Chemo for hospitalized patients.

RNKimmy · Jul 18, 2018

Hi,

We have designated med/surg units that the oncology patients will be admitted to. Those select nurses have gone through the ONS coursework to administer chemo. We work closely with the outpt center and docs in terms of ordering and preparing.

Did you have a more specific question or does that help?

YoBee · Jul 22, 2018

Hey. Thanks for your response. I realize my question is a little vague.

Do the nurses who are administering chemo also have a patient allocation (if yes how many?) or are they supernumerary? Are the trained nurses expected to attend other areas/wards in the hospital to give chemo?

Background: Im a little concerned about some recent changes at work and am trying to gauge what others do.

Buckeye.nurse · Jul 23, 2018

I'll do my best to answer your question! I work on a hematology floor--leukemia, lymphoma, and multiple myeloma patients--so we give a TON of chemo. We attend a basic oncology, basic chemo, and chemo certification classes to achieve certification...then take a yearly continuing ed hour and competency check. We do have a patient assignment. The goal is 1:3 or 4 patients on day shift, depending on the acuity of the patient load, and the complexity of their medications. So, for example, a nurse whose patient is receiving a 24 hour chemo infusion with Q 8 hour labs (or less frequent) might be able to manage 4 patients, but a nurse whose patient is receiving numerous IV push chemo meds, frequent piggy-back meds, or frequent labs would be assigned 3 patients.

We have resource nurses (without patient assignments) who float throughout the oncology floors, and help with monitored transport and start PIVs with ultrasound. They are also responsible for administering chemo in other areas of the hospital where the floor nurses are not certified.

AAOnc22 · Jul 25, 2018

I work bone marrow transplant and give tons of chemo! our ratios are 3:1, sometimes 2:1. Giving chemo is actually usually a really quick process, so we don't necessarily change our ratios based on a patient having chemo.

We are ONS certified in chemo/bio therapy and we make sure to review all orders from our outpatient clinic. When hanging chemo what really is the most inconvenient is finding a second nurse to check the order and check the math and check the drug.

Every once in awhile we have to go to another unit to give chemo, but there is never IV chemo on another unit if there is not an ONS nurse working on that unit. I have gone to another unit to give oral chemo, but it is also pretty rare.

Swellz · Jul 26, 2018

Good:

My staff job we were 1:3-4 days, 1:4-5 nights (excluding special cases like IL-2, chemo desensitization, etc, where the ratio was lower). Chemo was administered by the primary nurse, but on dayshift there was a chemo resource nurse without an assignment who made sure everybody's chemo was on time, did the second check for the checklist/hanging, etc. We got through residency and worked the floor a few months as new grads before being introduced to chemo admin. Everybody had to take a chemo course taught by our clin spec and our chemo pharmacists; it was modeled after the ONS course but we didn't get certified through them. The chemo resource nurse and the charge nurse would go to the ICUs to hang chemo.

Bad:

I'm on a travel assignment in a community hospital on an oncology floor that's more med-surg than onc. Ratio 1:4-5 days, 1:5-6 nights. There is no required chemo course; it is a skills checkoff for safe administration. Nursing is not involved with the chemo beforehand - no checking the dose, etc, until the chemo is prepared and to be hung. Charge nurse without assignment hangs the chemo, and will go to other floors to hang. The second nurse who checks the chemo does not have to be checked off in chemo administration.

Ugly:

I was a second check for chemo at my current assignment and the dose was off... the charge nurse said, "well at least it's under-dosed" and expected me to sign off on it without further investigation. Fun times.

PeakRN · Aug 1, 2018

Inpatient who are receiving chemotheraphy are either admitted to the oncology floor, BMT, ICU, Peds Onc, or PICU. There are nurses who have ONS chemo certification on ONC, BMT, and Peds Onc; all of those nurses are expected to be certified if they have been there six months to one year and those without certification typically don't get patients receiving chemo. If a patient is in the ICU or PICU receiving chemo then one of the Onc or Peds Onc nurses will come and give the chemo but not otherwise assume care of the patient.

On rare occasion we give chemo, biologics, or research drugs in the ED (either patients need more critical monitoring during infusion but will be discharged or they need emergent infusion during night time hours), those drugs are prepared by a chemo pharmacist and brought down to the ED and administered by ED nurses, our state does not require specific certification for this.

The outpatient infusion nurses are ONS certified.

YoBee · Aug 1, 2018

Hey,

This sounds like a similar system to what we are trying to achieve - however the allocation is less flexible and we have only a handful of staff who are actually trained to give chemo. eek.

Does your resource nurse only work day shift or do they cover all shifts?

Are most of your staff trained in chemotherapy admin? - do you feel this system works well?

YoBee · Aug 1, 2018

Hey Buckeye.nurse,

This sounds like a similar system to what we are trying to achieve - however the allocation is less flexible and we have only a handful of staff who are actually trained to give chemo. eek.

Does your resource nurse only work day shift or do they cover all shifts?

Are most of your staff trained in chemotherapy admin? - do you feel this system works well?

#oops about the double post - still figuring this out.

Swellz · Aug 2, 2018

Hey,
This sounds like a similar system to what we are trying to achieve - however the allocation is less flexible and we have only a handful of staff who are actually trained to give chemo. eek.
Does your resource nurse only work day shift or do they cover all shifts?
Are most of your staff trained in chemotherapy admin? - do you feel this system works well?

Assuming this is directed at me, at my first job the majority of nurses were chemo certified. The chemo resource nurses worked 12 hour dayshifts M-F. Weekend days there was still a free charge who could help, but nights you were on your own. But if you had any sort of complicated chemo overnight you were assigned fewer patients, and if anything went wrong, it was a teaching hospital so you could page the onc fellow.

I think it works really well having a free chemo nurse. They covered our unit and our sister unit so they were running all day, but they were amazingly helpful. The hospital I'm at now hardly anyone is chemo certified. It's not the best situation.

KelRN215, BSN, RN · Aug 4, 2018

When I worked in the hospital, there were 3 floors that administered chemotherapy- the heme/onc floor, the stem cell transplant floor and the neuroscience floor, which included neuro-onc patients. All nurses on the heme/onc floor and stem cell floors were expected to become APHON chemotherapy/biotherapy certified.

Chemo itself didn't usually warrant a change in patient assignment, as a previous poster said. When the kids were admitted with fever and neutropenia and on multiple IV antibiotics and needed frequent blood transfusions, their needs were much greater and they were much sicker.

If kids on chemo were in the ICU, the floor where they would be if not in the ICU was responsible for hanging their chemo. For example, a child with a brain tumor who was in the ICU for fluid management because he also has diabetes insipidus, the responsibility for the chemo would fall to the neuro-onc nurses. A child with leukemia or rhabdomyosarcoma, it would fall to the heme/onc nurses.

Buckeye.nurse · Aug 4, 2018

Hello YoBee,

Sorry for taking a few days to respond to your post. I don't get on Allnurses every day. The resource nurses are part of our float pool, and our nursing supervisors try very hard to staff 2 resource nurses around the clock. It doesn't always happen, but it's the ideal. When there is only 1 resource nurse, then a charge RN from one of the onc floors has to travel with the resource nurse to give chemo if needed in the main house (our cancer hospital is separate).

I'm not sure what the standard is on other onc floors that give less chemo, but on the hematology floor where I work all of our nurses are chemo certified. The time line is to be certified within 3 months of hire if you are an experienced nurse. Our nurse educator purposefully makes the new grads wait one year to take the chemo classes. She wants them to focus on skill acquisition, disease processes, and time management before throwing chemo administration into the mix.