SAN ANTONIO, Tex.–A formal nursing practice was developed to promote patient safety and adherence with oral chemotherapy, according to a presentation at the ONS 41st Annual Congress.1
Because the policies and practices relating to the use of oral chemotherapy agents differ in terms of what is considered safe, clinical staff at University of Pittsburgh Medical Center (UPMC) CancerCenter in Pittsburgh, Pennsylvania, sought to develop a formal process for oral chemotherapy initiation, education, and monitoring that would promote patient safety and compliance with the 2013 Oncology Nursing Society (ONS) and American Society of Clinical Oncology (ASCO) safety standards.
“The goals of this project were to develop a formal tracking system when initiating oral chemotherapy; cultivate patient education standards specific to the administration of oral chemotherapy; ensure patient education is provided by a nurse on an individual basis; and design a guided procedure for follow-up phone calls to monitor for side effects, toxicities, and adherence,” said Mary Kate Egan, MSN, RN, OCN, an advanced clinical education specialist at UPMC CancerCenter.
First, a survey was administered to nurse leaders of different UPMC sites, but results were inconsistent and demonstrated deficient processes. The investigators found that 57% of sites had no formal tracking system for initiating oral chemotherapy, 26% had no standardized plan for patient education, and only 30% of sites performed follow-up phone calls to monitor patients. Of the sites that did provide education, 57% were conducted by nurses and 43% were conducted by pharmacists or physicians.
“We created an oral therapy taskforce with the goal of creating a system-wide policy and guidelines for initiation, education, and monitoring,” Egan noted.
The policy and guidelines were piloted at 5 sites for 90 days with feedback provided to the taskforce. Revisions were then made to the guidelines and the guidelines were implemented throughout all CancerCenter locations.
The new oral therapy guidelines include the physician orders the oral agent; the nurse receives notification of initiation of oral therapy; the nurse documents required patient prescription information; the nurse confirms that informed consent was obtained; the nurse and/or pharmacist provides oral and written instruction specific to the drug and documents on an appropriate form; and the nurse completes follow-up phone calls on days 1 to 5 and days 10 to 14 and documents on appropriate form.
“We will always promote additional education from the pharmacist if available,” Egan added. “Also, most nurses complete 3 or 4 phone calls but only 2 phone calls are required.”
In addition, support documents, or cheat sheets, were developed by the pharmacists for the nurses to remind themselves to perform drug-specific related tasks, including laboratory tests.
1. Egan MK, Orndoff S, Steele C, et al. Implementation of formalized nursing practice to promote patient safety with oral chemotherapy. Oral presentation at: 2016 Oncology Nursing Society Annual Congress; April 28-May 1, 2016; San Antonio, TX.