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Siegel RD, LeFebvre KB, Temin S, Evers A, Barbarotta L, Bowman RM, Chan A, Dougherty DW, Ganio M, Hunter B, Klein M, Miller TP, Mulvey TM, Ouzts A, Polovich M, Salazar-Abshire M, Stenstrup EZ, Sydenstricker CM, Tsai S, Olsen MM. Antineoplastic Therapy Administration Safety Standards for Adult and Pediatric Oncology: ASCO-ONS Standards. JCO Oncol Pract 2024:OP2400216. [PMID: 38776491 DOI: 10.1200/op.24.00216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/04/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE To update the ASCO-Oncology Nursing Society (ONS) standards for antineoplastic therapy administration safety in adult and pediatric oncology and highlight current standards for antineoplastic therapy for adult and pediatric populations with various routes of administration and location. METHODS ASCO and ONS convened a multidisciplinary Expert Panel with representation of multiple organizations to conduct literature reviews and add to the standards as needed. The evidence base was combined with the opinion of the ASCO-ONS Expert Panel to develop antineoplastic safety standards and guidance. Public comments were solicited and considered in preparation of the final manuscript. RESULTS The standards presented here include clarification and expansion of existing standards to include home administration and other changes in processes of ordering, preparing, and administering antineoplastic therapy; the advent of immune effector cellular therapy; the importance of social determinants of health; fertility preservation; and pregnancy avoidance. In addition, the standards have added a fourth verification. STANDARDS Standards are provided for which health care organizations and those involved in all aspects of patient care can safely deliver antineoplastic therapy, increase the quality of care, and reduce medical errors.Additional information is available at www.asco.org/standards and www.ons.org/onf.
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Affiliation(s)
| | | | - Sarah Temin
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | - Amy Evers
- University of Pennsylvania Health System, Philadelphia, PA
| | - Lisa Barbarotta
- Smilow Cancer Hospital and Yale Cancer Center, New Haven, CT
| | - Ronda M Bowman
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | - Alexandre Chan
- University of California, Irvine, Chao Family Comprehensive Cancer Center, National Cancer Centre Singapore, Irvine, CA
| | | | - Michael Ganio
- ASHP (American Society of Health-System Pharmacists), Bethesda, MD
| | | | - Meredith Klein
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | - Tamara P Miller
- Emory University/Children's Healthcare of Atlanta, Atlanta, GA
| | | | | | | | - Maritza Salazar-Abshire
- Department of Nursing Education, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Susan Tsai
- Ohio State University Comprehensive Cancer Center, Columbus, OH
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Aebersold ML, Kraft S, Farris KB, Scherdt M, Olsen M, Polovich M, Shelton BK, Montgomery GH, Friese CR. Evaluation of an Interprofessional Training Program to Improve Cancer Drug Therapy Safety. JCO Oncol Pract 2021; 17:e1551-e1558. [PMID: 33577351 PMCID: PMC9810130 DOI: 10.1200/op.20.00816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Drug therapy for cancer is a high-risk, high-volume clinical intervention that requires interprofessional teams. Given the complexity of anticancer drug therapy and safety concerns, an interdisciplinary team developed a novel training program for oncology registered nurses and pharmacists to improve cancer drug safety. METHODS Participants completed preworkshop learning assessments and received access to web-based modules on six topics: hazardous drug handling, drug extravasation, hypersensitivity reaction management, sepsis recognition, immune checkpoint inhibitor toxicities, and oral oncolytic adherence. In a 7-hour workshop, participants applied module content in interactive exercises and high-fidelity simulations. Preworkshop and postworkshop questionnaires assessed changes in knowledge and confidence in each topic. Program satisfaction and changes to clinical practice or policies were assessed 3 months after the workshop. RESULTS Two hundred ninety-two nurses and 82 pharmacists applied to participate, and 103 (35%) and 44 (54%) have participated, respectively. Long-term follow-up data were available on 133 (90%) participants. Change scores in confidence to meet program objectives increased between pre- and postworkshop (range of increase 0.6-0.8, P < .01). Knowledge scores increased significantly between pre- and postworkshop (average improvement of 3.2 points, P < .01). Overall program satisfaction was high (mean 5.0, standard deviation [0.2] on a five-point scale). Seventy-seven (60%) reported that they had made at least one clinical practice or institutional policy change at 3 months. CONCLUSION An interprofessional education program with online modules, in-person interactive sessions, and simulation activities is a promising strategy to deliver cancer drug safety content to practicing oncology clinicians.
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Affiliation(s)
- Michelle L. Aebersold
- University of Michigan School of Nursing, Center for Improving Patient and Population Health, Ann Arbor, MI
| | - Shawna Kraft
- University of Michigan College of Pharmacy, Ann Arbor, MI,University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Karen B. Farris
- University of Michigan College of Pharmacy, Ann Arbor, MI,University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Marylee Scherdt
- University of Michigan School of Nursing, Center for Improving Patient and Population Health, Ann Arbor, MI
| | - MiKaela Olsen
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Martha Polovich
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA
| | - Brenda K. Shelton
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Guy H. Montgomery
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Center for Behavioral Oncology, New York, NY
| | - Christopher R. Friese
- University of Michigan School of Nursing, Center for Improving Patient and Population Health, Ann Arbor, MI,University of Michigan Rogel Cancer Center, Ann Arbor, MI,Christopher R. Friese, PhD, RN, AOCN, 400 North Ingalls Suite 1174, Ann Arbor, MI 48109-5482; twitter: @ChrisFriese_RN; e-mail:
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Santo L, Ward BW, Rui P, Ashman JJ. Antineoplastic drugs prescription during visits by adult cancer patients with comorbidities: findings from the 2010–2016 National Ambulatory Medical Care Survey. Cancer Causes Control 2020; 31:353-363. [DOI: 10.1007/s10552-020-01281-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 02/12/2020] [Indexed: 11/28/2022]
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Taibi A, Bardet M S, Durand Fontanier S, Deluche E, Fredon F, Christou N, Usseglio J, Mathonnet M. Managing chemotherapy extravasation in totally implantable central venous access: Use of subcutaneous wash-out technique. J Vasc Access 2020; 21:723-731. [PMID: 32056485 DOI: 10.1177/1129729820905174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Totally implanted venous access is widely used in chemotherapy administration. With over 1 million intravenous chemotherapy infusions given worldwide each day, complications are frequent. Accidental cases of extravasation in the presence of a catheter are rare yet very serious and may require discontinuation of chemotherapy. The aim of this study was to evaluate the feasibility and efficacy of the subcutaneous wash-out technique for chemotherapy extravasation treatment. METHODS We retrospectively reviewed the medical charts of patients who had received chemotherapy and sustained extravasation in our hospital between October 2013 and October 2016. Subcutaneous wash-out treatments were carried out exclusively, without the application of antidotes or the use of specific antidotes. RESULTS We documented seven cases of chemotherapy extravasation. Two cases were treated with antidotes and suffered necrosis in the following weeks. The five patients treated using subcutaneous wash-out had no necrosis and had a steady decrease in the inflammatory reaction of the cutaneous and subcutaneous soft tissues. For these five patients, chemotherapy was restarted within 1 month following extravasation. CONCLUSION This study would argue for the feasibility and effectiveness of subcutaneous wash-out in the treatment of chemotherapy extravasations.
