Chemotherapy Practice Competencies To be used in conjunction with Teesside University module: AHH3088-N - Chemotherapy Enhancing Practice in Cancer Care School of Health & Social Care NAME. PLACE OF WORK Updated May 2011 Review date May 2012
These competencies meet with the North Of England Cancer Network Chemotherapy Training And Assessment Policy For Nurses & Allied Health Professionals, (Appendix 1). They have been developed by the North of England Cancer Network Chemotherapy Nurses Forum. It aims to promote consistently high standards of chemotherapy delivery across the Network and promote safe practice in all areas where chemotherapy is administered. Practitioners will be assessed against the competencies by an expert chemotherapy practitioner. The Chemotherapy Practice Competencies are taken as part of the Teesside University module Chemotherapy Enhancing Practice in Cancer Care, and will be recognised by NECN and accredited by Teesside University. To enable staff to develop their expertise within chemotherapy practice a grading criteria, will be applied to each competency. The grades will be categorised as: In training Trained Assessor You will be required to submit your completed competencies with signed verification from your assessor to achieve the outcomes of the Chemotherapy Enhancing Practice in Cancer Care module at Teesside University. Written and reviewed by Sharon Harper Senior Nurse/Clinical Nurse Specialist Darlington Memorial Hospital - sharon.harper@cddft.nhs.uk Wendy Anderson Chemotherapy Macmillan Matron - South Tees NHS Trust wendy.anderson@stees.nhs.uk
CONTENTS: CHEMOTHERAPY PRACTICE COMPETENCIES PAGE: SPECIFIC SKILLS: Holistic Patient Assessment 1 Venepuncture 2 Cannulation 3 Administration of Chemotherapy 4 Care of Central Lines 5-6 Side Effects of Chemotherapy 7-8 24 Hour Rapid Assessment and Access 9-10 Discussion Topics 11 Annual Review of Chemotherapy Competencies 12-13 Appendix 1 14-16 PLEASE NOTE THAT IF EITHER THE PRACTITIONER OR ASSESSOR S SIGNITURE IS NOT READABLE THE COMPTENICES WILL BE INVALID.
CHEMOTHERAPY PRACTICE COMPETENCIES SPECIFIC SKILLS - Holistic Patient Assessment Skills Area In training Trained Assessor Comments Date /Signature Discuss the role of patient and carer assessment in the care of patients receiving chemotherapy, including the benefits of developing a holistic approach. Perform a holistic assessment of a chemotherapy patient, show evidence of patient review before next cycle of chemotherapy Discuss the importance of the procedure to the patient, the family and the multi-disciplinary team Describe the functions of various members of the health care team, including the key worker involved in the care of the patient receiving chemotherapy Discuss communication issues including internal (e.g. pharmacy) and external communications (e.g. primary care). Demonstrate appropriate involvement of the multidisciplinary team Describe care issues specific to chemotherapy patients which can be supported through use of Holistic Needs Concern Tool Discuss the importance of accurate record keeping.. 1
CHEMOTHERAPY PRACTICE COMPETENCIES SPECIFIC SKILLS - Venepuncture Skills Area In training Trained Assessor Comments Date /Signature Identify and explain the choice of various syringes and needles for venepuncture. Competently gather and assemble the appropriate equipment. Explain the importance of aseptic technique during venepuncture, Describe the normal anatomy of the arm including major arteries, veins and nerves. Identify these structures clinically. Identify and explain about veins suitable for venepuncture Select a vein suitable for venepuncture. Demonstrate correct application of a tourniquet. Competently and safely extract blood for sampling using vacutainer system. Explain which veins would be unsuitable for venepuncture. Explain causes for above. Describe in detail the importance of appropriate labelling, selection of tube for specific test eg: FBC, U&Es, X match, Coag screen, specimens at risk. Demonstrate the correct technique and methods for disposal of equipment. 2
