East Midlands Strategic Clinical Network Competency Workbook for the Administration of Cytotoxic Chemotherapy - NURSING
Name: Mentor: Clinical Area:
Document Code: EMCN-DC-0006-14 Date of Issue: November 2016 Review Date: November 2018 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: 1 Issue No: 2 Website: Check www.emsenate.nhs.uk for latest version Contents
Introduction ………………. ………………. 3 Reading List ………………………………… 4 Accountability ………………………………… 5 Cell Biology ………………. ………………. 6 Patient Assessment ………………………. 8 Principles of Chemotherapy ………………. 10 Health & Safety ……………………….. 12 Intravenous Administration Pumps ………. 15 Side effects of Chemotherapy ………. 16 GI tract ……………………...... 17 Bone Marrow Suppression ………. 19 Neurotoxicity/Skin ………………. 21 Urinary/Renal ……………………….. 22 Cardiotoxicity ……………………….. 23 Other Side Effects ………………. 23 Chemotherapy Administration ……… 25 Via Peripheral Cannula ……...... 27 Via CVAD ………………...... 30 Oral ……………………….. 30 Complications ………………………………… 32 Extravasation ……………………….. 32 Hypersensitivity/Anaphylaxis ……… 33 Tumour Lysis ………………………. 35 Drug Calculations ………………………. 36 Formative Assessments ……………… 39 Pre-Chemotherapy Assessments …….. 41 Triage Assessment ………………………. 43 Summative Assessment ……………… 45 Appendix 1: Data Sheet ……………… 46 Introduction
This workbook has been produced to ensure consistency in the training and education of all nurses working within Oncology & Clinical Haematology within the East Midlands Strategic Clinical Network (EMSCN). This workbook can be used by any member of staff starting work in an area where chemotherapy is administered. It can also be used to augment chemotherapy training provided in-house or via a university accredited course.
The workbook is designed to cover all aspects of patient care relating to chemotherapy administration. If a certain aspect covered in this workbook is not part of your job role (e.g. pre-chemotherapy assessment) then mark the assessment as not applicable.
It is anticipated that the registrant should complete this workbook within 3 months of receiving it.
Theory
The appropriate sections of this workbook must be correctly completed in full prior to the final summative assessment. The assigned mentor must be a Band 6 (or above) Chemotherapy nurse who has been assessed as fully competent to administer chemotherapy. The assigned mentor should support & facilitate the student to complete this workbook. A drug Data Sheet can be found in appendix 1 to facilitate learning about individual chemotherapy drugs. Data sheets should be completed for each assessed regime, with a variety of regimes and routes appropriate to your clinical area.
Practical
The student should be observed, supervised & assessed on at least 10 occasions with the administration of chemotherapy. These practical competencies should cover a variety of different regimens & include oral cytotoxic drugs if appropriate to your role. A 24 hour telephone triage/rapid access competency must also be completed if deemed necessary. Should patient pre-chemotherapy assessment take place in your clinical area, then you will need to be under supervision on at least three occasions. The above can be assessed by an assigned mentor.
The final summative assessment / competency sign-off must be undertaken by an assessor that fulfils the criteria as described in EMSCN Chemotherapy Training & Assessment Framework for Registered Nurses. The frame work can be accessed by using this address: http://www.eastmidlandscancernetwork.nhs.uk/Library/EMCNDC012711ChemoNursesTraini ngAssessmentFrameworkFinalVersionOct2011.pdf
To safely care for a patient undergoing chemotherapy treatment it is essential that clinical competence is maintained. It is therefore vital that the individual works within a specialist area that regularly handles chemotherapy.
Competency in the safe administration of Cytotoxic drugs MUST be assessed ANNUALLY in line with Local, Network and National Directives. This is included as part of the Annual Appraisal process and Cancer Peer Review.
