By Chris Pirschel and Kathleen Wiley, RN, MSN, AOCNS®
Most patients and practitioners associate chemotherapy with cancer treatments, yet the drugs are also used to treat a number of autoimmune diseases, including multiple sclerosis, rheumatoid arthritis, antineutrophil cytoplasmic antibody–associated vasculitis, and systemic lupus erythematosus.
With increasing use of chemotherapy for indications other than cancer, so do concerns about their safe handling and administration in non-oncology settings. Guidelines address this, but non-oncology personnel might not know of them. Bringing awareness to the standards available from the American Society of Clinical Oncology (ASCO) and ONS, U.S. Pharmacopeia, and National Institute for Occupational Safety and Health can help address the safety gap in practice.
Currently, it’s up to an institution’s discretion to decide who is permitted to administer chemotherapy agents and what training and competencies will be required of them. In these cases, it can be difficult for all parties to understand the process for delivering optimal care to patients requiring chemotherapy for management of conditions, regardless of indication.
What Do the ASCO/ONS Standards Say?
Chemotherapy should be administered by “a qualified physician, physician assistant, registered nurse, or advanced practice nurse.” This can include non-oncology professionals as long as they have the training and education required to administer the agents. In fact, Standard 1.2 indicates that “the healthcare setting will use a comprehensive education program for initial and ongoing educational requirements for all staff who prepare and administer chemotherapy.”
According to the ASCO/ONS standards, nurses in non-oncology units who lack training in chemotherapy administration as defined by their institution will need to consult a trained oncology nurse deemed competent to administer chemotherapy within the institution for administration of the agent.
Collaborating Across Healthcare Settings
Providing education and staff availability to nurses in non-oncology departments can help ensure safe chemotherapy delivery for patients and practitioners. Per the standards, oncology nurses cannot simply train a non-oncology nurse to administer chemotherapy because it does not constitute a comprehensive education program, but they can share valuable information about the process, the drugs used, potential side effects, and more. Collaboration can answer questions, address issues, and eliminate uncertainty. However, only healthcare professionals with institutional-specified training to deliver chemotherapy can be responsible for administration.
Smith presented a case study in which an oncology nurse assists with chemotherapy delivery in an intensive care unit (ICU) setting. After consulting with the ICU nurse, the oncology provider developed a plan for treatment where she would be present to administer the necessary chemotherapy. However, because of complications with the patient, treatment was pushed back in the day. The oncology nurse coordinated with her ICU colleague, provided further peer-to-peer education, and was able to monitor the situation to develop a new plan for treatment. Through collaboration, the plan was adjusted and an oncology nurse was made available to administer the treatment. After administering the chemotherapy agent, the oncology nurse successfully handed off monitoring to an incoming oncology- and chemotherapy-competent colleague.
What This Means for Your Practice
Create shared educational resources for non-oncology providers, have a plan in place for when oncology nurses are needed on another unit, and maintain open lines of communication with non-oncology settings. Some practices may choose to identify certain nurses who can be made available for such situations, thus eliminating the uncertainty as to who will respond.