In a first for South Africa, a group of local cancer practitioners have developed a set of chemotherapy administration guidelines with the aim of improving patient safety and protecting healthcare workers.

The new guidelines, which will be released as a single resource document this month, were compiled by members of the Independent Clinical Oncology Network (ICON) in consultation with oncologists and cancer experts from around the world.

“These guidelines and standards address a significant gap in local cancer care for both patients and healthcare workers,” said Clinical Oncology Advisor for ICON, Dr David Eedes.

Currently, there has been no single resource document in South Africa that addresses best practice at all three levels of chemotherapy administration: the oncologists who prescribe the medication, the pharmacists who dispense it, and the nurses who administer it.

According to ICON, chemotherapy administration errors are an issue not just in South Africa. A 2013 study on chemotherapy showed an error rate of over 30% in a sample of handwritten orders, while a study conducted in Turkey found that 83% of nurses reported one or more errors during chemotherapy preparation and administration.

Other research  by the National Centre for Biotechnology Information reported a lower rate, but a wider range of errors; ranging from under-and over-dosing to giving chemotherapy to the wrong patients.

“Whatever the true statistics for errors are, we believe that by following well documented protocols by each discipline involved in this complex process, and ensuring good communication between the different groups of professionals managing cancer patients, this will reduce the risk for errors and also enhance the experience for professional and patient alike,” said Dr Eedes.

Dr Eedes explains that the decision to draw up the chemotherapy administration guidelines came from the discovery of an unmet need while doing a routine audit of ICON’s chemotherapy and radiation practices.

“During these inspection visits, the chemotherapy personnel requested assistance in their day-to -day work in the form of standardised chemotherapy processes for all chemotherapy practices,” said Chemotherapy Nurse, Sister Belinda Bailey. Sister Bailey was instrumental in developing the guidelines.

In South Africa, as in most parts of the world, it is the chemotherapy nurses who are key in reducing administration and other errors. The new guidelines will help nurses do their jobs better by providing them easy access to important, updated information.

Staff competencies and staff safety are some of the important chapters in these guidelines.

“The more competent and focussed a chemotherapy nurse is, the more unlikely it is that errors will be made,” said Dr Eedes.

This is particularly crucial in some of the smaller medical practices where there is a small staff complement requiring the chemotherapy nurse to fill multiple roles – mixing and dispensing the medication and informing the patient.

“If they are not adequately trained or supported this is a recipe for serious errors,” added Dr Eedes.

The finalised guidelines will initially be released among the ICON clinical network, but later be made more broadly available to chemotherapy practices in general.

It’s an exciting project,” says Dr Eedes. “Our aim is to improve the overall standards of chemotherapy administration in South Africa and so serve our cancer patients better,” concluded Dr Eedes.

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