Document Code: EMCN-DC-0006-14 Date of Issue: November 2016 Review Date: November 2018 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: 3 Issue No: 2 Website: Check www.emsenate.nhs.uk for latest version
Reading List:
Bulman C & Schutz S (2013) Reflective Practice in Nursing. Oxford, Wiley-Blackwell
Corner J & Bailey C (2008) Cancer Nursing: Care in Context (2nd Ed.) Oxford, Wiley- Blackwell
Department of Health (2011) Improving Outcomes: A Strategy for Cancer. London, DoH
Gaze M (2003) Handbook of Community Cancer Care. London, Greenwich Medical Media
Griffith R & Tengnah C (2008) Law and Professional Nursing. Exeter, Learning Matters Ltd
Grundy M (2006) Nursing in Haematological Oncology. (2nd Ed.) London, Elsevier Health Balliere Tindal
Hamilton H & Bodenham AR (2009) Central Venous Catheters. Chichester, Wiley-Blackwell
Hinchcliffe R & Rogers S (2008) Competencies for Advanced Nursing Practice. London, Edward Arnold, Publishers
Hull C, Redfern L & Shuttleworth A (2005) Profiles & Portfolios. A Guide for Health & Social Care. (2nd Ed.) Hampshire, Palgrave MacMillan
Langhorne ME, Fulton JS & Otto SE (2007) Oncology Nursing. (5th Ed.) St Louis, Missouri, Mosby Elsevier Health Sciences
MacCready T and MacDonald J (2006) Introduction to Cancer Care. Whurr Publishers
National Chemotherapy Advisory Group (2008) Chemotherapy Services in England: Ensuring quality and safety. London, DoH
Priestman T (2012) Cancer Chemotherapy in Clinical Practice. (2nd Ed.) London, Springer- Verlag
Skeel RT (2011) Handbook of Cancer Chemotherapy. (8th Ed.) London, Lippencott Williams & Wilkins
Wilkes GM & Barton-Burke M (2014) Oncology Nursing Drug Handbook. (18th Ed.) London, Jones & Bartlett Publishing Inc
Yarbro CH, Frogge MH, Goodman M (2013) Cancer Symptom Management. (4th Ed.) Oxon, Jones & Bartlett Sudbury
Document Code: EMCN-DC-0006-14 Date of Issue: November 2016 Review Date: November 2018 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: 5 Issue No: 2 Website: Check www.emsenate.nhs.uk for latest version
Assessment of Knowledge:
Accountability:
Document Code: EMCN-DC-0006-14 Date of Issue: November 2016 Review Date: November 2018 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: 7 Issue No: 2 Website: Check www.emsenate.nhs.uk for latest version Cell Biology:
GO phase:
GI phase:.
S phase:
G2 phase:
M phase: Carcinomas:
Sarcomas:
Melanomas:
Lymphomas:
Leukaemia:
Myelomas:
Nerve cell tumours:
Germ cell tumour:
Document Code: EMCN-DC-0006-14 Date of Issue: November 2016 Review Date: November 2018 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: 9 Issue No: 2 Website: Check www.emsenate.nhs.uk for latest version 1)
2)
3)
Patient Assessment:
Patient assessment prior to each cycle of chemotherapy is an essential part of the chemotherapy process. Ensuring ‘fitness to treat’ and the correct management of side effects is crucial in maintaining patient safety. Some side effects and toxicities can be so severe that a dose reduction or deferral is needed. Sometimes treatment may be stopped altogether.
Remember - Treatment must NEVER be given without consulting a doctor first, if a clinician has requested a medical review which hasn’t happened or outcome of review is not known.
Document Code: EMCN-DC-0006-14 Date of Issue: November 2016 Review Date: November 2018 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: 11 Issue No: 2 Website: Check www.emsenate.nhs.uk for latest version Principles of Chemotherapy:
Classification Give two examples of drug
Alkylating Agents
Antimetabolites
Cytotoxic Antibiotics (anthracyclines)
Vinca Alkaloids
Topoisomerase- 1-11 inhibitors
Taxanes Radical / Curative:
Neo-adjuvant:
Adjuvant:
Palliative:
Concurrent:
Therapeutic:
Salvage:
Document Code: EMCN-DC-0006-14 Date of Issue: November 2016 Review Date: November 2018 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: 13 Issue No: 2 Website: Check www.emsenate.nhs.uk for latest version Health & Safety: Remember – IV administration sets should always be inserted into a bag of chemotherapy at waist level, in a tray with sides and NEVER when hanging on a drip stand.
