Transcript Safe Practice in the Administration of Chemotherapy to the

Safe Practice in the
Administration of
Chemotherapy to the
Pediatric Population
Amy Vogel BSN, RN, CPON
Hackensack University Medical Center
Objectives
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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)
Background/History
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Chemotherapy drugs are high cost,
high risk
6 or 7 years ago Hackensack
University Medical Center (HUMC)
performed a gap analysis re:
chemotherapy administration
How did we get here?
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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
Steps to Ensure Safety
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Preprinted order sets eliminate
– Unacceptable abbreviations or abbreviations for
chemotherapy drugs
– Floating zeros (i.e. 2.0)
– Cross outs
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Orders will ALWAYS include:
– Allergies
– Height and weight to allow for calculation of
body surface area (BSA)
Steps to Ensure Safety
(Cont.)
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Protocols are kept:
– Out-patient clinic
– Inpatient unit
– Pharmacy
*protocols are kept updated through our pediatric oncology
research department*
The Process: Double and
Triple Checking
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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
The Process (Cont.)
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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*
The Process (Cont.)
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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 patient’s name
 Medical record number
 Drug name, amount, and rate of infusion
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The Process (Cont.)
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ADMINISTRATION and MONITORING
– The verifying nurse must accompany
primary nurse to the patient’s bedside
Verify “five rights”
 Rate of infusion
 Pump settings
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Both RNs are responsible for signing
the MAR
Conclusion
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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.
Thank you!