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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: 2 Date of Issue: November 2016 Review Date: November 2018 Authorised by: EMCN Chemotherapy Group Page Number: 1/12 Website: Check www.emsenate.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: 2 Date ................................. Date of Issue: November 2016 Review Date: November 2018 Authorised by: EMCN Chemotherapy Group Page Number: 2/12 Website: Check www.emsenate.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: 2 Date of Issue: November 2016 Review Date: November 2018 Authorised by: EMCN Chemotherapy Group Page Number: 3/12 Website: Check www.emsenate.nhs.uk for latest version Essential Reading – Chemotherapy Policies/Procedures/Guidelines 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 YES / NO / N/A TO TRUST (Delete as appropriate) YES / NO / N/A TO TRUST (Delete as appropriate) YES / NO / N/A TO TRUST (Delete as appropriate) YES / NO / N/A TO TRUST (Delete as appropriate) YES / NO / N/A TO TRUST (Delete as appropriate) YES / NO / N/A TO TRUST (Delete as appropriate) YES / NO / N/A TO TRUST (Delete as appropriate) YES / NO / N/A TO TRUST (Delete as appropriate) YES / NO / N/A TO TRUST (Delete as appropriate) YES / NO / N/A TO TRUST (Delete as appropriate) YES / NO / N/A TO TRUST (Delete as appropriate) YES / NO / N/A TO TRUST (Delete as appropriate) YES / NO / N/A TO TRUST (Delete as appropriate) YES / NO / N/A TO TRUST (Delete as appropriate) YES / NO / N/A TO TRUST (Delete as appropriate) I have read and understood the above documents: Document Code: EMCN-DC-0007-14 Written By: Andrew Feltham C Penn Issue No: 2 Date of Issue: November 2016 Review Date: November 2018 Authorised by: EMCN Chemotherapy Group Page Number: 4/12 Website: Check www.emsenate.nhs.uk for latest version Signed ..................................... Date............................. 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 Document Code: EMCN-DC-0007-14 Written By: Andrew Feltham C Penn Issue No: 2 Date of Issue: November 2016 Review Date: November 2018 Authorised by: EMCN Chemotherapy Group Page Number: 5/12 Website: Check www.emsenate.nhs.uk for latest version appropriate advice to patients (24hr contact etc) 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 Document Code: EMCN-DC-0007-14 Written By: Andrew Feltham C Penn Issue No: 2 Date of Issue: November 2016 Review Date: November 2018 Authorised by: EMCN Chemotherapy Group Page Number: 6/12 Website: Check www.emsenate.nhs.uk for latest version 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 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 Document Code: EMCN-DC-0007-14 Written By: Andrew Feltham C Penn Issue No: 2 Date of Issue: November 2016 Review Date: November 2018 Authorised by: EMCN Chemotherapy Group Page Number: 7/12 Website: Check www.emsenate.nhs.uk for latest version Identify the patient correctly by name and date of birth/first line of address Fully assess the patient holistically, using CTC scoring and 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 Document Code: EMCN-DC-0007-14 Written By: Andrew Feltham C Penn Issue No: 2 Date of Issue: November 2016 Review Date: November 2018 Authorised by: EMCN Chemotherapy Group Page Number: 8/12 Website: Check www.emsenate.nhs.uk for latest version 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 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 – Timing and Administration procedure Document Code: EMCN-DC-0007-14 Written By: Andrew Feltham C Penn Issue No: 2 Date of Issue: November 2016 Review Date: November 2018 Authorised by: EMCN Chemotherapy Group Page Number: 9/12 Website: Check www.emsenate.nhs.uk for latest version Storage of Oral Chemotherapy Handling Different sizes and strength of tablets Importance of contacting Unit/Ward – 24 hour contact numbers 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: Document Code: EMCN-DC-0007-14 Written By: Andrew Feltham C Penn Issue No: 2 Date of Issue: November 2016 Review Date: November 2018 Authorised by: EMCN Chemotherapy Group Page Number: 10/12 Website: Check www.emsenate.nhs.uk for latest version Signed by Assessor ................................. Print Name ................................................... Date .................................... If NOT fully competent to practice please give details below (To be completed by the Assessor ): Training/Education plan: Document Code: EMCN-DC-0007-14 Written By: Andrew Feltham C Penn Issue No: 2 Date of Issue: November 2016 Review Date: November 2018 Authorised by: EMCN Chemotherapy Group Page Number: 11/12 Website: Check www.emsenate.nhs.uk for latest version 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: 2 Date of Issue: November 2016 Review Date: November 2018 Authorised by: EMCN Chemotherapy Group Page Number: 12/12 Website: Check www.emsenate.nhs.uk for latest version