Document Code: EMCN-DC-0006-14 Date of Issue: November 2016 Review Date: November 2018 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: 15 Issue No: 2 Website: Check www.emsenate.nhs.uk for latest version Cytotoxic waste must be incinerated at 1000°C by a waste disposal contractor at a licensed site in accordance with COSHH regulations. Cytotoxic waste should be disposed of in a designated receptacle designed for that purpose.
Bodily fluids can also be considered as cytotoxic waste, depending on the time that the chemotherapy was administered.
W Intravenous Administration Pumps:
Before you administer any chemotherapy or IV drug through a mechanical device/pump, you MUST have received training on how to use the equipment.
Document Code: EMCN-DC-0006-14 Date of Issue: November 2016 Review Date: November 2018 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: 17 Issue No: 2 Website: Check www.emsenate.nhs.uk for latest version Remember – all pump rates must be INDEPENDENTLY checked by two nurses when administering chemotherapy
Side Effects of Chemotherapy:
Chemotherapy affects the normal, healthy cells as well as the cancer cells. Rapidly dividing cells are most vulnerable to the effects of chemotherapy, and some drugs have specific effects on specific organs. The prevention, detection and management of chemotherapy side effects is a vital nursing role.
Immediate
Short-term / Delayed
Long-term The Gastrointestinal (GI) tract
Side effects involving the GI tract are common and can range from mild to life-threatening. They include Mucositis, Nausea and Vomiting and Diarrhoea
Document Code: EMCN-DC-0006-14 Date of Issue: November 2016 Review Date: November 2018 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: 19 Issue No: 2 Website: Check www.emsenate.nhs.uk for latest version Group Drug
Bone Marrow Suppression:
Most, but not all chemotherapy drugs cause bone marrow suppression. It needs to managed carefully to avoid potentially fatal complications.
Anaemia
Thrombocytopenia
Pancytopenia
Document Code: EMCN-DC-0006-14 Date of Issue: November 2016 Review Date: November 2018 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: 21 Issue No: 2 Website: Check www.emsenate.nhs.uk for latest version
Neurotoxicity & Skin:
Document Code: EMCN-DC-0006-14 Date of Issue: November 2016 Review Date: November 2018 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: 23 Issue No: 2 Website: Check www.emsenate.nhs.uk for latest version
Urinary / Renal Side Effects:
Cardiac Side Effects:
Other Side Effects:
Document Code: EMCN-DC-0006-14 Date of Issue: November 2016 Review Date: November 2018 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: 25 Issue No: 2 Website: Check www.emsenate.nhs.uk for latest version
Bleomycin
Epirubicin
High-dose Methotrexate
Chemotherapy Administration: Pre-Chemo Administration Checks – refer to the Cytotoxic Policy for full administration guidelines
Haemoglobin (Hb)
White blood cells (WBC)
Neutrophils
Platelets
Haemoglobin (Hb)
White blood cells (WBC)
Neutrophils
Platelets
Bilirubin
ALT
AST (if no ALT)
ALP
Document Code: EMCN-DC-0006-14 Date of Issue: November 2016 Review Date: November 2018 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: 27 Issue No: 2 Website: Check www.emsenate.nhs.uk for latest version Serum Creatinine
Creatinine Clearance
Chemotherapy Administration via Peripheral Cannulae & Extravasation: Intravenous chemotherapy must be given through a recently sited cannula, preferably in the cephalic or basilic veins, followed by the dorsal venous network, then the wrist.
It is the responsibility of the nurse administering the chemotherapy to ensure that vein integrity is maintained throughout. When vein integrity is compromised, there is potential for the drugs to extravasate causing severe tissue damage and treatment delays. Care must be taken to ensure appropriate checks are performed to assess vein and cannula integrity before administration.
Document Code: EMCN-DC-0006-14 Date of Issue: November 2016 Review Date: November 2018 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: 29 Issue No: 2 Website: Check www.emsenate.nhs.uk for latest version Venous return alone does not provide confirmation of correct cannula placement; equally, lack of venous return does not necessarily mean that a cannula is no longer in a vein. Patient assessment of vein function is dependent upon: The presence or absence of blood return The amount of blood return Drip rate on gravity Patient discomfort Visible changes around cannula site
Always exercise caution when there is evidence of a slowing drip rate/pump occlusion alarm or a lack of blood return. If ever in doubt – re-cannulate.
