ASCO/ONS Chemotherapy Safety Standards Updated to Include All Delivery Settings

Martha Polovich, PhD, RN, AOCN

The chemotherapy safety standards developed by the American Society of Clinical Oncology and the Oncology Nursing Society (ASCO/ONS) were recently updated to reflect the fact that chemotherapy is delivered in a variety of settings. This and other updates were presented at the ONS 37th Annual Congress.

Martha Polovich, PhD, RN, AOCN, Oncology Clinical Nurse Specialist at Duke Oncology Network, Durham, North Carolina, is an author of the document. The standards were initially published in 2009 but were revised upon feedback from ONS members, mostly regarding limiting the standards to the outpatient setting.

In short, the standards now reflect the commitment to safety for all patients receiving chemotherapy, regardless of the treatment setting. The standards have also become a “living document” that will be regularly reviewed to incorporate changes that occur in the field, Polovich said.

“In 2009, the scope of the standards was outpatient adult chemotherapy, which seemed reasonable because the majority is given this way. But ONS members were asking whether these standards apply only in the outpatient setting. Of course, the answer is ‘no,’ so we needed to also promote the safety standards in all settings,” Polovich said.

“There are a few challenges with giving chemotherapy in the home care setting, nursing homes, and other settings where there are no oncology nurses, and it may be more difficult for some organizations to meet these standards, but that should be the goal,” she added.

Another change was the endorsement of chemotherapy safe handling precautions, which broadens the focus on safety to include providers, not just patients. “The safe handling of chemotherapy is an important issue that was not addressed in the original standards,” according to Polovich. “This is certainly an expectation we have in our practices.”

Other minor changes were also made to the standards:

• The standards now state that order verification should include cycle and day of treatment, and the expiration date on the drug label is required only when the drug is not intended for immediate use.
• Parts of the psychosocial assessment regarding referrals and resources were reworded.
• The informed consent section was reworded to reflect that informed consent may be a responsibility of a provider other than the physician.

Application of the Standards

Peggy Esper, MSN, MSA, ANP-BC, AOCN, nurse practitioner in Medical Oncology at the University of Michigan, Ann Arbor, said that implementing safety standards is one way of demonstrating an institution’s commitment to providing quality care.

She noted that multiple departments are involved in safe chemotherapy administration, and that organizational buy-in and support are important in implementing these standards.

A critical assessment of chemotherapy delivery in one’s facility is necessary, and any gaps in safety should be formally addressed with an action plan, she said.

“Take an honest look at your practice,” she suggested. “How are you doing right now? Where is there room for improvement? You should develop a quality improvement plan related to standards.”

An annual competency assessment for staff administering chemotherapy can uncover deficiencies. “It’s not a one-and-done thing,” she pointed out. “If you have career ladders, there are opportunities for your staff in this.”

In implementing the standards, expectations for practice change should be made clear, she continued. “Avoid being vague. Communicate to all involved clinicians,” she said. A timeline for implementation should be set, including a start date, implementation steps, and a deadline for compliance.

Audience response at the session indicated not only awareness but action in this area: 87% of attendees indicated that the ASCO/ONS chemotherapy safety standards were either being implemented at their institutions, or soon would be.

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