New guidelines set benchmark for chemotherapy

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The Chemotherapy Administration Guidelines was compiled by members of the Independent Clinical Oncology Network (ICON) in consultation with oncologists and cancer experts from around the world. to address a significant gap in local cancer care protocol. The resource, which is a first for South Africa, will be released this month.

To date, there has been no single resource document in South Africa, and perhaps the world, that addresses best practice at all three levels of chemotherapy administration: the oncologists who prescribe the medication, the pharmacists who dispense it, and the nurses who administer it, says Dr David Eedes, clinical oncology advisor for ICON.

Administration errors

Because of the ever-increasing complexity of cancer treatments, and the fact that chemotherapy is potentially toxic if rigorous safety standards for both healthcare workers and patients are not followed, this initiative by ICON is long overdue, says Eedes. “Chemotherapy is a particularly specialised form of medical treatment,” he explains.

Chemotherapy administration errors are a worldwide issue. Medical errors in general rank third amongst the most common causes of death in the United States, and a 2013 study on chemotherapy found a error rate of over 30% in a sample of handwritten orders, while a study conducted in Turkey found that 83% of nurses reported one or more errors during chemotherapy preparation and administration. Other research by the National Centre for Biotechnology Information reported a lower rate, but a wider range of errors; from under-and over-dosing to giving chemotherapy to the wrong patients.

“Whatever the true statistics for errors are, we believe that by following well documented protocols by each discipline involved in this complex process, and ensuring good communication between the different groups of professionals managing cancer patients, this will reduce the risk for errors and also enhance the experience for professional and patient alike,” says Eedes.

Improving standards and reducing costs

The ICON network is dedicated to providing cost-effective cancer treatment based on the latest evidence for the mutual benefit of patients, healthcare providers and funders. But, says Eedes, “ICON is not just about trying to cut costs, but also about improving standards of care for our patients and the quality of the working environment for staff. It’s not only clinical protocols and formularies – we look carefully at the quality of care given to patients. Good clinical management is central to what we do.”

He explains that the decision to draw up the chemotherapy administration guidelines came from the discovery of an unmet need while doing a routine audit of ICON’s chemotherapy and radiation practices.

“During these inspection visits, the chemotherapy personnel requested assistance in their day-to -day work in the form of standardised chemotherapy processes for all chemotherapy practices,” says Sister Belinda Bailey, a specialist nurse with extensive experience in chemotherapy administration, who was instrumental in developing the guidelines.

Role of the chemotherapy nurse

The central involvement of the chemotherapy nurses in developing these practical guidelines is critical, says Eedes. In South Africa, as in most parts of the world, it is the chemotherapy nurses who play the central role in this process. It is the nurses, believes Bailey, who are key in reducing administration and other errors, so improving outcomes and safety standards. The new guidelines, she says, will help them do their jobs better by providing them easy access to important, updated information.

Staff competencies and staff safety are some of the important chapters in these guidelines. “The more competent and focused a chemotherapy nurse is, the more unlikely it is that errors will be made,” says Eedes. This is particularly crucial in some of the smaller medical practices where there is a small staff complement requiring the chemotherapy nurse to fill multiple roles - mixing and dispensing the medication and informing the patient. “If they are not adequately trained or supported this is a recipe for serious errors."

The finalised guidelines, will initially be released among the ICON clinical network, but later be made more broadly available to chemotherapy practices in general.

“It’s an exciting project,” says Eedes. “Our aim is to improve the overall standards of chemotherapy administration in South Africa and so serve our cancer patients better.”