All chemotherapy drugs can be classified into one of the following categories: Vesicant DNA Binding Vesicant Non – DNA Binding Irritant Non – Vesicant Chemotherapy Administration via a Central Venous Access Device (CVAD):
Chemotherapy regimens often include the need to administer chemotherapy bolus drugs. Bolus chemotherapy should be given in a standard sequence relating to the potential to cause tissue damage. Drugs with the highest potential for damage should be given first.
Chemotherapy administration via a CVAD:
Central Venous Access Devices should only be used after a catheter has been assessed for suitability and fitness for use. This should be done by establishing a gravity feed infusion prior to treatment. The following signs and symptoms MUST be investigated BEFORE treatment:
Document Code: EMCN-DC-0006-14 Date of Issue: November 2016 Review Date: November 2018 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: 31 Issue No: 2 Website: Check www.emsenate.nhs.uk for latest version Persistent Withdrawal Occlusion (PWO) – CVAD flushes well but there is no blood return Pinch-off syndrome Partial/total occlusion Infection Migration Swelling of insertion site or skin tunnel Leakage from exit site Pain/discomfort in neck, shoulder or chest
Oral Chemotherapy:
Oral Chemotherapy is becoming increasingly prevalent. Whilst this has its benefits, it also has its limitations and risks. The same stringent guidelines and procedures in relation to patient assessment and principles of administration should be the same as intravenous, or any other chemotherapy delivery. Document Code: EMCN-DC-0006-14 Date of Issue: November 2016 Review Date: November 2018 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: 33 Issue No: 2 Website: Check www.emsenate.nhs.uk for latest version Potential Complications:
Hypersensitivity/Anaphylaxis:
Virtually all chemotherapeutic agents have the potential to cause infusion reactions. An infusion reaction is a type of hypersensitivity reaction that develops during or shortly after administration of a drug. Hypersensitivity to a chemotherapeutic agent is defined as an unforeseen reaction whose signs and symptoms cannot be explained by the known toxicity of the drug. Anaphylaxis is a severe, life threatening, generalized or systemic hypersensitivity reaction. It is characterized by rapidly developing life-threatening airway and/or breathing and/or circulation problems, as well as skin and mucosal changes. In most cases, prompt and appropriate action in response to an infusion reaction or hypersensitivity/allergic reaction can prevent a reaction to an infusion developing into life- threatening anaphylaxis.
Document Code: EMCN-DC-0006-14 Date of Issue: November 2016 Review Date: November 2018 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: 35 Issue No: 2 Website: Check www.emsenate.nhs.uk for latest version Tumour Lysis Syndrome:
This is a relatively rare complication of chemotherapy, but can occur spontaneously in an active tumour. Drug Calculations & Chemotherapy Dosing:
These are mostly measured in milligrams per body surface area (mg/m2). There are standard doses of chemotherapy for each regime but these will vary according to each individual patient’s size. The dose of chemotherapy will be calculated by the prescribing doctor and checked by the pharmacist. However as the chemotherapy nurse accountable for administering the drug you must check that the dose is correct. Simply multiply the standard dose required in mg, by the patient’s surface area in m2 to check that the prescribed dose for each individual patient is correct. e.g. Oxaliplatin 130mg / m2 regime Standard dose is 130 mg/ m2 Patient’s surface area is 1.8 m2
130 x 1.8 = 234 mg (patient’s individual total dose) Remember that this dose can be rounded up or down by pharmacy (dose banding).
Carboplatin Dosing:
Carboplatin doses are based on renal function rather than body surface area. The Calvert formula is used which is based on the desired serum exposure, expressed as the area under the serum concentration time curve (AUC).
Carboplatin dose in mg = AUC(GFR + 25) The Doctor should specify which AUC is required e.g. 5,6 or 7 GFR means globular filtration rate (a measurement of renal function). Use the Creatinine clearance result for this.
Example: The patient has a Creatinine clearance result of 80ml / minute. The Doctor has specified the AUC required is 5. Calculate the dose of Carboplatin as follows: Carboplatin dose in mg = AUC 5 (80+25) Work out the sum in the brackets first. Then multiply this answer by the figure outside the brackets. This means 80+25 = 105 105 x 5 = 525 mg of Carboplatin.
