chemo administered on med/surg floor

Aeterna, BSN, RN · Jul 17, 2012

Wow. It's my opinion that only nurses who are trained in the administration of parenteral chemotherapy should be handling it, only because it's very specific with certain risks involved that are not the same as other IV medications. I hope you were even wearing the proper PPE when you were changing the bags! If something had gone seriously wrong, it certainly is a huge risk you and your unit were taking on. Why wasn't the patient transferred to an oncology unit?

At the hospital I work at, chemo is only administered in the out-patient cancer center or in the in-patient oncology unit. There is the rare occasion where a chemo/chemo-like drug must be administered in the ICU so an oncology nurse had to go down to hang it, but a critical care patient obviously has to stay in ICU (and the ICU nurses are probably better equipped to handle any serious adverse reactions than we are).

But, to address the infusion rate of the chemo, was there not specific orders as to how long to run it over? Our chemo orders always have the following information that is always double-checked by 2 RNs:

1) Patient name

2) Patient ID number

3) Drug name

4) Drug dosage

5) How fast to run the drug over (i.e. over 1 hour)

6) What and how much fluid it's diluted in (i.e. 500 ml of normal saline)

7) Anything else we should know and/or monitor if applicable (i.e. monitor BP closely, vesicant precautions)

luellamae · Jul 17, 2012

I'm not sure why the patient was put on our floor but yes proper protective gear was worn. And now looking back I realize I should have said I"m uncomfortable and shouldn't have taken the patient...live and learn?

thesundowner · Jul 17, 2012

Wow - I had just logged on to ask the SAME EXACT QUESTION and saw this post. Yesterday, I also had a patient on my med-surg floor receive chemo. A nurse from our chemo floor (where their ratio is 1:4) came over to access the patient's port and start the chemo drip. Once it was started, she gave me her extension and said to call her if any issues arose, to run the bag over the 90 min (as the bag stated on it) and to double flush the port once it was done. Then she was gone. I was so nervous - I stayed and charted in the pt's room while keeping an eye on her. Didn't even think about wearing PPD when removing the bag - should I have?

Is this safe/ok? I know NOTHING about chemo, not a damned thing. The chemo nurse told me that if I know enough to hang blood, I know enough to hang the chemo (!?!?!?)

Aeterna, BSN, RN · Jul 17, 2012

If it were me, I'd be raising hell about having a chemo patient on a non-oncology floor. It's unsafe, both to the staff (who are not properly trained) and the patient. I'd be discussing it with the charge nurse and getting him/her to press whoever decides where patients are admitted to get the patient transferred to the appropriate floor ASAP. I'd also raise the issue with your manager. For example, we sometimes get stroke patients but none of us are certified to perform those stroke-specific tests. If this happens, we keep pressing bed allocation to transfer them to the stroke unit as soon as a bed opens up there, and we keep badgering them until it happens. It's really for the best interest of the patient in question.

Didn't even think about wearing PPD when removing the bag - should I have?
Is this safe/ok? I know NOTHING about chemo, not a damned thing. The chemo nurse told me that if I know enough to hang blood, I know enough to hang the chemo (!?!?!?)

NO. Blood and chemo are not the same thing. That would be like saying if you can do do a packing dressing, you can do a Vac dressing, or if you know enough to access a PICC, then you know enough to access a Port-a-cath.

As for PPE, you need a waterproof gown specific to chemo administration, two pairs of chemo-tested gloves (one set to tuck underneath the chemo gown, and the second pair to wear over top the cuff of the chemo gown), and eye protection. This is for any time you could be exposing yourself to chemo, such as hanging it and taking it down.At least, that's what we do. Check your facility's policy.

blondy2061h, MSN, RN · Jul 18, 2012

When I first started as a new grad in oncology we were all scheduled to take the OCN Chemo and Biotherapy course within 6 months of hire. Before that we were allowed to hang chemo only with direct supervision from a nurse who was Chemo and Bio certified. I remember my new grad self wondering what the heck I needed a two day course to learn how to hang chemo for. After the course I was terrified to touch the stuff.

I am appalled at a chemo patient being on a non-oncology floor. First off, where did you throw the chemo bag when it was empty? Do you have chemo bins? Did you double glove and gown to hang it? (Thesundowner, probably not a big deal if you missed it once, but definitely don't do it again). Did you look at the original order and double check the dose along with the calculations (mg/kg, mg/m2, whatever it was)? Did you check for blood return? What type of chemo was this?

There's just too much to pay attention to with chemo to go to someone not trained. And as someone mentioned, oncology often has better ratios than medsurg.

Thankfully, it sounds like the patient was okay (was he?). What type of chemo was it?

RNewbie · Jul 18, 2012

I've worked on med surg floors where chemo was administered. A chemo nurse would initiate and discontinue the chemo, we would just monitor it and let the chemo nurse know of something was not right.

tokmom, BSN, RN · Jul 20, 2012

Next time tell them NO if you aren't going to get training. I worked for a facility that dumped chemo pts on us with zero education. It's unfair to both pt and nurse.