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/depts/uwhealth/ambulatory-education/ambulatory-orientation/checklists/resources/Specialty_OncHem_Nov2015.pdf

201511314

page

100

UWMF,

Learning and Development,

Departments & Programs,UW Health,Ambulatory Education,Ambulatory Orientation,Checklists - Core and Department Specific,Resources

Oncology/Hematology

Oncology/Hematology - Departments & Programs, UW Health, Ambulatory Education, Ambulatory Orientation, Checklists - Core and Department Specific, Resources


1

Oncology- Hematology CLINICAL TRAINING CHECKLIST ----- This is due three months from hire date------

Employee Name: __________________________________ Employee Credentials:________ Hire Date: ____________

Clinic Location/ number: _______________________ Employee Number ________________________

*refer to appropriate UWMF policy *** N/A on checklist indicates that it is not indicated for the employee***
***Each area should either be discussed or observed by preceptor***

AREA OF ORIENTATION Discussed Observed Preceptor’s Signature Completed date
Employee has knowledge and is able to gather data relevant to the following types of
cancers:

Lung - number of years smoked, asbestos or uranium exposure
- signs of cough, hemoptysis, dyspnea, shoulder pain, SVCS, increased
ADH

Breast - family history, cystic disease, ionizing radiation exposure, self exams
Skin - exposure to sunlight, ionizing radiation, coal
- scar following burns, fair or freckled complexion, albinism, acquired nevi
- immunologic deficiency/suppression or renal transplant, Bowen's disease
- signs of a sore that does not heal, persistent lumps or swellings
Non-melanoma - changes in skin marking ie: size, color, shape, sensation,
elevation

Melanoma - Size(enlargement) color (especially red or black) surface (oozing)
Shape (irregular) surrounding skin (redness, swelling)
Sensation (itchy, tender, painful, lumpy) irregular border of a mole

Prostate - highest among African Americans, exposure to cadmium
- signs of dysuria, urinary hesitancy, urgency, hematuria, retention
- late signs bone pain, weight loss, lethargy bronchopneumonia
Cervical - last PAP test, number of sexual partners, coitus at an early age, hx of
herpes

Ovarian - last pelvic exam, number of sexual partners, coitus at an early age
Uterine/Endometrial - last pelvic exam, post-coital bleeding, dyspareunia,
obesity, watery discharge between periods, late
menopause, family history

Colorectal - low fiber diets, history of Crohn's disease, adenomatous polyps or
family hx

- Right colon - anemia, GI bleeding with weight loss
- Left colon - mucus in stools, obstructive symptoms
- Sigmoid colon - obstructive symptoms, may be blood (rare)

2


AREA OF ORIENTATION Discussed Observed Preceptor’s Signature Completed date
Head and Neck - number of year smoked, alcohol consumption, wood dust exposure
- nickel refining exposure, Epstein-Barr virus exposure

- signs of a neck node, ulcer that doesn't heal, bloody nasal
discharge

- hoarseness, pain, dysphagia, stridor, cough, hemoptysis
Leukemia - ALL 25%, ANLL 35%, CLL25% CML15% - signs of anemia, bone
pain

Thrombocytopenia, granulocytopenia, splenomegaly, lymphadenopthy

Employee has knowledge is able to gather data relevant to the following:
Signs and symptoms of mucositis ie: erythema, white patches (thrush), changes in moisture,
cracks, fissures, ulcers and blisters

Signs and symptoms of dehydration ie: dizziness, pale, lightheaded, weak, dark urine, dry
mouth

Signs and symptoms of diarrhea ie: abnormal increase in liquid stool and frequency,
abdominal pain, cramping, urge to defecate, perineal discomfort, fecal incontinence

Signs and symptoms of constipation ie: Abdominal distention, bloating, oozing stool, back
pain, stomach pain

Signs and symptoms of anemia ie: Headache, shortness of breath, chest pain,
ringing in ears, pale skin

Signs and symptoms of nausea & vomiting r/t chemotherapy administration ie: Onset,
Duration, frequency, intensity, aggravating or ameliorating factors


Employee is able to gather data relevant to the following:
Oncologic Emergencies
DIC ie: leukemia Pts sepsis, hemolytic transfusion reaction or hypotensive episode or
shock

SIADH ie: Endocrine disorder, fluid retention, dilutional hyponatremia, inability to
secrete, dilute urine

Septic Shock ie: fever, chills, confusion, decreased blood pressure
Tumor Lysis Syndrome ie: potentially fatal metabolic complication – pt’s with high
tumor burden with rapid response to chemotherapy may result in renal failure and death

Anaphylaxis ie: Shortness of breathe, chest, facial flushing, throat tightness
Cardiac Tamponade ie: severe decrease in cardiac output caused by pericardial
effusions, rapid progression of dyspnea, chest tightness, tachycardia

Spinal Cord Compression ie: Back pain, leg weakness with sensory loss, loss of
bowel & or bladder

Superior Vena Cava Syndrome ie: Shortness of breathe, facial edema, neck and
chest vein , distention, cough, stridor



3
AREA OF ORIENTATION Discussed Observed Preceptor’s Signature Completed date
Understanding increases and decreases in blood counts: WBC, Hgb, HCT,
ANC, Plts, creatinine, PT/INR, etc.

