Chemotherapy ordering and preparation

Purpose:
To ensure safe ordering, preparation, and administration of chemotherapy medications.

1.1 To develop standards for safe chemotherapy handling & administration to all patients with cancer for
in patients and outpatient settings.
1.2 To achieve the best outcomes of the therapy and to prevent chemotherapy administration related
errors

Definitions:
Chemotherapy: is a cytotoxic drug that uses powerful chemicals to kill fast growing cells in the
body. It is an effective way to treat many cancers but it also carries a risk of side effects and has
potential to harm the body.
Chemotherapy protocol: - One or more chemotherapeutic agents used alone or in combination in a
well-defined protocol, generally administered in regular cycles as per protocol.
Personal Protective Equipment (PPE): Specialized clothing or equipment wore by employees for
protection against health and safety hazards. These equipment‟s include (gloves, goggles if needed,
gown and masks).
Vesicant: It is the chemotherapy agent that causes extensive tissue necrosis with /without
ulceration or blistering.
Irritant: Any agent that causes aching, tightness, and phlebitis but without necrosis.
Biological Agents: A substance that is made from a living organism or its
Products and is used in the prevention, diagnosis, or treatment of cancer and other diseases.
Biological drugs include antibodies, interleukins, and vaccines. Also called biologic
Chemotherapy routs include Oral, Intravenous, Intrathecal, Intracavitary, Topical, Intramuscular,
and Subcutaneous, or by any rout as required by protocol.
Policy:
 Chemotherapy should be written by attending privileged physicians, no order to be
written by hospitalist.
All protocols shall be labeled with patient identification and signed by the primary attending
physician , pharmacist ,registered nurse (clinical nurse coordinator or charge nurse).
 Before each chemotherapy cycle the patient should assessed as being fit to receive the
prescribed treatment by an appropriately qualified and competent physician.
 Clinical pharmacist will check all chemotherapy orders against the provided care plan
and double check the calculated doses.
Chemotherapy protocol should be sent to pharmacy, where it’s re-checked and
transcribed on the system by competent pharmacist.
If the dosing parameters do not match the established chemotherapy protocol then the
pharmacist should contact the physician/the clinical pharmacist for a clarification.
Chemotherapy order transcribed by pharmacist should only be validated by another
pharmacist after reviewing the order, dosage accuracy, and calculations.
 Patient should receive chemotherapy in designated ward or outpatient setting that are well
equipped to deal with any emergencies that may arise from the treatment.
 Patient and/or family should receive detailed information about the goal of treatment,
alternative treatment, and possible side effect. This should be followed by completing
chemotherapy consent form.
Physician and nurse are responsible for documenting the protocol and cycle number for
the patient as a separate note.

 Chemotherapy order should include the following:

 The following measurement should be available and recorded in patient medical record
before any chemotherapy order:
allergy
patient weight and height
 Absolute neutrophil count (ANC)
 Body surface area (BSA)
 Any required laboratory tests
 Medication name should be clear without abbreviations
 All chemotherapy medications are prepared by trained pharmacist/assistant pharmacists
and administered by trained nurses.(check the chemotherapy handling and administration
policy).
Verbal and telephone orders are absolutely prohibited.
 In case of any question related to any component of the chemotherapy order, the licensed
registered nurse, clinical pharmacist, pharmacist, should clarify the order from the
ordering physician, the order should be corrected prior to treatment.
Chemotherapy preparation:
 A pharmacist reviews the chemotherapy order to ensure that all required
information is documented.
 If the dosing parameters do not match established chemotherapy protocols, then
the pharmacist shall contact the physician for clarification.
Chemotherapy shall be prepared in biological safety cabinets in by properly
trained pharmacist. When applicable, closed system is used in the preparation of
parenteral chemotherapeutic agents
All oral cytotoxic agents that require crushing or compounding must be prepared in
pharmacy. Cytotoxic drugs should be dispensed in the form in which it is to be
administered.
 Chemotherapy preparation shall be double checked by another pharmacist,
including checking the labels
 Special personal protective equipment (water proof with tight sleeves gown,
cover shoes, special mask, eye goggle,double gloves( powder free latex), head
cap) should be used during chemotherapy preparation. (when there are no powder
free gloves or any staff has latex allergy, you can use nylon gloves and latex with
powder gloves..
 The one who prepare chemotherapy follows reconstitution and preparation
guidelines for the preparation of chemotherapy agents.
 Priming of the giving set should be done properly by pharmacist during
preparation.
 After chemotherapy preparation, a label with the following information will be
placed on the medication:
Patient identification label
Drug name
Drug dose
Drug volume
Rate of administration
Route of administration
 Prepared chemotherapy medication will be checked by registered nurse upon
receiving.