The Case of the Safety Session
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.
The Case of the Pregnancy Predicament
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.
Protect Yourself and Your Colleagues From the Dark Side of Caring
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.
FDA Recalls Textured Breast Implants Because of Lymphoma Risk
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.
The Case of the Explicit Exposure
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.
Here’s How You Can Confront Workplace Violence in a Healthcare Setting
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.
What USP Means for Safe Oncology Nursing Practice
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?
Prevent Important Information From Getting Lost in Translation
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?
Safety Is Key in Use of Radiopharmaceuticals
Radiopharmaceuticals, or radioactive drugs, are playing an increasing role in cancer diagnosis and treatment and thus are an increasingly relevant area of practice for oncology nurses, Paul Searfoss, BS, CNMT, ARRT (N, CT), of Vanderbilt Medical Center in Nashville, TN, said during a session on Saturday, April 13, 2019, at the ONS 44th Annual Congress in Anaheim, CA.
Good Documentation Is a Nurse’s Best Defense
Good documentation is the best defense a nurse can have in the event of a lawsuit. This was the take-home message of a presentation by Joann Wortham, MSN, JD, CPHQ, CPPS, CPHRM, of Beta Healthcare Group in Alamo, CA, a large provider of professional liability insurance for hospitals, and Cyndi Maag, RN, BA, LNCC, of Eckenrode-Maupin, a legal practice in St. Louis, MO, during a session on Saturday, April 13, 2019, at the ONS 44th Annual Congress in Anaheim, CA.
Safe Handling of Hazardous Drugs Is No Accident
Oncology nurses must remain vigilant to protect patients and themselves from chemotherapy exposure. During a session on Friday, April 12, 2019, at the ONS 44th Annual Congress in Anaheim, CA, Martha Polovich, PhD, RN, AOCN®, of Georgia State University in Atlanta, and MiKaela Olsen, APRN-CNS, MS, AOCNS®, FAAN, of Sidney Kimmel Comprehensive Cancer Center in Baltimore, MD, instructed nurses on how to ensure safe handling of hazardous drugs (HDs) in their practice settings.
Speakers Discuss Strategies for Reducing Workplace Violence
Workplace violence is both highly prevalent and underreported in health care settings, according to Melissa Weigel, RN, and Lorina Welper, APRN, CNS, MS, of the Mayo Clinic in Rochester, MN, who spoke during a session on Friday, April 12, 2019, at the ONS 44th Annual Congress in Anaheim, CA.
For Oxaliplatin Hypersensitivity Reactions, Prevention Is the Best Strategy, but Here’s How to Manage Them
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.
Joint Commission Focuses on Quality, Safety for 2019
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.
Evidence Doesn’t Support Antioxidant Supplementation for Patients With Cancer
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?
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.
Nursing Workplace Violence; Aggressive Drug Pricing Legislation; Gottlieb Steps Down
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.
Hospital-Acquired Conditions Reduced by Nearly 1 Million From 2014–2017
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.
Do Cytotoxic Agents Impact Ground Soil or Well Water?
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?
ONS Safe Handling Guidelines Are Consistent With National Recommendations
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 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.
Action Plan May Reduce CLABSIs in Hospitalized Patients With Cancer
Despite being preventable, central line-associated bloodstream infections (CLABSIs) result in thousands of deaths each year and cost the U.S. healthcare system billions of dollars. Infection is a common problem in patients with cancer, particularly those receiving chemotherapy and radiation.
How Oncology Nurses Support Non-Oncology Units Administering Chemotherapy
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.
Monitoring Surface Contamination of Hazardous Drugs and Considerations for Remediation
Hazardous drugs are medications known to cause adverse health effects because of exposure in the workplace, according to the National Institute for Occupational Safety and Health. Examples of such agents include chemotherapy drugs, antivirals, hormones, and bioengineered drugs.
Which of the Following Drug Spills Doesn’t Require a Full-Facepiece, Chemical Cartridge-Type Respirator or PAPR?
Which of the following drug spills doesn’t require a full-facepiece, chemical cartridge-type respirator or PAPR during clean up?
D. Nitrogen mustard
What Happens if Patients With Cancer Have Bedbugs?
Lurking in the dark corners of bedrooms across the country, unseen figures wait to feast of the blood of humans and animals alike. When the lights go dark, they come out for dinner. No, they’re not vampires or mystical beasts—they’re bedbugs. These parasitic insects feed exclusively on the blood of humans and animals and are a prevalent parasite in the United States.
