Merseyside and Cheshire Cancer Network Chemotherapy Training Pack

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Merseyside and Cheshire Cancer Network Chemotherapy Training Pack




Final version : August 2006

    Review due : September 2007


    This training programme has been developed by the Merseyside & Cheshire Cancer Network Chemotherapy Nurse‟s group, in collaboration with the Chemotherapy Clinical Network Group, in response to the need to meet the demand of training issues for chemotherapy practitioners, across the Cancer Network.

    The structure of the training programme has been developed in line with the Royal College of Nursing IV therapy competencies, the National Chemotherapy Advisory Group and Skills for Health chemotherapy competencies and is aimed at qualified nurses wishing to undertake chemotherapy administration.

    The expectation is that the programme, which is work based and includes specific training common to all types of chemotherapy delivery, will be used locally by the named trainer for the clinical chemotherapy service. This will promote a standardised approach to training in chemotherapy delivery across the Cancer Network and comply with the Manual of Cancer Services quality measures. It is recognised that some aspects of the programme may not be applicable in specific patient groups i.e. pediatrics and local adaptation may be necessary.

    In standardising the training and assessment of chemotherapy delivery, it is anticipated that practitioners will be able to demonstrate their level of skill through a “ declaration of competency” which will be transferable across the Merseyside

    & Cheshire Cancer Network.

    The MCCN Chemotherapy Group and the MCCN Chemotherapy CNG, accept that meeting the training needs for chemotherapy delivery is an onerous commitment for the clinical chemotherapy service; the programme has been developed as a practical solution to assist this process. A review of the programme, both in content and the ability to deliver the programme will be undertaken throughout the year with a formal report of the review produced in September 2007.

Signed Signed……………………….

    Chair Chair MCCN Chemotherapy Nurse Group

    Chemotherapy CNG

The Network would like to acknowledge Emma Carrick‟s input in developing this

    training programme during her time as Chair of the Network Chemotherapy Nurse Group.



    1 Overview of programme content

    2 Over view of assessment process

     3 Guidance on assessing competencies

    4 Chemotherapy delivery competency framework

    (i) Competencies

    (ii) Education programme content

    (iii) Declaration of competency

5 Oral chemotherapy


1. Overview of Programme Content

    Registered practitioners required to deliver chemotherapy must, within the scope of professional practice, have

    ; Expanded their scope of professional practice into the administration of

    cytotoxic agents

    ; Been assessed as competent in the safe handling of cytotoxic agents

    The training programme to support the safe delivery of chemotherapy will be a 12-week practical competency based package in the administration of cytotoxic chemotherapy (THIS DOES NOT ADDRESS THE USE OF INTRA-THECAL


    The programme will include 6 study days over the 12-week period to be delivered by the named nurse trainer(s) for the clinical chemotherapy service. It is advised that each cohort consist of no more than 3 students at a time on any one ward.

The content of the study days will address:

    ; Cannulation and phlebotomy skills

    Infection control

    Why it is necessary

    Practical assessment 10 successful attempts at both

    Trust policy

    ; What is cancer and why do we give chemotherapy?

    Basic cell biology

    Classification of chemotherapy (drug groups)

    Targeted therapies

    ; Routes of administration and Safe Handling of cytotoxics

    Intravenous Infusions

    Bolus chemotherapy

    Volumetric pumps

    Oral chemotherapy

    Safe handling of cytotoxics

    Protective equipment


    Disposal of chemotherapy

    Trust Policies


    ; Side effects and Adverse Reactions

    Bone marrow depression



    Nausea and vomiting


    Diarrhoea and constipation


    Anaphylactic Reactions

    Cardiac Arrest

    ; Central vascular access devices (CINS)


    Tunneled central venous catheters

    Infection control issues

    Assessment for the correct catheter for the correct patient

    Trust Policy

    ; Holistic Assessment

    Activities of daily living and the importance

    Toxicity scoring



    Understanding a cancer patients journey to receiving chemotherapy

    The programme will act as a learning tool to ensure safe practice in the administration of chemotherapy drugs, reducing the potential for harm to both patient and staff, whilst maintaining staff competencies.

    Each student must be allocated a designated mentor who works with the student at least 50% of the working week. This would offer continuity and support to the student.

    The student will be reminded that they will still be accountable for their practice as detailed in clause 1.3 of the NMC code of professional conduct:

    You are personally accountable for your practice. This means that you are answerable for your actions and omissions, regardless of advice or directions from another professional.’


2. Overview of the Assessment Process

    On successful completion of the programme the nurse will be awarded by the named trainer for the chemotherapy service, a declaration of competency in the administration of chemotherapy. The practitioner will hold a copy within their personal profile and the trainer will maintain a record locally. The declaration will be recognised across all Trusts within the Merseyside and Cheshire Cancer Network.

    Prior to being assessed as competent to administer cytotoxic agents, it is vital that the student is able to:

    ; Identify the implications of the Nursing and Midwifery Code of Conduct and

    Scope of Professional Practice (November 2004)

    ; Identify and understand the implications of legal and professional issues

    relevant to administering cytotoxic chemotherapy

    ; Identify, understand and apply the theoretical knowledge underpinning the

    clinical skills required to administer cytotoxic chemotherapy ; Demonstrate a clear understanding of the correct procedure for administering

    cytotoxic chemotherapy

    ; Demonstrate knowledge of the documentation required for all patients

    receiving cytotoxic chemotherapy

    ; Identify the pharmacological properties of cytotoxic substances and

    understand their implications for the administration of cytotoxic chemotherapy

    If the student does not fulfill all of the above criteria its his/her responsibility to contact his/her assessor in order to discuss how competency may be achieved.


