Safe Practice in the Administration of Chemotherapy to the Pediatric Population

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Safe Practice in the Administration of
Chemotherapy to the Pediatric Population

• Amy Vogel BSN, RN, CPON
• Hackensack University Medical Center

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Objectives

• Describe a method to safely transcribe
  chemotherapy orders
• Discuss methods to safely administer chemotherapy
• Apply a multidisciplinary approach to analyze
  potential areas for error including physicians
  (ordering), pharmacy (dispensing), and nursing
  (administering and monitoring)

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Background/History

• Chemotherapy drugs are high cost, high risk
• 6 or 7 years ago Hackensack University Medical
  Center (HUMC) performed a gap analysis re
  chemotherapy administration

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How did we get here?

• Took old process apart step by step
• Performed a process review and found areas where
  we needed improvement
• Multidisciplinary collaboration to improve our
  processes and arrive at our current policy

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Steps to Ensure Safety

• Preprinted order sets eliminate
• Unacceptable abbreviations or abbreviations for
  chemotherapy drugs
• Floating zeros (i.e. 2.0)
• Cross outs
• Orders will ALWAYS include
• Allergies
• Height and weight to allow for calculation of
  body surface area (BSA)

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Steps to Ensure Safety (Cont.)

• Protocols are kept
• Out-patient clinic
• Inpatient unit
• Pharmacy
• protocols are kept updated through our pediatric
  oncology research department

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The Process Double and Triple Checking

• ORDERING CHEMOTHERAPY 3 CHECKS
• Advanced Practice Nurse (APN) initially writes
  orders as per patient protocol
• Second APN verifies accuracy, dosage, legibility
  of the orders written
• Orders reviewed by attending physician and signed

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The Process (Cont.)

• TRANSCRIPTION 2 Checks
• Orders sent to inpatient unit and to pharmacy
• Chemotherapy certified nurse checks protocol
  verifying BSA, math, and dosage then transcribes
  orders onto a medication administration record
  (MAR)
• Order clarification if any is done at this step
• A second nurse performs a second check making
  sure the BSA, math, dosage, and transcription to
  MAR is accurate
• Both RNs must sign order sheets and MAR

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The Process (Cont.)

• ADMINISTRATION and MONITORING
• 2 RNs, utilizing the orders, verify BSA and math
  corresponding to the drug they are administering
• RNs verify information on bag/bottle label to
  written order
• Spelling patients name
• Medical record number
• Drug name, amount, and rate of infusion

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The Process (Cont.)

• ADMINISTRATION and MONITORING
• The verifying nurse must accompany primary nurse
  to the patients bedside
• Verify five rights
• Rate of infusion
• Pump settings
• Both RNs are responsible for signing the MAR

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Conclusion

• The Basis for improving our chemotherapy
  administration process is to help us at
  Hackensack University Medical Center achieve one
  of our most important patient safety goals
  Medication management from prescribing through
  dispensing to administration.

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Thank you!