Which route of administration is commonly used to administer chemotherapeutic agents Quizlet

From Cancer Guidelines Wiki

Introduction

Cancer therapy and associated treatment can be administered by several routes including oral, intravenous infusion, intravenous bolus, intraventricular, subcutaneous and intradermal. Many of these routes require administration by an appropriately credentialed cancer nurse or an appropriately informed patient, where the medication is being self-administered. Administration via more specialised routes such as intrathecal and intraperitoneal may require a medical practitioner with specialist or surgical experience. There are a number of safety checks required to ensure safe administration of cancer therapy.

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Evidence Summary

Policies, procedures and equipment for safe administration and handling of cancer therapy must be easily accessible, understood and adhered to by all nurses involved in the administration of cancer therapy.[1][2][3][4]

Administering cancer treatment in an area that is suitable for the process and equipped to manage any reasonably foreseeable adverse events associated with the medication or route of administration is an essential part of medication safety. The environment should be free from unnecessary noise and activity. The patient conditions (e.g. seating, lighting) should enable the patient to comfortably receive therapy and encourage easy communication with nursing staff.

The availability of local procedures, medical assistance and medications to manage any complications that may arise during administration ensure adverse events are managed appropriately and in a timely manner.

Administration of cancer therapy by the wrong route can result in serious or fatal consequences.[5][6][7][8]

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Recommendations

Consensus-based recommendation
Which route of administration is commonly used to administer chemotherapeutic agents Quizlet

The chemotherapy, targeted therapy and related medications must be checked at the point of administration by two registered nurses with the appropriate training and skills. All dosage and administration rate-related calculations should be independently verified (White et al, 2010a; White et al, 2010b).


At least one staff member with current, age appropriate training in basic life support should be present during chemotherapy administration (Neuss et al, 2017; Belderson and Billett, 2017).


Only healthcare professionals who have obtained competence in the administration of cancer therapy by the specific administration route should administer cancer therapy via that route.


Cancer therapy should be administered in an area that is equipped to manage any reasonably foreseeable adverse events that may be associated with the medication or route of administration.


Local occupational health and safety workplace guidelines must be followed when handling hazardous medications (NIOSH, 2014; Clinical Oncology Society of Australia and Cancer Pharmacists Group of Australia, 2013).


Policies and procedures for safe medication administration, management of extravasation and emergency procedure protocols must be followed when administering cancer therapy (Polovich et al, 2014; Goldspiel et al, 2015a).


All administrations, observations and actions related to the patient during administration must be documented in the patient’s healthcare records including vital signs, adverse events and patient reported concerns (Polovich et al, 2014). The entry must be made at the time and point of delivery of patient care and be signed and dated.


Nursing staff involved in the administration of therapy in the home should ensure that appropriate procedures are in place to manage any complications and be able to access medical assistance and medications for the management of an adverse event (Evans et al, 2016). Procedures must maximise patient safety and minimise the risk of errors.

(White et al, 2010a)[9] ;(White et al, 2010b)[10] ;(Neuss et al, 2017)[2] ;(Belderson and Billett, 2017)[11] ;(NIOSH, 2014)[12] ;(Clinical Oncology Society of Australia and Cancer Pharmacists Group of Australia, 2013)[13] ;(Polovich et al, 2014)[1] ;(Goldspiel et al, 2015a)[14] ;(Evans et al, 2016)[15]

Practice point
Which route of administration is commonly used to administer chemotherapeutic agents Quizlet

Administration of cancer treatments closer to home for people with cancer from rural and remote locations is currently being implemented in some Australian states (Sabesan et al, 2012; Clinical Oncology Society of Australia, 2015; SA Cancer Clinical Network Steering Committee, 2010). Under these service models nursing staff should ensure that procedures for administration are followed that maximise patient safety and minimise the risk of errors.


Preparations for parenteral administration must be checked for leaks, precipitation or any other visual signs of problems with the solution. Seek advice from the providing Pharmacist if any concerns or if advice is required.

(Sabesan et al, 2012)[16] ;(Clinical Oncology Society of Australia, 2015)[17] ;(SA Cancer Clinical Network Steering Committee, 2010)[18]

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Tables

Table 16: Administration of cancer therapy by specified routes

ADMINISTRATION VIA THE INTRAVENOUS ROUTE

[1][4][14][19][20]

  • For all prolonged infusions and vesicant medications a Central Venous Access Device (CVAD) is the preferred route of administration.
  • Intravenous chemotherapy and targeted therapy should be administered during operational hours where possible to ensure appropriately trained medical staff are available to assist in an emergency. For protocols with complex scheduling times (e.g. cytarabine given every 12 hours) this may not always be possible and consideration must be given to the timing and minimising risk.
  • Intravenous lines must not be primed with cytotoxic chemotherapy or monoclonal therapy unless specific instructions are given or a risk assessment has been conducted.
  • The nurse should be aware of the risk of extravasation and be able to identify which medications are vesicants or irritants. Staff must be able to manage an extravasation according to local procedure.
  • The nurse should be aware of the risk of hypersensitivity reactions, be able to identify which medications have potential for these reactions and be able to manage them according to local procedure.
  • All therapy must be given according to the sequencing of the protocol where stated or according to local administration policy.
  • Programming for infusion pumps should be independently checked by a second competent nurse to include calculation of infusion rates. Care must be taken to ensure the rate is correctly set according to the time span (i.e. mLs/h or mLs/24 h). The use of error reduction software or smart pumps should be considered.[21][22]
  • The rate of infusions should be checked at the initiation of the infusion, periodically throughout the infusion and when a new nurse takes over the care of the patient. Due attention should be given to the Clinical Handover process.[23]
  • After administration the intravenous line must be flushed with a sufficient volume of compatible fluid to ensure the medication is cleared from the line.
ADMINISTRATION VIA THE INTRAMUSCULAR AND SUBCUTANEOUS ROUTE

[1][4][19][14][20][24]

  • Where appropriate, checks and cautions that apply to intravenous administration also apply to the intramuscular and subcutaneous route.
  • Intramuscular injections are administered deep into the muscle.
  • Subcutaneous injections are administered through the epidermal and dermal layers into the subcutaneous tissue.
  • Injections sites may need to be rotated if multiple injections are needed.
ADMINISTRATION VIA THE INTRATHECAL ROUTE

[8][25][26]

  • Where appropriate, checks and cautions that apply to intravenous administration also apply to the intrathecal route.
  • All staff responsible for administering intrathecal chemotherapy (including checking of intrathecal chemotherapy) should be aware of the catastrophic outcomes associated with errors in administering incorrect chemotherapy medications via the intrathecal route.
  • All staff involved in administering intrathecal therapy should undergo appropriate training and be assessed as competent to perform their roles and responsibilities regarding intrathecal therapy.
  • A register of staff designated as competent to administer intrathecal therapy for cancer should be maintained and accessible across the institution. Only staff listed on the register should undertake the task.
  • Staff administering intrathecal medication must use checking procedures that include a “Time Out” involving at least two health professionals. “Time Out” is a final patient safety check undertaken immediately before commencing the treatment. This should be carried out without interruption.[19]

Note: Further recommendations on intrathecal cancer therapy are provided under the General Information section of these guidelines.

ADMINISTRATION VIA THE ORAL ROUTE

[3][19][27][28][29][30]

  • Where appropriate, checks and cautions that apply to intravenous administration also apply to the oral route.
  • Oral cancer medications carry the same risks in terms of toxicity and risk of medication errors as therapy administered by other routes.
  • Ensure that the patient can swallow the medication and there are no risk factors for aspiration.
  • Oral cytotoxic and targeted therapy tablets and capsules should not be crushed. Crushing tablets and opening capsules carries both exposure risks and changes to bioavailability. If a patient is unable to swallow or medication is being administering via a PEG tube or nasogastric tube, contact the pharmacist for advice on alternative dose formulations. The Society of Hospital Pharmacists also provide a resource with advice on crushing medications.[31]
  • Oral cancer therapy should be administered using the “non touch technique”. Uncoated tablets and liquid formulations should be administered using full personal protective equipment.
  • If an antiemetic is required then this should be administered not less than 30 minutes prior to, and not more than 90 minutes before the administration of oral therapy unless instructed otherwise in the protocol.
  • If the patient experiences emesis immediately after ingestion of an oral cancer therapy agent a further dose must not be administered. Inform the treating medical officer of the episode for further guidance.
  • Where oral cancer therapy is administered outside the hospital setting by the patient or their carer, ensure that appropriate education has been provided (verbal and written) and follow up appointments have been scheduled.
  • Targeted therapies are not considered cytotoxic but should be handled with caution. Immunomodulatory medicines (IMiDs) e.g. thalidomide, lenalidomide, pomalidomide are teratogenic and must be handled with caution by pregnant staff.

Note: Further recommendations on oral cancer therapy are provided under the General Information section of these guidelines.

