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.
Who Is Monitoring Your Infusions for Administration Safety?
Inquiries received in the ONS clinical inbox often ask about various responsibilities of nurses who hold an ONS chemotherapy provider card and have been deemed competent to administer cancer treatments within their practice setting.
What Oncology Nurses Need to Know About USP <800>
Because of the risks and dangers associated with hazardous drugs, guidelines surrounding their use and handling have been issued since 1981. Since then, several organizations, including ONS (in tandem with the American Society of Clinical Oncology), the American Society of Health-System Pharmacists, the Occupational Safety and Health Administration, and the National Institute of Occupational Safety and Health, have released guidelines for various providers who handle the drugs.
Raise Awareness in July for Ultraviolet Safety and Skin Cancer Risk
With summer in full swing, it’s the perfect time to head outdoors and enjoy the sunny weather. But are you protecting yourself from potential risks? The U.S. Department of Health and Human Services has named July as Ultraviolet (UV) Safety Month. The goal is to spread the word about how important it is to protect everyone’s skin from the harmful effects of UV rays. This presents a teaching opportunity for oncology nurses and their patients—not just during July but all year long.
CDC Warns Healthcare Workers of Emerging, Multidrug-Resistant Fungus
Candida auris is a multi-drug resistant yeast that is known to cause invasive infection and death. It first emerged in June 2016 and continues to present itself as a serious global threat. According to the Centers for Disease Control and Prevention (CDC), throughout 2017, healthcare facilities in multiple countries report serious illnesses caused by C.auris in hospitalized patients.
When Ineffective Pain Control Means Chemical Coping
Central to our role as oncology nurses is provision of symptom relief balanced with a manageable side-effect profile. Although opioids are extremely effective at cancer pain management, they also bind to the brain’s limbic system and can produce reward responses. This can result in dependence and drug-seeking behaviors.
Multidisciplinary Approach Is Useful for Radiation Safety Training
Tara Tatum, MBA, RN, and Stella Dike, MSN, RN, OCN®, both from the University of Texas MD Anderson Cancer Center, presented the findings during a poster session at the ONS 42nd Annual Congress in Denver, CO. The poster was titled “Radiation Safety Education: An Innovative, Multidisciplinary Approach to Enhancing the Knowledge and Skills of Oncology Nurses in an Inpatient Radiation Setting.”
What Are ONS’s Recommendations for Safe Handling of Hazardous Drugs?
Research suggests that healthcare workers who handle hazardous drugs may experience acute effects such as skin rashes or more chronic effects including adverse reproductive events and malignancy. This has led numerous government agencies to make recommendations regarding the safe handling of hazardous drugs.
What Oncology Nurses Need to Know About Immunotherapy Agents
As immunotherapeutic options for cancer treatments continue to grow, oncology nurses need a deeper understanding of the therapies, how they work, and how to manage their side effects, so they can continue to provide the best patient care.
Mindfulness Meditation Can Improve Safety in Your Practice
Mindfulness meditation is a popular topic in the media now. Research has already demonstrated the clinical benefits of mindfulness-based stress reduction for patients with chronic pain or anxiety disorders. Although there’s been limited research about the benefits of mindfulness stress reduction for oncology nurses and their patients, some evidence suggests that engaging in mindfulness exercises could lead to a safer environment.
Competencies Create Expert, Accountable Nurses Delivering Quality Care
When the National Academy of Medicine, formerly the Institute of Medicine, released its 2010 report, The Future of Nursing: Leading Change, Advancing Health, it cited a need for improvement in nursing education and practice through the implementation of nursing competencies.
Do You Know the Best Practices for Targeted Medication Safety?
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.
New Access Device Standards Will Help Improve Safety in Your Practice
Access devices have been used for decades to administer the complex treatments and supportive care that oncology nurses deliver daily to patients with cancer. As these devices and other products evolve, nurses need evidence-based methodologies for critiquing their safety and effectiveness.
What Is ONS’s Stance on Handling Chemotherapy While Pregnant, Breastfeeding, or Trying to Conceive?
One of the questions that ONS commonly receives in the clinical inbox is whether nurses who are pregnant, breastfeeding, or trying to conceive can safely administer or handle chemotherapy and other hazardous drugs.