MaineGeneral Medical Center Competency Based Orientation Tool RN Staff Care of the Patient Receiving Intraperitoneal Chemotherapy

Transcription

1 MaineGeneral Medical Center Competency Based Orientation Tool RN Staff Care of the Patient Receiving Intraperitoneal Chemotherapy Scale: 3 = met: knowledgeable and able to perform independently. 2* = Knowledgeable: continued need for practice. 1* = Needs review, practice and supervision. *All scores of 1 and 2: should be communicated to the new employee s manager for follow up. Performance Scale: The Evaluating Nurse will initial and date upon completion of the task/criteria. Key Considerations: The goal is consistency with education and competency evaluation. Identify an individual preceptor for each newly hired RN/New Graduate to instruct and review performance. New Employees must complete the self-assessment prior to beginning clinical orientation. Preceptors must review the self-assessment with the new employee. New employees may not perform identified competencies until verified by the preceptor. Length of orientation process to be identified and agreed upon by preceptor and orientee, and Manager. Unit scheduling should be established to support successful orientation and socialization to role. Preceptor(s) Initials Signature Initials Signature Orientee revised: May 2007, SMC & N.Tar 1

2 MaineGeneral Medical Center Registered Nurse Competency Based Orientation Tool Oncology Service Line Care of the Patient Receiving Intraperitoneal Chemotherapy Name: Unit: Clinical Competency Prior to Administration Policy # MM-37: Administration of Intraperitoneal Antineoplastics Preceptor instruction, 1. Familiarizes self with agents Reviews patient s allergy history Assesses patient s response to previous therapy 4. Verifies that consent for treatment is signed 5. Checks that laboratory values are within acceptable parameters and reports results to MD/PA as needed - Absolute Neutrophil Count - CBC-Diff - Electrolytes - Renal Function Tests

3 6. Verifies written order with patient profile Recalculates drug doses Checks chemotherapy order for drug, dose, route, rate, schedule (Cycle # and day), and mode of administration 9. Verifies that patient education, premedication, prehydration, and other preparations are completed Intraperitoneal Administration Policy # MM-37: Administration of Intraperitoneal Antineoplastics Review Article: Management of Intraperitoneal Chemotherapy for Treatment of Ovarian Cancer Preceptor instruction, 1. Compares original order to delivered drug (checks with second RN) Verifies patient identification Provides pre-medication/ prehydration, if indicated

4 4. Assembles appropriate supplies Assesses the area around the port for - Redness - Edema - Warmth - Tenderness - Infection - Leakage 6. Accesses implanted port using - Aseptic technique - 19-gauge non-coring needle of appropriate length Withdraws 10 ml of discard Flushes the port with 20 ml of Normal Saline to ensure patency 9. Positions patient in a semi-fowler s position 10. Establishes a running line with warmed Normal Saline

5 11. Demonstrates safe-handling precautions - Drug spray or contact with skin or mucous membranes - Drug spill 11. Review Policy #PC-56: Precautionary Measures for Cytotoxic Agents Infuses the warmed IP chemotherapy at the prescribed rate - Usually over 30 minutes to several hours 13. Demonstrates safe administration via gravity infusion - Ensures appropriate rate of administration - Stops infusion immediately if severe pain is experienced - Slows the rate of infusion if the patient experiences - Shortness of breath - Discomfort

6 14. Demonstrates appropriate monitoring// management for specific acute drug effects - Myelosuppression - Neutropenia - Anemia - Thrombocytopenia - GI and Mucosal Side Effects - Nausea and Vomiting - Diarrhea - Mucositis - Anorexia - Constipation - Alopecia - Fatigue - Cardiac Toxicity - Pulmonary Toxicity - Hepatotoxicity - Nephrotoxicity - Neurotoxicity - Alterations in Sexuality and Reproductive Function - Peritonitis 15. Takes appropriate action in the event of hypersensitivity reaction 16. Repositions the patient from side to side every 15 minutes for 1 hour

7 After Administration Policy # MM-37: Administration of Intraperitoneal Antineoplastics Preceptor instruction, 1. Flushes port with 20 ml of Normal Saline, followed by 10 ml of Heparin (100 units/ml) 2. Appropriately removes non-coring needle 3. Disposes of chemotherapy waste according to procedure 4. Documents - Procedure - of site - Size of needle - Education - Patient response 5. Communicates post-treatment considerations to patient, family members, and appropriate personnel - How to contact clinic - Assure that patient has Rx and understands directions

8 Care of the Patient with an Intraperitoneal Port 1. Follows procedure for port access and maintenance 1. Review Procedure: Implanted Port, Accessing Review Procedure: Central Venous Access Devices Dressing Changes Review Policy# PC-07: Line Therapy Preceptor instruction, States measures to take in the event of complications - Access difficulty - Catheter fragment - Catheter migration - Fibrin sheath - Infection - Kinking of catheter - Occlusion - Retrograde flow of infusate into port pocket 2. Review Article: Management of Intraperitoneal Chemotherapy for Treatment of Ovarian Cancer 2. Patient Education Preceptor instruction, 1. Provides education related to the drug administration process, side effects of the drug, side effects of the route, and measures to manage/minimize the side effects

9 Written 1/24/07 TLP 9