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References

  1. ↑ 1.0 1.1 1.2 1.3 Polovich M, Olsen M and LeFevre KB. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice (Fourth Edition). Pittsburg: Oncology Nursing Society; 2014.
  2. ↑ 2.0 2.1 Neuss MN, Gilmore TR, Belderson KM, Billett AL, Conti-Kalchik T, Harvet BE, et al. 2016 Updated American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards, Including Standards for Pediatric Oncology. Oncol Nurs Forum 2017 Jan 6;44(1):31-43 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28067033.
  3. ↑ 3.0 3.1 Carrington C, Stone L, Koczwara B, Searle C, Siderov J, Stevenson B, et al. The Clinical Oncological Society of Australia (COSA) guidelines for the safe prescribing, dispensing and administration of cancer chemotherapy. Asia Pac J Clin Oncol 2010 Sep;6(3):220-37 Available from: http://www.ncbi.nlm.nih.gov/pubmed/20887505.
  4. ↑ 4.0 4.1 4.2 Cancer Institute NSW. eviQ Cancer Treatments Online. [homepage on the internet]; [cited 2016 Sep]. Available from: https://www.eviq.org.au.
  5. Gilbar PJ, Seger AC. Accidental intrathecal administration of bortezomib: preventing fatalities. Asia Pac J Clin Oncol 2013 Sep;9(3):290-1 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23176407.
  6. Goldspiel BR, DeChristoforo R, Hoffman JM. Preventing chemotherapy errors: updating guidelines to meet new challenges. Am J Health Syst Pharm 2015 Apr 15;72(8):668-9 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25825190.
  7. Schulmeister L. Preventing chemotherapy errors. Oncologist 2006 May;11(5):463-8 Available from: http://www.ncbi.nlm.nih.gov/pubmed/16720846.
  8. ↑ 8.0 8.1 Department of Health UK (Chief Medical Officer). Health Service Circular HSC 2008/001: Updated national guidance on the safe administration of intrathecal chemotherapy.; 2008 [cited 2016 Sep] Available from: http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_086844.pdf.
  9. White RE, Bourrier V, Dobish R, Easty AC. Improving the safety of ambulatory intravenous chemotherapy in Canada. Canadian Journal of Hospital Pharmacy 2010;63(1):80-1.
  10. White RE, Trbovich PL, Easty AC, Savage P, Trip K, Hyland S. Checking it twice: an evaluation of checklists for detecting medication errors at the bedside using a chemotherapy model. Qual Saf Health Care 2010 Dec;19(6):562-7 Available from: http://www.ncbi.nlm.nih.gov/pubmed/20724398.
  11. Belderson KM, Billett AL. Chemotherapy safety standards: A pediatric perspective. Pediatr Blood Cancer 2017 Jun;64(6) Available from: http://www.ncbi.nlm.nih.gov/pubmed/28306217.
  12. NIOSH. By Connor TH, MacKenzie BA, DeBord DG, Trout DB, O’Callaghan JP. NIOSH list of antineoplastic and other hazardous drugs in healthcare settings 2014. Publication No. 2014-138 (Supersedes 2012-150). Cincinnati, OH: US Department of Health and Human Services (DHHS), Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health (NIOSH); 2014 [cited 2016 Sep] Available from: http://www.cdc.gov/niosh/docs/2014-138/pdfs/2014-138.pdf.
  13. Clinical Oncology Society of Australia and Cancer Pharmacists Group of Australia. Position Statement: Safe handling of monoclonal antibodies in healthcare settings.; 2013 [cited 2016 Sep] Available from: https://www.cosa.org.au/media/173517/cosa-cpg-handling-mabs-position-statement_-november-2013_final.pdf.
  14. ↑ 14.0 14.1 14.2 Goldspiel B, Hoffman JM, Griffith NL, Goodin S, DeChristoforo R, Montello CM, et al. ASHP guidelines on preventing medication errors with chemotherapy and biotherapy. Am J Health Syst Pharm 2015 Apr 15;72(8):e6-e35 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25825193.
  15. Evans JM, Qiu M, MacKinnon M, Green E, Peterson K, Kaizer L. A multi-method review of home-based chemotherapy. Eur J Cancer Care (Engl) 2016 Sep;25(5):883-902 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26545409.
  16. Sabesan S, Larkins S, Evans R, Varma S, Andrews A, Beuttner P, et al. Telemedicine for rural cancer care in North Queensland: bringing cancer care home. Aust J Rural Health 2012 Oct;20(5):259-64 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22998200.
  17. COSA Teleoncology Guidelines Working Group. Clinical practice guidelines for teleoncology. [homepage on the internet] Sydney: Cancer Council Australia; Available from: http://wiki.cancer.org.au/australia/COSA:Teleoncology.
