Development of guidelines for the safe prescribing, dispensing and administration of cancer chemotherapy.

AIM: The issue of medication safety is highly significant when anti-cancer therapy is used due to the high potential for harm from these agents and the disease context in which they are being used. This article reports on the development of multidisciplinary consensus guidelines for the safe prescribing, dispensing and administration of cancer chemotherapy undertaken by a working group of the Clinical Oncological Society of Australia (COSA). METHODS: A working group of pharmacists, nurses and medical oncologists was convened from the COSA membership. A draft set of guidelines was proposed and circulated to the COSA council and the wider membership of COSA for comment. The final version of the guidelines was then distributed to 25 key stakeholders in Australia for feedback and endorsement. RESULTS: An initial draft was developed based on existing standards, evidence from the literature and consensus opinion of the group. It was agreed that published case studies would be used as evidence for a particular statement where related processes had resulted in patient harm. The group defined 13 areas where a guidance statement was applicable to all professional disciplines and three individual sections based on the processes and the professionals involved in the provision of cancer therapy. CONCLUSION: The guidelines development represents a multidisciplinary collaboration to standardize the complex process of providing chemotherapy for cancer and to enhance patient safety. These are consensus guidelines based on the best available evidence and expert opinion of professionals working in cancer care. They should be seen as a point of reference for practitioners providing chemotherapy services.

The Clinical Oncological Society of Australia (COSA) guidelines for the safe prescribing, dispensing and administration of cancer chemotherapy.

The issue of medication safety is highly significant when anti-cancer therapy is used as a treatment modality due to the high potential for harm from these agents and the disease context in which they are being used. These guidelines provide recommendations on the safe prescribing, dispensing and administration of chemotherapy and related agents used in the treatment of cancer. The guidelines represent a multidisciplinary collaboration to standardise the complex process of providing chemotherapy for cancer and to enhance patient safety. These are consensus guidelines based on the best available evidence and expert opinion of professionals working in cancer care. The aim of these guidelines is to assist in the prevention of medication errors and to improve patient safety with respect to the treatment of cancer. This guidance is intended for a multi-disciplinary audience and will have most relevance for medical, nursing and pharmacy staff involved in the complex processes of delivering chemotherapy and associated treatment. The scope of the guidelines includes; all patients and age groups receiving chemotherapy and targeted therapy for the treatment of cancer and cancer therapy administered by any route in both the hospital and home setting. These guidelines should be seen as point of reference for practitioners providing cancer chemotherapy services.

Nurses' decision-making in pressure area management in the last 48 hours of life.

AIM: To report on an aspect of a study that explored nurses' clinical decision-making in pressure area management of people in the last 48 hours of life. DESIGN: A qualitative approach of interpretive description was used to collect and analyse 12 semi-structured interviews with registered nurses working in a palliative care unit and two haematology/oncology wards. FINDINGS: In this study nurses described their experiences of providing pressure care management for the patient in the last 48 hours of life. Nurses experienced difficulties with determining the frequency of turning the patient, especially during the last phase of life. Factors such as clinical assessment of the patient, ensuring patient comfort, use of pressure relieving aids, patient and family wishes and the influence of professional colleagues were variously valued and prioritised in importance. The context of care informed clinical practice and complicated decisions, which went beyond the consideration of clinical needs. CONCLUSION: Nurses need to strive for consensus in clinical practice on the best care for the patient and, where possible, include the patient and family in the discussions. The development of further evidence on the options available for pressure management practices at the end of life can assist in clinical decision-making.

Creating comfort: nurses' perspectives on pressure care management in the last 48 hours of life.

The aim of this paper is to report the results of a study exploring the pressure care management of patients during their last 48 hours of life, from the perspective of registered nurses caring for such patients in an acute care hospital setting. A qualitative approach of interpretative description was used. Semi-structured interviews were conducted with twelve registered nurses working in palliative care/haematology/oncology wards in a metropolitan hospital in Melbourne, Australia. Analysis of the experiences of nurses in pressure care management of the patient in the last hours of life offered understandings into the nurse's role as a moral agent in the clinical setting. As moral agents, nurses were motivated by a desire to 'do the best for the patient'; in this instance to provide comfort and a peaceful death. They made decisions based on their past experience, knowledge and beliefs. However, their actions could be constrained by the beliefs of their colleagues, the culture of the organisation, and respect for the wishes of both patients and family members, which contributed to moral dilemmas that could give rise to clinician distress. Nurses need to strive for consensus in clinical practice as to what is the best care for the patient and where possible include the patient and family in these discussions. The development of policies such as advance directives and processes that highlight quality communication and conflict management may assist nurses in clinical decision making in this area.