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Chemotherapy Competence for Nurses (Adult & Pediatric) (10.28AP)

Chemotherapy Competence for Nurses (Adult & Pediatric) (10.28AP) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Medications

10.28AP


NURSING PATIENT CARE POLICY & PROCEDURE




Effective Date:
April 13, 2015
Amended: April 4, 2017
Administrative Manual
Nursing Manual (Red)
Other _______________
Policy #: 10.28AP
Original
Revision
Page
1
of 5
Title: Chemotherapy Competence for Nurses
(Adult & Pediatric)

I. PURPOSE

A. To define the levels of chemotherapy competence for nursing personnel caring for
patients receiving chemotherapy for the treatment of cancer.
B. To outline the process and responsibilities for nurses caring for patients receiving
chemotherapy for an indication other than cancer.

II. POLICY

A. Nurse Clinicians and Advance Practice Nurses who have successfully completed
the requirements for chemotherapy administration will be able to administer
cancer chemotherapy.
B. When chemotherapy is given for an indication other than cancer, the unit/clinic
manager, in collaboration with the hematology/oncology clinical nurse specialist
(CNS) and/or hematology/oncology nursing education specialist (NES), is
responsible for ensuring competence of the Registered Nurses (RNs), and that all
appropriate policies and procedures are followed.
C. In the event that chemotherapy is ordered for an indication other than cancer and
the administering unit has not yet been trained to give the drug safely, the
hematology/oncology CNS, nurse manager, or care team leader will coordinate
administration as outlined below. In addition, this person will notify relevant
nursing leaders from both areas to set up educational programs.
D. Safe handling of hazardous drugs is described in Hospital Administrative Policy
8.89, Preventing Non-Therapeutic Exposure to Hazardous Drugs.
E. Chemotherapy drugs are defined in “Appendix A” of Hospital Administrative
Policy 8.59, Chemotherapy Processes: Informed Consent, Ordering, Verification,
Documentation, and Patient/Family Education.
F. Refer to the Investigational Drug Monographs for information on safe handling of
research drugs.

III. FORMS

A. Letter indicating successful course completion
B. Signed attendance form for the chemotherapy skills practicum
C. Chemotherapy practicum skills competency
D. Other as deemed appropriate by unit/clinic manager

IV. ELIGIBILITY CRITERIA


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A. There are three (3) levels of chemotherapy competence:
1. Chemotherapy Competent: Indicated for nurses who routinely care for
patients receiving cancer chemotherapy.
2. Chemotherapy Competent for Certain Agents: Indicated for nurses who
administer or handle one or more chemotherapy agents limited to a
specified indication.
3. Competent for Chemotherapy Order Verification (according to Hospital
Administrative Policy8.59): Indicated for nurses who verify
chemotherapy orders, but do not administer chemotherapy.
B. Nurses new to UWHC and new to the field of Oncology/Hematology seeking to
practice as Chemotherapy Competent will:
1. Attend the Chemotherapy Course and Chemotherapy Skills Lab
Practicum
2. Successfully complete a written exam with a score of at least 85%
3. Complete a clinical practicum and skills competency with a UWHC
preceptor, preferably within six (6) weeks of course completion, either
in the clinic and/or inpatient setting.
C. Nurses new to UWHC with recent chemotherapy experience seeking to practice
as Chemotherapy Competent may:
1. Complete the course, practicum, and exam requirements or
2. Successfully pass the exam with a score of at least 85% and complete a
clinical practicum and skills competency with a UWHC preceptor.
D. Nurses seeking to practice as Chemotherapy Competent for Certain Agents will:
1. Complete education as provided by the CNS or NES.
2. Complete a clinical practicum and skills competency.
E. Nurses new to UWHC seeking to practice as Competent for Chemotherapy Order
Verification will:
1. Attend the Chemotherapy Course
2. Successfully complete a written exam with a score of at least 85%
F. All levels of chemotherapy competent nurses will complete an annual review
through completion of a self-study module.
G. In the event that an inpatient is placed on a non-oncology unit, the guidelines for
off-unit placement must be adhered to as outlined below.

V. GUIDELINES FOR OFF-UNIT TREATMENT OF PATIENTS RECEIVING
CANCER CHEMOTHERAPY

A. Outpatient:
1. If cancer chemotherapy needs to be administered outside of the
hematology/oncology outpatient areas, the patient's nurse needs to page
the hematology/oncology CNS to coordinate care, as this is a very rare
occurrence.
B. Inpatient:
1. In the event that a Hematology/Oncology bed is not available, or the
patient requires a higher level of care, the following sections outline the
responsibilities of the inpatient units.
C. Responsibilities of the Hematology/Oncology Inpatient Unit:
1. Care Coordination
a. The inpatient adult or pediatric care team leader, nurse manager, or

