Revisions to the 2009 American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards: expanding the scope to include inpatient settings

Interventions to Promote Safety Culture in Cancer Care: A Systematic Review

OBJECTIVES

There is limited guidance on how to effectively promote safety culture in health care settings. We performed a systematic review to identify interventions to promote safety culture, specifically in oncology settings.

METHODS

Medical Subject Headings and text words for "safety culture" and "cancer care" were combined to conduct structured searches of MEDLINE, EMBASE, CDSR, CINAHL, Cochrane CENTRAL, PsycINFO, Scopus, and Web of Science for peer-reviewed articles published from 1999 to 2021. To be included, articles had to evaluate a safety culture intervention in an oncology setting using a randomized or nonrandomized, pre-post (controlled or uncontrolled), interrupted time series, or repeated-measures study design. The review followed PRISMA guidelines; quality of included citations was assessed using the ROBINS-I risk of bias tool.

RESULTS

Eighteen articles meeting the inclusion criteria were retained, reporting on interventions in radiation (14 of 18), medical (3 of 18), or general oncology (1 of 18) settings. Articles most commonly addressed incident learning systems (7 of 18), lean initiatives (4 of 18), or quality improvement programs (3 of 18). Although 72% of studies reported improvement in safety culture, there was substantial heterogeneity in the evaluation approach; rates of reporting of adverse events (9 of 18) or Agency for Healthcare Research and Quality Safety Culture survey results (9 of 18) were the most commonly used metrics. Most of the studies had moderate (28%) or severe (67%) risk of bias.

CONCLUSIONS

Despite a growing evidence base describing interventions to promote safety culture in cancer care, definitive recommendations were difficult to make because of heterogeneity in study designs and outcomes. Implementation of incident learning systems seems to hold most promise.

Evaluation to the chemotherapy use in patients with diffuse large B-cell lymphoma

Background Non-Hodgkin lymphoma (NHL) is a large group of primary malignancies of solid lymphoid tissue. Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of NHL. DLBCL has an aggressive natural history but responds well to chemotherapy. The objective of this study was to review the use of chemotherapy, identify its side effects, and examine the response to chemotherapy in patients with NHL at Dr. Soetomo General Hospital. Methods This study was a retrospective observational study using secondary data obtained from patients' medical records from 2016 to 2018. Demographic data (age, sex), clinical characteristics, chemotherapy regimens, side effects of chemotherapy, and response to chemotherapy were recorded. Results Results revealed that of the 43 patients (age ranged from 21 to 80 years) who were included in this study, the prevalence of DLBCL was higher in male patients (74%) and about 44% patients were at stage III. R-CHOP (rituximab-cyclophosphamide, doxorubicin, vincristine/oncovin, prednisone) (53%) was the most used chemotherapy regimen in this study. A total of 65% of patients showed good responses and 35% showed no response to the therapy. The most common side effect was myelosuppression, including 25% and 8% of the patients having anemia and leukopenia, respectively. Conclusions R-CHOP is the most used regimen. Most of patients with NHL have a complete response and the predominant side effect is anemia.

PATIENT SAFETY IN THE ADMINISTRATION OF ANTINEOPLASTIC CHEMOTHERAPY AND OF IMMUNOTHERAPICS FOR ONCOLOGICAL TREATMENT: SCOPING REVIEW

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.

The provision of ambulatory systemic anti-cancer therapy

This article reflects on the changing nature of the provision of care and delivery of ambulatory systemic anti-cancer therapy (SACT) services. It reviews the national guidance and looks at ambulatory SACT in terms of patients being treated closer to home, i.e. ambulatory care in its truest sense. It considers the impact on quality of life for patients receiving treatments at a place of their choice. It explores the role of the nurse as an advanced practitioner while also examining the safety and delivery of complex regimens ensuring robust pathways are in place to deliver care in a safe and standardised way.

Oral agents for cancer: safety challenges and recommendations

BACKGROUND

The lack of knowledge and standardization of safety practices related to prescribing, dispensing, administering, and monitoring oral agents for cancer (OACs) has created significant safety challenges for patients and healthcare providers. Problems identified with the use of OACs include possible medication errors, increased potential for toxicity, unintentional exposure of hazardous medications to healthcare providers and informal caregivers, and possible pollution of the environment.

OBJECTIVES

The purpose of this review is to provide information about the current state of knowledge and recommendations in the literature regarding safety concerns with OACs and strategies for risk reduction.

METHODS

Articles published from 2003-2014 were retrieved using PubMed, CINAHL®, and the Cochrane Library.

FINDINGS

As the number of OACs continues to increase, existing standards related to medication errors and safety will require ongoing revision to lessen the risks and hazards for patients, caregivers, and healthcare providers.

Importância das organizações civis de enfermagem: revisão integrativa da literatura

RESUMO Objetivo: identificar e analisar as evidências trazidas por estudos sobre a importância das organizações civis de enfermagem. Método: trata-se de uma revisão integrativa da literatura em que foram realizadas buscas nos bancos de dados LILACS, PubMed/MEDLINE, SciELO, BDENF e Scopus. Resultados: foram selecionados 16 artigos publicados entre os anos de 2004 a 2013, sendo que 68,75% dos trabalhos são originados do Brasil e 31,25% são publicações estadunidenses. Conclusão: as entidades da Enfermagem são importantes e necessárias, pois têm colaborado decisivamente nas lutas da categoria em favor da classe e da sociedade em geral, e essas contribuições incidem sobre os vários eixos de atuação profissional.

