chemotherapy cumulative dose

by Michele Galioto, Kris LeFebvre, Stephanie Jardine, Barb Lubejko, Laurl Matey, Lydia Richardson, and Tracy Wyant

A significant number of oncology nurses acquiesce verifying cumulative cancer drug dose, according to data obtained from participants in the ONS/ONCC Chemotherapy Biotherapy Certificate Course. The participants reported having great faith in physicians’ and pharmacists’ knowledge and capabilities. However, this raises a concern about who can be held responsible in the case of drug overdoses.

Oncology Nurses’ Safety Concerns

Liabilities for the verifying and administering nurses are very real: nurses at Dana-Farber Cancer Institute were cited for administering overdoses of chemotherapy in 1994. Even though hospital policy did not require dose verification prior to administration, the state board of nursing indicated the nurses were accountable for these safety checks prior to administration.

According to course participants, a significant barrier to monitoring cumulative doses of chemotherapy is that the information is not readily available. Nurses indicated that they do not have access to cumulative dose information, either in paper charts or electronic health records (EHRs). This is especially true when patients are treated in multiple facilities and drug administration records are not easily accessed by nurses or pharmacists. Several nurses have noted that they used to follow cumulative dose when they had paper documentation, but when EHRs were implemented, they no longer had access.

The existence of a policy or process for monitoring cumulative dose is not always the issue. Several participants indicated the presence of a policy but that only physicians need to know and have access to cumulative dose information. Sometimes the information is communicated directly to pharmacists. However, documentation is inconsistent across practices or institutions, and many participants indicated that their practices or institutions had no policies or processes at all. Across the board, nurses are feeling at risk for administration errors.

How the Certificate Course Can Help

The ONS/ONCC Chemotherapy Biotherapy Certificate Course, which launched in January, offers cutting-edge information focusing primarily on safe administration of these cancer treatments. Course content and learning activities consider safety from the perspective of patients as well as healthcare professionals administering the drugs. A variety of evidence-based resources support the course content, but most is drawn from the ASCO/ONS Chemotherapy Administration Safety Standards and the ONS Chemotherapy and Biotherapy Guidelines and Recommendations for Practice.

To date, more than 5,500 nurses have completed the certificate course and participated in discussions about core safety issues. The importance of monitoring cumulative doses of chemotherapy that may cause toxicities with increases in the lifetime dose of a drug has generated significant discussion among course participants, who have expressed a desire to make changes in current practice.

Updated in 2013, the ASCO/ONS Chemotherapy Administration Safety Standards call for physician practices and institutions to maintain a process to track cumulative doses of chemotherapy that are affiliated with cumulative toxicities. Safety standards task force discussions indicated that EHRs and e-prescribing might reduce errors with respect to all orders, including cumulative dose monitoring. However, documented processes are still critical to ensuring patient safety.

Nurses have long recognized their role in ensuring safe drug administration through verification of safety checks prior to drug administration, including validation of
•    Drug name
•    Drug dose
•    Drug volume
•    Rate of administration
•    Route of administration
•    Expiration dates/times
•    Appearance and physical integrity of the drugs.

When administering chemotherapy and biotherapy, the verification process takes place with two chemotherapy-competent individuals. The drug dose should include monitoring of the cumulative dose of drugs with known cumulative toxicities.

Instituting Practice Change

According to ONS, course participation is driving nurses to step forward in a leadership role to improve the safety of chemotherapy biotherapy administration, for their patients and their own liability. Several have said they plan to talk with practice and institution administrators to ensure that cumulative dose monitoring is part of their safety check prior to drug administration. Where policies and procedures don’t exist, participants indicated plans to request or create them. Several have said they plan to discuss the current layout of drug order information in their EHRs, working to move the cumulative dose to a dashboard concept that is easily noted by nurses and includes drug verification documentation. Course participants also said they plan to involve patients in their safety plans, informing patients about the need to monitor cumulative doses of certain agents and asking them to track these doses along with their care team.

ONS will continue this conversation with past, current, and future course participants to assess practice and systems improvements. Healthcare providers who administer the drugs are the last safety checkpoint during chemotherapy and biotherapy administration. Awareness of patients’ history, intended regimen, and cumulative dose to date are critical data points for nurses to ensure patient safety.

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Posted by Sarah (not ve… (not verified) 2 years 11 months ago

cumulative biotherapy doses

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