On March 30, 2020, Democrats in the U.S. House of Representatives began drafting a fourth COVID-19 coronavirus relief package to include substantial infrastructure investments, said Speaker Nancy Pelosi. Pelosi said the legislation could be ready for a vote by late April.  

Although the United States federal government is coordinating the nation’s public health campaign against the COVID-19 coronavirus pandemic, the states—and the governors in particular—are coordinating across the country and party lines to implement containment plans using all the public and private tools at their disposal. 

With almost daily public briefings, the White House is taking a more aggressive approach to communicating updates on the COVID-19 coronavirus to the American population.  

Although many federal health agencies are involved in the COVID-19 coronavirus pandemic, central to every discussion has been the Centers for Disease Control and Prevention (CDC). Charged with the safety of the American public’s health, CDC is spearheading the United States’ epidemiologic approach, including how healthcare workers should recognize, test for, report, and respond to the coronavirus. 

Change at the federal level takes time and perseverance. Thanks to great effort from the smoking cessation community—including ONS—the federal government is updating package and advertising warning for tobacco products for the first time since 1984. Advocates have been calling on agencies to exercise authority over tobacco products along with their marketing and distribution, and on March 17, 2020, the U.S. Food and Drug Administration (FDA) issued a final rule requiring new health warning labels for cigarette packages and advertisements.

The alarmingly quick spread of the COVID-19 coronavirus has put a strain on the U.S. healthcare system, including the availability of personal protective equipment and other safety resources. The speed at which the virus spreads requires an even swifter response from federal agencies, government officials, and public health experts to combat the disease. To cut the red tape and accelerate data collection, the Department of Health and Human Services (HHS) has used statutory authority under the Paperwork Reduction Act to survey Health Resources and Services Administration healthcare institutions to understand the current COVID-19 response, challenges institutions are facing, and ways to help.

Alongside 11 other national nursing organizations, ONS Chief Executive Officer Brenda Nevidjon, MSN, RN, FAAN, participated in a meeting with President Trump, Vice President Pence, and other leaders from the administration at the White House on March 18, 2020, to discuss the nursing community’s needs and response to the COVID-19 novel coronavirus pandemic. Administrators from the Centers for Medicare and Medicaid Services, Centers for Disease Control and Prevention, and Coronavirus Task Force also attended.  

Although many oncology nurses are well versed in donning and doffing (removal) of personal protective equipment (PPE) for administering hazardous drugs, but not infection control. Additionally, nursing colleagues in other specialties may not wear PPE as part of their daily practice. As the COVID-19 novel coronavirus pandemic changes that, oncology nurses should understand PPE use for infection control to promote safety for nurses and patients.   

The COVID-19 novel coronavirus pandemic is turning the world, inside and outside of the hospital, upside down. Not only are oncology nurses seeing high demands at work, but changes and restrictions are being instated at home as well.

Drug pricing is a top legislative issue for Congress, and amid rising COVID-19 concerns, health policy topics are more pressing than ever. On March 5, Senator Martha McSally (R-AZ) introduced the Lowering Prescription Drug Prices for America’s Seniors and Families Act of 2020, which would allow Medicare to negotiate prices after a drug’s patent expires as well as cap out-of-pocket prescription spending for seniors at $3,100 per year.

With the Centers for Disease Control and Prevention’s recommendations for practicing social distancing to slow the national risk of transmission of COVID-19 novel coronavirus, oncology nurses must take increased precautions with patients with cancer who are at increased risk for contracting or experiencing poorer outcomes from COVID-19. Patients require communication and education in these uncertain times.

During the COVID-19 novel coronavirus pandemic, patients might be fearful and uncertain if they should come to their clinic appointments. COVID-19 presents greater risks to older adults and people with comorbid diseases such as cancer and other chronic conditions, and patient concerns will likely increase the volume of phone calls into your clinics and telephone triage lines. Oncology nurses can use the opportunity to assess and educate patients.