Verbal Abuse Is Still Violence, Joint Commission Says
Healthcare workers, especially nurses, are less likely to report incidents of workplace violence, including verbal abuse from patients, families, and coworkers, according to a sentinel event alert the Joint Commission released in April.
Organizational Learning and Perception Tied to Improved Patient Safety Culture
Patient safety is an important focus for hospitals: protecting patients improves outcomes and quality of care, meets standards, and ensures payments and reimbursement. But what factors contribute to a culture of safety? Researchers assessed and analyzed the components of patient safety culture and published their study findings in conjunction with the 2018 American Society of Clinical Oncology Annual Meeting.
What’s the Preferred Method for Vincristine Administration When Treating a Patient With Lymphoma or Leukemia?
What is the preferred method to administer vincristine into a peripheral IV site when treating a patient with lymphoma or leukemia?
A. Direct IV push by syringe
B. By syringe through free-flowing IV fluids (side-arm technique)
C. Gravity drip using an IV minibag
D. By minibag using an IV pump
Which Is Not an ASCO/ONS Chemotherapy Safety Standard?
Which of the following is NOT an ASCO/ONS Chemotherapy Administration Safety Standard?
A. Chemotherapy orders include sequencing of agents, when applicable.
B. A licensed independent practitioner is on-site and readily available to staff where chemotherapy is administered.
C. Two chemotherapy-competent RNs must be in the infusion area at all times when chemotherapy is infusing.
D. If chemotherapy is administered in a non-healthcare setting, a second identifier such as a driver’s license, is used to verify the patient’s identity.
Supporting Second Victims Will Make Your Practice Safer
Adverse events and traumatic moments send shockwaves through the entire care team. As families grieve the loss of a loved one, providers can often suffer from feelings of overwhelming guilt, remorse, or helplessness. When clinicians struggle with the aftermath of a tragic care event, they become known as second victims. Second victim experiences can lead to lapses in safety and care and could be potentially dangerous for future patients.
States Have a Role in Creating Public Health Policies
The federal government structure in Washington, DC, is hard to ignore. U.S. children are taught about it in schools, and we hear about it regularly as elections, legislation, appointments, and the like are discussed in the news. Less recognized, though, is that each state has a similar legislative structure.
Safety Information on Varubi (Rolapitant) Injectable Emulsion
The Oncology Center of Excellence of the U.S. Food and Drug Administration (FDA) is informing healthcare providers about new safety information for Varubi® (rolapitant) injectable emulsion, a substance P/neurokinin (NK-1) receptor antagonist indicated for the prevention of delayed nausea and vomiting associated with cancer chemotherapy in adults.
Prevent Physical Injury Through Safe Patient Handling
Every job has its perils, and some of those perils are more pronounced than others. For nurses, professional hazards range from dangerous chemical exposure to workplace violence, to severe back and arm injuries, and everything in between. In fact, National Public Radio reported that more than 35,000 nursing professionals experience back and body injuries every year.
How Are You Tracking Patients on Oral Chemotherapy?
Oral cancer treatments are effective and practical and can provide a level of flexibility for patients, allowing them to seamlessly continue their treatments without the burden of infusion visits. With many patients receiving oral chemotherapy, oncology nurses must recognize complications that can arise regarding procedure and documentation in practice.
What You and Your Patients Should Know About the Flu This Season
As an oncology nurse, you know the prevention of any infection is critical to patients. This couldn’t be truer than with flu. Although not all illnesses are preventable, the flu vaccine is the first and best way that patients with cancer can protect themselves from flu. Oncology nurses should keep the following new information for the 2017–2018 flu season in mind.
What’s the Procedure for Delivering Chemotherapy to an Inpatient Unit?
The elements of an oncology unit are often very similar from location to location—the crescendo of plastic wheels clicking across brightly shined linoleum, beaming fluorescent lights that flicker to life when switched on, mounted fountains of cool hand sanitizer gel. But although oncology units have many similarities, clear differences exist as well.
Take Patients From Falls Risk to Mobility
Promoting a culture of safety is the responsibility of all members of the healthcare team. Nurses and advanced practice providers have a unique role in ensuring patient safety, especially through interventions aimed at reducing the risk of falls and falls with injury. Hundreds of thousands of hospitalized patients fall each year, each costing organizations an average additional $14,000 and resulting in more than six additional hospital days. Up to 30% of falls result in injury, including fractures, decreased mobility, and a loss of independence.