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Affiliation(s)
- Abdelkader Taibi
- Visceral Surgery Department, Dupuytren University Hospital, Limoges, France.,University Limoges, CNRS, XLIM, UMR 7252, Limoges, France
| | | | - Sylvaine Durand Fontanier
- Visceral Surgery Department, Dupuytren University Hospital, Limoges, France.,University Limoges, CNRS, XLIM, UMR 7252, Limoges, France
| | - Elise Deluche
- Oncology Department, Dupuytren University Hospital, Limoges, France
| | - Fabien Fredon
- Visceral Surgery Department, Dupuytren University Hospital, Limoges, France
| | - Niki Christou
- Visceral Surgery Department, Dupuytren University Hospital, Limoges, France
| | - Julie Usseglio
- Reconstructive and Aesthetic Surgery Department, Dupuytren University Hospital, Limoges, France
| | - Muriel Mathonnet
- Visceral Surgery Department, Dupuytren University Hospital, Limoges, France
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Oliveira PPD, Santos VEP, Bezerril MDS, Andrade FBD, Paiva RDM, Silveira EAAD. PATIENT SAFETY IN THE ADMINISTRATION OF ANTINEOPLASTIC CHEMOTHERAPY AND OF IMMUNOTHERAPICS FOR ONCOLOGICAL TREATMENT: SCOPING REVIEW. TEXTO & CONTEXTO ENFERMAGEM 2019. [DOI: 10.1590/1980-265x-tce-2018-0312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to identify and synthesize the scientific evidence on cancer patient safety in the administration of antineoplastic and immunotherapeutic chemotherapeutic agents. Method: a scoping review, according to the Joanna Briggs Institute and to the recommendations of the PRISMA-ScR international guide. The research was conducted in five electronic databases, the Cochrane Library and eight catalogs of theses and dissertations. The inclusion criteria were the following: studies related to patient safety in the administration of antineoplastic and immunotherapeutic chemotherapy by nurses in places where cancer care occurs, published entirely in Portuguese, Spanish and/or English, with no time limit. The extracted data were analyzed and synthesized in narrative form. Results: a total of 14,444 records were retrieved and 47 studies were kept for review. Most publications (44.7%) had a qualitative approach, while 40.4% were quantitative and 14.9%, mixed. When summarizing the findings, the following themes emerged: Safety standards in parenteral administration of antineoplastic chemotherapy; Good practices for patient safety using oral antineoplastic therapy; Administration and safe handling of immunotherapies; Prevention and management of errors related to the administration of antineoplastic and immunotherapeutic chemotherapeutic agents. Conclusion: patients safety with cancer in the administration of antineoplastic therapy occurs when there is implementation of evidence-based protocols, continuing education of nurses and implementation of safety standards and processes, as a strategy to prevent errors in drug administration.
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Vera R, Otero MJ, Ayala de la Peña F, González-Pérez C, Peñuelas Á, Sepúlveda JM, Quer N, Doménech-Climent N, Virizuela JA, Beorlegui P, Gorgas MQ. Recommendations by the Spanish Society of Hospital Pharmacy, the Spanish Society of Oncology Nursing and the Spanish Society of Medical Oncology for the safe management of antineoplastic medication in cancer patients. Clin Transl Oncol 2018; 21:467-478. [DOI: 10.1007/s12094-018-1945-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
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Bernabeu-Martínez MA, Ramos Merino M, Santos Gago JM, Álvarez Sabucedo LM, Wanden-Berghe C, Sanz-Valero J. Guidelines for safe handling of hazardous drugs: A systematic review. PLoS One 2018; 13:e0197172. [PMID: 29750798 PMCID: PMC5947890 DOI: 10.1371/journal.pone.0197172] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 04/27/2018] [Indexed: 12/12/2022] Open
Abstract
Objective To review the scientific literature related to the safe handling of hazardous drugs (HDs). Method Critical analysis of works retrieved from MEDLINE, the Cochrane Library, Scopus, CINHAL, Web of Science and LILACS using the terms "Hazardous Substances", "Antineoplastic Agents" and "Cytostatic Agents", applying "Humans" and "Guidelines" as filters. Date of search: January 2017. Results In total, 1100 references were retrieved, and from those, 61 documents were selected based on the inclusion and exclusion criteria: 24 (39.3%) documents related to recommendations about HDs; 27 (44.3%) about antineoplastic agents, and 10 (33.3%) about other types of substances (monoclonal antibodies, gene medicine and other chemical and biological agents). In 14 (23.3%) guides, all the stages in the manipulation process involving a risk due to exposure were considered. Only one guide addressed all stages of the handling process of HDs (including stages with and without the risk of exposure). The most described stages were drug preparation (41 guides, 67.2%), staff training and/or patient education (38 guides, 62.3%), and administration (37 guides, 60.7%). No standardized informatics system was found that ensured quality management, traceability and minimization of the risks associated with these drugs. Conclusions Most of the analysed guidelines limit their recommendations to the manipulation of antineoplastics. The most frequently described activities were preparation, training, and administration. It would be convenient to apply ICTs (Information and Communications Technologies) to manage processes involving HDs in a more complete and simpler fashion.