Page 3 of 5

CNS coordinates chemotherapy administration with the non-
oncology unit:
i. Screens all admissions for chemotherapy complexity.
ii. Attempts to transfer appropriate patients as outlined above
to allow chemotherapy patients to be admitted to their
primary units.
iii. Notifies attending physician, fellow, and pharmacist of the
location of the patient.
iv. Coordinates timing of chemotherapy administration with
the off-unit care team leader, nurse manager, or CNS.
Makes initial contact within two (2) hours of first becoming
aware of the need for off-unit chemotherapy administration.
2. Verification and Administration
a. The chemotherapy competent nurse:
i. Performs order verification according to Hospital
Administrative Policy 8.59.
ii. Instructs the patient's nurse on the off-unit NOT to perform
RN verification on the MAR for chemotherapy orders. That
is the responsibility of the chemotherapy competent nurse
as part of order verification.
iii. Instructs the non-chemotherapy RN staff about the
following:
• The chemotherapy toxicities specific to drugs
being administered.
• Highlights of Hazardous Drug precautions as
outlined in Hospital Administrative Policy 8.89.
• Who to call in the event of questions, concerns, or
in the event of a chemotherapy spill.
b. Verifies the product with another chemotherapy competent RN.
c. Administers the chemotherapy drug(s).
3. Patient Monitoring, Disposal, and Patient/Family Education
a. The chemotherapy competent nurse:
i. Performs immediate monitoring required and instructs the
patient's nurse on any subsequent monitoring.
ii. Reminds the patient's nurse to post a "Hazardous Drug
Precautions" sign on the door.
iii. Reviews with the patient's nurse the disposal of the
secondary tubing set as with any hazardous drug.
iv. Provides written instructions on the chemotherapy agents
and other side effect management as indicated, and reviews
discharge instructions with patient/family and nursing staff
as it relates to chemotherapy.
v. Reviews location of chemotherapy spill kit, if applicable,
with patient’s nurse. Procedure for chemotherapy spill is
outlined in Hospital Administrative Policy 8.89.
D. Responsibilities of the Non-Hematology/Oncology Inpatient Unit
1. Care Coordination
a. The unit coordinates chemotherapy administration with the
Hematology/Oncology unit. Initial contact should be made within

Page 4 of 5

two (2) hours of first becoming aware of the need for off-unit
chemotherapy administration.
2. Off-Unit Nurse's Responsibilities :
a. Ensure all the appropriate lab results as indicated on the
chemotherapy orders are obtained
b. Ensure that the chemotherapy medications are ready for the
chemotherapy nurse to administer
c. Perform RN verification for non-chemotherapy medications (i.e.,
premedications, antiemetics, etc.), but does NOT perform RN
verification for the chemotherapy medications
d. Coordinate timing with chemotherapy nurse, and administers non-
chemotherapy medications
e. In the event of a chemotherapy spill, contact the chemotherapy
nurse immediately for assistance.
f. Follow directions of the chemotherapy nurse in monitoring,
managing, and documenting toxicities.
E. Responsibilities for Monitoring During Prolonged Continuous Infusions (greater
than one [1] hour):

Type of Infusion Chemotherapy RN Non-Chemotherapy RN
Continuous infusion
of non-vesicant
chemotherapy via
peripheral line
Check for blood return prior to,
every eight (8) hours during
infusion, and at the end of
infusion or more frequently if
RN suspects vein integrity has
been compromised (swelling,
leakage, or complaints of
discomfort).
Check IV site before
infusion, hourly during infusion,
and whenever RN suspects vein
integrity is compromised. Contact
chemo certified RN if vein integrity
is suspect.
Continuous infusion
of a vesicant via
CVAD
(non-implanted port)
Check for a blood return prior to,
every eight (8) hours during
infusion, and at the end of
infusion or more frequently if off
unit RN suspects catheter is not
functioning properly.
Site should be assessed before
infusion, every hour during
infusion, and whenever RN suspects
device integrity is compromised.
Monitor the patient for swelling,
leakage, or complaints of discomfort
or shoulder pain during the infusion
and contact chemotherapy RN with
any concerns.
Continuous infusion
of a vesicant via an
implanted port
Check a blood return every eight
(8) hours, and check the site
every four (4) hours.
Check the site hourly for signs of
swelling, leakage, discoloration,
complaints of pain at the port site or
shoulder area. Contact
chemotherapy RN with any
concerns.
For all continuous
infusions
Monitor pump every four (4)
hours.
Monitor pump hourly. If the hourly
rate/volume is not correct, the off
unit RN will contact the
chemotherapy RN.

Page 5 of 5


VI. UWHC CROSS REFERENCES

A. UW Health Clinical Policy 6.1.1, Chemotherapy Processes: Informed Consent,
Ordering, Verification, Administration, Documentation and Patient/Family
Education
B. UWHC Administrative Policy 8.89, Preventing Non-Therapeutic Exposure to
Hazardous Drugs
C. Investigational Drug Monographs

VII. REVIEWED BY

Clinical Nurse Specialist, Pediatric Hematology/Oncology
Director, Oncology
Nursing Education Specialist, Nursing Education & Development
Nurse Managers, Inpatient and Outpatient Hematology/Oncology
Oncology Care Practice Committee
Nursing Patient Care Policy and Procedure Committee, November 2014

SIGNED BY

Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive