Standards and Guidelines
The American Society of Clinical Oncology (ASCO) and ONS are conducting an ongoing collaborative project to use a rigorous, consensus-based process to develop standards for safe administration of chemotherapy. Current ASCO/ONS standards address safety of all routes of chemotherapy administration to adult patients in the outpatient setting and inpatient setting.
Statement on the Scope and Standards of Oncology Nursing Practice: Generalist and Advanced Practice addresses standards for both oncology registered nurses and oncology advanced practice nurses. Reflecting how practitioners at all levels of nursing practice are working together to transform healthcare, your new standards combines and updates Statement on the Scope and Standards of Advanced Practice Nursing in Oncology (Jacobs, 2003) and Statement on the Scope and Standards of Oncology Nursing Practice (Brant & Wickham, 2004).
View this 16-minute presentation to learn how chemotherapy doses are calculated.
Unlike radiation exposure, exposure to hazardous drugs cannot be measured with a badge or device. Instead, healthcare workers must strive to minimize exposure to these drugs. In addition to engineering controls, safer work practices, and the use of personal protective equipment (PPE), healthcare workers should be routinely monitored in a medical surveillance program. ONS, the Occupational Safety and Health Administration (OSHA), and the American Society of Health-System Pharmacists (ASHP) all have recommendations related to employee medical surveillance.
In "Neutropenia: State of the Knowledge," a two-part ONS white paper, the authors identify what currently is known and, importantly, not known about the most common dose-limiting toxicity of cancer chemotherapy: chemotherapy-induced neutropenia (CIN).
"Oncology Nurses' Use of National Comprehensive Cancer Network Clinical Practice Guidelines for Chemotherapy-Induced and Febrile Neutropenia," available as a journal article and podcast, summarizes findings from the first study to assess oncology nurses’ reported use of National Comprehensive Cancer Network clinical practice guidelines for chemotherapy-induced neutropenia (CIN) and febrile neutropenia (FN).
Nurses can minimize exposure to hazardous drugs with the use personal protective equipment and careful technique. Spill kits should be available wherever chemotherapy is located. Although they are commercially available, clinicians can assemble their own kits (American Society of Health-System Pharmacists, 2006). A hazardous drug spill kit should include the following contents.
Recommendations for what personal protective equipment (PPE) to wear when handling chemotherapy or contaminated materials are consistent across several groups, including the National Institute for Occupational Safety and Health (NIOSH), Occupational Safety and Health Administration (OSHA), American Public Health Association, and ONS. These recommendations don’t differentiate between high- and low-risk situations, as there is no known minimum safe exposure and always the potential for contamination.
If you are seeking resources related to determining nurse staffing in radiation oncology, the following organizations can help guide you. As part of its mission, the American College of Radiation Oncology (ACRO) has developed a Practice Accreditation Program, consisting of standards for radiation oncology. According to the Manual for ACRO Accreditation, general staffing recommendations call for 1 nurse per 200–300 new patients per year.
The American Nurses Association’s (ANA’s) Principles for Nurse Staffing is designed to address safe and sufficient nurse staffing across diverse healthcare settings and specialty areas, establishing criteria for evaluating the comprehensiveness of healthcare systems. The ANA development panel recognized that patient care needs are so complex and variable that relying on minimum staffing standards often does not reflect the reality of safe patient care.
There are currently no published standards for nurse-patient ratios in oncology settings. In fact, ONS has decided not to recommend staffing standards because of significant variations among institutions, patient populations, care settings, and individual patient needs.
Guidelines for the safe handling of hazardous wastes have existed for 20 years or more, but with nearly six million healthcare workers handling these wastes as of 2009, the importance of maintaining safety guidelines has never been greater.