SPECIFIC SKILLS - Cannulation Skills Area In training Trained Assessor Comments Date /Signature Identify and explain choice of cannula and cannula size. Discuss choice of IV dressing. Explain the importance of aseptic technique when cannulating. Identify the suitability of patients for cannulation Identify a vein suitable for cannulation. Demonstrate correct application of a tourniquet. Competently and safely insert and fix a cannula in place. Explain and recognise veins unsuitable for cannulation. Explain causes of above. Discuss the maintenance of patency. Discuss the complications of having a cannula in place and their prevention. Demonstrate awareness of procedure when unable to site a peripheral cannula for chemotherapy. 3
SPECIFIC SKILLS - Administration of Chemotherapy Skills Area In training Trained Assessor Comments Date /Signature Discuss the possible routes of administering chemotherapy Demonstrate an understanding of the reason for using the different routes described above Administer intravenous chemotherapy safely through an infusion, according to local cytotoxic guidelines, local control of infection and COSHH guidelines. Discuss and demonstrate correct use, care and maintenance of pumps and other medical devices used in the chemotherapy department Administer intravenous chemotherapy safely as a bolus injection, in accordance with local policy Demonstrate awareness of health and safety aspects of chemotherapy administration including protective clothing and safe handling Demonstrate awareness of health and safety procedures including the disposal of waste and the management of spillages Discuss main principles within the Network Oral Anti Cancer Medicine Policy Administer oral chemotherapy according to policy. Discuss patient information regarding take home medication especially safe handling, storage and administration 4
SPECIFIC SKILLS - Care of Central Lines Skills Area In training Trained Assessor Comments Date /Signature Discuss the purpose of a Hickman line and its uses and disadvantages. Describe the anatomy of the central veins and arteries. Explain how the line is inserted and what problems may follow. Discuss how these problems may be minimised. Discuss maintenance of patency. State the purpose of heparinisation. Demonstrate heparinisation of the line. Describe what to do if the line appears to be blocked. Discuss dressings for the exit site. Demonstrate dressing the site Describe how to take blood from the line. Demonstrate how to take blood from the line. Discuss problems that may be associated with taking blood, how they occur and what action to take should this occur. Demonstrate and explain correct use of needle free access systems, i.e. bionectors 5
SPECIFIC SKILLS - Care of Central Lines (continued) Skills Area In training Trained Assessor Comments Date /Signature Discuss information to be given to the patients/relatives regarding line insertion and its subsequent care. Describe how to take blood cultures from a patient with a central line in place. Describe the advantages/disadvantages of a PICC line Discuss the methods of maintaining patency of a PICC line Demonstrate how to dress a PICC line exit-site Discuss complications, which may occur following PICC insertion and action to take. Discuss information/advice to be given to the patient regarding PICC line insertion and its subsequent care. 6
Side Effects of Chemotherapy Skills Area In training Trained Assessor Comments Date /Signature Discuss the common side-effects of chemotherapy Demonstrate awareness of drug specific side effects including; monoclonal antibodies, hormone therapies, bisphosphonates. Demonstrate awareness of local protocols for chemotherapy dose adjustments Demonstrate an understanding of chemotherapy protocols and regimes used in the chemotherapy department. EXTRAVASATION: What is extravasation? What are the signs of extravasation? How is extravasation treated? How can the risk of extravasation be minimised? ANAPHYLAXIS: What is anaphylaxis? What are the signs of anaphylaxis? How is anaphylaxis treated? How can the risk of anaphylaxis be minimised? HAEMATOLOGICAL DISORDERS Discuss the functions of Erythrocytes Lymphocytes Monocytes Neutrophils Platelets 7
Side Effects of Chemotherapy (cont d) Objective In training Trained Assessor Comments Date /Signature NEUTROPENIC CARE What is neutropenia? Discuss the significance of the measurement of temperature in the neutropenic patient. Demonstrate ability to recognise signs of all aspects of myelosuppresion and its safe management. Demonstrate awareness of the local antibiotic regime and discuss its importance, especially in relation to 1 hour door to needle time. Demonstrate awareness of the local neutropenia policy and discuss its importance Discuss the role of health promotion in the management of chemotherapy related side effects Discuss the role of personal hygiene in managing neutropenia. Discuss the importance of oral hygiene in neutropenic patients Demonstrate awareness of the evidence base regarding clean diets/dietary protocols. Discuss thrombocytopenia precautions. 8
