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Non-chemo nurses giving hazardous drugs

  • 1.  Non-chemo nurses giving hazardous drugs

    Posted 07-19-2019 11:34
    ​I work on an inpatient oncology unit, where nurses take the ONS Chemotherapy/Immunotherapy Certificate online course prior to hanging chemo.  My question is, as we have more and more hazardous drugs being used for non-oncology purposes, we are constantly getting calls from other units to come administer these meds, specifically drugs that are not chemo but are hazardous drugs. There are plenty of hazardous drugs that they already give-Prograf, finasteride, fluconazole, etc. How do you determine which HD's should be given by a chemo nurse and which don't have to? Can they give immunotherapy? Our peds nurses give Remicade without issue. We get so many different answers from providers, pharmacy, and nursing supervisors. I've searched all over for some guidelines on this but have been unsuccessful. Any advice would be so appreciated! Thanks so much!

    Danielle Robertson BSN RN OCN
    Registered Nurse
    Penn Medicine Lancaster General Health
    Lancaster PA

  • 2.  RE: Non-chemo nurses giving hazardous drugs

    Posted 07-20-2019 12:14

    i used to work inpatient nursing, but have since moved into the clinic. In the hospital, we had a policy stating that all oral chemo can be administered by any RN within the hospital. This negates the nurses opting to say those other oral meds that are to be handled like chemo, need to be administered by a chemo certified nurse. I'm not coming to your floor to give Megace.. etc.
    We are transitioning to non- first time rituxan to be given by non chemo RN's as well. It's not a chemo, it's an monoclonal antibody and they can triage out and treat the symptoms, like any other infusion. Hope this helps some. Good luck on your continued search!

    Cindy Trujillo RN MSN
    Nursing Navigator
    Lakeside CA

  • 3.  RE: Non-chemo nurses giving hazardous drugs

    Posted 07-28-2019 20:34
    Hi Danielle,
    As these drugs become approved for more indications by the FDA, your organization needs to create policy, training, and competency assessment for the nursing staff. Traditional chemo (drugs that aren't targeted therapy) should probably still be given by nurses who give it with frequency and have experience with management of side effects. Targeted therapies and immunotherapies are being used for many diseases outside of oncology. Your nurses should be supported by their organizations to provide training and as nurses, they have the obligation to learn about these new therapies just as the doctors have had to, to provide up to date care for the patients.

    Goley Richardson, MSN, RN, OCN
    MD Anderson Cancer Center

    Goley Richardson, MSN, RN, OCN
    Associate Director - Nursing Program
    Houston, TX

  • 4.  RE: Non-chemo nurses giving hazardous drugs

    Posted 08-05-2019 16:28

    It is ONS' position that any nurse involved in the care of a patient receiving anti-neoplastic medications be deemed competent by their institutions to do so. Preparation for any nurse administering or caring for clients receiving chemotherapy, biologics, and/or immunotherapy should encompass both didactic (classroom) education and clinical practicum. This is stated in the ONS position statement on the Education of the Nurse who Administers and Cares for the Individual Receiving Chemotherapy, Targeted Therapy and Immunotherapy. In this position statement, ONS does not differentiate between settings (oncology or non-oncology), indications, routes or doses when advocating for practice standards related to anti-neoplastic administration.

    The ASCO/ONS Chemotherapy Administration Safety Standards, standard 3.18: "Chemotherapy is administered by a qualified physician, physicians assistant, registered nurse, or advanced practice nurse defined in standard 1.1" These standards, for the purposes of administration, do not delineate between intravenous chemotherapy and oral chemotherapy.

    The bottom line is the recommendation that anyone administering chemotherapy/immunotherapy or caring for those receiving these drugs should have the education and clinical preparation to help maintain patient safety. Each employer must determine how that would occur in their setting, based on the appropriate state rules and standards of practice.

    I hope you found this information helpful!

    Erin Dickman MS RN OCN
    Oncology Clinical Specialist
    Oncology Nursing Society
    Columbus OH

  • 5.  RE: Non-chemo nurses giving hazardous drugs

    Posted 08-06-2019 09:08
    ​I think about Hazardous Drug training as having two parts -

    1) OSHA requires safe handling training for all HDs - NIOSH 1, 2 & 3. So - potentially every nurse in your facility needs this education and training. If your Chemotherapy Competent RNs are administering all HDs, is this practical and sustainable in your facility? What training do other staff receive re: HDs, including how to handle body fluids?

    2) When it comes to chemotherapy, nurses need not only OSHA safe handling training, but also specific education about the drugs, administration process, and monitoring/management of side effects. This falls under "Chemotherapy Competency" which ONS Position Statements support and Commission on Cancer Standards require.

    Rae Norrod, MS, RN, AOCN, CNS
    Manager, Cancer Support Services
    Kettering Health Network
    Kettering, OH