Cockcroft Formula:
This is used as an alternative to measuring a patient’s renal function with a 24 hour urine collection. Instead the Creatinine clearance is calculated using the following formula:
Women
Document Code: EMCN-DC-0006-14 Date of Issue: November 2016 Review Date: November 2018 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: 37 Issue No: 2 Website: Check www.emsenate.nhs.uk for latest version Creatinine clearance = (140 – age) x weight in kg x 1.04 divided by serum creatinine
Men Creatinine clearance = (140 – age) x weight in kg x 1.23 divided by serum creatinine
Example: For a 55 year old man who weighs 80kg and has a serum Creatinine result of 70. Work out the sum in the brackets first
(140-55) = 85 85x80 = 6800 6800 x 1.23 = 8364 8364 divided by 70 = 119.5 Therefore the Creatinine Clearance is 119.5 ml / min
Chemotherapy Calculations Quiz:
Use a calculator but write the method used to work out the problem.
1. Calculate the following rates for an infusion pump (ml/hour):
You need to give 1 litre of saline over 2 hours. What is the rate?
You need to give 250ml infusion of chemotherapy over 90 minutes. What is the rate?
2. Calculate the dose of Carboplatin for a patient with a creatinine clearance of 68ml/min. The AUC specified is 5. 3. How would you calculate the creatinine clearance for your 52 year old female patient whose weight is 60 kg and who has a serum creatinine result of 79?
4. Mrs.Brown is due cycle 3 of her oral chemotherapy. Her surface area is 1.5mg/m2. She received 1800mg twice daily for the first two cycles but has been experiencing side effects. As a result her consultant has now prescribed a dose reduction of 25%. The tablets only come in 150mg and 500mg doses. What should her new dose be?
5. A patient has been prescribed chemotherapy at 1000mg/m2. They have a SA of 1.68 and they need a 20% dose reduction. What should the new dose be?
Cytotoxic Drug Administration – Formative Assessment:
This is the suggested assessment criteria for cytotoxic drug administration; however please refer to local assessment criteria if necessary. It is anticipated that you should complete at
Document Code: EMCN-DC-0006-14 Date of Issue: November 2016 Review Date: November 2018 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: 39 Issue No: 2 Website: Check www.emsenate.nhs.uk for latest version least 10 differing assessments (including oral chemotherapy) under the direct supervision of your assessor. If more assessments are required please find them on the EMCN website.
Assessment Criteria: Assessor Initials 1 2 3 4 5 6 7 8 9 10 Demonstrate sound knowledge of the treatment regime & required pre- treatment investigations. Read patient’s notes, prescription & relevant regimen protocol & identify any special instructions, investigations, (including abnormal blood test results) or issues for which you need to seek advice. Ensure appropriate consent forms have been completed. Greet & accurately identify patient. Review patient’s history since last attendance & use the Common Toxicity Criteria to assess & document the patient’s physical condition and their fitness for treatment. Seek advice from appropriate team member if required. Assess the patient’s psychological / emotional state & respond appropriately, including referrals to appropriate agencies and personnel. Give opportunity for, and subsequently answer both patient & carers questions appropriately. Check the patient and / or carer understands the treatment to be given & any potential or immediate / delayed side effects together with their management (including awareness of reactions & how to call for help). Demonstrate the correct checking procedure including drug calculations, blood results & infusion pump checks Ensure the administration of any pre- meds and/or supportive medications Assemble all venous access equipment, confirming that IV route is appropriate & that venous access device is suitable for use. Cannulate following protocol if necessary. Infection control, ANTT, PPE & effective hand washing adhered to at all times. Undertake final check of treatment drugs against prescription & patient’s Assessment Criteria: Assessor Initials 1 2 3 4 5 6 7 8 9 10 identity before administration. Give required drugs via prescribed route, at prescribed rate, in appropriate order. Correctly observe vein patency on cannulation and at suitable periods throughout administration. The patient must never be left unattended whilst bolus vesicant drugs / vinca alkaloids are being administered. Monitor patient for indications of extravasation, discomfort or any allergic / hypersensitivity reactions & act appropriately. When chemotherapy administered, dispose of cytotoxic waste and sharps as per policy. Confirm details of the next appointment and any prior investigations or tests with the patient and/or carer including blood test forms. Ensure patient has all medication to take home & understands how to handle, take & store them. Re-iterate 24 hour helpline numbers.
