ASCO/ONS Chemotherapy Standards
Kris LeFebvre – Oncology Nursing Society, Pittsburgh, USA
Can you tell us about the history of the ASCO/ONS chemotherapy safety standards?
We started the process in 2008, it was a joint venture between the American Society of Clinical Oncology, which is ASCO, and the Oncology Nursing Society, which is ONS. We wanted to try to have guidelines for folks taking care of patients receiving chemotherapy to try to make sure that it was given as safely as it could possibly be given. We started the process by putting together a planning team and doing a literature review and finding out where the errors had occurred in the literature and to map out the process of giving chemotherapy. Then we pulled together a team of many different disciplines; we had physicians and nurses and pharmacists, social workers, patient advocates, hospital administrators. We had a big variety of folks and we really mapped out every single step of the way of giving chemo and then saw where the gaps were and where we wanted to make sure that we had a standard to cover for it. Then, after that, we made sure that things weren’t duplicated and edited them down and so forth until we ended up with our final 31 standards that were published in 2009.
We revised them after they had been in use for a couple of years. At the beginning of 2011 we looked at them again and saw where people had some questions; they had some trouble implementing them because it wasn’t really clear what the standard was saying and things like that. So in 2011 we clarified some things, put it out for public comment again and updated the standards then. But we found that when we did that in 2011 it became more and more clear that we really needed to look at oral chemotherapy because it’s being given so much more frequently and it’s out of the control of healthcare providers. So in 2012 we did that whole process again, pulling together all those different stakeholders, and we wrote the oral chemotherapy safety standards. Then we incorporated them into the existing standards and they are in the final stages now of getting approved by the boards of directors from both ASCO and ONS and then they’ll be released as soon as we have that information available.
What type of information is held within the guidelines?
The standards have several different sections and they’re set up according to the process of giving chemotherapy. So, for example, one section is knowing what the staff needs to have for education so anyone giving chemotherapy has a certain level of education or a preparation to give the drugs. Also what they need to know when they go to order a drug, so a physician would have to have, for example, the history and physical and an accurate diagnosis and so forth. The safety checks that need to be in place when a drug is mixed up or prepared for administration; the safety checks to be in place when the nurse gives the drug, also things to watch for when monitoring a patient afterwards. So every step of the way we’ve really looked at it closely to see where potential gaps are, where the patient could be at risk, and try to maintain a standard for that.
Are conferences like this useful in disseminating the work you’ve done?
It’s a really exciting opportunity because every country does things differently. The resources that are available in different countries is going to be different so what works in the US may not work in somebody’s particular region. So to talk about how the process was done so that they could do a similar process in their region that would work for their population, so hopefully the conference will be helpful with that.
Is it educational levels for all members who are involved in chemotherapy administration?
In a way, for example, in the States we require, or it is highly recommended, it’s in the standards, that the nurse giving chemotherapy is a registered nurse, not a licensed practical nurse or a technical nurse but a registered nurse. The folks who can order chemotherapy, it must be a physician or a physician assistant or a nurse practitioner who has been educated in chemotherapy. So that will hopefully restrict someone who doesn’t work in the field ,is not familiar with the drugs, to just write a quite prescription for an oral chemotherapy which could potentially be dangerous to a patient if they are not educated and know what needs to be included.
Are you able to see if these standards are implemented in other areas?
We have been in close touch with our members and the standards have also been incorporated into ASCO’s QOPI programme which is a quality programme where they certify outpatient oncology practices in the States and part of the ability to get certified is that you’re following those standards. We also poll or we’ve asked our nurses at ONS whether or not they’re using the standards and how difficult it is for them to implement them and what kind of barriers they’ve encountered and so forth.
What types of barriers have been identified?
Every practice is a little bit different so what they have at one practice might be different than another, even if they’re in a shared practice. So you may have a doctor that works with three or four different sites and each site is set up a little different: one might have an electronic record, one might have paper and so forth. We also have, of course, the challenges with communication with any healthcare team and trying to overcome those and getting everyone to be committed to making changes, because it’s so difficult to make changes in the healthcare field.