DVTs ie: pain in calf (leg)
Signs of Infection ie: redness, warmth, temperature, green/yellow drainage,
swelling


Employee is able to gather data relevant to the following:
Able to elicit patient’s expectations in medical care
Able to determine patient’s knowledge level/deficit and ability to understand
Able to identify cultural practices related to care
Able to elicits info regarding relationships with significant others
Stage of disease, course of treatment or treatment options

Patient Education- Employee participates in patient/family teaching
Health Education - Employee demonstrates knowledge & can discuss with patient:
Chemotherapy Drugs and their specific side effects:
Alopecia, Anemia, Constipation/Diarrhea, Dysphagia, Dehydration, Edema,
Fever/Chills

Fatigue, Immobility, Insomnia, Nausea/Vomiting, Pain Control, Stomatitis,
Mucositis

Sexual and Reproductive Dysfunction, Xerostomia, Iron deficiency anemia
Prolastin Infusions, blood transfusions, and iron infusions
Grief and Loss
Course or progression of the disease, Secondary Malignancy
Oncological emergencies: allergic reaction to drug; phlebotomies- fainting

Employee is able to appropriately care for (or follow-up) with a patient with the
following:

Undergoing surgery, radiation, or chemotherapy
Undergoing blood transfusion or combination therapy
Undergoing Immunotherapy or Biologic Response Modifiers
Cardiac Tamponade, DIC, SIADH, Hypercalcemia, Sepsis, SCC, TLS
Central Catheters: Groshong, (Hickmans, PICC lines, Portacaths, (peripheral
IVs)

G & J tubes
Ostomy care

4

AREA OF ORIENTATION Discussed Observed Preceptor’s Signature Completed date
Employee is able to appropriately care for (or follow-up) with a patient with the
following specific cancers

Breast
Brain
Bladder
Colon/Rectal
Esophagus
Head & Neck
Leukemia – Chronic/Acute
Liver
Lung
Lymphoma (nonHodgkins/Hodgkins)
Melanoma
Multiple Myeloma
Ovarian
Prostate
Metastatic Disease

Employee is able to gather data relevant to the following:
Consults/referrals to other departments (nutrition) or specialists.
Pain clinic, Nutrition clinic, PT, OT, Respiratory Therapy, Medical Imaging
Inpatient Units, Hospice, General Surgery, Home Care

Demonstrate competence in counseling and provide appropriate resources
Hospice / Home Health
CanSurmount, I Can Cope, American Cancer Society, Renewing Life, Bosom
Buddies

Look Good Feel better
Equipment/ Supplies
Assure all equipment/supplies are available based on patient needs/ give pt
script for supplies

Assure all equipment functions before use
Assure all emergency equipment/supplies are current and available at all times
Demonstrate competence in the care of equipment in the oncology clinic
i.e., oxygen wall/ tanks, Pulse ox, pumps, abbot portable, infusion pumps


5

AREA OF ORIENTATION Discussed Observed Preceptor’s Signature Completed date
Procedures- Demonstrate competence to assist/set-up/patient care/follow-up
Incisional/excisional/needle biopsy
Bone morrow biopsy
Paracentesis
Punch biopsy
Sterile Dressing change *
Phlebotomy
Intrathercal Chemotherapy
Thoracentesis, spinal tap
Obtains vital signs* (Wt, Ht, BP, P, & Pulse ox), smoking history
Proper and complete labeling of specimens and paperwork (in needed)

Diagnostic/therapeutic tests- Demonstrate rational for the following
Diagnostic laparotomy
CT Scans Bone Scans PET Scans MRI
Schedule placement of : portacaths, Groshongs, PICC lines
Preauthorizations for surgery or procedures
Administration of Medications
Understands the following drug compatibility’s
Understands the following drug compatibility's. (Including IV fluids such as:
normal saline, dextrose, and KCL)