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Affiliation(s)
- Mari A. Bernabeu-Martínez
- Department of Public Health and History of Science, School of Medicine, Miguel Hernandez University, Elche, Spain
| | - Mateo Ramos Merino
- Department of Telematics Engineering, Telecommunication Engineering School of the University of Vigo, Vigo, Spain
| | - Juan M. Santos Gago
- Department of Telematics Engineering, Telecommunication Engineering School of the University of Vigo, Vigo, Spain
| | - Luis M. Álvarez Sabucedo
- Department of Telematics Engineering, Telecommunication Engineering School of the University of Vigo, Vigo, Spain
| | - Carmina Wanden-Berghe
- Health and Biomedical Research Institute of Alicante, University General Hospital of Alicante, Alicante, Spain
| | - Javier Sanz-Valero
- Department of Public Health and History of Science, School of Medicine, Miguel Hernandez University, Elche, Spain
- * E-mail:
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Bertrand A, Favier B, Devaux Y, Goy F, Marcault-Derouard A, Veyet V, Cervos M, Schell M. [Intravenous chemotherapy at home: A pediatric monocentric experience]. Bull Cancer 2018; 105:155-161. [PMID: 29395041 DOI: 10.1016/j.bulcan.2017.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/06/2017] [Accepted: 10/07/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Our home care unit (HCU) developed the administration of IV chemotherapy at home for some pediatric oncologic patients. METHODS We conducted a retrospective monocentric analysis, leading to identify patients with at least one sequence of chemotherapy at home in 2015. RESULTS Two hundred and forty four sequences of home chemotherapy have been administered in 2015. We identified two situations for home IV chemotherapy. Pediatric oncologist of day hospital prescribes the sequence. The chemotherapy is delivered at hospital for the first day. HCU takes over for the next days at home. For a sequence replacing a conventional hospitalization, the attending physician examines the patient, and confirm the clinical validation. The pediatric oncologist of HCU checks lab exams, and prescribes the chemotherapy. For both situations, IV chemotherapy is prepared by our hospital pharmacy, delivers at home or at day hospital, and HCU team manages home material and organizes hospitalization. CONCLUSIONS This kind of organization allows setting up home IV CT for more and more patients. It allows to limit daily hospitalization for some patients living far from the hospital, and whose therapies lead to several hospitalizations.
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Affiliation(s)
- Amandine Bertrand
- Centre Léon-Bérard, hospitalisation à domicile pédiatrique, IHOPe, 1, place du Pr-J.-Renaut, 69373 Lyon cedex 08, France.
| | | | - Yves Devaux
- Centre Léon-Bérard, hospitalisation à domicile adulte, 28, rue Laennec, 69008 Lyon, France
| | - Florence Goy
- Centre Léon-Bérard, hospitalisation à domicile pédiatrique, IHOPe, 1, place du Pr-J.-Renaut, 69373 Lyon cedex 08, France
| | | | - Véronique Veyet
- Centre Léon-Bérard, hospitalisation à domicile pédiatrique, IHOPe, 1, place du Pr-J.-Renaut, 69373 Lyon cedex 08, France
| | - Marie Cervos
- Centre Léon-Bérard, hospitalisation à domicile pédiatrique, IHOPe, 1, place du Pr-J.-Renaut, 69373 Lyon cedex 08, France
| | - Matthias Schell
- Centre Léon-Bérard, hospitalisation à domicile pédiatrique, IHOPe, 1, place du Pr-J.-Renaut, 69373 Lyon cedex 08, France; ESPPéRA, ERRSPP Rhône-Alpes, 1, place du Pr-J.-Renaut, 69373 Lyon cedex 08, France
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Shibata Y, Yokooji T, Itamura R, Sagara Y, Taogoshi T, Ogawa K, Tanaka M, Hide M, Kihira K, Matsuo H. Injury due to extravasation of thiopental and propofol: Risks/effects of local cooling/warming in rats. Biochem Biophys Rep 2017; 8:207-211. [PMID: 28955958 PMCID: PMC5613958 DOI: 10.1016/j.bbrep.2016.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/23/2016] [Accepted: 09/05/2016] [Indexed: 11/25/2022] Open
Abstract
Inadvertent leakage of medications with vesicant properties can cause severe necrosis in tissue, which can have devastating long-term consequences. The aim of this study was to evaluate the extent of extravasation injury induced by thiopental and propofol, and the effects of cooling or warming of local tissue on extravasation injury at macroscopic and histopathologic levels. Rats were administered intradermally thiopental (2.5 mg/100 µL) or propofol (1.0 mg/100 µL). Rats were assigned randomly to three groups: control (no treatment), cooling and warming. Local cooling (18-20 °C) or warming (40-42 °C) was applied for 3 h immediately after agent injection. Lesion sizes (erythema, induration, ulceration, necrosis) were monitored after agent injection. Histopathology was evaluated in skin biopsies taken 24 h after agent injection. Thiopental injection induced severe skin injury with necrosis. Peak lesions developed within 24 h and healed gradually 18-27 days after extravasation. Propofol induced inflammation but no ulceration, and lesions healed within 1-2 days. Local cooling reduced thiopental- and propofol-induced extravasation injuries but warming strongly exacerbated the skin lesions (e.g., degeneration, necrosis) induced by extravasation of thiopental and propofol. Thiopental can be classified as a "vesicant" that causes tissue necrosis and propofol can be classified as an "irritant". Local cooling protects (at least in part) against skin disorders induced by thiopental and propofol, whereas warming is harmful.