Nurses and other healthcare providers are navigating a rapidly changing world during the COVID-19 novel coronavirus pandemic, and that includes answering patients’ questions about the disease. Anthony A. Fauci, MD, director of the U.S. National Institute of Allergy and Infectious Diseases, in a Clinical Conversations podcast, suggested a two-pronged approach to talking with patients about COVID-19.

On March 10, 2020, the U.S. Food and Drug Administration (FDA) granted accelerated approval to the combination of nivolumab and ipilimumab (Opdivo^® and Yervoy^®) for patients with hepatocellular carcinoma (HCC) who have been previously treated with sorafenib. 

On February 4, 2020, BD announced a recall of all lots of affected models of its Alaris System pump modules because of multiple system errors, software errors, and use-related errors. On March 6, 2020, the U.S. Food and Drug Administration identified it as a class I recall, its most serious level of recalls, because of the possibility of serious injuries or death.

One aspect that ambulatory oncology nurses must consider in the greater staffing conversation is the time spent on educating patients and caregivers about oral chemotherapy safety in the home setting. Developing an educational framework to guide those conversations not only ensures that all critical information is covered but also that it’s delivered in a standard and efficient process. 

As part of its focus to dismantle the 2010 healthcare law, the GOP repealed the Affordable Care Act individual mandate in 2017. Republican state attorneys general then challenged the law’s constitutionality in a series of lower court cases, and the most recent has been lingering in federal courts for more than a year. On March 2, the Supreme Court agreed to take up the issue, marking the third time the law will be heard at the highest court in the country.  

COVID-19 is a novel coronavirus (a large family of viruses that can cause cold-like illnesses) first identified in Wuhan, China, in December 2019. It is a respiratory illness and can be spread from person to person, possibly through respiratory droplets during close contact. The first case of COVID-19 in the United States was reported on January 21, 2020.

As the COVID-19 strain of the coronavirus disease spreads and affects medical supply manufacturing locations, concerns are mounting about the availability of personal protective equipment (PPE) for hazardous drug (HD) handling. Martha Polovich, PhD, RN and MiKaela M. Olsen, DNP, APRN-CNS, AOCNS®, FAAN, editors of ONS’s Safe Handling of Hazardous Drugs book, shared guidance for nurses facing supply challenges.

When cleaning patients’ skin in preparation for lumbar puncture procedures, oncology nurses must consider side effects from use of various germicide solutions. Chlorhexidine gluconate (CHG) solution has been considered the broad-spectrum germicide effective against most nosocomial yeasts and gram-positive and -negative bacteria. It’s available as 2% or 5% CHG in 70% isopropyl alcohol and is used as an antiseptic for skin preparation and central venous catheter dressings.

Because of the potential for leakage at the joint between the blood filters and tubing, B. Braun issued a voluntary recall of 22 lots of its y-type blood administration sets in November 2019. The recalled sets are used to deliver blood from a container to a patient's vascular system through an IV catheter inserted into a vein or central venous catheter.

The short answer is yes—guidelines from ONS, National Institute of Occupational Safety and Health, Occupational Safety and Health Administration, and U.S. Pharmacopia all call for nurses to always wear appropriate personal protective equipment (PPE) when at risk for exposure, including disconnecting a patient’s chemotherapy. Wearing a gown and other PPE isn’t just good practice—it protects nurses at one of many touchpoints during chemotherapy administration and patient care where healthcare providers are at risk for exposure to hazardous drugs.

Despite medical cannabis’s legalization for medical use throughout 31 different jurisdictions in the United States, practicing providers have little research and few guidelines for patient care. To address the gap, in 2018 the National Council of State Boards of Nursing published Nursing Guidelines for Medical Marijuana, which provides general nursing education and guidance—yet doesn’t discuss drug interactions, specifically. To understand how medical cannabis affects concomitant pharmaceuticals, nurses must have a basic knowledge of the endocannabinoid system (ECS).  

