Goals, Outline, and Teaching Plan: 7/8/2009
Chemotherapy & Biotherapy Administration Competency:
Clinical Practicum/Skills lab
Goals of Practicum:
Following the RN’s successful completion of the ONS Chemotherapy and Biotherapy Provider Course, the RN new to chemotherapy administration will complete the mandatory Clinical Practicum session, in which the RN will demonstrate skills and competencies necessary to provide safe administration of cytotoxic drugs. This practicum may also be taken as a refresher course. Using case studies, reference materials, PPE, closed-system IV tubing, and Mid Coast Hospital policies, the RN will:
Clinical Practicum Outline & Discussion Points:
I. Identify necessary actions prior to administration (90 minutes)
Tools: Case study (students read before lab), References available on MedSurg, Discussion with Evaluator
Goal: With 1-2 RNs, Evaluator will review case study. Each RN will serve as primary RN and second RN checking orders, calculations, and dosages. RNs will use available references to research case.
o Review patient clinical information that is critical to safe administration, dose determination, and effective delivery of chemotherapy and biotherapy.
§ H&P, progress notes, medical orders, current labwork
§ Patient status: performance status, nutrition, symptoms and management, current height and weight
§ Patient education; does patient understand treatment and agree with plan of care?
§ IV access route, patency, date of peripheral IV
· Peripheral IV should be < 24 hours old and preferably not in hand or wrist.
· Vesicant requires central line access.
o Locate reference materials available in chemotherapy cart on unit.
§ See Reference lists below and have available during practicum for use with case studies.
o Calculate BSA and drug doses, using case studies.
§ Each RN needs to independently demonstrate that she can calculate BSA and drug doses.
o Check original physician order with known protocols and pharmacy order.
§ RN should know how to find protocol.
o Coordinate delivery times with pharmacy for premedication and drug delivery.
§ Chemo should not be scheduled to be hung at change of shift. Call pharmacy if drugs need to be rescheduled.
§ Ensure you have enough time to complete appropriate double-checking of orders and medications, and have completed appropriate patient education before starting pre-medications.
o Identify aspects of & provide appropriate education for patient, staff, and family members before drug administration.
§ Treatment plan (it may be helpful to give some patients a copy of the protocol)
§ Drug information sheet from Micromedex on all drugs to be given, highlighting immediate reactions patient needs to report, and giving information regarding patient’s concerns, symptom management plan, possible side effects, and risks of treatment.
§ Other information pertaining to illness or treatment as patient desires.
§ Appropriate websites for patients to research information:
· National Cancer Institute: www.cancer.gov
· American Cancer Society: www.cancer.org
o Verify BSA, correct drug, dose, schedule and route with 2nd chemo-competent RN with physician order and delivered medication.
§ Use case study physician orders and dummy IV bags with patient & drug labels.
References available in Chemotherapy cart on MedSurg:
Chemotherapy and Biotherapy Guidelines and Recommendations for Practice, 3rd edition 2009, ONS.
Clinical Guide to Antineoplastic Therapy; A Chemotherapy Handbook 2nd edition 2007, ONS.
Regimen/Protocol books:
Guide to Selected Cancer Chemotherapy Regimens and Associated Adverse Events, Amgen.
The Elselvier Guide to Oncology Drugs and Regimens
Chapter 6, Chemotherapy Regimens (pp. 365-425) in Clinical Guide to Antineoplastic Therapy; A Chemotherapy Handbook 2nd edition 2007, ONS.
MCH policies:
MCH Vascular Access Guidelines
IV In-Line Filter Use Guidelines
Care and Use of Central Lines
Clearing Occluded Central Lines
Chemotherapy Administration
Chemotherapy Handling
Infiltration and Extravasation of IV Medications
Hazardous Material Management Program
Hazardous Materials Spill Procedure
II. Identify necessary actions during administration (105 minutes)
Tools: In addition to above, case studies, dummy labeled IV bags, IV pump, Spiros tubing, Personal Protective Equipment (PPE), Chemo waste disposal bucket, discussion with evaluator.
Goal: With 1-2 RNs, Evaluator will continue with case study, discussing identified venous access, chemotherapy drugs, how to administer (including proper setup of closed system IV tubing), what to monitor, and how to dispose of waste.
o Demonstrate patient identification and safe administration of vesicants and non-vesicants.
o Verbalize appropriate routes of administration.
o Identify aspects of appropriate education for patient, staff, and family members during drug administration.
o Verbalize considerations of adequacy of venous access, site selection, assessment, frequency of monitoring for blood return, and flushing between drugs.
o Demonstrate how to set up closed-system (Spiros) IV tubing and connectors.
o Demonstrate appropriate monitoring/observation for extravasation and specific acute drug effects, using case study.
o Verbalize appropriate action in the event of hypersensitivity reaction.
§ Define hypersensitivity reaction
o Verbalize appropriate action in the event of extravasation.
§ Define signs/symptoms of extravasation
§ Define potential harm to patient of extravasation
o Demonstrate safe practice and handling of drugs, wearing of PPE (Personal Protective Equipment), and verbalize appropriate management of spills.
o Verbalize proper disposal of chemotherapy waste and body fluids.
§ Define chemo spill
§ Define Chemo precautions for body fluid waste
§ Discuss appropriate disposal of soiled linens
§ Discuss appropriate disposal of PPE & tubing, syringes, etc.
III. Identify post-administration care (45 minutes)
Tools: As above, discussion with Evaluator.
Goal: With 1-2 RNs, Evaluator will continue with case study, discussing documentation and education, including appropriate handoff communication to following RN and patient/family education.
o Verbalize appropriate post-chemo assessment and care for venous access device.
o Document medication, education, and patient response.
o Identify aspects of appropriate patient education for patient, staff, and family members after drug administration (including RN handoff).
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