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Affiliation(s)
- Yuuka Shibata
- Department of Pharmaceutical Services, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoharu Yokooji
- Department of Pharmaceutical Services, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ryo Itamura
- Faculty of Pharmaceutical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yumeka Sagara
- Faculty of Pharmaceutical Sciences, Hiroshima University, Hiroshima, Japan
| | - Takanori Taogoshi
- Department of Pharmaceutical Services, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Katsunari Ogawa
- Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan
| | - Maiko Tanaka
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Michihiro Hide
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kenji Kihira
- Faculty of Pharmaceutical Sciences, Hiroshima International University, Hiroshima, Japan
| | - Hiroaki Matsuo
- Department of Pharmaceutical Services, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Belderson KM, Billett AL. Chemotherapy safety standards: A pediatric perspective. Pediatr Blood Cancer 2017; 64. [PMID: 28306217 DOI: 10.1002/pbc.26484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/06/2017] [Accepted: 01/10/2017] [Indexed: 11/06/2022]
Affiliation(s)
| | - Amy L Billett
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
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Belderson KM, Billett AL. Chemotherapy Safety Standards: A Pediatric Perspective. J Pediatr Oncol Nurs 2017; 34:156-159. [PMID: 28415960 DOI: 10.1177/1043454217697670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Amy L Billett
- 2 Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
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He B, Mendelsohn-Victor K, McCullagh M, Friese C. Personal Protective Equipment Use and Hazardous Drug Spills Among Ambulatory Oncology Nurses. Oncol Nurs Forum 2017; 44:60-65. [PMID: 28067030 PMCID: PMC5225785 DOI: 10.1188/17.onf.60-65] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose/Objectives To examine patterns and organizational correlates of personal protective equipment (PPE) use and hazardous drug spills. Design Cross-sectional mailed survey. Setting Ambulatory practices in California, Georgia, and Michigan. Sample 252 Oncology Nursing Society members who administer hazardous drugs. Methods Bivariate and multivariable regression analyses. Main Research Variables Outcomes were PPE use and hazardous drug spills. Covariates included nursing workloads, nurses’ practice environments, and barriers to PPE use. Findings Twenty-six percent reported a recent drug spill, and 90% wore only one pair of chemotherapy-tested gloves. Increased PPE use was associated with increased nurse participation in practice affairs, nonprivate ownership, increased nursing workloads, and fewer barriers to PPE use. Spills were associated with significantly less favorable manager leadership and support and higher workloads. Conclusions Drug spills occur often in ambulatory settings. PPE use remains low, and barriers to PPE use persist. Higher workloads are associated with more drug spills. Implications for Practice Managers should monitor and correct aberrant workloads and ensure that PPE is available and that staff are trained.
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Perlman KL, Shelby RA, Wren AA, Kelleher SA, Dorfman CS, O'Connor E, Kim C, Johnson KS, Soo MS. Positive and negative mood following imaging-guided core needle breast biopsy and receipt of biopsy results. PSYCHOL HEALTH MED 2016; 22:1149-1162. [PMID: 28007008 DOI: 10.1080/13548506.2016.1271438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Positive and negative mood are independent psychological responses to stressful events. Negative mood negatively impacts well-being and co-occurring positive mood leads to improved adjustment. Women undergoing core needle breast biopsies (CNB) experience distress during CNB and awaiting results; however, influences of mood are not well known. This longitudinal study examines psychosocial and biopsy- and spirituality-related factors associated with mood in patients day of CNB and one week after receiving results. Ninety women undergoing CNB completed questionnaires on psychosocial factors (chronic stress, social support), biopsy experiences (pain, radiologist communication), and spirituality (peace, meaning, faith) day of CNB. Measures of positive and negative mood were completed day of CNB and one week after receiving results (benign n = 50; abnormal n = 25). Multiple linear regression analyses were conducted. Greater positive mood correlated with greater peace (β = .25, p = .02) day of CNB. Lower negative mood correlated with greater peace (β = -.29, p = .004) and there was a trend for a relationship with less pain during CNB (β = .19, p = .07). For patients with benign results, day of CNB positive mood predicted positive mood post-results (β = .31, p = .03) and only chronic stress predicted negative mood (β = .33, p = .03). For women with abnormal results, greater meaning day of CNB predicted lower negative mood post-results (β = -.45, p = .03). Meaning and peace may be important for women undergoing CNB and receiving abnormal results.
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Affiliation(s)
- Katherine L Perlman
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center (DUMC) , Durham , NC , USA
| | - Rebecca A Shelby
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center (DUMC) , Durham , NC , USA
| | - Anava A Wren
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center (DUMC) , Durham , NC , USA
| | - Sarah A Kelleher
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center (DUMC) , Durham , NC , USA
| | - Caroline S Dorfman
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center (DUMC) , Durham , NC , USA
| | - Erin O'Connor
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center (DUMC) , Durham , NC , USA
| | - Connie Kim
- b Department of Radiology, Breast Imaging Division , DUMC , Durham , NC , USA
| | - Karen S Johnson
- b Department of Radiology, Breast Imaging Division , DUMC , Durham , NC , USA
| | - Mary Scott Soo
- b Department of Radiology, Breast Imaging Division , DUMC , Durham , NC , USA
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Schwappach DLB, Pfeiffer Y, Taxis K. Medication double-checking procedures in clinical practice: a cross-sectional survey of oncology nurses' experiences. BMJ Open 2016; 6:e011394. [PMID: 27297014 PMCID: PMC4916573 DOI: 10.1136/bmjopen-2016-011394] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Double-checking is widely recommended as an essential method to prevent medication errors. However, prior research has shown that the concept of double-checking is not clearly defined, and that little is known about actual practice in oncology, for example, what kind of checking procedures are applied. OBJECTIVE To study the practice of different double-checking procedures in chemotherapy administration and to explore nurses' experiences, for example, how often they actually find errors using a certain procedure. General evaluations regarding double-checking, for example, frequency of interruptions during and caused by a check, or what is regarded as its essential feature was assessed. METHODS In a cross-sectional survey, qualified nurses working in oncology departments of 3 hospitals were asked to rate 5 different scenarios of double-checking procedures regarding dimensions such as frequency of use in practice and appropriateness to prevent medication errors; they were also asked general questions about double-checking. RESULTS Overall, 274 nurses (70% response rate) participated in the survey. The procedure of jointly double-checking (read-read back) was most commonly used (69% of respondents) and rated as very appropriate to prevent medication errors. Jointly checking medication was seen as the essential characteristic of double-checking-more frequently than 'carrying out checks independently' (54% vs 24%). Most nurses (78%) found the frequency of double-checking in their department appropriate. Being interrupted in one's own current activity for supporting a double-check was reported to occur frequently. Regression analysis revealed a strong preference towards checks that are currently implemented at the responders' workplace. CONCLUSIONS Double-checking is well regarded by oncology nurses as a procedure to help prevent errors, with jointly checking being used most frequently. Our results show that the notion of independent checking needs to be transferred more actively into clinical practice. The high frequency of reported interruptions during and caused by double-checks is of concern.