Palbociclib (Ibrance), ribociclib (Kisqali), and abemaciclib (Verzenio) used to treat some patients with advanced breast cancers may cause rare but severe inflammation of the lungs, the U.S. Food and Drug Administration (FDA) announced on September 13, 2019. It approved new warnings about the risk on the prescribing information and package insert for the entire class of cyclin-dependent kinase 4/6 (CDK 4/6) inhibitor medicines. However, “the overall benefit of CDK 4/6 inhibitors is still greater than the risks when used as prescribed,” the agency noted.

Bags used to store and administer total parenteral nutrition (TPN) are being recalled because of leaks near the divider rod and channel when the rod is removed, the Metrix Company of Dubuque, IA, announced on September 9, 2019.

Oncology nurses are dedicated to providing the best, safest cancer care to their patients—protecting them from medical harm and prolonging life. But when it comes to protecting themselves, nurses sometimes take shortcuts in wearing personal protective equipment (PPE) that guards them against exposure to hazardous drugs. 

The evidence is clear: for more than 40 years, reports have confirmed that hazardous drug exposure poses significant safety risks to providers who handle many agents related to cancer treatments. Healthcare professionals experience several substantial health threats, including reproductive problems, airway and skin irritation, and cancers. Despite the potential health risks, the data are also clear: nurses routinely do not wear personal protective equipment as recommended when handling hazardous drugs.

Chicago ONS Chapter member Janice Phillips, RN, CENP, PhD, FAAN, said it all in her op-ed published on Morning Consult. The entire Democratic field of presidential candidates has declared some form of healthcare overhaul, albeit to varying degrees of change. With expanded access and reduced costs for patients and families as a priority, the centerpiece to most presidential hopefuls’ domestic policy program is redesigning a struggling system.

U.S. Pharmacopeia (USP) chapter <800> provides safety measures for all healthcare workers in any setting where hazardous drugs (HDs) are used in the health system. For situations from the initial delivery of the drug to the institution through administration and disposal, USP <800> provides a vast number of safety measures intended to minimize risk and potential exposure to HDs. To meet the new requirements, medical institutions and pharmacies have had to make significant changes in various systems.

Police officers wear body armor and construction workers wear hard hats. Why? Because these professions carry inherent dangers in the line of duty­—and oncology nursing does too. Statistically, healthcare workers face more workplace-related dangers than both law enforcement and construction, yet attention to safety and personal protection isn’t always a central focus. This can be especially true in cancer care, where nurses are required to administer hazardous drugs (HDs) and handle dangerous medications on a daily basis. Although safety recommendations exist, few enforceable standards are protecting nurses handling HDs.

Doug is a 48-year-old triathlete who was recently diagnosed with chronic myeloid leukemia (CML) after a routine blood test showed an increase in white blood cells and a subsequent bone marrow biopsy showed greater than 20% blast cells. The medical oncologist prescribed the oral drug dasatinib. Doug and his wife meet with Staci, RN, to receive oral therapy education. During the teaching, Doug says his wife will have no trouble dispensing the dasatinib because she already prepares all of their meals and nutritional supplements.  

A 33-year-old woman presents to the emergency department with fever, weight loss, and dyspnea. She is five months pregnant. A computed tomography (CT) chest scan without contrast shows a large mediastinal mass. Biopsy demonstrates Hodgkin lymphoma (HL), but magnetic resonance imaging (MRI) of her abdomen and pelvis without contrast is negative for lymphadenopathy. Her echocardiogram and pulmonary function testing are normal.

Nursing requires emotional energy and hard work to provide care to those we serve. However, there’s a dark side to the profession: workplace violence, or the exchanges perceived to be offensive or intimidating that can progress as far as homicide.  

On July 24, 2019, the U.S Food and Drug Administration (FDA) requested that Allergan recall its BIOCELL textured breast implants and tissue expanders because of the associated increased risk of breast implant-associated anaplastic large cell lymphoma; Allergan agreed and is removing the products from the global market.

