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Administration of chemotherapy by non-chemo trained nurses

  • 1.  Administration of chemotherapy by non-chemo trained nurses

    Posted 13 days ago
    ​Hi everyone,

    My organization is looking to update our chemotherapy administration policy to include exceptions when patients not on the oncology or stem cell transplant unit are admitted and need oral chemotherapy that is a continuation of their home dose, it can be given by non-oncology nurses.  Current practice is that two oncology/ chemo competent nurses are verifying the orders in the EMR, then both leaving the unit to administer these medications.  We are seeing more patients being admitted to other floors needing their oral chemo, having our nurses leave the floor to perform this task multiple times a shift to multiple units is burdensome.  Nurses on our units, including myself, feel this policy change would be a big win.  We are experiencing some hesitancy from upper leadership about changing this policy because of the additional education all nurses in the hospital would need to go through.  I was reaching out to see if other organizations have a policy that allows non-chemo competent/ oncology nurses administer chemotherapy.  Are there limitations to the types of drugs?  How was education directed to staff?  Have there been any additional challenges or adverse events from allowing this practice?  I'm meeting with our CNO next week, would appreciate any feedback positive or negative that could help direct our conversation!!

    Elaine Harmon BSN, RN, OCN
    Assistant Patient Care Manager
    University of Chicago Medical Center


  • 2.  RE: Administration of chemotherapy by non-chemo trained nurses

    Posted 12 days ago
    At our hospital you are not required to have chemo certification or double sign off for oral chemo. We do require two chemo nurses to go to other units if they are getting IV chemo (usually to the ICU). We provided education to our service line about safe handling of medications and body excretions while patients are on chemotherapy and we are always available as a resource if they have questions. To my knowledge there have not been any adverse events. My thinking is these medications are given by lay people in the home any RN has the basic skills to administer them safely in the hospital. So many people are on oral chemotherapy these days I can't imagine how you would have the time and resources to be sending two nurses off you unit every time an oral medication needed to be administered.

    Chandra Gass RN BSN OCN
    St Marys Hospital & Medical Center
    Grand Jct CO

  • 3.  RE: Administration of chemotherapy by non-chemo trained nurses

    Posted 12 days ago
    We divide our policy and training to for malignancy and non-mailgnancy.

    For non-malignancy, we provide a one day class, that is a very shortened version of our 3 day chemo class for malignancy . After that class, they can administer chemistry and bios for any non-mailignant reason.

    For malignancy, we have a 3 day class to start, then after about 2 years we start the online content thru ONS.

    For oral chemo for mailgnancy off unit, we require that a hem/onc attending writes the order and we maintain our double check process by an oncology rn, as that can be done on the home unit.  If it is a brand new regimen, the oncology nurse must go and give the oral agent for the first 7 days (or we would keep them or move them to an oncology specific unit).  After those 7 days, any rn can administer the agent, and we do require a witness at the point of care.  If they are admitted on an oral checheco for malignancy, we still require a heme/onc attending to write the order, and the oncology nurses to verify the order (still 2 of them).  The oncology nurse has to administer the first dose, and then all subsequent doses can be done by the admitting unit.

    We do this for several reasons.  While pts are taking these meds at home, they are now admitted and we want to verify that it is still safe for the to continue the regimen.  Unlike a blood pressure medication, where most people could recognize and think to hold that med if someone came in with a low bp, most people are not in tune with a focused asessment for those oral chemo.meds And side effects . We hope to verify that it is still safe for the pt to continue that regimen, and that their reason for admission is not due to the oral chemo.  When the chemo nurse give that first dose, they are also to provide education to the boarding unit and a resource, as well as check in with the other and make sure they are ok, as well as make sure they do not need any additional education on the regimen.

    Any other route of chemo would require a chemo competent rn to go and start the administration of that drug, but the boarding unit can monitor the pt after it is started.

    Susan Mason RN BS MSN
    UNC Hospitals
    Mebane NC