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Affiliation(s)
- D L B Schwappach
- Swiss Patient Safety Foundation, Zuerich, Switzerland Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | | | - Katja Taxis
- Department of Pharmacy, Unit of Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, The Netherlands
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Kreidieh FY, Moukadem HA, El Saghir NS. Overview, prevention and management of chemotherapy extravasation. World J Clin Oncol 2016; 7:87-97. [PMID: 26862492 PMCID: PMC4734939 DOI: 10.5306/wjco.v7.i1.87] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/04/2015] [Accepted: 11/11/2015] [Indexed: 02/06/2023] Open
Abstract
Chemotherapy extravasation remains an accidental complication of chemotherapy administration and may result in serious damage to patients. We review in this article the clinical aspects of chemotherapy extravasation and latest advances in definitions, classification, prevention, management and guidelines. We review the grading of extravasation and tissue damage according to various chemotherapeutic drugs and present an update on treatment and new antidotes including dexrazoxane for anthracyclines extravasation. We highlight the importance of education and training of the oncology team for prevention and prompt pharmacological and non-pharmacological management and stress the availability of new antidotes like dexrazoxane wherever anthracyclines are being infused.
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Zimmer J, Niemann D, Seltmann K, Fischer L, Christiansen H, Frontini R, Kiess W, Neininger MP, Bertsche A, Bertsche T. Managing of oral medicines in paediatric oncology: can a handbook and a pharmaceutical counselling intervention for patients and their parents prevent knowledge deficits? A pilot study. Eur J Hosp Pharm 2015; 23:100-105. [PMID: 31156825 DOI: 10.1136/ejhpharm-2015-000716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/25/2015] [Accepted: 09/07/2015] [Indexed: 11/04/2022] Open
Abstract
Objectives To assess knowledge deficits of patients/parents and prevention strategies. Methods After receiving ethics approval, we performed a controlled, quasi-randomised, prospective intervention study. We enrolled patients/parents involved in managing oral medicines in three groups: control (routine care only), handbook intervention and pharmaceutical counselling intervention group. At baseline and after the interventions, we assessed patients'/parents' knowledge deficits (incorrect or missing answers) by questionnaire. Results We enrolled 64 patients/parents. At baseline, knowledge deficits among the groups were similar: 17% in controls, 22% in the handbook group and 24% in the pharmaceutical counselling group. After the intervention, knowledge deficits decreased to 13% in the handbook group and to 8% in the pharmaceutical counselling group (NS; p=0.003 compared with controls, respectively). For controls, knowledge deficits remained almost unchanged (19%). Results for the pharmaceutical counselling group showed a strong correlation between baseline knowledge deficits and the extent of the deficit decrease after the intervention (τ=-0.74; p<0.001), whereas no significant correlation was found in the control or handbook group. Conclusions In paediatric oncology, patients'/parents' knowledge of managing oral medicines was improved. Pharmaceutical counselling substantially reduced high knowledge deficits but no significant improvement was seen with the handbook approach. Pharmaceutical counselling should be offered to patients/parents with high knowledge deficits to reduce errors in managing medicines and increase safety.
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Affiliation(s)
- Janine Zimmer
- Department of Clinical Pharmacy and Drug Safety Center, University of Leipzig, Leipzig, Germany.,Pharmacy Department and Drug Safety Center, University Hospital Leipzig, Leipzig, Germany
| | - Dorothee Niemann
- Department of Clinical Pharmacy and Drug Safety Center, University of Leipzig, Leipzig, Germany
| | - Kirsten Seltmann
- Department of Clinical Pharmacy and Drug Safety Center, University of Leipzig, Leipzig, Germany
| | - Lars Fischer
- Department of Women and Child Health, Hospital for Children and Adolescents and Centre for Paediatric Research, University of Leipzig, Leipzig, Germany.,Department of Paediatric Oncology, Haematology and Haemostaseology, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Holger Christiansen
- Department of Women and Child Health, Hospital for Children and Adolescents and Centre for Paediatric Research, University of Leipzig, Leipzig, Germany.,Department of Paediatric Oncology, Haematology and Haemostaseology, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Roberto Frontini
- Pharmacy Department and Drug Safety Center, University Hospital Leipzig, Leipzig, Germany
| | - Wieland Kiess
- Department of Women and Child Health, Hospital for Children and Adolescents and Centre for Paediatric Research, University of Leipzig, Leipzig, Germany
| | - Martina P Neininger
- Department of Clinical Pharmacy and Drug Safety Center, University of Leipzig, Leipzig, Germany
| | - Astrid Bertsche
- Department of Women and Child Health, Hospital for Children and Adolescents and Centre for Paediatric Research, University of Leipzig, Leipzig, Germany
| | - Thilo Bertsche
- Department of Clinical Pharmacy and Drug Safety Center, University of Leipzig, Leipzig, Germany
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Tipton J. Overview of the Challenges Related to Oral Agents for Cancer and Their Impact on Adherence. Clin J Oncol Nurs 2015; 19:37-40. [DOI: 10.1188/15.s1.cjon.37-40] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Arthurs G, Simpson J, Brown A, Kyaw O, Shyrier S, Concert CM. The effectiveness of therapeutic patient education on adherence to oral anti-cancer medicines in adult cancer patients in ambulatory care settings: a systematic review. ACTA ACUST UNITED AC 2015. [DOI: 10.11124/01938924-201513050-00014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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20
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Blayney DW, McNiff K, Eisenberg PD, Gilmore T, Jacobsen PB, Jacobson JO, Kadlubek PJ, Neuss MN, Simone J. Development and Future of the American Society of Clinical Oncology's Quality Oncology Practice Initiative. J Clin Oncol 2014; 32:3907-13. [DOI: 10.1200/jco.2014.56.8899] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Douglas W. Blayney
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA
| | | | | | - Terry Gilmore
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | | | - Michael N. Neuss
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
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VanHoose L, Black LL, Doty K, Sabata D, Twumasi-Ankrah P, Taylor S, Johnson R. An analysis of the distress thermometer problem list and distress in patients with cancer. Support Care Cancer 2014; 23:1225-32. [DOI: 10.1007/s00520-014-2471-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 10/01/2014] [Indexed: 11/28/2022]
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Abstract
OBJECTIVES The use of oral chemotherapy has increased substantially. This adds a level of complexity beyond that of traditional intravenous chemotherapy. This article discusses challenges and strategies to meet patient needs. DATA SOURCES Research and peer-reviewed journal articles. CONCLUSION Adherence is a challenge for oral chemotherapy. A systematic approach serves as the best way to facilitate a comprehensive oral chemotherapy plan. IMPLICATIONS FOR NURSING PRACTICE Nurses' knowledge is required to support and monitor patient adherence. Nurses must master effective utilization of resources to monitor and positively impact successful patient outcomes.