USP <800> Implementation Delayed to December 2019
The U.S. Pharmacopeia (USP) announced on September 29, 2017, it would delay the implementation of USP General Chapter <800> Hazardous Drugs—Handling in Healthcare Settings to coordinate its implementation with chapter <797> Pharmaceutical Compounding—Sterile Preparations. According to USP, chapter <797> is still undergoing revisions and will be available for public comment in fall 2018. UPS <800> was set for implementation by July 1, 2018, but both chapters are now expected to become official on December 1, 2019.
Should a Provider Be on Site During Chemotherapy Administration?
In clinics and oncology floors across the country, IV pumps are infusing, chemotherapy is administered through IV push, and nurses are moving swiftly from one patient to the next. Administering chemotherapy is a complex, in-depth procedure that requires training, education, and a level of experience beyond that of the standard healthcare professional. However, even the best oncology nurses need the support of their team members and the administration to provide the safest possible care environments for their patients.
What Precautions and Recommendations Are Necessary for Patients Receiving Oral Chemotherapy in the Home?
So far, 2017 has seen an incredible amount of U.S. Food and Drug Administration approvals for new agents and indications. Biotherapy and targeted agents represent many of the newly approved treatment options—a great deal of which are offered in oral form, increasing the opportunity for patients to receive treatment at home.
September Is Sepsis Awareness Month
As September winds down, ONS, a partner in the Centers for Disease Control and Prevention’s (CDC’s) and American Nurses Association’s Nursing Infection Control Education Network, is raising awareness of Sepsis Awareness Month by highlighting resources and strategies for oncology nurses who are deeply rooted in preventing and treating sepsis in patients with cancer.
How Did You Continue to Provide Cancer Care for Patients After a Natural Disaster?
When a severe tornado hit Joplin, MO, on the evening of May 22, 2011, the situation was serious. St. John’s Regional Medical Center in Joplin was hit so hard that it is still unusable. It needed to be evacuated, nearby Freeman hospital became quickly overwhelmed with patients, and the surrounding community prepared for action.
Cancer Care When Disaster Strikes
In the early hours of September 13, 2008, Hurricane Ike—a category 2 hurricane—hit Galveston Island, TX, bringing with it sustained winds of up to 110 miles per hour and storm surges reaching as high as 17 feet. By the next day, more than 200 shelters had opened across Texas to house the estimated 40,000 people who had been forced to evacuate from their homes.
Natural Disasters Take a Toll on Both Patients and Nurses, at the Cancer Center and at Home
I live in Middle Tennessee, an area that’s part of tornado alley, a pathway across central United States that has a higher incidence of tornadoes. We routinely prepare for the storms, listening for the tornado sirens whether at home or work. Although there have been a number of tornado touchdowns in our region in recent years, fortunately none have directly hit our healthcare facilities.
What Is ONS’s Perspective on the Ambulatory Staffing Dilemma?
Appropriate nurse staffing is only one of the critical factors that contribute to optimal patient outcomes and is as important as the systems, technology, and quality standards in any care setting. The relationship between poor staffing, daily variation in quality, and increased workload to increased care errors, missed care, and patient and nurse dissatisfaction is well described.
Time Is Short When Addressing Hypersensitivity Reactions to Chemotherapy
Between administering antineoplastic agents, monitoring patient vitals, and preparing patients for treatment, oncology nurses are required to balance their attention between many intricate tasks. Chief among the division of duties is that oncology nurses closely monitor their patients for hypersensitivity reactions (HSRs) to prescribed agents.
How Safe and Effective Is Scalp Cooling for Chemotherapy-Induced Alopecia?
Chemotherapy-induced alopecia has been reported by 77% of patients as the most-feared side effect of cancer treatment. In fact, as many as 10% of women say they would consider refusing chemotherapy or choosing a less effective treatment to avoid losing their hair.
Safely Provide Outpatient Care to Patients Receiving Hematopoietic Stem Cell Transplantations
High-dose chemotherapy with hematopoietic stem cell support is a well-established treatment for many hematologic malignancies. This treatment can be a difficult journey for patients and families. Historically, patients have been treated in a traditional hospital setting in anticipation of severe side effects, including mucositis, febrile neutropenia, thrombocytopenia, and pulmonary, renal, and hepatic complications. Patients can remain profoundly immunosuppressed for months while recovering from transplant. However, better supportive care in recent years has allowed many centers to move all or a portion of their transplant care into an outpatient setting.
Using Standards Balances Technology Advancements With Critical Thinking
Advancements in medical records technology provide safeguards and contribute to overall patient safety. However, consider the following treatment scenarios and how they may present opportunities for error and jeopardize patient safety.