Open Access Article

American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards

Joseph O. Jacobson

Martha Polovich

Kristen McNiff

Kristine B. LeFebvre

Charmaine Cummings

Michele Galioto

Katherine R. Bonelli

Michele McCorkle

safe handling, chemotherapy
ONF 2009, 36(6), 651-658. DOI: 10.1188/09.ONF.651-658

Standardization of care can reduce the risk of errors, increase efficiency, and provide a framework for best practice. In 2008, the American Society of Clinical Oncology (ASCO) and the Oncology Nursing Society (ONS) invited a broad range of stakeholders to create a set of standards for the administration of chemotherapy to adult patients in the outpatient setting. At the close of a full-day structured workshop, 64 draft standards were proposed. After a formal process of electronic voting and conference calls, 29 draft standards were eliminated, resulting in a final list of 35 draft measures. The proposed set of standards was posted for 6 weeks of open public comment. Three hundred twenty-two comments were reviewed by the Steering Group and used as the basis for final editing to a final set of standards. The final list includes 31 standards encompassing seven domains, which include the following: review of clinical information and selection of a treatment regimen; treatment planning and informed consent; ordering of treatment; drug preparation; assessment of treatment compliance; administration and monitoring; assessment of response and toxicity monitoring. Adherence to ASCO and ONS standards for safe chemotherapy administration should be a goal of all providers of adult cancer care.

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    American Society of Clinical Oncology: Criteria for facilities and personnel for the administration of parenteral systemic antineoplastic therapy. J Clin Oncol 22:4613-4615, 2004
    Polovich M, White JM, Olsen, M (eds.): Chemotherapy and Biotherapy Guidelines and Recommendations for Practice (ed 3). Pittsburgh, PA, Oncology Nursing Society, 2009
    American Society of Health-System Pharmacists: ASHP guidelines on preventing medication errors with antineoplastic agents. Am J Health Syst Pharm 59:1648-1668, 2002
    Clinical Oncological Society of Australia: Guidelines for the Safe Prescribing, Dispensing and Administration of Cancer Chemotherapy.
    Bonnabry P, Cingria L, Ackermann M, et al: Use of a prospective risk analysis method to improve the safety of the cancer chemotherapy process. Int J Qual Health Care 18:9-16, 2006
    Ford CD, Killebrew J, Fugitt P, et al: Study of medication errors on a community hospital oncology ward. J Oncol Pract 2:149-154, 2006
    Womer RW, Tracy E, Soo-Hoo W, et al: Multidisciplinary systems approach to chemotherapy safety: Rebuilding processes and holding the gains. J Clin Oncol 20:4705-4712, 2002
    Schulmeister L: Preventing chemotherapy errors. Oncologist 11:463-468, 2006
    Schulmeister L: Ten simple strategies to prevent chemotherapy errors. Clin J Oncol Nurs 9:201-205, 2005
    Walsh KE, Dodd KS, Seetharaman K, et al: Medication errors among young adults and children with cancer in the outpatient setting. J Clin Oncol 27:891-896, 2009
    Gandhi TK, Bartel SB, Shulman LN, et al: Medication safety in the ambulatory chemotherapy setting. Cancer 104:2477-2483, 2005
    Goldspiel BR, DeChristoforo R, Daniels CE: A continuous-improvement approach for reducing the number of chemotherapy-related medication errors. Am J Health Syst Pharm 57:S4-S9, 2000 (suppl 4)
    Fischer DS, Alfano S, Knobf MT, et al: Improving the cancer chemotherapy use process. J Clin Oncol 14:3148-3155, 1996
    Shulman LN, Miller RS, Ambinder EP, et al: Principles of safe practice using an oncology EHR system for chemotherapy ordering, preparation, and administration, part 1 of 2. J Oncol Pract 4:203-206, 2008
    Shulman LN, Miller RS, Ambinder EP, et al: Principles of safe practice using an oncology EHR system for chemotherapy ordering, preparation, and administration, part 2 of 2. J Oncol Pract 4:254-257, 2008
    Weingart SN, Brown E, Bach PB, et al: NCCN Task Force Report: Oral chemotherapy. J Natl Compr Canc Netw 6:S1-14, 2008 (suppl 3)
    Patton J: Increased use of oral chemotherapy drugs spurs increased attention to patient compliance. J Oncol Pract 4:175-177, 2008
    Hartigan K: Patient education: The cornerstone of successful oral chemotherapy treatment. Clin J Oncol Nurs 7:21-24, 2003
    Moore S: Facilitating oral chemotherapy treatment and compliance through patient/family-focused education. Cancer Nurs 30:112-122, 2007
    Hollywood E, Semple D: Nursing strategies for patients on oral chemotherapy. Oncology 15:37-40, 2001
    Lee CR, Nicholson PW, Souhami RL, et al: Patient compliance with oral chemotherapy as assessed by a novel electronic technique. J Clin Oncol 10:1007-1013, 1992
    American Society of Health-System Pharmacists: ASHP guidelines on handling hazardous drugs. Am J Health Syst Pharm 63:1172-1193, 2006
    Birner AM, Bedell MK, Avery JT, et al: Program to support safe administration of oral chemotherapy. J Oncol Pract 2:5-6, 2006
    Birner AM: Safe administration of oral chemotherapy. Clin J Oncol Nurs 7:158-162, 2003
    Oncology Nursing Society: ONS Position Statement: Education of the RN Who Administers and Cares for the Individual Receiving Chemotherapy and Biotherapy, 2007.
    US Department of Labor Occupational Safety & Health Administration: OSHA Technical Manual: Controlling Occupational Exposure to Hazardous Drugs. Section VI: Chapter 2.
    The Joint Commission: National Patient Safety Goals: Disease Specific Care, 2009.
    Langhorne M, Fulton J, Otto S: Oncology Nursing (ed 4). St. Louis, MO, Mosby Elsevier, 2007
    National Quality Forum: Safe practices for better healthcare 2006 update.
    Institute of Medicine, National Research Council: Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. Washington, DC, National Academies Press, 2007
    Perry, M: The Chemotherapy Source Book (ed 4). Philadelphia, PA, Lippincott Williams & Wilkins, 2008
    Weingart SN, Brown E, Bach PB, et al: NCCN Task Force Report: Oral chemotherapy. J Natl Compr Canc Netw 6:S1-14, 2008 (suppl 3)
    Storm C, Casillas J, Grunwald H, et al: Informed consent for chemotherapy: ASCO member resources. J Oncol Pract 4:289-295, 2008
    American Society of Clinical Oncology: Statement regarding the use of outside services to prepare or administer chemotherapy drugs, 2004.
    The Institute for Safe Medication Practices: Principals of designing a medication label for community and mail order pharmacy prescription packages draft document, 2009.
    Partridge AH, Avorn J, Wang PS, et al: Adherence to therapy with oral antineoplastic agents. J Natl Cancer Inst 94:652-661, 2002
    James, BC: Intermountain Advanced Training Program in Healthcare Delivery Improvement, Salt Lake City, UT, 2008.…
    Pronovost P, Needham D, Berenholtz S, et al: An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 355:2725-2732, 2006