is it safe to mix your own chemo in an outpatient oncology setting?

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    Hi, I am a new graduate who has been working in an outpatient hematology/oncology setting for the past 7 months. I am just wondering on how some of my jobs practices compare to other outpatient facilities. I am not oncology certified, I do not have enough hours to qualify for the test yet, nor am I chemo certified. I know to work in a hospital you would be chemo certified through them, but I am not sure how to do this on my own. I am responsible for mixing my own meds, which I administer without a pump…. when I first started and asked about why they don't use pumps, they said that they used to use them but they had more infiltrates that way. The meds are mixed under a hood, using gloves and a gown. The only time a dose is second checked by another nurse is when it is a 5-fu pump that will be going home with a patient (of course I can always ask another nurse if I am unsure about my calculations, or just have a question, but it is not required). I am wondering if this is how it is done in other facilities? Is what I am doing completely unsafe, and out of my scope? I feel like I may be being taken advantage of, given my inexperience by 1. how under compensated I am being, and 2. tasks that I am doing that maybe I shouldn't be. I don't feel that I am doing anything that I am uncomfortable with, but am I so new that I don't even know what I shouldn't be doing (if that makes sense)? I do work with several OCN nurses, and I feel like I am guided and have good resources with working with them. This all started because I went on an interview (I am desperately trying to find a hospital job with 12 hour shifts) and the nurse manager told me that she thinks what I am doing is dangerous… so my question to all my fellow nurses is, am I being dangerous and I don't even know it???
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  5. 0
    Interested in responses. Following.
  6. 3
    You can, and should, get your chemo provider card (it is not a certification) through ONS. (www.ons.org) I think your situation is a case of "You don't know what you don't know." If you take the chemo provider course, you'll find out there's a lot to know about chemotherapy and administering meds.

    Where I worked, we double-checked everything before administration. Every now and then, mistakes were caught. You can't be too careful.

    When I first started working in OP oncology, the nurses took turns mixing meds. After I was there about a year, all mixing was taken over by pharmacy.
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    Hi, thanks for responding.. I am a member of the ONS, and I think it would be good for me to get the chemo provider card, I think that would make me feel more comfortable. I don't think my job will be going over to a pharmacy providing the mixing. I like that your job made you double check all medications, this seems like the safest way to me.. Maybe my job doesn't do it because it's too time consuming? Each nurse has on average 5-7 patients per day, and there are usually 2 nurses. It can get hectic doing your own schedule, if you had to check somebody else's calculations too it might be too much.. but what is too much when it comes to being safe? Did your practice use pumps, or did you just do drip rates?
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    Are you saying you're not certified to give chemo? As in, you haven't taken the Chemo & Biotherapy provider course?

    If so, I'm amazed and a bit disturbed that you're allowed to handle chemotherapy at all.
    OCNRN63 likes this.
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    No, I am not certified, and I have not taken the provider course. My job did not require the provider course (I really have only found out about it recently), but it is encouraged that I become certified when I am eligible. Have you worked in outpatient oncology before? If you have, I would like to hear how your practice maybe differs from mine. While writing you are amazed and disturbed is fine, if you have anything more constructive to add I would appreciate the feedback. Like I said, I am a new nurse, and was really happy that I found a job fairly easily, and I took what my supervisors and fellow infusion nurses said for face value.. Now a few months in though, I am wondering if what I am doing is ok. I mean, does the law require you to take the provider course, and be certified?? Maybe how this practice does things is not ideal, but is it wrong?
  10. 1
    I worked both outpatient and inpatient oncology.

    I'm stunned because of the level of risk associated with chemotherapy, especially the mixing piece. It was risky to the point where they created an oncology pharmacy full of folks whose sole purpose in life was to mix our meds for us to reduce our risk of exposure.

    To allow a nurse who has not been trained in the basics of handling chemotherapy and the patients who are exposed to mix, administer and monitor oncology patients it is simply unthinkable by the standards I was taught. By neglecting to ensure that you have adequate training, your facility is not only putting you at risk, but your patients as well.
    OCNRN63 likes this.
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    Thanks for you input… I was really wondering what other outpatient facilities do. I'm not sure if you still do outpatient, but you do make a good point about by my employer not requiring the chemo provider course, they are putting both me and my patients at risk. I wouldn't say that my training was inadequate though, maybe just not as detailed as it possibly could've been?? I shadowed an OCN for WEEKS, and when I did start mixing and hanging, she was shadowing me. Regardless, I will work on doing the chemo provider course. Being so new, in an office setting, it's kind of easy to be persuaded, and talked into what the standard is for that particular place. I feel like in a hospital, the training and standards are just such higher.. I do have an interview for the emergency department in a local hospital, and I am just hoping with everything I have that I get this job!!
  12. 1
    Quote from gvrn13
    Hi, thanks for responding.. I am a member of the ONS, and I think it would be good for me to get the chemo provider card, I think that would make me feel more comfortable. I don't think my job will be going over to a pharmacy providing the mixing. I like that your job made you double check all medications, this seems like the safest way to me.. Maybe my job doesn't do it because it's too time consuming? Each nurse has on average 5-7 patients per day, and there are usually 2 nurses. It can get hectic doing your own schedule, if you had to check somebody else's calculations too it might be too much.. but what is too much when it comes to being safe? Did your practice use pumps, or did you just do drip rates?

    We ran our chemo on pumps.


    Are you double-checking labs before you give your chemo? (e.g. checking ANC, H&H, BUN&Cr, etc?)

    I agree with Soldier; it's very disconcerting that you are mixing and giving chemo with no double check and without proper education. The ONS Chemotherapy/Biotherapy Course is now all online, so you could do it during downtime and at home. You will get a good chunk of CEUs for it.

    You really need to do this, not only for the safety of your patients but for your own safety as well.
    SoldierNurse22 likes this.
  13. 2
    Quote from gvrn13
    No, I am not certified, and I have not taken the provider course. My job did not require the provider course (I really have only found out about it recently), but it is encouraged that I become certified when I am eligible. Have you worked in outpatient oncology before? If you have, I would like to hear how your practice maybe differs from mine. While writing you are amazed and disturbed is fine, if you have anything more constructive to add I would appreciate the feedback. Like I said, I am a new nurse, and was really happy that I found a job fairly easily, and I took what my supervisors and fellow infusion nurses said for face value.. Now a few months in though, I am wondering if what I am doing is ok. I mean, does the law require you to take the provider course, and be certified?? Maybe how this practice does things is not ideal, but is it wrong?
    Neither are required but consider a scenario where a patient is harmed during their infusion, and they sue. The patient's attorney is going to ask you what kind of education you have to make you qualified to administer chemo. They may ask you if you've taken the ONS course. If you can't provide adequate education and training, you're really going to be in hot water.

    I would strongly suggest that you join ONS. It's ~$100 to join, but you get discounts on CEU, courses, and reading materials. Get the manual for Chemotherapy/Biotherapy Administration; it will help you when you take the course (which you are going to do), and it's a good reference manual for day to day practice. I would also suggest getting the ONS Core Curriculum for Oncology Nursing. It reviews the major oncology diseases you'll encounter, the different oncologic emergencies and professional practice.

    ​Do you have an experienced nurse who can act as your mentor?
    gvrn13 and SoldierNurse22 like this.


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