Chemo Check!

[RNview]

In our hospital, we check a lot of things before we hang the chemo. It has to be double checked by the 2nd RN who is also chemo certified.

• original order VS MAR VS Chemo Tag
  
• Patients Full Name
  
• Patients Medical record/ Account Number
  
• MD's Calculations VS Nurse Calculations

Questions:

1) Do you ever check the pump too? Like how the primary nurse sets up the pump?

2) In the outpatient infusion center and/or hospital setting, do you check all the chemo all at once (for one patient)? Or do you check it one at a time prior to each infusion?

I'd appreciate your feedback. I'm just wondering how other institutions do their safety checks on chemo. I've heard some issues at work related to my questions above. Thank you.

[sggirl]

I work in the outpt Oncology clinic setting. The only infusion pump the primary nurse verifies is the portable ( take home continuous infusion pump) CADD pump. We do not check the regular infusion pumps. We do confirm infusion rates for chemotherapies in which the rates vary from patient to patient depending on dose (ex. Abraxane- small volume)

After the chemo is mixed by chemotherapy certified pharmacy tech, the chemo is checked by 2 RN's. Now, if the pharm tech mixes all the drugs at once then it is checked all at once. We are a very busy clinic so in order that all patients start their chemo in a timely manner the pharm tech may mix one of the patients chemo drugs ( ex. Rituxan-ChOP) and then mix for the next patient . Once the chemo has been checked and chemo order initialed by 2nd RN, it is either hung on the IV pole above the pump or it is placed in a basket near the patient. This process works well for our busy clinic.

[Reno1978, BSN, RN]

I just finished an oncology rotation for school and both nurses checked the pump settings and infusions were checked one at a time.

The other checks you mentioned were pretty much the same, except the MD doesn't do any calculations. They write the order then the nurse calculates the BSA and dose and the pharmacist double checks the calculations. The oncology floor I was on had a FT pharmacist just for that unit, though.

[RN50, ASN, BSN]

Two RN's check the order, and then check the chemo. Then we recalculate the dose on paper, then we use a reference book written by one of our oncologists to determine if the dose is within the safe limits to administer. We don't usually check the pump though, but that is a good point that I will bring up at work.

[EmmaG, RN]

I have posted this thread under Specialties but there's not much traffic over there, so I am hoping to get some feedbacks from here. Sorry, I am just curious about this.

In our hospital, we check a lot of things before we hang the chemo. It has to be double checked by the 2nd RN who is also chemo certified.

• original order VS MAR VS Chemo Tag
  
• Patients Full Name
  
• Patients Medical record/ Account Number
  
• MD's Calculations VS Nurse Calculations

Questions:

1) Do you ever check the pump too? Like how the primary nurse sets up the pump?

2) In the outpatient infusion center and/or hospital setting, do you check all the chemo all at once (for one patient)? Or do you check it one at a time prior to each infusion?

I'd appreciate your feedback. I'm just wondering how other institutions do their safety checks on chemo. I've heard some issues at work related to my questions above. Thank you.

We do what you all do, with an added check between the pharmacist and nurse when the chemo is delivered (name, account number, drug/dose) as it's entered into the chemo book. As far as your questions, there is a check of the pump settings, and each drug is checked prior to administration, not all at once.

[EmmaG, RN]

The other checks you mentioned were pretty much the same, except the MD doesn't do any calculations. They write the order then the nurse calculates the BSA and dose and the pharmacist double checks the calculations. The oncology floor I was on had a FT pharmacist just for that unit, though.

We have specific chemo order sheets the docs fill out, and they have to show all the calculations. If they aren't completed in full, we send them back to the docs. We also take no verbal or phone orders on anything related to the chemo or its administration.

[ORSmurf]

I work at an outpatient cancer center and we always check the chemo, with 2 chemo RN's, for each patient all at once when the phamramcy delivers it. We also double check the pump settings each time a new chemo is hung.

[RNview]

Thank you guys. I work in the inpatient and usually we check one chemo at a time. When I first started working there, there was no policy whether we check the pump rate too. One time, a nurse from the infusion center worked in our unit and asked another nurse to double check chemo with her. 3 different chemo for one patient were checked per protocol. Then the CNS questioned these 2 RN for doing it and for not checking the rate of the pump. NOTE: the nurse who floated to our unit is from our outpatient cancer center. We have the same manager, the same protocols. It's good to know that some institution checks the pump settings too. I think it is safer that way. Thank you for your responses.

[RNview]

I work in the inpatient and we also have our own pharmacist. In our OUTPATIENT they check everything at once for EACH patient. One time, when an OUTPATIENT RN floated to our unit, she double checked all the 3 chemo for the same patient all at once with another chemo certified RN. Our CNS questioned them. Our inpatient and outpatient infusion center have the same manager, same CNS and same protocol and it has been like that for years. I think double checking the pump setting is such a great idea for safety. Because one time, we had a case when a chemo was hung and double checked per protocol. It was supposed to run for 24 hours but in 2 hours it was all done... The patient survived, the nurse almost pass out. She was so sure she checked everything but there's no witness. From then on every time we hang chemo, we also lock the pump. And now we are double checking the pump setting too. And I think we are in the process of changing the rules and policy for checking the chemo. The outpatient nurses need to check chemo one at a time now. I don't know how are they going to do it in a very busy and fast paced outpatient clinic. Thank you for sharing.

[lilgreenrn]

hey new grad here, can you tell me more about your floor? is it a med/surg chemo floor? Or has anyone worked on a floor like that? I am looking at new job option. I accepted a thoracic surgery floor but honestly not sure if thats what I want, and Im thinking maybe I am interested in a basic med/surg, or just surg fl or mayeb chemo floor? Please share your stories.... Thx!

[RNview]

hey new grad here, can you tell me more about your floor? is it a med/surg chemo floor? Or has anyone worked on a floor like that? I am looking at new job option. I accepted a thoracic surgery floor but honestly not sure if thats what I want, and Im thinking maybe I am interested in a basic med/surg, or just surg fl or mayeb chemo floor? Please share your stories.... Thx!

I work in Med/Onc. We have medical patients mostly but not limited to Pneumonia, MI, CHF patients. Then we have oncology patients. Our manager sends new nurses to a chemo certification class after 6 months of hire date. I love where I work. I also started as a new grad in that unit, and I'm still there and very well at home Goodluck!