The Institute for Safe Medication Practices (ISMP) has added five new best practices and revised two existing ones for safe medication administration in its recent release of the 2016-2017 Targeted Medication Safety Best Practices for Hospitals. In total, the institute recommends 11 best practices for safe medication handling and administration, many of which align directly with the ASCO/ONS Chemotherapy Administration Safety Standards. Several ISMP recommendations are important to oncology nurses, including the following.
- Dispense vincristine (and other vinca alkaloids) in a minibag.
- Use a weekly dosage regiment default for oral methotrexate in electronic systems when medication orders are entered.
- Weigh patients on admission and during appropriate outpatient or emergency department encounters. Avoid using historical weight.
- Administer high-alert IV medication infusions through a programmable infusion pump using dose error-reduction software.
- Ensure all appropriate antidotes, reversal agents, and rescue agents are readily available and have standardized protocols or coupled order sets in place that permit their emergency administration.
ONS member MiKaela Olsen, APRN-CNS, MS, AOCNS®, served as an editor for the ISMP guidelines, providing an oncology nursing perspective for the updated best practices. “One of the most important things for me in this list was addressing the use of minibags for vinca alkaloids,” Olsen said. “That was one I felt we needed to take a very strong stance on. If it’s accidentally administered into the spinal fluid, it isn’t a potential death or a possibility: the patient will die.”
Olsen, who also worked on the ASCO/ONS Chemotherapy Administration Safety Standards, will be presenting evidence-based research in a poster session at the 42nd Annual ONS Congress to support the usage of minibags when dispensing vinca alkaloids. She said she hopes her evidence will help other oncology nurses put the issue to rest.
Be sure to review all of the ISMP best practices, along with the ASCO/ONS Chemotherapy Administration Safety Standards, to help reduce potential harm to yourself, your colleagues, and your patients when administering potentially hazardous medications.