Administration of Chemotherapeutic Agents Contributed by The Outer Banks Hospital Nags Head, NC Leading Practices Library Organizations submit practices to The Joint Commission that they have found to be leading practices, with permission to share them with other organizations. The Joint Commission makes these leading practices available to organizations that may wish to examine their applicability to their particular circumstances. Please understand that The Joint Commission can make no representations as to the results that any organization can expect from their use or adaptation of a leading practice to their particular circumstances. 4/16/2010 1
SUBJECT: Administration of Chemotherapeutic agents NUMBER: A-91 ORIG: 12/08 REVIEWED: 06/09 REVISED: 06/09 RESPONSIBLE PARTY: PREPARED BY: APPROVED BY: PURPOSE To safely administer chemotherapeutic agents and dispose of the articles used for chemotherapy. POLICY Chemotherapeutic drugs may be administered by registered nurses who have been competency checked in the Administration of Chemotherapy. Preparation and Teaching: Explain the procedure to the patient. Assemble equipment: IV Pump IV Start Kit or Central line Kit for ports Huber Needle or Small gauge IV needle Secondary set Primary tubing 250cc Normal saline Preinfusion: 1. Drug order written by MD. Chemo Tag initiated. 2. Order reviewed and calculated by RN and signed. Verifies height, weight, and allergies. 3. Order and Chemo Tag sent to pharmacy. Copy of order made and placed in Chemotherapy administration book. Original filed in chart. 4. Pharmacist verifies order. 5. Pharmacist enters order into order entry system. 6. Pharmacist verifies Pharmacy Dispensing Record with original handwritten order. 7. Pharmacist prepares the order. 8. Drug delivered to oncology. 1 2
9. Nurse verifies with the pharmacist against original order; Implementation: 1. Review drug information, as needed. 2. Confirms patient s identity using 2 identifiers. Name and date of birth ( medical record number and Acct number are to be placed in appropriate space on Chemo Tag). Patient will have name band applied per Hospital ID policy. 3. Access IV site. Avoid use of the antecubital area. 4. Assure that IV is patent by infusing with NS or appropriate solution. Use an IV pump for continuous infusion. NOTE: Continuous infusions of vesicants are administered through central venous lines. 5. Give pre-medication (usually an antiemetic), if ordered. 6. Two Nurses verify Pt name, DOB, MR#, ACCT #, Medication and dose. 7. Apply PPE. 8. Connect primed secondary container and line to primary tubing. a. Patient to report immediately any change in sensation particularly pain, burning or stinging. 9. Administer medication according to physician s orders, observing for signs of infiltration, local redness or swelling. 10. Dispose of bottles, gloves, tubing, needles and any other items used for chemotherapy in appropriate chemo waste container. 11. Wear gloves while handling chemotherapy items and patient s linen. Linen contaminated with urine, feces, blood or vomitus must be handled with particular care, because chemotherapeutic agents are excreted in body secretions. (See additional information for treatment of contamination and spills). 12. Give post-medication(s), usually antiemetics and diuretics, if ordered by physician/np. 2 3
Documentation: 1. Record chemotherapeutic agent, dosage, route of administration and type and the amount of IV fluid in EMR for patient. 2. Complete appropriate information throughout form and document in computer. 3. Complete LDA Docflow sheet in EMR. 4. Make all documentation entries in medical record according to policies and procedures. Additional Information: 1. Use extreme caution to protect yourself and others from contact with chemotherapeutic agents. If contamination does occur, treat as follows: a. Immediately remove the gloves, mask, and/or gown. b. Wash the affected skin area immediately with soap (not germicidal cleaner) and water. For eye exposure, immediately flush the eye for five minutes with water or isotonic eyewash designated for that purpose. c. Report exposure immediately to Occupational Health Nurse. 2. Avoid spills of chemotherapeutic agents. If spills of less than 30 ml occur: a. Employees will always wear personal protective equipment when cleaning up a spill. For example, gowns, double powder-free latex gloves, and splash goggles. b. Liquid spills will be cleaned up by the use of designated absorbent gauze pads. c. Solid spills will be wiped with wet absorbent mats. d. Dispose of all materials in appropriate chemo waste container. e. The spill area will be cleaned three times using a detergent solution followed by clean water. f. Obtain Chemo Spill Kit for clean up of spills greater than 30 ml. 3. Chemotherapy drugs will be administered in the order written, unless otherwise specified by the physician. 3 4
4. The nurse stays with the patient the entire time a vesicant is administered through peripheral line. 5. Encourage P.O. intake of fluids for chemotherapy patients unless contraindicated. *List of Vesicants Carmustine Esorubicin Vinblastine Cerubidine Etoposide Vincristine Cisplatin 5-Fluorouracil Vindesive Dacarbazine Idarubicin Vinorelbine Dactinomycin Mechlorethamine Oxaliplatin Daunorubicin Doxorubicine Epirubicin Mitomycin Plicamycin Porfiromycin * Refer to ONS Chemotherapy and Biotherapy Guidelines and Recommendations for Practice, for any vesicants, and irritants and the appropriate treatment for each. 4 5