Who Is Monitoring Your Infusions for Administration Safety?

July 25, 2017 by Tracy Wyant DNP, RN-BC, AOCN®, CHPN®, CPPS

Inquiries received in the ONS clinical inbox (clinical@ons.org) 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.

One issue periodically mentioned is an institutional policy or procedure that requires specially trained oncology nurses to start treatment infusions on units that may not have nurses with adequate training to do so, such as an intensive care or telemetry unit. In some instances, chemotherapy-competent nurses are asked to leave their patient assignment to perform a treatment order verification, start or discontinue an infusion on another unit, and return to their own unit and patient workload while the treatment is infused. In these situations, the question to ask is, does the person monitoring the patient receiving treatment have the education and training to be able to recognize an infusion reaction or other toxicity and to properly intervene?

Organizational Procedures and Training

The training of nurses who administer and monitor chemotherapy and care for clients receiving chemotherapy needs to be established by each institution. Safety of the patient and nursing staff are of utmost importance, and organizational policy and procedure development should be guided by practice recommendations and standards, such as the ONS position statement (https://www.ons.org/advocacy-policy/positions/education/chemotherapy-biotherapy) on the Education of the Nurse Who Administers and Cares for the Individual Receiving Chemotherapy and Biotherapy, the American Society of Clinical Oncology/ONS Chemotherapy Administration Safety Standards (https://www.ons.org/sites/default/files/2016%20ASCO_ONS%20Chemo%20Standards.pdf), and the ONS Standard for Educating Nurses Who Administer Chemotherapy and Biotherapy (https://www.ons.org/sites/default/files/ONS_Standard_Educating_Nurses_Chemo_Pathway_Web_111016.pdf).

Regardless of the care setting type, treatment indication, route of administration, or patient population, any healthcare professional who handles hazardous drugs should be specially educated regarding their use, side effects, administration practices, safe handling, potential spill issues, patient complications, and potential for emergency procedures.

Timeframe for Monitoring

A key point that both the ONS Access Device Standards (https://www.ons.org/access-device-standards) and the Infusion Nurses Society’s Infusion Therapy Standards of Practice (https://www.learningcenter.ins1.org/products/infusion-therapy-standards-of-practice-2016) support is that the clinical evaluation of treatment administration includes the entire time an agent or regimen is infusing, from the start to the end of the infusion. This includes monitoring the administration site while protecting the patient from adverse events throughout the infusion.

Therefore, a chemotherapy-competent nurse who initiates the infusion holds responsibility for assessment of infusion site complications and immediate or acute symptoms until patient care transitions to another chemotherapy-competent nurse. Although evidence is lacking regarding a recommended time frame in which a patient needs to be monitored for symptoms following treatment, drug-specific and patient-related factors that can affect treatment response must be considered. As a result, the staff monitoring patients receiving chemotherapy and caring for those who have received chemotherapy must have the knowledge, skills, and ability to identify and safely address issues that may arise during and following treatment.

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