Chemotherapy is a high-alert medication, and errors in administration may lead to serious patient harm. Carole Elledge, RN, MSN, AOCN®, Mary Krivoy, RN, BSN, OCN®, and Cheryl Downey, RN, BSN, OCN®, developed a systematic, hospital-wide approach for safe chemotherapy administration at the Methodist Hospital, in San Antonio, TX, and presented their program during a poster session at the ONS 41st Annual Congress in San Antonio, TX. The poster was titled “Implementation of Checklists to Improve Safe Practice Surrounding Chemotherapy Administration.”  

The program was based on chemotherapy administration guidelines published by ONS and the American Society of Clinical Oncology, which was recently revised in 2013. The safety model called for a multidisciplinary approach, unit champions, and nursing education. The program was developed by revising current chemotherapy policies and obtaining approval, developing preprinted standardized order sets for chemotherapy, creating preadministration and administration checklists, and training nursing staff for implementation, with a long-term goal of decreasing errors related to chemotherapy administration. 

Once the process was in place, the following steps were carried out.

  1. Written order is received. 
  2. Two chemotherapy-competent RNs review the order for required elements, verify all calculations, and complete the preadministration checklist. 
  3. Order is scanned to the pharmacy. 
  4. Prior to administration, two chemotherapy-competent RNs verify completion and results of all required pretests, administration of premedication and hydration, and independently verify dosing calculations with the original order. 
  5. At the bedside, two chemotherapy-competent RNs verify patient identities, pump settings (if applicable), and administration initiation. 
  6. Chemotherapy administration checklist is completed, signed by administering RN, and returned to the file for auditing. 

Audits were completed on all returned checklists beginning in September 2013. Initial compliance rates averaged less than 40%, but by 2014, compliance rates had increased to more than 85%. 

“Checklists have a demonstrated role in complicated, task-oriented processes and may potentially mitigate errors associated with [healthcare provider] fatigue, complacency, or distraction,” the researchers concluded. “Implementation of these checklists has decreased chemotherapy administration-related errors and improved patient safety [as] evidenced by clinical observations and decreased event report rates.” 

The researchers noted that they have future plans to incorporate these checklists into patient electronic health records.

Elledge, C., Krivoy, M., & Downey, C. (2016). Implementation of checklists to improve safe practice surrounding chemotherapy administration. Poster presented at the ONS 41st Annual Congress, San Antonio, TX, April 28–May 1, 2016.

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