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Adelson KB, Qiu YC, Evangelista M, Spencer-Cisek P, Whipple C, Holcombe RF. Implementation of Electronic Chemotherapy Ordering: An Opportunity to Improve Evidence-Based Oncology Care. J Oncol Pract 2014; 10:e113-9. [DOI: 10.1200/jop.2013.001184] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The authors anticipate that the Epic Beacon platform will allow them to capture data on chemotherapy regimen use for each disease by stage, individual regimen toxicity, and patients' clinical outcome.
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Affiliation(s)
- Kerin B. Adelson
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Icahn School of Medicine at Mount Sinai; Epic Transformation Group, Mount Sinai Hospital, New York, NY
| | - Ying Chun Qiu
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Icahn School of Medicine at Mount Sinai; Epic Transformation Group, Mount Sinai Hospital, New York, NY
| | - Michelle Evangelista
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Icahn School of Medicine at Mount Sinai; Epic Transformation Group, Mount Sinai Hospital, New York, NY
| | - Patricia Spencer-Cisek
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Icahn School of Medicine at Mount Sinai; Epic Transformation Group, Mount Sinai Hospital, New York, NY
| | - Clare Whipple
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Icahn School of Medicine at Mount Sinai; Epic Transformation Group, Mount Sinai Hospital, New York, NY
| | - Randall F. Holcombe
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Icahn School of Medicine at Mount Sinai; Epic Transformation Group, Mount Sinai Hospital, New York, NY
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Ayers P, Adams S, Boullata J, Gervasio J, Holcombe B, Kraft MD, Marshall N, Neal A, Sacks G, Seres DS, Worthington P, Malone A, Teitelbaum D, Andris DA, Ayers P, Baroccas A, Compher C, Ireton-Jones C, Jaksic T, Robinson LA, Van Way CW, Ayers P, Adams S, Boullata J, Gervasio J, Holcombe B, Kraft M, Neal T, Sacks G, Seres DS, Taylor B, Worthington PA. A.S.P.E.N. Parenteral Nutrition Safety Consensus Recommendations. JPEN J Parenter Enteral Nutr 2013; 38:296-333. [DOI: 10.1177/0148607113511992] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Phil Ayers
- Baptist Health Systems, Department of Pharmacy, Jackson, Mississippi
| | - Stephen Adams
- Vitaline Infusion Pharmacy Services, Geisinger Medical Center, Danville, Pennsylvania
| | | | - Jane Gervasio
- Butler University College of Pharmacy and Health Science, Indianapolis, Indiana
| | - Beverly Holcombe
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland
| | - Michael D. Kraft
- University of Michigan Health System, Department of Pharmacy Services, Ann Arbor
| | | | - Antoinette Neal
- Infusion Pharmacy, Cleveland Clinic at Home, Independence, Ohio
| | - Gordon Sacks
- Department of Pharmacy Practice, Harrison School of Pharmacy, Auburn University, Auburn, Alabama
| | - David S. Seres
- Division of Preventive Medicine and Nutrition, New York Presbyterian Hospital–Columbia University Medical Center, New York
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Lester J. Safe Handling and Administration Considerations of Oral Anticancer Agents in the Clinical and Home Setting. Clin J Oncol Nurs 2012. [DOI: 10.1188/12.cjon.e192-e197] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Seger AC, Churchill WW, Keohane CA, Belisle CD, Wong ST, Sylvester KW, Chesnick MA, Burdick E, Wien MF, Cotugno MC, Bates DW, Rothschild JM. Impact of robotic antineoplastic preparation on safety, workflow, and costs. J Oncol Pract 2012; 8:344-9, 1 p following 349. [PMID: 23598843 DOI: 10.1200/jop.2012.000600] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2012] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Antineoplastic preparation presents unique safety concerns and consumes significant pharmacy staff time and costs. Robotic antineoplastic and adjuvant medication compounding may provide incremental safety and efficiency advantages compared with standard pharmacy practices. METHODS We conducted a direct observation trial in an academic medical center pharmacy to compare the effects of usual/manual antineoplastic and adjuvant drug preparation (baseline period) with robotic preparation (intervention period). The primary outcomes were serious medication errors and staff safety events with the potential for harm of patients and staff, respectively. Secondary outcomes included medication accuracy determined by gravimetric techniques, medication preparation time, and the costs of both ancillary materials used during drug preparation and personnel time. RESULTS Among 1,421 and 972 observed medication preparations, we found nine (0.7%) and seven (0.7%) serious medication errors (P = .8) and 73 (5.1%) and 28 (2.9%) staff safety events (P = .007) in the baseline and intervention periods, respectively. Drugs failed accuracy measurements in 12.5% (23 of 184) and 0.9% (one of 110) of preparations in the baseline and intervention periods, respectively (P < .001). Mean drug preparation time increased by 47% when using the robot (P = .009). Labor costs were similar in both study periods, although the ancillary material costs decreased by 56% in the intervention period (P < .001). CONCLUSION Although robotically prepared antineoplastic and adjuvant medications did not reduce serious medication errors, both staff safety and accuracy of medication preparation were improved significantly. Future studies are necessary to address the overall cost effectiveness of these robotic implementations.
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Affiliation(s)
- Andrew C Seger
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont St, Boston, MA 02120-1613, USA
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Jacobson JO, Polovich M, Gilmore TR, Schulmeister L, Esper P, Lefebvre KB, Neuss MN. Revisions to the 2009 American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards: expanding the scope to include inpatient settings. Oncol Nurs Forum 2012; 39:31-8. [PMID: 22201653 DOI: 10.1188/12.onf.31-38] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In November 2009, the American Society of Clinical Oncology (ASCO) and the Oncology Nursing Society (ONS) jointly published a set of 31 voluntary chemotherapy safety standards for adult patients with cancer, as the end result of a highly structured, multistakeholder process. The standards were explicitly created to address patient safety in the administration of parenteral and oral chemotherapeutic agents in outpatient oncology settings. In January 2011, a workgroup consisting of ASCO and ONS members was convened to review feedback received since publication of the standards, to address interim changes in practice, and to modify the standards as needed. The most significant change to the standards is to extend their scope to the inpatient setting. This change reflects the conviction that the same standards for chemotherapy administration safety should apply in all settings. The proposed set of standards has been approved by the Board of Directors for both ASCO and ONS and has been posted for public comment. Comments were used as the basis for final editing of the revised standards. The workgroup recognizes that the safety of oral chemotherapy usage, nononcology medication reconciliation, and home chemotherapy administration are not adequately addressed in the original or revised standards. A separate process, cosponsored by ASCO and ONS, will address the development of safety standards for these areas.
