Safe administration of chemotherapy and compliance with hospital policy and regulatory guidelines require a specific verification process that must be documented as part of the patient record when administering chemotherapy, according to research presented at the Oncology Nursing Society 36th Annual Congress.
Since errors in chemotherapy administration can cause significant harm to patients, nurses must review each regimen for side effects, appropriateness for the indication, and whether such use is evidence-based. This includes confirming the name of the drug as well as its dose, volume, rate, route, expiration, and appearance.
Although oncology nurses at Advocate Good Samaritan Hospital in Downers Grove, Illinois, were completing the verification process, their actions were not specifically being documented, noted Colleen O’Leary, RN, MSN, AOCNS, and Karen Hagemaster, RN, BSN. To address this issue, a process improvement plan was implemented.
First, all chemotherapy orders were copied and put into a central chemotherapy orders binder and a verification form with all aspects of required verification was developed. Nurses were then educated regarding use of the new form, which included an independent double check prior to administration of all chemotherapy. Finally, audits were performed to verify compliance with the new procedure.
From January to March 2010, prior to the plan’s implementation, 54% of chemotherapy administered had appropriate documentation of verification. This percentage increased to 89% in the first month following implementation; however, the goal was 100%, O’Leary noted during her presentation.
She identified one barrier to reaching this goal: the forms detailing administration of outpatient chemotherapy were being left in the outpatient chart and sent to medical records. Since the form was not a part of the permanent record, it was discarded and therefore rated as “not completed.” Subsequently, a checklist for outpatients was developed that included placing the verification form in the binder at completion of administration. As a result, the goal of 100% compliance was reached for 29 of the 36 weeks studied (81% of the weeks).
When an item was identified as missing, specific nurses involved were contacted and coached regarding proper documentation. This “documentation of verification” helps assure all aspects of the process are completed so that administration of chemotherapy can be as safe as possible.