Congress Abstracts 2003

69

A SYSTEM FOR THE SAFE ADMINISTRATION OF ORAL CHEMOTHERAPEUTIC AGENTS IN THE HOME SETTING. Susanne Conley, BSN, RN, CPON^®, Kristen Graham, BSN, RN, Maryann Lefrancois, MS, PNP, RN, Christine Chordas, MS, PNP, RN, and Peter Blanding, MS, RPh, Dana-Farber Cancer Institute, Boston, MA.

Background: The increased use of oral chemotherapy agents in children becomes problematic when patients are unable to swallow the tablets or capsules. The dilemma occurs because: 1) pharmaceutical directions state that capsules should not be opened or tablets crushed, and 2) they recommend rigorous precautions if the agents are accidentally opened. The need to develop safety guidelines for the home setting when oral agents needed to be crushed or opened for patients unable to swallow capsules was recognized.

A quality improvement initiative at an NCI-designated comprehensive cancer center embarked to develop guidelines that would maximize safety and promote correct administration of the prescribed dose. The issues identified were as follows: 1) Precautions for family members to protect themselves against exposure to the agent, particularly female caregivers of childbearing age or who are currently pregnant/nursing; 2) Manufacturer guidelines regarding the pharmacokinetics of the drug when mixed with a food vehicle and a list of compatible food substances that do not degrade the drug; 3) Safe disposal of utensils and capsule remnants; 4) Emergency interventions and reporting mechanisms for accidental drug exposures (e.g., splashes, inhalation); 5) Routine monitoring of the quantity of drugs in the home setting to ensure correct dosing and compliance with prescribed therapy. To address these issues, a comprehensive program for the safe administration of oral agents in the home setting and a new standard of care for our patients and families were developed. The tools developed included policies and procedures, patient and family teaching sheets, patient diaries, and a system to periodically count the number of dispensed oral agents. In addition, all staff members were required to attend inservices to learn about the new system and incorporate this standard of care into their practice.

Evaluation: Healthcare providers have expressed a new level of confidence with these guidelines. It has provided a mechanism to monitor compliance with prescribed therapy and maximize safety for family caregivers. Protocols with oral agents continue to open, expanding the applicability of the guidelines. The program is newly implemented and formal evaluation is in progress.

Interpretation/Discussion: Even though this was initially developed for pediatric patients in the home setting, we have found that our guidelines are applicable to inpatient and outpatient settings and are also appropriate for adult populations. As therapies for cancer develop and change, the oncology nurse must continuously evaluate teaching materials and evolving patient and caregiver safety issues.