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28
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Jacobson JO, Polovich M, Gilmore TR, Schulmeister L, Esper P, LeFebvre KB, Neuss MN. Revisions to the 2009 american society of clinical oncology/oncology nursing society chemotherapy administration safety standards: expanding the scope to include inpatient settings. J Oncol Pract 2012; 8:2-6. [PMID: 22548003 PMCID: PMC3266311 DOI: 10.1200/jop.2011.000339] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2011] [Indexed: 11/20/2022] Open
Abstract
In November 2009, ASCO and the Oncology Nursing Society (ONS) jointly published a set of 31 voluntary chemotherapy safety standards for adult patients with cancer, as the end result of a highly structured, multistakeholder process. The standards were explicitly created to address patient safety in the administration of parenteral and oral chemotherapeutic agents in outpatient oncology settings. In January 2011, a workgroup consisting of ASCO and ONS members was convened to review feedback received since publication of the standards, to address interim changes in practice, and to modify the standards as needed. The most significant change to the standards is to extend their scope to the inpatient setting. This change reflects the conviction that the same standards for chemotherapy administration safety should apply in all settings. The proposed set of standards has been approved by the Board of Directors for both ASCO and ONS and has been posted for public comment. Comments were used as the basis for final editing of the revised standards. The workgroup recognizes that the safety of oral chemotherapy usage, nononcology medication reconciliation, and home chemotherapy administration are not adequately addressed in the original or revised standards. A separate process, cosponsored by ASCO and ONS, will address the development of safety standards for these areas.
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Affiliation(s)
- Joseph O. Jacobson
- Dana Farber Cancer Institute, Boston MA; Duke Oncology Network, Durham, NC; American Society of Clinical Oncology, Alexandria, VA; Oncology Nursing Consultant, New Orleans, LA; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Oncology Nursing Society, Pittsburgh, PA; and Oncology Hematology Care, Cincinnati, OH
| | - Martha Polovich
- Dana Farber Cancer Institute, Boston MA; Duke Oncology Network, Durham, NC; American Society of Clinical Oncology, Alexandria, VA; Oncology Nursing Consultant, New Orleans, LA; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Oncology Nursing Society, Pittsburgh, PA; and Oncology Hematology Care, Cincinnati, OH
| | - Terry R. Gilmore
- Dana Farber Cancer Institute, Boston MA; Duke Oncology Network, Durham, NC; American Society of Clinical Oncology, Alexandria, VA; Oncology Nursing Consultant, New Orleans, LA; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Oncology Nursing Society, Pittsburgh, PA; and Oncology Hematology Care, Cincinnati, OH
| | - Lisa Schulmeister
- Dana Farber Cancer Institute, Boston MA; Duke Oncology Network, Durham, NC; American Society of Clinical Oncology, Alexandria, VA; Oncology Nursing Consultant, New Orleans, LA; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Oncology Nursing Society, Pittsburgh, PA; and Oncology Hematology Care, Cincinnati, OH
| | - Peg Esper
- Dana Farber Cancer Institute, Boston MA; Duke Oncology Network, Durham, NC; American Society of Clinical Oncology, Alexandria, VA; Oncology Nursing Consultant, New Orleans, LA; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Oncology Nursing Society, Pittsburgh, PA; and Oncology Hematology Care, Cincinnati, OH
| | - Kristine B. LeFebvre
- Dana Farber Cancer Institute, Boston MA; Duke Oncology Network, Durham, NC; American Society of Clinical Oncology, Alexandria, VA; Oncology Nursing Consultant, New Orleans, LA; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Oncology Nursing Society, Pittsburgh, PA; and Oncology Hematology Care, Cincinnati, OH
| | - Michael N. Neuss
- Dana Farber Cancer Institute, Boston MA; Duke Oncology Network, Durham, NC; American Society of Clinical Oncology, Alexandria, VA; Oncology Nursing Consultant, New Orleans, LA; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Oncology Nursing Society, Pittsburgh, PA; and Oncology Hematology Care, Cincinnati, OH
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Gaguski ME, Karcheski T. Dosing done right: a review of common chemotherapy calculations. Clin J Oncol Nurs 2011; 15:471-3. [PMID: 21951734 DOI: 10.1188/11.cjon.471-473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The potential for medication error is great with chemotherapy agents because of their high toxicity profile, small therapeutic index, and numerous dose-limiting adverse effects. The oncology team involved with chemotherapy treatment planning and administration assumes an active role in preventing such events by obtaining and maintaining competency in dose calculations, having knowledge of dose-limiting toxicities, appropriate ordering of drug regimens, and participation in safety verification processes. This article will provide a review of evidence-based formulas and their rationale for use in dosing chemotherapy, case scenarios with practice calculations, and recommendations for safe verification of chemotherapy drug order accuracy.
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Chemotherapy in home care: one team's performance improvement journey toward reducing medication errors. ACTA ACUST UNITED AC 2011; 30:28-37. [PMID: 21921798 DOI: 10.1097/nhh.0b013e318233a75e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A home care patient received an unintended dose of 5-fluorouracil. This article details the agency's journey from error to the creation of a multidisciplinary collaboration to the implementation of statewide practice changes in an effort to improve patient safety.
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Lewis MA, Hendrickson AW, Moynihan TJ. Oncologic emergencies: Pathophysiology, presentation, diagnosis, and treatment. CA Cancer J Clin 2011; 61:287-314. [PMID: 21858793 DOI: 10.3322/caac.20124] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Oncologic emergencies can occur at any time during the course of a malignancy, from the presenting symptom to end-stage disease. Although some of these conditions are related to cancer therapy, they are by no means confined to the period of initial diagnosis and active treatment. In the setting of recurrent malignancy, these events can occur years after the surveillance of a cancer patient has been appropriately transferred from a medical oncologist to a primary care provider. As such, awareness of a patient's cancer history and its possible complications forms an important part of any clinician's knowledge base. Prompt identification of and intervention in these emergencies can prolong survival and improve quality of life, even in the setting of terminal illness. This article reviews hypercalcemia, hyponatremia, hypoglycemia, tumor lysis syndrome, cardiac tamponade, superior vena cava syndrome, neutropenic fever, spinal cord compression, increased intracranial pressure, seizures, hyperviscosity syndrome, leukostasis, and airway obstruction in patients with malignancies. Chemotherapeutic emergencies are also addressed.