Learning from disaster: patient safety and the role of oncology nurses

When the Oncology Nursing Society (ONS) was almost exactly half its present age, in November 1994, a Boston Globe health columnist named Betsy Lehman was admitted to the Dana-Farber Cancer Institute in Boston, Massachusetts, to receive an investigational regimen for breast cancer. Her treatment ended in disaster. In one of the most notorious patient safety failures of modern times, Lehman was given severe overdoses of cyclophosphamide during a four-day period. On each of those four days, nurses, physicians, and pharmacists at Dana-Farber failed to notice that Lehman was receiving doses four times greater than the intended amount (Aspden, Wolcott, Bootman, & Cronenwett, 2007). Lehman died of cyclophosphamide toxicity on December 3, 1994.
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Current nursing practice for patients on oral chemotherapy: a multicenter survey in Japan

BACKGROUND

With a paradigm shift toward a chronic care model in cancer, the issue of adherence is becoming increasingly important in oncology.

METHODS

We mailed two self-reported surveys on current nursing practices for patients on oral chemotherapy to all 309 designated cancer centers and 141 large general hospitals in Japan. The first survey was based on a nurse-based questionnaire containing 40 items concerning nurse's characteristics, nurse staffing at workplace, general nursing care for new patients on oral chemotherapy and those with refilled prescriptions, follow-up, and system-based approach. The second survey was based on a patient-based questionnaire containing 10 items about patient characteristics and adherence-related nursing practice for 249 patients taking oral chemotherapy of 903 systematically sampled. We used multivariate logistic regression to identify factors that were associated with adherence-related nursing practices.

RESULTS

A total of 62 nurses (mean age: 41.5 years) from 62 hospitals who consented participated in the both nurse-based survey and patient-based survey about 249 patients. The results of nurse-based survey indicated that practices varied, but nurses were less likely to ask adherence-related questions of patients with refilled prescriptions than of new patients. The results of patient-based survey found that questions on side effects, discussions about barriers to achieving balance between treatment and daily life activities, and medication management were all significantly related to the question about unused medicines. Logistic regression revealed that adherence-related nursing practices were associated with the nurse's background, type of treatment, and healthcare system-related factors. Patient orientation on oral chemotherapy, interdisciplinary learning, and having a system-based approach for detecting prescription errors were identified as healthcare system-related factors.

CONCLUSIONS

A more systematic approach must be developed to ensure patients receive safe and effective oral chemotherapy, while nurses should play significant roles in patient education and monitoring.

Oral chemotherapy handling and storage practices among Veterans Affairs oncology patients and caregivers

Purpose

This questionnaire-based study was designed to identify the oral chemotherapy medication handling, storage, and disposal practices among cancer patients and their caregivers.

Methods

This was a single-center observational survey study approved by the Investigational Review Board and VA Research & Development Committee. Patients were eligible for inclusion if they had an active order for an oral antineoplastic medication and an appointment at the oncology clinic. A questionnaire related to the storage, handling, disposal, patient education and counseling, and patients’ perception of safety of oral antineoplastic medications was developed and given to patients in the clinic. Survey responses were analyzed using descriptive statistics.

Results

A total of 45 surveys were given to eligible patients in the oncology clinic and 42 surveys were returned to the study team. The majority, 40 participants (95%) were male. Participants ranged in age from 51 to 85 years (median, 65 years). Thirty-eight patients (90.5%) responded that the medication was stored away from extreme heat, cold, and humidity. Thirty-two patients (76%) reported keeping their medications in the original container. Hand washing was not a consistent practice among patients. Eleven patients (26%) reported always washing their hands after handling their anticancer medication; another 6 (14%) responded “sometimes”. Of the 42 participants who answered, only 6 patients (14%) reported always or sometimes wearing gloves.

Conclusion

The majority of patients responding to this survey store their oral anticancer medications appropriately, but patients’ and caregivers’ handling and disposal practices are inconsistent and frequently do not follow the published recommendations.

The noninvestigational use of tyrosine kinase inhibitors in thyroid cancer: establishing a standard for patient safety and monitoring

CONTEXT

The increasing use of tyrosine kinase inhibitor therapy outside of the context of the clinical trial for treatment of advanced thyroid cancer has highlighted the need for a systematic approach to the clinical application of these agents in order to improve patient safety and monitoring promote consistency among providers, and ensure compliance with both institutional and industry standards.

EVIDENCE

We reviewed professional thyroid cancer guidelines, the National Comprehensive Cancer Network task force reports, American Society of Clinical Oncology safety standards, review articles, and clinical trials published within the past 10 yr and also included relevant older studies.

CONCLUSIONS

Review of available published data and the collective experience prescribing tyrosine kinase inhibitors at The University of Texas MD Anderson Cancer Center have highlighted the need for a systematic, comprehensive, and uniform approach to managing these patients. This paper discusses the approach adopted by the Department of Endocrine Neoplasia at the MD Anderson Cancer Center and illustrates practice patterns, experience, and our standardized approach related to prescribing commercially available tyrosine kinase inhibitors outside of the context of a clinical trial for patients with advanced thyroid cancer.