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.
Oral chemotherapy adherence is a well-documented issue, and oncology nurses are continually working to ensure patients are educated about the importance of adhering to their prescription instructions and treatment protocols (https://voice.ons.org/news-and-views/adherence-to-oral-agents-for-cancer). Related to that, best practices for tracking patients receiving oral chemotherapy is also a challenge, recently raised on the ONS communities (http://communities.ons.org/home). No current guidelines define this; however, the ONS Oral Adherence Toolkit (https://www.ons.org/sites/default/files/ONS_Toolkit_ONLINE.pdf) suggests several considerations for developing tracking methods.
When approaching oral chemotherapy tracking, ask:
- Who is responsible for obtaining the medication history?
- What medications are included?
- Is a standardized form used?
- Who adds this form or information to the chart?
- Who identifies variances?
- What is the time frame to act on variances?
- When medications are changed, how is it documented?
- How are medication changes communicated between specialties?
- Who communicates changes to patients and caregivers?
- How is the process monitored?
Consider Standardized Tracking in Your Practice
One of ONS’s considerations for oral chemotherapy tracking is to question whether using a standardized form is right for your institution. Some institutions have begun using electronic resources such as electronic medical records to run daily reports. Other nurses on the ONS communities have reported using electronic charting systems like EPIC to create oral chemotherapy flowsheets that includes patient information, medication, dosing, toxicity assessments, side effects, and follow-up appointments. In some cases, electronic systems can allow nurses to share tracking information between specialties, providing a simple way for pharmacy and nursing staff to communicate within a patient’s document.
Ultimately, oral oncolytics offer patients more independence and flexibility during treatment. However, the practical option of oral chemotherapy doesn’t have to come at the cost of safety or quality of care. Begin the conversation of standardizing tracking at your institution by referring to the ONS Oral Adherence Toolkit to identify which procedures are best for your practice.