Mr. Larsen presents to the clinic for his first dose of R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone) for a diagnosis of diffuse large B-cell lymphoma. Elizabeth, his oncology nurse, just started the cyclophosphamide when she is paged to the desk for a call from Mr. Larsen’s oncologist. She quickly removes her face shield and gloves as she hurriedly leaves the room to take the call. After completing the call, she returns to Mr. Larsen’s room to remove her gown.  

RNs encounter workplace violence and abuse at a far higher rate than in any other profession in the United States. Although the topic is uncomfortable, it’s a very real aspect of health care for many professionals. Most nurses have likely experienced an abusive, dangerous, or violent encounter in the healthcare setting at some point in their careers.  

Nurses in oncology who compound hazardous drugs may be familiar with the U.S. Pharmacopeial Convention (USP) because of chapter <795> related to compounding nonsterile medications and chapter <797> addressing compounding sterile medications. But what is USP really, and why does it have an impact on oncology nursing practice?

At the heart of patient-centered cancer care is communication and understanding, and oncology nurses have a responsibility to ensure that their patients have all the information they need to successfully navigate their cancer journey. But what happens when language barriers inhibit the flow of information between patient and practitioner? 

As the use of oxaliplatin in the treatment of gastrointestinal, gynecologic, and other cancers continues to grow, so too does the incidence of hypersensitivity reactions connected to the drug. Because the development of HSRs may require patients to discontinue oxaliplatin even if it’s effective against their cancer, oncology nurses need to be able to prevent or minimize reactions whenever possible.

As part of its ongoing work “to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating healthcare organizations and inspiring them to excel in providing safe and effective care of the highest quality and value,” the Joint Commission hosts an annual Health Care Association Forum to educate associations about the commission’s latest initiatives and goals. Here are the outcomes that affect nursing practice in 2019.

Reactive oxygen species (ROS), such as hydroxyl and superoxide radicals, singlet oxygen, and hydrogen peroxide, are byproducts of metabolic processes in the body and play an important role in regulating cell physiology and function. But uncontrolled ROS formation (oxidative stress) can result in DNA, protein, and lipid damage, which has been implicated in several diseases, including cancer. Antioxidants, produced endogenously or in supplemental form, function as ROS scavengers and inhibit oxidative stress. Popular antioxidants include vitamins C and E, selenium, beta carotene, lycopene, resveratrol, flavonoids, anthocyanins, and catechins. They are widely used to prevent cancer and its recurrence.

Which of the Following Should Not Be Recommended to Patients Taking Oral Antineoplastic Medication at Home?

A. Handwashing before and after handling the medication is important.

B. Use a urinal or bedpan instead of a toilet to reduce the risk of contamination via body fluids.

C. Keep oral antineoplastic drugs separate from other medications.

D. Do not touch tablets or capsules with bare hands; wear disposable gloves.      

Although nurses are the number one trusted profession in the United States for the past 18 years in a row, they’re not necessarily the most protected sector. Hostile workforce environments and exposure to hazardous chemicals are still a part of too many nurses’ daily lives. Recently, the U.S. House Education and Labor Committee held hearings on workforce safety to better understand the what nurses and other healthcare workers endure.

According to an Agency for Healthcare Research and Quality (AHRQ) analysis, the number of hospital-acquired conditions (HACs) reported in the United States dropped by 910,000 (13%) from 2014–2017. 

When patients go home after receiving their regimen of powerful cytotoxic agents, oncology nurses routinely encourage them to double flush after using the bathroom to ensure that trace amounts of hazardous medication are eliminated from the environment to prevent other members of the household from being exposed. But what happens with chemotherapy chemicals found in human waste as they enter a patient’s septic system—and eventually the water supply?

Last week, the American Society of Clinical Oncology (ASCO) released its 2019 safe handling standards. Although oncology nurses contributed to the expert panel, ONS does not endorse the ASCO standards because they differ from ONS guidelines and recommendations and guidelines from national and governmental organizations in several key ways. As an oncology nurse administering hazardous drugs, here’s what you need to know to keep yourself, your colleagues, and your patients safe.