Congress Abstracts 2006

24

ADMINISTERING CHEMOTHERAPY IN NON-ONCOLOGY SETTINGS: A DIFFERENT APPROACH. Sheree Dunn, RN, OCN^®, and Lucy Mauney, RN, BSN, OCN^®, Duke University Health System, Durham, NC.

Nurses responsible for administering chemotherapy are required to have specialized expertise and clinical competency to deliver treatment appropriately. As new indications for chemotherapy agents and targeted therapies are prescribed for non-oncology diagnoses, challenges arise when these agents are administered among units other than those designated for oncology patients. This presents a dilemma because of competencies required for chemotherapy administration. Prior to implementation of this model, off-service chemotherapy was delivered by infusion nurses.

It was determined that nurses on a 31-bed inpatient hematology/oncology unit are most competent to deliver chemotherapy due to the high volume of chemotherapy administered on a daily basis. Hospital administration implemented a model focusing on utilizing the expertise of chemotherapy-competent nurses to efficiently administer chemotherapy to off-service patients. This presentation outlines the resources used to effectively implement this hospital-wide system.

The hematology/oncology unit is notified of all patients requiring chemotherapy. Upon notification, a designated nurse is assigned to administer treatment. This consists of carrying out the following responsibilities: reviewing physician's orders and arranging a chemotherapy administration time with the care nurse, notifying the physician or pharmacy of any discrepancies within the orders and holding therapy until discrepancies are resolved; double-checking chemotherapy orders with another chemotherapy-competent nurse; discussing agent-specific guidelines, premedications, lab values and other pertinent monitoring required for administration. Additionally, the designated nurse is responsible for ensuring appropriate IV access for therapy. Once treatment is initiated by chemotherapy-competent nurses, education is provided to the patient and care nurse regarding adverse effects.

Prior to initiation of this model in 4/05, there were inconsistencies related to the administration of chemotherapy among off-service patients. Over the following 6 months, 204 agents were given. Because chemotherapy was administered by a select group of nurses, the hospital system received feedback from nurses on other units reflecting increased staff and patient satisfaction.

This model had a significant impact on timely administration of chemotherapy as well as providing consistent resources for staff nurses hospital-wide. Other oncology nurses can use this model to effectively increase consistency among chemotherapy administration practices thereby increasing patient and staff satisfaction.