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Section 1: Ordering Chemotherapy 
Section 2: Pharmacy 
Section 3: Nursing 
Administration of New Agents 
Appendix 1  

 
Section 3: Nursing

Nurses administering chemotherapy must be certified in the administration of chemotherapy through the completion of an approved chemotherapy course. Certification will ensure knowledge of:

  • Approved indications(s), contraindications, therapeutic dose range, dosage adjustments (if necessary), monitoring parameters and special precautions for all chemotherapy; recommended method of administration, rate of administration, potential risks related to administration, potential adverse reactions and toxicities and the management thereof
  • Storage, stability, method of preparation, and recommended concentration of chemotherapy
  • Patient education required regarding chemotherapy potential side effects, toxicities, and the management thereof; as well as self care during chemotherapy
  • Policies regarding waste disposal and management of chemotherapy spill

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1. Prior to chemotherapy administration
 

a) Ensure a copy of the original chemotherapy letter that corresponds with the chemotherapy prescription is on the patient’s chart. Copies of chemotherapy letters for oral chemotherapy agents, for patients outside St. John’s, must also be maintained on the patient’s chart on the nursing unit responsible for overseeing the care of the patient. 
 
b) Ensure that a copy of the informed consent for chemotherapy has been signed by the patient and physician and is maintained in the patient’s chart.
 
c) Provide appropriate patient education and teaching, including: specific chemotherapy information, blood counts, side effects and the management thereof. Instruct the patient regarding self care and their role in safety, including the use of personal protective equipment when handling blood, vomitus, or excreta, and double flushing the toilet when receiving chemotherapy.
 
d) Ensure patients are assessed by a responsible physician prior to the delivery of each cycle of chemotherapy, oral or intravenous. Nursing staff must be aware of patient diagnosis and relevant patient history and are responsible for performing a nursing assessment during each chemotherapy treatment.
 
e) Confirm that appropriate laboratory tests have been completed and are within acceptable limits
 
f) Determine appropriate site for venous access and utilize appropriate sterile technique for access.  Or, assess and ensure patency, including blood return of central venous access device, per the institutional policy.
 
g) Measure and record baseline vital signs.
 
h) Verify patient’s allergy history.
 
i) Initiate pre-treatment therapies (e.g., hydration, test dosing, anti-emetics, anti-hypersensitivity meds, etc.).
 
2. Chemotherapy Administration:

a) Don appropriate Personal Protective Equipment (PPE) for the handling of cytotoxic agents (double gloves and gown) (face shield is to be worn when there is a risk of a splash and safety mask when aerosolization is a risk).

b) Ensure appropriate personnel and emergency equipment, including an approved spill kit and extravasation kit is ready and easily accessible.
 
c) Ensure chemotherapy medications are received in clean, dry syringes or bags of IV fluids inside zipper-seal plastic bags and are appropriately labeled by pharmacy.
 
d) Inspect bags before opening to ensure no spillage in the bag. If spillage has occurred, keep the container sealed and notify pharmacy.
 
e) Review physician’s chemotherapy orders. Confirm BSA and dose calculations.
 
f) Ensure all chemotherapy is clearly labeled. At the time of chemotherapy administration, two clinicians (nurses, physicians, pharmacists) are to independently verify information on the chemotherapy label (i.e. patient name, HCN (Health Care Number), drug name, dosage, etc.).  Two clinicians are to check final product label against original chemotherapy order.

g) Ensure intravenous sets are primed with compatible IV solution, NOT chemotherapy medication.  Use Luer-Lok fittings for intravenous sets and syringes.
 
h) Bring chemotherapy agent to the patient. Place a plastic backed absorbent pad over the work area in case of spillage.

i) Ensure positive patient identification (PPI) using two unique patient identifiers (i.e., verbal, arm band, hospital card/HCN, date of birth, mother’s name, picture ID).  The PPI process is to be consistent with the organization’s policy regarding PPI and verified immediately prior to administering chemotherapy.
 
j) When spiking a bag of chemotherapy medication, spike at waist level to decrease the risk of eye/face contamination.

k) Assess health of venous access site.  Assess for blood return, swelling and erythema.
 
l) Attach syringe to intravenous system using needleless equipment (i.e., BD Lever Lock Cannula). Utilize the closed system equipment that your institution has adopted.  Place gauze under the attachment area when connecting or disconnecting the syringe to catch any droplets.

m) Monitor administration sets and IV sites for leakage.
 
n) Check patient’s condition and the status of the venous access site/device periodically during administration.

o) Do not disconnect tubing at any point in the system until the tubing has been thoroughly flushed.
 
p) Dispose all chemo waste in designated cytotoxic waste disposal containers, ensuring all is clearly marked as cytotoxic waste.

q) Remove personal protective equipment and discard in designated cytotoxic waste disposal containers.

3.   Post Chemotherapy Administration:

a)  Document on medication administration record, chemotherapy flow sheet and nurse’s notes as per the policy of the health facility where the chemotherapy is being administered.

b)  Ensure the patient has received direction regarding accessing care after hours if required.

c)  Ensure follow up appointments are coordinated as outlined in the chemotherapy letter.
Note:  Refer to the Eastern Health Policy:  Management of Exposure to Hazardous Medications (HR-OH (O)-090).
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Updated Dec 4, 2013