Download Chemotherapy Assessment - East Midlands Cancer Network

East Midlands Strategic Clinical Network
Annual Peer Assessment for the
Administration of Cytotoxic Chemotherapy
- NURSING
Name:
Mentor:
Clinical Area:
Document Code: EMCN-DC-0007-14
Written By: Andrew Feltham C Penn
Issue No: 1
Date of Issue: July 2014
Review Date: July 2016
Authorised by: EMCN Chemotherapy Group
Page Number: 1/11
Website: Check www.eastmidlandscancernetwork.nhs.uk for latest version
Introduction
It is essential that competency in the safe administration of Cytotoxic drugs is maintained and assessed annually in line with Local,
Network and National Directives. This is included as part of the Annual Appraisal process and Cancer Peer Review.
Guidance notes for completion
Demonstration of competency is part of your professional accountability for practice. Evidence must be documented within your
professional portfolio. This document is therefore your record of annual competency in these skills and you should keep it in a safe
place and be able to produce this record on request of your employer. This does not replace any initial chemotherapy training that you
have had and can be reviewed by your line manager or Lead Chemotherapy Nurse should any issues arise.
This Annual Competency assessment can only be carried out by individuals or colleagues who have been identified by your line
manager/Lead chemotherapy nurse as competent to do so.
If at any point during this assessment either you or your assessor feels that you require further training or education then your line
manager should be informed and this should be identified in your KSF appraisal.
A copy of this document will need to be given to your line manager/Lead chemotherapy nurse.
I have read and understood the above:
Signed ..............................................
Document Code: EMCN-DC-0007-14
Written By: Andrew Feltham C Penn
Issue No: 1
Date .................................
Date of Issue: July 2014
Review Date: July 2016
Authorised by: EMCN Chemotherapy Group
Page Number: 2/11
Website: Check www.eastmidlandscancernetwork.nhs.uk for latest version
Guidelines for Assessors
This document is a record of annual competency in the safe administration of cytotoxic chemotherapy. As the assessor you MUST
observe and assess competency in both IV and Oral administration of chemotherapy. You may choose to assess individual IV and Oral
regimes, or alternatively you could choose to assess an IV/Oral combination chemotherapy regime which would be sufficient.
 The assessor MUST have permission from the Lead Chemotherapy Nurse to undertake this annual assessment
 The assessor must be competent in the skill for which they are assessing and must have carried out this skill competently for a
minimum of six months after their own initial training and competency assessment
 The assessor must have undertaken education in the role of an assessor
 WHEN YOU ARE SIGNING A COMPETENCY PEER ASSESSMENT, YOU ARE ACCOUNTABLE FOR YOUR DECISION AND ARE
SIGNIFYING THAT YOU HAVE OBSERVED THAT MEMBER OF STAFF PERFORMING THE SKILL AND THAT THEY HAVE SHOWN TO
HAVE A SOUND KNOWLEDGE AND SKILL BASE IN LINE WITH UP-TO-DATE EVIDENCE BASED PRACTICE.
I have read and understood the above as the assessor: Signed……………………………………………….Print Name………………………………….
Document Code: EMCN-DC-0007-14
Written By: Andrew Feltham C Penn
Issue No: 1
Date of Issue: July 2014
Review Date: July 2016
Authorised by: EMCN Chemotherapy Group
Page Number: 3/11
Website: Check www.eastmidlandscancernetwork.nhs.uk for latest version
Essential Reading – Chemotherapy Policies/Procedures/Guidelines
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Cytotoxic policy
Extravasation policy
Cytotoxic Spillage procedure
Intrathecal policy and National Guidance
Anti-emetic/Stomatitis/Management of Diarrhoea
Intravenous therapy
Venepuncture & Cannulation
Anaphylaxis policy
Care of Central Venous Access Device (CVAD) policy
Aseptic Non-Touch Technique protocol
Neutropenic Sepsis Policy
Guidelines for use of GCSF
Oral anti-cancer medicines handbook
Scalp Cooling Policy
Anti Emetic Policy
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I have read and understood the above documents:
Signed .....................................
Document Code: EMCN-DC-0007-14
Written By: Andrew Feltham C Penn
Issue No: 1
Date.............................
Date of Issue: July 2014
Review Date: July 2016
Authorised by: EMCN Chemotherapy Group
Page Number: 4/11
Website: Check www.eastmidlandscancernetwork.nhs.uk for latest version
THEORETICAL KNOWLEDGE
Signed (Assessor)
ASSESSMENT TYPE – DISCUSSION /
OBSERVATION / THEORY - COMMENTS
The action of chemotherapy
Which individuals are authorised to prescribe cytotoxic
chemotherapy
Which individuals are authorised to administer cytotoxic
chemotherapy
The relevance of clinical results (i.e.
