Problem
Failure to identify chemotherapy infusion errors may lead to catastrophic consequences that may involve loss of life or limb.
Significance
The high occurrence of preventable errors in hospitals continues to be a concern. Chemotherapy-certified nurses provide the last link in the process steps in the administration of chemotherapy and are therefore in the best position to identify and reduce errors and improve quality outcomes for patients.
Purpose
To provide chemotherapy-certified nurses with a tool to identify and eliminate errors in chemotherapy administration.
Background
The public health problem of death and serious harm resulting from medication errors has gained national attention largely through an error that caused the death of Boston Globe medical writer Betsy Lehman of a chemotherapy overdose. Most recently, the JCAHO has issued a requirement for hospitals to perform one Failure Mode Effects Analysis (FMEA) each year in light of the excessive occurrence of preventable errors. FMEA recognizes that humans will err; however, these errors need to be acknowledged, not as a result of individual incompetence but rather of multiple breakdowns throughout the healthcare system. Errors related to chemotherapy administration result from a multitude of factors within the healthcare system. Generally, errors may occur at any time during the entire chemotherapy administration process including staff education and competence; ordering, transcribing, dosing, verification, and preparation/dispensing; administration; and the influence of the work environment. Contrary to what most chemotherapy-certified nurses would assume, Reed et al (1998) revealed that medication error rates were not correlated with patient acuity but were more likely to indicate quality of nursing care. Chemotherapy-certified nurses play an important role in the chemotherapy administration process and for that reason must assume an active role in the identification and reduction of errors to improve quality outcomes for patients.
Practice Innovation
A descriptive design will be used to examine and describe the practices of chemotherapy administration prior to and after the introduction of a Chemotherapy Verification Form. Chemotherapy-certified nurses will be asked to participate in a study requesting them to carry out mock-up chemotherapy orders utilizing current policies and procedures. The same nurses will then be provided with a Chemotherapy Verification Form and will again be asked to carry out the same orders. To emphasize the simplicity and fool-proof design of the form, no verbal instructions or directions will be given on how to utilize the form.
Expected Outcome
Based on anecdotal reports of nonverification of chemotherapy orders and nonadherence to the current policies and procedures, errors may occur during the chemotherapy administration process. Utilizing the Chemotherapy Verification Form, nurses will be prompted to verify data that may inadvertently be missed.
Conclusion
Oncology nurses have acquired the knowledge and skills necessary to administer treatments and provide services safely. Their aptitude to identify errors prior to the administration of chemotherapy will greatly reduce the risk of serious and sometimes fatal consequences.
Implications for Practice
Chemotherapy administration involves the effort of a team of health professionals, including the oncologist, pharmacist, nurse, ancillary staff, and the patient. Albeit everyone is responsible for providing safe and quality care, it is ultimately the chemotherapy-certified nurse who will provide the last safeguard against an error that may have occurred in the process. Providing nurses with a tool that is convenient and functional leaves nothing to chance, underscoring their role in delivering safe quality care.
Section Description
This year's annual NACNS conference is planned for Orlando, Fla, March 9-12, 2005. Over 300 clinical nurse specialists (CNSs) are expected to attend, and as with past conferences, attendees will also include graduate faculty from CNS programs, nurse administrators, and nurse researchers. The theme of the conference, CNS Leadership: Navigating the Healthcare Environment Toward Excellence, was selected to showcase the many ways CNSs acquire and disseminate knowledge and innovative practices in their specialty areas. Two preconference sessions are scheduled. One session, sponsored by NACNS Legislative/Regulatory Committee, targets information for CNSs interested in understanding the legislative/regulatory process as it deals with the practice of nursing, and will also help build skills CNSs need to engage in the process. The second session, sponsored by NACNS Education Committee, focuses on CNS education issues, and as with the education preconferences of past years, anticipates informative dialogue and much sharing among CNS educators around curriculum design, teaching strategies, and indicators of quality in the curriculum that link to the NACNS education standards to program review and excellence. The conference planning committee is proud and pleased to have Jeanette Ives Erickson, MS, RN, CNA, Senior Vice President for Patient Care Services and Chief Nurse Executive of Massachusetts General Hospital as the opening keynote speaker. She will begin the conference by highlighting the importance of CNS practice on patient safety. The planning committee is equally proud and pleased to have NACNS past-president Rhonda Scott, PhD, RN, Chief Nursing Officer of Grady Health System as the closing speaker. Dr Scott will challenge attendees to use the information from the conference to shape quality care delivered in a safe environment and to advance the profession of nursing through direct care to clients, influencing standards of care delivered by other nurses, and influencing the healthcare delivery system to be to support innovative, cost-effective, quality nursing care. A total of 64 abstracts for podium and poster presentations were selected in addition to graduate student posters. The abstracts address the 3 spheres of CNS practice with a strong emphasis on clinical practice improvements. As you will note from the abstracts published in this issue of the journal, specialty practice areas represented in the abstracts include children, adults, and gerontological patient groups; hospital, outpatient, and home care settings, and community health. In addition, a wide variety of specialty topics including smoking cessation programs, end-of-life care issues, and protocols outlining nursing approaches to improved diabetes, cardiovascular and ventilator management. A number of the abstracts described hospital and healthcare system level innovations that resulted from CNS practice. Collectively, these abstracts reflect the breadth, depth, and richness of CNS contributions to the well-being of individuals, families, groups, and communities. The following abstracts are from those presenters who elected to have their work published in the journal so those who are unable to attend this year's conference can share in the knowledge of the conference. As you read each abstract, consider the talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to improved outcomes for patients and healthcare organizations. You may want to contact individual presenters to network, collaborate, consult, or share your own ideas about these topics. Watch for next year's call for abstracts and consider submitting an abstract for presentation at NACNS's next conference in Salt Lake City, Utah, March 15-18, 2006.