makes pharmacy workforce recommendations on numbers of pharmacists required to ensure the mandated verification of chemotherapy prescribing occurs.
Nurse-to-patient ratios are mandated in Queensland which define a minimum number of nurses required on a ward according to the number of admitted patients. This is not cancer specific.
Non labour resources
The use of electronic programs to facilitate the prescribing, dispensing and administration of cancer therapy has been demonstrated to improve safety. Electronic prescribing systems require careful implementation and ongoing monitoring to be effective in reducing risk. The need to duplicate data entry into multiple systems requires additional staff resources and can contribute significantly to medication errors.
Staff numbers and skill mix must be suitable for the activity and cancer type. Staffing resources should take into account the range of tumour groups treated, the complexity of the treatment, the case mix and number of patients that attend the facility for treatment and/or management of side effects from cancer therapy.
Electronic information management systems should be in place to support the provision of cancer therapy. Systems for prescribing, dispensing and administration should provide seamless data entry or be linked to minimise the need to duplicate data entry.
Up-to-date information resources that support the delivery of cancer therapy must be available to all staff at the point of care. With the frequency that new cancer treatments and protocols evolve it is recommended that electronic reference resources be utilised to inform day-to-day practice.
All staff should have access to up-to-date and well maintained equipment (e.g. computers, infusion pumps) to support the delivery of cancer therapy.
A process should be in place for capacity management to ensure staffing resources match patient activity and treatment complexity.
A structured peer support or mentoring program should be available to all staff new to cancer or new to the facility (Ashley et al, 2011).
Specialist populations (e.g. geriatrics, paediatrics and patients undergoing stem cell transplant) require a reduced staff-to-patient ratio to ensure safe practices can be maintained. It is recommended that transplant facilities follow the 'Foundation for the Accreditation of Cellular Therapy' (FACT) accreditation standards.
Staffing resources should include skilled Information Technology (IT) support to manage implementation and maintenance of electronic prescribing systems.
Non labour resources
All staff must have easy access to up-to-date information resources to support their role. Minimum resources that should be available include:
- 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.
- The Society of Hospital Pharmacists of Australia - Committee of Specialty Practice. Standards of Practice for Clinical Pharmacy Services. Chapter 9; Staffing levels and structure for the provision of services. J Pharm Pract Res 2013;43, S32-34.
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