Record details of treatment in patient’s notes, prescription chart / ePrescribing & chemotherapy care plan. Communicate with appropriate colleagues as required. Signature of Assessor:
Name of Assessor:
Date:
NB Shaded boxes are not applicable for Oral chemotheray Patient Pre-Chemotherapy Formative Assessment:
Complete at least 3 assessments under the direct supervision of your assessor.
Assessment Criteria: Assessors Initials:
Document Code: EMCN-DC-0006-14 Date of Issue: November 2016 Review Date: November 2018 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: 41 Issue No: 2 Website: Check www.emsenate.nhs.uk for latest version 1 2 3 Arrange for an independent translator / interpreter if you have reason to believe this will assist the patient’s understanding. Demonstrate an understanding of the referral process and ensure that the assessment is undertaken within an appropriate timescale after admission/referral. Read the patient’s notes, prescription - if previously prepared - and protocol, and identify any special instructions. Review the results of all relevant investigations (including blood test results) and identify any issues on which you need to seek advice. Ensure the environment provides for maximum possible privacy, dignity and comfort throughout the assessment and determine whether the patient wishes to have any other person present. Take action to pre-empt and prevent interruptions from communication devices and visitors to the room. Greet, accurately identify the patient and introduce yourself and any colleagues present to the patient and/or carer. If a carer is present, ensure that the patient consents to their presence throughout the assessment and is willing for them to receive the same information as that given to the patient. Undertake the assessment within your own sphere of competence and involve the patient and/or carer in the assessment as appropriate. Determine the patient’s and/or carer’s understanding of their current circumstance in a manner which reassures the patient that you are familiar with their history. Review the patient’s history since their last attendance. Assess the patient’s physical condition and their fitness for treatment and seek advice from an appropriate professional colleague if required. Use visual clues to add to your understanding of the patient’s care needs, circumstances, choices and preferences. Explain the treatment and their risks and benefits to the patient and/or carer together with any potential side effects and their management and accurately answer any questions at a pace & level which is appropriate to the patients: Emotional state Level of understanding Culture and background Preferred ways of communicating Needs Explain in terms that the patient and/or carer can understand how the treatment works: Basic cell cycle Why there are different regimes Effects on healthy cells – cause of side effects, cells recover Emphasise the seriousness of neutropenia, reporting it and taking precautions to prevent infection: Potentially life-threatening Thermometer Use of paracetamol Explain actions to take if any side effects occur i.e. how and when to contact the unit. Emphasise the specific side effects that MUST be reported. Explains the importance and timing of blood tests prior to a course of chemotherapy. Explanations of waiting times (Pharmacy system, chemo tailor made etc). Makes appropriate referrals to minimise the impact of side effects e.g. wig referral. Check that the patient and/or carer understands the treatment choices being offered, the implications of this choice and any potential side effects together with their management. Determine whether or not the patient is willing to proceed. Confirm the details of the appointment for their first course and any prior investigations or tests with the patient and/or carer, if appropriate. Provide information on how to obtain help at any time. Provides appropriate written information to support verbal information. Completes all documentation following consultation. Correctly calculates and orders the regimen for the patient’s first course if applicable. Signature of Assessor
Name of Assessor
Date:
NB Shaded boxes are not applicable in Paediatrics
Document Code: EMCN-DC-0006-14 Date of Issue: November 2016 Review Date: November 2018 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: 43 Issue No: 2 Website: Check www.emsenate.nhs.uk for latest version 24 Hour Triage & Access Competency Assessment:
Following completion of triage training and assessment process, complete at least 3 triage assessments under the direct supervision of your assessor.