    Updates and assessment should be maintained annually as a minimum requirement and more frequently when changes in practice have been indicated (e.g. updated research/ government guidelines, new drugs and/or administration techniques) and where the practitioner is not regularly using this method of cytotoxic administration, as stated in The Manual for Cancer Services 2004, Measure 3C-151.

    Accessing annual competency assessment for administration of chemotherapy. Is the individual responsibility of the practitioner.


3. Guidance on Assessing Competencies

The following offer some guidance on the criteria, which should be considered

    when assessing competence. These points are not exhaustive and should be

    used as prompts only.

Chemotherapy competency Points to be considered

    Cytotoxic Regimens

    Brief understanding of cell cycle and how Briefly explains the phases of the cell

    this relates to drug classification. cycle.

    Learners should understand the difference Discusses the effects of cytotoxic drugs between phase specific and phase non-on the cell. specific drugs. Basic understanding of different modes of action of chemotherapy Should monoclonal antibodies be drugs. included?

    Student should be able to identify the key

    stages of the cell cycle. Go, resting phase

    (chemo not active in this stage), G1, S

    synthesis of DNA, G2, & M mitosis cell

    division & growth.

    Chemotherapy most active in diving cells.

    Phase specific drugs only kill cells in

    specific phase of the cell cycle. Example:

    5FU, methotrexate active in the S phase.

    Vinka alkaloids (Vinblastine, vinoralbine) &

    Taxanes (Docetaxol, Pacitaxol) active in

    the mitosis stage. Non phase specific

    drugs can kill the cell at any phase of the

    cell cycle.

    Demonstrates knowledge of the Outlines common drug regimens found

    drugs/regimens to be administered. within own clinical area.

    Understands the regimen and knows how

    often cycles are repeated. Provides

    explanation / educates patient.

    Ask student to identify at least two

    common regimes, how they are given, how

    often they are repeated & what key

    information both verbal and written would

    be given to the patient.


Recognises risks of associated side Discusses the importance of

    effects, including nausea, vomiting and scheduling anti-emetics and fluids

    nephrotoxicity. within the chemotherapy regimen.

    Ask the student to discuss the anti emetic policy timing and anti-emetics used with

    certain drugs. For example ‘which regimes commonly require pre & post hydration, eg Cisplatin and the reason why?’

Recognises implications of administering Discusses the rationale for

    chemotherapy via the incorrect route. administering cytotoxic drugs by

     different routes. Student can identify some of the different routes used in oncology to deliver chemotherapy. For example oral, central,

    peripheral administration of drugs. If a student is working in Oncology they must complete the capecitabine training attached with this programme.

Recognition and management of common Explain common and long-term side

    and long term side effect of chemotherapy. effects of chemotherapy drugs given

    Ensure actions have been taken to within own area. minimize potential side effects of the treatment. Explain to the patient the most common potential side effects of their treatment.

Student can identify common short term

    effects such as bone marrow depression, nausea & vomiting, mucositis, alopecia. Late side effects include cardio toxicity, secondary malignancy and infertility.

Recognition and management of side Discusses side effects of other drugs

    effects of drugs given with chemotherapy. administered in conjunction with

    Discuss common prophylactic drugs & chemotherapy in regimens used in their known side effects. own area.

    e.g Granesetron - constipation,

    headaches. Demamethasone increased

    appetite, peri anal irritation if given too fast, weight gain, indigestion.


    Safe Handling

    Names the three main routes of exposure. Discusses the potential hazards to

    Understands potential consequences of health associated with cytotoxic drugs.


    Inhalation, indigestion, absorption (skin contact). Cytotoxic drugs have carcinogenic, teratogenic, mutagenic properties.

Aware of relevant guidance. Acts in Reflects on professional and local

    accordance with local policies and guidelines in relation to

    procedures. - Safe handling of cytotoxic drugs. - Transporting and storing - needlestick injury cytotoxics - administration chemotherapy - Spillage of cytotoxic - extravasation - Disposal of cytotoxic waste - spillage

    - anaphylaxis

Observed technique. Demonstrates preparation of

    Appropriate placement of cytotoxic bin, equipment and the environment to

    avoids spillage. Takes measures to assess reduce the risk of contamination / risk and minimise exposure. exposure.

    Assessor should observe the student‟s technique of wearing appropriate safety equipment, changes bag over the trolley on a flat surface with gauze, takes cytotoxic bin with them to the patient.

Demonstrates safe handling of cytotoxics Takes measures to protect the health

    which reduces the potential for spillage, of patients, colleagues and self when

    airborne or skin contamination. administering cytotoxic drugs. Handles and changes intravenous sets in a manner, which reduces the potential for spillage, splashing, and airborne or skin contamination. Wears protective clothing.

    Changes bags away from patients. Washes hands.

    Assessors should observe the students technique of wearing apron & gloves, doesn‟t change chemo bag at eye level, change bag over the trolley on a flat

    surface with gauze, takes cytotoxic bin with them to the patient. Hand washing. Doesn‟t re-use equipment, and can identify

    single use equipment.


Dispose of unused drugs, used equipment Takes measures to protect the health

    and other cytotoxic waste in adherence of patients, colleagues and self when

    with local policy. Ensures appropriate disposing cytotoxic waste. facilities for disposal of waste are available.

    Ensures waste is clearly labeled and packaged appropriately.

    Wears protective clothing. Washes hands. Adheres to local policies for cleaning reusable equipment.


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