24 Hour Rapid Assessment and Access Competency Assessment This is to deem that...has been assessed as competent in the use and application of the 24 Hour Rapid Assessment and Access Tool Kit The Practitioner is reminded that they will still be accountable for practice as detailed in clause 1.3 of the NMC code of conduct. You are personally accountable for your practice. This means that you are answerable for your actions and omissions, regardless of advice or directions from another professional Performance Criteria In Training Trained Assessor Comments Date /Signature You need to: 1 Be able to explain clearly and calmly to the assessor your own role and its scope, responsibilities and accountability in relation to the provision of interim clinical advice 2 Explain clearly: a) Any clinical advice to be followed and its intended outcome b) Anything they should be monitoring and how to react to any changes c) Any expected side effects of the advice d) Any actions to be taken if these occur 3 Clarify and confirm that the individual understands the advice being given and has the capacity to follow required actions 4 Provide information that: a) Is best current practice b) Can be safely put into practice by people who have no clinical knowledge or experience c) Acknowledges the complexity of any decisions that the individual has to make d) Is in accordance with patient consent and rights 5 Communicate with the individual, in a manner that is appropriate to their level of understanding, culture and background, preferred ways of communicating and which meets their needs. The ability to communicate in a caring and compassionate manner. Updated May 2011 Review date May 2012 9
24 Hour Rapid Assessment and Access Competency Assessment Continued... Performance Criteria In Training Trained Assessor Comments Date /Signature 6 Communicate with the individual in a manner that is mindful of a) How well they know the patient b) The accuracy and detail that they can give you regarding the situation and the patient s medical history, medication etc c) Patient confidentiality, rights and consent 7 Manage any obstacles to effective communication and check that your advice has been understood 8 Provide reassurance and support to the individual or third party who will be implementing your advice, pending further assistance 9 Ensure that you are kept up to date regarding the patient s condition so that you can modify the advice you give if required 10 Ensure that the full details of the situation and the actions already taken are provided to the person or team who take over the responsibility for the patient s care 11 Recognise the boundary of your role and responsibility and the situations that are beyond your competence and authority 12 Seek advice and support from an appropriate source when the needs of the patient and the complexity of the case are beyond your competence and capability 13 Ensure you have sufficient time to complete the assessment 14 Provide information on how to obtain help at any time 15 Record any modifications which are made to the agreed assessment process and documentation and the reasons for the variance 16 Record and report your findings, recommendations, patient and/or carer s response and issues to be addressed according to local guidelines 17 Inform the patient s medical team on the outcome of the assessment as per assessment pathway 18 Demonstrate competent use of the assessment tool and completion of the assessment pathway 10
DISCUSSION TOPICS Topic In training Trained Assessor Comments Date /Signature Demonstrate an understanding of national and network guidance including national quality measures and reports about chemotherapy. Discuss the role of the cancer network and the structures/groups connected to chemotherapy and drugs and therapeutics Discuss the ethical and legal issues associated with the administration of chemotherapy Demonstrate awareness of research and audit within your area Demonstrate awareness of Intrathecal Guidelines Updated May 2011 Review date May 2012 11
