What Are Your Concerns About Administering Chemotherapy on Non-Oncology Units?
April 1, 2012
YouTube Is Not a Substitute for Training
About six months ago, one of our patients with cancer was admitted to the rehabilitation floor. The patient was due to have her port needle changed and labs drawn. None of the rehab nurses had experience with ports; therefore, one nurse went on YouTube and watched how one was accessed. I was utterly shocked and feared for the patient’s safety!
I appreciated her need for education in this matter. I took her aside and went over the port protocol and the dangers. I told her I was happy to give her and other nurses a class. One other nurse joined us, and the patient was even glad to offer her wisdom and assistance. The nurse was welcomed to call to the oncology suite for future assistance, questions, or practice with us. She agreed.
Karen Dubay, RN, OCN® Nashua, NH
Chemotherapy Dose Variability Only Increases Risk of Error
Staff in non-oncology units are not trained to administer chemotherapy and care for patients who have received it. Oncology is about the only discipline where drug dosages are not fixed. They vary according to disease type (e.g., methotrexate may be 80 mg/m2 in breast cancer but 5,000 mg/m2 in lymphoma). This increases risk for errors, whether in the prescribing, preparation, or administration.
Non-oncology staff are not trained to care for patients with side effects or oncologic emergencies. We find that staff in non-oncology units do not like caring for people with cancer—they cannot get patients back into our units quickly enough.
Then there is the issue with oral chemotherapy drugs being administered as immunosuppressants in autoimmune diseases. The medical staff prescribe doses that require tablets to be cut, and the pharmacy does not have a safety cabinet for this purpose—the safety cabinet is only for parenteral drugs. The main issue is that medical consultants do not recognize the risk to the safety of staff and the environment. We can train the nursing staff, but we are currently in the throes of enlightening the medical staff.
Alayne Reid, RN, BN, MN, MHSC, OCN® Education Coordinator (Cancer) Mater Education Centre Mater Health Services South Brisbane, Australia
I Don’t Know How Chemotherapy Affects Non-Oncology Conditions
My concerns, especially as an ONS chemotherapy/biotherapy trainer, are that I know how to systematically verify a chemotherapy order, administer it safely, and monitor the patient, but I do not necessarily know the underlying pathophysiology of the non-oncology diseases being treated with chemotherapy and am afraid to answer questions specifically about how the agents are affecting overall patient outcomes of non-oncology conditions.