Verbalizes appropriate patient, dose, proper administration route, and time
Also, becomes familiar with possible signs of allergic reaction and side effects.
Classifications of Medications
Reduced Folate - leucovorin
Monoclonal antibodies - rituxan, herceptin, avastin, erbitux
Taxanes - taxol, taxotere, abraxane
Platinums - cisplatin, carboplatin, oxaliplatin
Hormones - tamoxifen, leuprolide, megace, arimidex, faslodex
Enzyme - asparaginase
Biologic Response Modifier - Interferon
Antimetabolites - cytarabine, 5-FU, 6-mercaptopurine, methotrexate
Biphosphonate - pamidronate, zometa, boniva, fosamax, actonel
Nitrosoureas - BCNU, CCNU
Vinca Alkaloids - vinblastine, vincristine, VP-16
Antitumor Antibiotics - bleomycin, adriamycin, mitomycin-C, doxil
Alkylating Agents - cytoxan, dacarbazine, nitrogen mustard, procarbazine


6
AREA OF ORIENTATION Discussed Observed Preceptor’s Signature Completed date
Anticoagulation Initiative
RN only - Complete LDS course “Anticoagulation Management with Warfarin Guidelines”
RN only - Attend live training program “Anticoagulation Management with Warfarin
Guidelines” offered quarterly (optional)

RN only - Develop warfarin management plan for a minimum of 5 patients requiring dose
adjustments – cases must be reviewed and approved by anticoagulation champion or
responsible physician.

RN only - Case 1. 2. 3. 4. 5.
When handling and giving chemotherapy agents
Check appropriate laboratory data prior to giving chemotherapy agents
Verify provider order and/or chemotherapy protocols prior to giving
chemotherapy

Calculate the drug dosage appropriately, using the body surface area chart
Observe the precautions in handling and giving chemotherapy agents
Wash hands before and after giving chemotherapy agents
Properly labels syringe or IV bag with pt's name, medical record number ie.
premeds

Use appropriate PPE - personal protective equipment
When vesicants are being used-assess for blood return when the IV is inserted,
during, and after

When vesicants are being used – instill 10-15cc of normal saline prior to
chemotherapy

When vesicants are being used-every 3 - 5 ml the blood return will be re-
assessed

During all chemotherapy infusions assessment for extravasation will be
continually done

Discard unused portion of drug in proper container for hazardous waste disposal
Follow policy and procedure should there by a medication spill or contact with
skin

Document in the patient's chart the name of drug, amount given, date and time
given *

Administer IM, SQ, ID, and sublingual medications *
Administer IV medications *
DEA Procedures/Controlled Substances Log *
Controlled Substances Abuse *

Oncology Hematology Policies (See Oncology Hematology Policy Book)
TB Skin Testing *
Anaphylaxis *
PICC line, and Groshong Flushing, Teaching and Care *
Lumbar Punctures

7
AREA OF ORIENTATION Discussed Observed Preceptor’s Signature Completed date
Paracentesis and Thoracentesis
Phlebotomy
Port-a-cath
Restoring Patency to Catheters
Transfusions- (at Meriter) Pre-Admission phone calls/paperwork
Vesicant Extravasation
Bone marrow biopsy and aspiration


Status/Recommendations/Comments:
____________________________________________________________________________________________________________________

I, _________________________________________ (employee name) have completed the Oncology/Hematology Clinical Training Checklist and
attest the information is true and valid. I have demonstrated or discussed these skills and I am responsible for performing patient care as a Certified
Medical Assistant / Licensed Practical Nurse / Registered Nurse (circle one).

__________________________________________________ ___________________
Preceptor Date

____________________________________________________ ___________________
Supervisor Date

__________________________________________________ ___________________
Provider Date

Additional Preceptor Signatures/initials:
1. _________________________________________________
2. _________________________________________________
3. _________________________________________________
4. _________________________________________________

Revised 12-19-02, Updated 05-20-03, 08-26-04, 09-29-04, 8-3-05, 8/15/2007, 8/23/2011,3/14/2012, 6/20/14, 11/5/2015

 Send the original signed Clinical Training Checklist to Clinical Staff Education - 414.
 One copy of the signed Clinical Training Checklist should be placed in the clinic’s staff employee’s file, and a copy given to the employee.

REFERENCES:
Brener, T., Doyle, R.M. (Ed.). (2008). Nursing 2008 drug handbook. Philadelphia, PA: Lippincott Williams & Wilkins.
Kowalak, J. P. (Ed.). (2009). Lippincott’s nursing procedures (5th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Perry, A.G. & Potter, P.A. (2002). Clinical nursing skills & techniques. (5th ed.). St. Louis, MO: Mosby.
Perry, A.G. & Potter, P.A. (2009). Fundamentals of Nursing. (7th ed.). Hall, A. & Stockert, P.A. (Eds.). St. Louis, MO: Mosby Elsevier.