Cumulative Dose Monitoring

[AprilDawnLeverett]

Ok, so I just took the ONS online course (learned a TON!) and am now a little nauseated! I am fairly new to the chemotherapy infusion clinic and have found that we are not really practicing cumulative dose monitoring. I am going to have a meeting tomorrow with my supervisor about this because I am super concerned, but am wondering what this looks like in other clinics. Do you all keep running flowsheets for each patient or does your med administration software track it for you? Looking for some solutions to the problem I am presenting her with. Thanks!

[OCNRN63, RN]

Our pharmacy kept track of that information. We had a pharmacy within the outpatient infusion department; very convenient and great when you had a question about a med, dosage calc., etc.

[edimo]

With each round of chemo, orders are submitted into the med admin software program and re-evaluated by a physician and pharmacist before proceeding. The software will give a better tally of how much has been given and eliminates paper flow sheets which can get lost, may be inaccurate, and may not depict the whole picture.

[cancer.sucks]

It is much easier and more reliable to track cumulative dosing levels in the electronic world. There are several electronic documentaiton systems that provide ready access to the number for bedside nurses. I am grateful that I now practice in an electronic environment. However, I continue to say that no electronic system will be able to take the place of a nurse's brain or assessment skills. I ask that it be stressed that the cumulative lifetime dose is just a number that estimates what the upper safe limit for most patients is. Many of our patients will exhibit that toxicity long before they reach the actual number. Relying too heavily on that number can take attention away from a thorough nursing assessment. If you assess a patient and he or she is exhibiting onset of symptoms of CHF, the symptoms have to be evaluated as potential cardiac toxicity even if the cumulative lifetime dose of the anthracycline is well below 550mg/m2.

Of course track the total number. Keep it in consideration. but know the importance of looking carefully at your patient and trust in your ability to keep your patient safe.

[NelletheNurse, ADN, BSN, MSN, APRN, NP]

yes...after taking the OCN, this sparked my interest. as an outpatient clinic, with nurses mixing chemo....no onsite pharmacy. it's an on ongoing issue to accurately monitor cumulative doses.