Assessment Criteria: Assessors Initials: 1 2 3 Explain your own role and its scope, responsibilities & accountability in relation to the provision of interim clinical advice Ask appropriate questions to understand the reasons why the patient is contacting the unit for advice Explain clearly: Any clinical advice to be followed and its intended outcome Anything they should be monitoring and how to react to any changes Any expected side effects of the advice Any actions to be taken if these occur Confirm that the individual understands the advice being given & has the capacity to follow required actions Provide information that: Is current best practice Can be safely put into practice by people who have no clinical knowledge or experience Acknowledges the complexity of any decisions that the individual has to make Is in accordance with patient consent & rights Communicate with the individual, in a manner that is appropriate to their level of understanding, culture or background, preferred ways of communicating and which meets their needs. Communicate in a caring and compassionate manner Communicate with the individual in a manner that is mindful of: How well they know the patient The accuracy and detail that they give you regarding the situation and the patient medical history, medication etc. Patient confidentiality, rights and consent Manage any obstacles to effective communication and check that your advice has been understood Provide reassurance and support to the individual or third party who will be implementing your advice pending further assistance Ensure that you are kept up to date regarding the patient’s condition so that you can modify the advice you give if required Ensure that full details of the situation and the actions already
Document Code: EMCN-DC-0006-14 Date of Issue: November 2016 Review Date: November 2018 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: 44 Issue No: 2 Website: Check www.emsenate.nhs.uk for latest version Assessment Criteria: Assessors Initials: 1 2 3 taken are provided to the person or team who take over the responsibility for the patients care. Recognise the boundary of your role and responsibility and the situations that are beyond your competence and authority 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 Ensure you have sufficient time to complete the assessment Provide information on how to obtain help at anytime Record any modifications which are made to the agreed assessment process and documentation and the reasons for the variance Record and report your findings, recommendations, patients response and issues to be addressed according to local guidelines Inform the patients’ medical team on the outcome of the assessment Demonstrate competent use of the assessment tool and completion of assessment pathway If the patient is part of a clinical trial inform the trials team as soon as possible Signature of Assessor
Name of Assessor
Date:
Oncology / Haematology 24 Hour Triage (Rapid Assessment & Access Tool Kit) UKONS Central West Chemotherapy Nurses Group
Document Code: EMCN-DC-0006-14 Date of Issue: November 2016 Review Date: November 2018 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: 45 Issue No: 2 Website: Check www.emsenate.nhs.uk for latest version Summative Assessment of Chemotherapy Competency
If not applicable to your clinical area, please mark N/A.
Date: Mentor Signature: Chemotherapy course / programme completed: Electronic prescribing training completed: ANTT training completed: IV Cannulation completed: Central Venous Access Device training completed: Infusional Pump training completed: Minimum of 10 Chemotherapy Administrations: Minimum of 3 Pre-Chemotherapy Assessments: Minimum of 3 Triage Assessments if appropriate: Completed all aspects of the workbook
I have the knowledge and skills to competently administer chemotherapy and triage emergency chemotherapy related calls.
Name: ……………………………………………………….
Signature: …………………………………………………..
Date: ………………………………………………………...
Sign-Off Assessor Name: …………………………………
Signature: …………………………………………………..
Document Code: EMCN-DC-0007-14 Date of Issue: Aug 2014 Review Date: Aug 2016 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number Issue No: 1 Website: Check www.eastmidlandscancernetwork.nhs.uk for latest version Appendix 1: Data Sheet (photocopy as required)
Record of Drug Knowledge:
Regime/protocol administered ………………… Assessment no
Type of cancer treated …………………………..
Drug Type of Drug (e.g. Alkylating Agent) & How It Works
Investigations Required Prior to Each Course Indication for Dose Reduction
Document Code: EMCN-DC-0007-14 Date of Issue: Aug 2014 Review Date: Aug 2016 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: Issue No: 1 Website: Check www.eastmidlandscancernetwork.nhs.uk for latest version Drug Emetogenicity Drug Specific Short Term Potential Long Term Effects (Grade 1-5 And Description Side Effects e.g. Low)
Evidence to Support the Use of These Agents In This Type Of Cancer (e.g. NICE, Trust Guidelines / Protocols etc.)
Document Code: EMCN-DC-0007-14 Date of Issue: Aug 2014 Review Date: Aug 2016 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: Issue No: 1 Website: Check www.eastmidlandscancernetwork.nhs.uk for latest version Document Code: EMCN-DC-0007-14 Date of Issue: Aug 2014 Review Date: Aug 2016 Written By: Andrew Feltham C Penn Authorised by: EMCN Chemotherapy Group Page Number: Issue No: 1 Website: Check www.eastmidlandscancernetwork.nhs.uk for latest version