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Affiliation(s)
- Mark A Lewis
- Senior Hematology and Oncology Fellow, Division of Hematology, Department of Oncology, Mayo Clinic College of Medicine, Rochester, MN
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Boyd D, Merkh K, Rutledge DN, Randall V. Nurses' perceptions and experiences with end-of-life communication and care. Oncol Nurs Forum 2011; 38:E229-39. [PMID: 21531673 DOI: 10.1188/11.onf.e229-e239] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To characterize oncology nurses' attitudes toward care at the end of life (EOL) and their experiences in caring for terminally ill patients, hospice discussions with patients and families, and the use of palliative care practices. DESIGN Descriptive correlational survey study. SETTING A Magnet®-designated hospital in southern California with more than 500 beds. SAMPLE 31 oncology nurses. METHODS Nurses completed the adapted version of the Caring for Terminally Ill Patients Nurse Survey. MAIN RESEARCH VARIABLES Attitudes toward care at EOL and care experiences with terminally ill patients. FINDINGS Despite having fairly positive attitudes toward hospice and having discussions about prognosis with terminally ill patients, nurses reported missed opportunities for discussions and patient referrals to hospice. On average, nurses cared for more than seven terminally ill patients during a three-month period while only discussing hospice care with a third of these patients and their family members. Most nurses acknowledged that patients would benefit from earlier initiation of hospice care. Specific palliative care practices used by nurses in the past three months varied, with active and passive listening and requesting increased pain medications used most frequently and aromatherapy and guided imagery used least. CONCLUSIONS Missed opportunities may reflect nurses' attitudes. However, lack of patient and family member acceptance was the most important barrier to discussion of hospice. IMPLICATIONS FOR NURSING Strategies to enable nurses to have a stronger voice during this critical time for their patients are needed and, when developed, supported in practice to ensure that they are used.
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Given BA, Spoelstra SL, Grant M. The challenges of oral agents as antineoplastic treatments. Semin Oncol Nurs 2011; 27:93-103. [PMID: 21514479 DOI: 10.1016/j.soncn.2011.02.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Given the increasing use of oral antineoplastic agents in cancer management, patient adherence is critical to successful treatment outcomes. This article reviews the scope of the problem and issues of adherence to oral antineoplastic agents. DATA SOURCES Research-based and other articles, newsletters, and conference presentations. CONCLUSION Suboptimal adherence to oral antineoplastic agents is a significant clinical problem that may result in disease or treatment complications, adjustment in treatment regimen, disease progression, and premature death. IMPLICATIONS FOR NURSING PRACTICE Healthcare providers need to monitor and facilitate adherence by identifying barriers and implementing strategies to assure adherence, and therefore, improve clinical outcomes.
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Affiliation(s)
- Barbara A Given
- Michigan State University, College of Nursing, East Lansing, MI 48824, USA.
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Abstract
OBJECTIVE To present a clinical update on the prevention, detection, and evidence-based management of vesicant chemotherapy extravasations. DATA SOURCES Journal articles, published and unpublished case reports, personal experience. CONCLUSION In the 4 years that have elapsed since the publication of the original article, much more is known about vesicant chemotherapy extravasation, and effective evidence-based treatments now are available. The antidotes sodium thiosulfate for mechlorethamine extravasations and hyaluronidase for plant alkaloid extravasations are recommended by the manufacturers of these vesicants and cited in nursing guidelines. The anthracycline extravasation treatment dexrazoxane for injection, the first and only extravasation treatment with proven effectiveness, is now available as Totect (dexrazoxane; TopoTarget USA, Rockaway, NJ, USA) in the US and Savene (SpePharm, Amsterdam, The Netherlands) in Europe. IMPLICATIONS FOR NURSING PRACTICE Nurses who administer vesicant chemotherapy agents need to be aware of the most current evidence (or lack of evidence) for various types of extravasation treatment. Well-informed nurses are patient advocates and instrumental in detecting, managing, and documenting extravasations. Most importantly, nurses play a key role in preventing vesicant chemotherapy extravasations.
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Hassett MJ, Rao SR, Brozovic S, Stahl JE, Schwartz JH, Maloney B, Jacobson JO. Chemotherapy-related hospitalization among community cancer center patients. Oncologist 2011; 16:378-87. [PMID: 21349949 DOI: 10.1634/theoncologist.2010-0354] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To describe the frequency, nature, trends, predictors, and outcomes of chemotherapy-related hospitalizations (CRHs) among a nonselected population of cancer patients treated at a community cancer center, and to explore the feasibility of implementing continuous quality improvement methodologies in routine oncology practice. METHODS We conducted a prospective cohort study of consecutive adult cancer patients who received chemotherapy at a community cancer center January 2003 to December 2006. Demographic, comorbidity, diagnosis, treatment, and laboratory data were collected via medical record abstraction. Hospitalizations were classified as chemotherapy related or unrelated by a multidisciplinary panel. Patients who experienced CRHs were compared with those who did not. Using a randomly sampled subset of cases and controls, we built a logistic regression model to identify independent predictors of CRH. RESULTS Of 2,068 chemotherapy recipients, 179 (8.7%) experienced 262 CRHs. Most hospitalizations were not chemotherapy related (73.7%). The mean monthly rate of CRH was 1.5%, the median length of stay was 5 days, the most common type of CRH was gastrointestinal (46.1%) followed by infectious (31.4%), and 0.9% of chemotherapy recipients had a fatal CRH. Significant predictors of CRH included having a comorbidity score of 3-4 versus 0 and having a higher creatinine level. CONCLUSIONS Although the vast majority of chemotherapy recipients did not experience a CRH, these events were, unfortunately, not without serious consequences. Care should be taken when offering chemotherapy to patients with multiple comorbid conditions. Systematic efforts to monitor toxicity can lead directly to improvements in quality of care.
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Affiliation(s)
- Michael J Hassett
- Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, MA 02215, USA.
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