  18. South Australian Cancer Clinical Network Steering Committee. Standards for Chemotherapy Services in South Australia.; 2010 [cited 2017 May] Available from: http://www.sahealth.sa.gov.au/wps/wcm/connect/89ec480045a68ae78fdeaf9f9859b7b1/Standards+for+Chemotherapy+Services+in+South+Australia+January+2011.pdf?MOD=AJPERES&CACHEID=89ec480045a68ae78fdeaf9f9859b7b1.
  19. ↑ 19.0 19.1 19.2 19.3 Cancer Institute NSW. eviQ Cancer Education Online. [homepage on the internet]; Available from: https://education.eviq.org.au/.
  20. ↑ 20.0 20.1 The National Cancer Nursing Education Project (EdCaN). A national professional development framework for cancer nursing.; 2009 Available from: http://edcan.org.au/assets/edcan/files/docs/EdCanWeb_2nded.pdf.
  21. Fluorouracil: dosing errors with infusion pumps. Prescrire Int 2014 Oct;23(153):242 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25969854.
  22. Institute for Safe Medication Practices. ISMP Safety alert: Fluorouracil error ends tragically, but application of lessons learned will save lives. [homepage on the internet]; 2007 Sep 20 Available from: http://www.ismp.org/newsletters/acutecare/articles/20070920.asp.
  23. Australian Commission on Safety and Quality in Health Care. National Safety and Quality Health Service (NSQHS) Standard 6: Clinical Handover. [homepage on the internet]; 2007 [cited 2016 Sep]. Available from: https://www.safetyandquality.gov.au/our-work/clinical-communications/clinical-handover/.
  24. Schulmeister L. Preventing vincristine administration errors: Does evidence support minibag infusions? Clin J Oncol Nurs 2006 Apr;10(2):271-3 Available from: http://www.ncbi.nlm.nih.gov/pubmed/16708708.
  25. Noble DJ, Donaldson LJ. The quest to eliminate intrathecal vincristine errors: a 40-year journey. Qual Saf Health Care 2010 Aug;19(4):323-6 Available from: http://www.ncbi.nlm.nih.gov/pubmed/20211962.
  26. Marliot G, Le Rhun E, Sakji I, Bonneterre J, Cazin JL. Securing the circuit of intrathecally administered cancer drugs: example of a collective approach. J Oncol Pharm Pract 2011 Sep;17(3):252-9 Available from: http://www.ncbi.nlm.nih.gov/pubmed/20525750.
  27. Lester J. Safe handling and administration considerations of oral anticancer agents in the clinical and home setting. Clin J Oncol Nurs 2012 Dec;16(6):E192-7 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23178361.
  28. Carrington C. Oral targeted therapy for cancer. Aust Prescr 2015 Oct;38(5):171-6 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26648656.
  29. Carrington C. Safe use of oral cytotoxic medicines. Australian Prescriber 2013;36(1):9-12.
  30. NHS National Patient Safety Agency UK. Rapid Response Report (NPSA/2008/RRR001). Risks of incorrect dosing of oral anti-cancer medicines. [homepage on the internet]; 2008 Jan 22 [cited 2016 Sep]. Available from: http://www.nrls.npsa.nhs.uk/resources/?entryid45=59880.
  31. Society of Hospital Pharmacists of Australia. Don't Rush to Crush. 2nd edition; 2015.

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Which route of administration is commonly used to administer chemotherapeutic agents?

Intravenous. The intravenous (IV) route is a common way of giving medicine, especially chemotherapy, directly into a vein.

What route of drug administration is the most commonly used for drug therapy?

The oral route is the most common route for drug administration. It is the most preferred route, due to its advantages, such as non-invasiveness, patient compliance and convenience of drug administration.

What are the routes of medication administration quizlet?

Terms in this set (23).
Oral. The oral route is the easiest and the most commonly used route. ... .
Sublingual. Some medications are readily absorbed after being placed under the tongue to dissolve. ... .
Buccal. ... .
Parenteral Routes. ... .
Advanced Body Cavity Injection Sites. ... .
Epidural. ... .
Intrathecal. ... .
Intraosseous..

What is the most frequent route of administration?

Oral administration This is the most frequently used route of drug administration and is the most convenient and economic. Solid dose forms such as tablets and capsules have a high degree of drug stability and provide accurate dosage.