ANNUAL REVIEW OF CHEMOTHERAPY COMPETENCIES KNOWLEDGE & SKILLS UPDATE PRACTITIONER (print and sign name) ASSESSOR (print and sign name) DATE PLEASE NOTE THAT IF EITHER THE PRACTITIONER OR ASSESSOR S SIGNITURE IS NOT READABLE THE COMPTENICES WILL BE INVALID. Updated May 2011 Review date May 2012 12
ANNUAL REVIEW OF CHEMOTHERAPY COMPETENCIES KNOWLEDGE & SKILLS UPDATE PRACTITIONER (print and sign name) ASSESSOR (print and sign name) DATE PLEASE NOTE THAT IF EITHER THE PRACTITIONER OR ASSESSOR S SIGNITURE IS NOT READABLE THE COMPTENICES WILL BE INVALID. 13
Appendix 1. NORTH OF ENGLAND CANCER NETWORK CHEMOTHERAPY TRAINING AND ASSESSMENT POLICY FOR NURSES & ALLIED HEALTH PROFESSIONALS The Chemotherapy Training and Assessment Policy outlines a programme of education for nurses and Allied Health Professionals administering chemotherapy¹. The policy is supported by the constituent organisations of the North of England Cancer Network (NECN), Teesside University, University of Northumbria and the University of Cumbria. The NECN Chemotherapy Education Pathway and related resources developed by the NECN Chemotherapy Nursing Forum (see appendix) underpins the policy. 1. All nursing staff and allied health professionals who deliver chemotherapy as part of their role will have undertaken or be working towards a network recognised Chemotherapy module² and Chemotherapy Practice Competencies. 2. Only staff that have demonstrated advanced practice in chemotherapy administration and assessment³ will be eligible to undertake the assessment of other staff. These staff will participate in an annual peer review process to assure their level of expertise. This review process will be monitored by the Trust Lead Chemotherapy Nurse. 3. Assessors may be asked to be involved in the design, delivery and review of the Chemotherapy Module. 4. All Trained and Assessor chemotherapy nurses should be involved in the delivery of local chemotherapy education programmes, particularly to ward staff and community nurses. Teaching programmes will be supported by the NECN chemotherapy teaching package. 5. Chemotherapy nurses and allied health professionals who continue to work in the field of chemotherapy will have their clinical knowledge and skills peer reviewed annually against the network recognised Chemotherapy Practice Competencies as part of the local appraisal process. 6. This policy will be reviewed annually and updated as required by the NECN Chemotherapy Nursing Forum and the Universities of Cumbria, Teesside and Northumbria. 14
North of England Chemotherapy Training and Assessment Policy Area In Training Trained Assessor Theoretical aspects of chemotherapy Local Programmes & Teaching Resources Accredited Chemotherapy Module Skills & knowledge competencies Network Recognised Chemotherapy Practice Competencies, Skills for Health and Knowledge and Skills framework Clinical assessors for Advanced Practice for Assessment practice competencies, identified through appraisal. Teesside University link http://www.tees.ac.uk/schools/soh/subjects/cancer%5fcare/ Northumbria University link http://sits.unn.ac.uk/live/webserv/mod.php?code=ac0310 University of Cumbria link Contact Michelle Garner: michelle.garner@cumbria.ac.uk 15
¹For the purpose of this policy, chemotherapy is deemed as all anti-cancer treatments; systemic and oral and biological therapies; angiogenesis inhibitors and anti-growth inhibitors. ²Other accredited chemotherapy modules that are equivalent in terms of content and accreditation may be approved if appropriate. ³To be classed as an Assessor in chemotherapy administration and assessment is considered as someone who has: An accredited course in chemotherapy An accredited course in teaching and/or assessing in clinical practice Has been identified through appraisal as being competent to assess Their name on the register collated and updated annually by the Trust Lead Chemotherapy Nurse Policy reviewed and Updated by: NECN Chemotherapy Nurses Forum Date April 2011 Approved by: Network Chemotherapy Group Signature: Review date: April 2012 Circulation List: NECN Chemotherapy Nursing Forum members Trust Lead Cancer Nurses & Directors of Nursing Chemotherapy Heads of Service NECN Chemotherapy Group Universities of Cumbria, Teesside and Northumbria 16