FBC/U&E’s/Cr/LFT’s/CrCl/ECG/Echo etc)
Chemotherapy Dosing – including all drug calculations (Surface
Area , AUC etc)
The main side effects of chemotherapy and how these are
managed
Assessment of patients using Common Toxicity Criteria (CTC),
Performance Status and instances when Chemotherapy should
be withheld
How to identify potential Neutropenic Sepsis and give
appropriate advice to patients (24hr contact etc)
Document Code: EMCN-DC-0007-14
Written By: Andrew Feltham C Penn
Issue No: 1
Date of Issue: July 2014
Review Date: July 2016
Authorised by: EMCN Chemotherapy Group
Page Number: 5/11
Website: Check www.eastmidlandscancernetwork.nhs.uk for latest version
The procedure and policy for the admission and treatment of
Unwell/potential Neutropenic Sepsis patients
The correct safety procedures to protect self, colleagues and
patients: Chemotherapy storage, administration and waste
disposal and why these procedures are necessary
The different routes of chemotherapy drug administration and
specific safety procedures for each individual route
The correct procedure in the event of a cytotoxic
chemotherapy spillage
EXTRAVASATION –
 The signs and symptoms of extravasation
 How to prevent/reduce incidence of extravasation
 Discuss vein selection and rationale for this
 The classification of cytotoxic drugs
 The correct action to be taken in event of an
extravasation and why
HYPERSENSITIVITY –
 Which anti-cancer drugs are most likely to cause
hypersensitivity?
 The signs and symptoms of hypersensitivity reaction
 The action to be taken in the event of a hypersensitivity
reaction
Document Code: EMCN-DC-0007-14
Written By: Andrew Feltham C Penn
Issue No: 1
Date of Issue: July 2014
Review Date: July 2016
Authorised by: EMCN Chemotherapy Group
Page Number: 6/11
Website: Check www.eastmidlandscancernetwork.nhs.uk for latest version
PRACTICAL KNOWLEDGE
Read and check patient notes/database for review outcomes
and recent activity
Check that patient has been reviewed as per Dr request and
according to treatment plan
Demonstrates knowledge of schedule of treatment and
appropriate pre-treatment investigations have been carried out
and checked
Correctly states both immediate and delayed potential side
effects of the drugs being administered
Verifies that informed consent has been obtained
Identify the patient correctly by name and date of birth/first
line of address
Fully assess the patient holistically, using CTC scoring and
Document Code: EMCN-DC-0007-14
Written By: Andrew Feltham C Penn
Issue No: 1
Date of Issue: July 2014
Review Date: July 2016
Authorised by: EMCN Chemotherapy Group
Page Number: 7/11
Website: Check www.eastmidlandscancernetwork.nhs.uk for latest version
performance status. Take appropriate action as a result of
identifying side effects/symptoms/issues
Meet the patients information and education needs and give
opportunity for, and subsequently answer, both patient and
carers questions appropriately
Check all drug details against prescription chart/treatment
(including drug calculations and blood results) and follow up
any errors
Informs the patient and/or carer about potential drug reactions
and whom to report them to immediately
Demonstrate safe and correct handling of cytotoxic drugs
Protective clothing worn appropriately and rationale stated and
understood
Decontaminate hands correctly and administer drugs using
aseptic non-touch technique (ANTT)
Cannulation procedure performed safely and effectively with
regard to site selection, previous trauma, drug to be
administered and patient preference
Administer drugs in appropriate order and at correct rate
Correctly observes for vein patency on cannulation and at
appropriate periods throughout drug administration
Document Code: EMCN-DC-0007-14
Written By: Andrew Feltham C Penn
Issue No: 1
Date of Issue: July 2014
Review Date: July 2016
Authorised by: EMCN Chemotherapy Group
Page Number: 8/11
Website: Check www.eastmidlandscancernetwork.nhs.uk for latest version
Ensure comfort and safety of patient throughout
Disposes of cytotoxic waste safely and correctly as per policy
Rebook patient for next treatment/investigations/clinic
appointments/blood tests etc
Document administration/full procedure on the
prescription/medical notes/nursing notes
Uses effective communication skills throughout
Performs correct procedure for storing, issuing and dispensing
TTO/ TTA’s
Communicate effectively to the patient –
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Timing and Administration procedure
Storage of Oral Chemotherapy
Handling
Different sizes and strength of tablets
Importance of contacting Unit/Ward – 24 hour contact
numbers
Document Code: EMCN-DC-0007-14
Written By: Andrew Feltham C Penn
Issue No: 1
Date of Issue: July 2014
Review Date: July 2016
Authorised by: EMCN Chemotherapy Group
Page Number: 9/11
Website: Check www.eastmidlandscancernetwork.nhs.uk for latest version
Annual Competency Assessment for the Administration of Cytotoxic Chemotherapy
Name:
Date Assessed:
Annual Review Date:
Fully Competent to Practice (please circle):
YES
NO
(if NO go to page 11)
Comments:
Signed by Assessor .................................
Print Name ................................................... Date ....................................
Document Code: EMCN-DC-0007-14
Date of Issue: July 2014
Review Date: July 2016
Authorised by: EMCN Chemotherapy Group
Page Number: 10/11
Written By: Andrew Feltham C Penn
Issue No: 1
Website: Check www.eastmidlandscancernetwork.nhs.uk for latest version
If NOT fully competent to practice please give details below (To be completed by the Assessor ):
Training/Education plan:
Date of Re-assessment:
Signed by Assessor ............................................. Signed by Learner ............................................. Date ..........................................
Document Code: EMCN-DC-0007-14
Written By: Andrew Feltham C Penn
Issue No: 1
Date of Issue: July 2014
Review Date: July 2016
Authorised by: EMCN Chemotherapy Group
Page Number: 11/11
Website: Check www.eastmidlandscancernetwork.nhs.uk for latest version