How does your PICU handle Chemotherapy administration

[Starbuck4]

I am new to the PICU world, (although not to nursing-10 yrs) and new to PICU in my current hospital. We have just been given a lecture on how this PICU handles chemotherapy administration. Please note that none of the nurses are chemo-certified in the PICU. It goes like this: PICU RN (non-chemo certified) notices that orders are in place for chemotherapy. PICU RN calls Peds HemOnc Charge RN to let them know an order has been placed for patient X. Peds HemOnc Charge RN is supposed to review order- doses, etc against a roadmap only available to the HemOnc floor (I can't even look up the drug doses if I wanted to- which I do). Peds HemOnc Charge RN calls PICU RN when completed and signs off that s/he reviewed the order and is correct. When chemotherapy is due to be hung. PICU RN finds another non-chemo certified PICU RN to "double check" chemo-medication and both sign off drug.

I am uncomfortable with this. As the non-chemo certified PICU RN I am totally relying on another nurse that is located on a completely different floor and that I have never met to do part of my five rights before drug administration. And that nurse never sets eyes on the patient. I seem to be the only one with an issue here, as it is current practice and no one else in my class spoke up. I brought up my concerns to the instructor who said since the review nurse checked it everything should be fine and i don't need to know if the dose is correct, length of time of infusion is ordered correctly, etc.

Just curious what other PICUs do for those patients that need the ICU but also chemotherapy and if anyone else has concerns with this. If you don't have concerns please share why to help ease my mind! Thank you.

[tryingtohaveitall]

Our PICU has some nurses who are chemo certified. If they aren't available, a chemo nurse from the heme-onc unit comes and gives the chemo. ONLY chemo Certified nurses give chemo.

[NotReady4PrimeTime, RN]

At our hospital all PICU nurses are certified to administer cytotoxics such as mycophenolate mofetil, valgancyclovir, azathioprine and similar drugs. But when it comes to chemotherapeutics such as cytarabine, cyclophosphamide, 5-FU and etoposide, we rely on the hem-onc unit to send us someone to hang and monitor. Hospital policy. No exceptions. Two nurses from the hem-onc floor come down, check the orders, dose and identify the patient, sign the MAR and one then stays behind to give the drug.

[imaginations]

We have a similar protocol to janfrn. CICU nurses should, in theory, be accredited to give certain cytotoxic drugs (usually anti-rejection and post transplant drugs e.g. MMF, valgancyclovir, azathioprine, cyclosporin). Accreditation involves completely a learning package/workbook, having pre commencement and then annual blood tests and being assessed by an accredited cytotoxic administration assessor in the actual giving of the drug. However, like janfrn, actual chemotherapeutic agents (doxorubicin, vincristine, IV methotrexate etc) only haem-onc nurses are accredited to give these and will come to CICU to hang and give these drugs. Under no circumstances should a non-accredited nurse ever be giving either these drugs in our hospital -- per policy.

[HazelLPN, LPN]

It was fairly uncommon for our PICU patients to be on chemo. If at all possible, the hem/onc nurses managed all but their very sickest patients on the floor...even staffing them as 1:1, which was rare on any of the floors. If they needed drips that required an A line, we would get them but send them back as soon as we were able. We had a few former hem/onc RNs in the unit who were chemo certified who would take these kids, but most of our nurses were not certified. The regular hem/onc staff RNs could not give chemo off their floor. During day shift, their clinical nurse specialist would give the chemo. Other shifts, some house supervisors could give it or one of the docs would give it.

[Julius Seizure]

Our unit has a few chemo certified nurses, but if they aren't available then hem-onc comes to use to give the med. it's ALWAYS two chemo certified nurses, no exceptions. If they can't come right away, the med waits until they can come. I wouldn't feel safe giving the meds, neither pt safety wise or legal-wise.