Greater safety for chemotherapy in SA

The new ICON Chemotherapy Administration Guidelines are set to provide chemotherapy practices in the network with much-needed safety standards aimed at both improving patient care and protecting staff. 

In a first for South Africa, and a progressive move globally, a group of local cancer practitioners has developed a set of guidelines for chemotherapy administration with the aim of improving both patient outcomes and staff safety.

The new ICON Chemotherapy Administration Guidelines, which will be released as a single resource document in January 2017, were compiled by members of the Independent Clinical Oncology Network (ICON) and in consultation with oncologists and cancer experts from around the world.

These guidelines and standards address a significant gap in local cancer care for both patients and healthcare workers, says Dr David Eedes, Clinical Oncology Advisor for ICON. To date, there has been no single resource document in South Africa, and perhaps the world, that addresses best practice at all three levels of chemotherapy administration: the oncologists who prescribe the medication, the pharmacists who dispense it, and the nurses who administer it.

Because of the ever-increasing complexity of cancer treatments, and the fact that chemotherapy is potentially toxic if rigorous safety standards for both healthcare workers and patients are not followed, this initiative by ICON is long overdue, says Dr Eedes. “Chemotherapy is a particularly specialised form of medical treatment,” he explains.

Chemotherapy administration errors are an issue not just in South Africa. Medical errors in general rank third amongst the most common causes of death in the United States, and a 2013 study on chemotherapy found a error rate of over 30% in a sample of handwritten orders, while a study conducted in Turkey found that 83% of nurses reported one or more errors during chemotherapy preparation and administration. A further study by the National Centre for Biotechnology Information reported a lower rate, but a wider range of errors; ranging from under-and over-dosing to giving chemotherapy to the wrong patients.

“Whatever the true statistics for errors are, we believe that by following well-documented protocols by each discipline involved in this complex process, and ensuring good communication between the different groups of professionals managing cancer patients, the risk of errors will be reduced and the experience for professional and patient alike will be enhanced,” says Dr Eedes.

The ICON network is dedicated to providing cost-effective cancer treatment based on the latest evidence for the mutual benefit of patients, healthcare providers and funders. But, says Dr Eedes, “ICON is not just about trying to cut costs, but also about improving standards of care for our patients and the quality of the working environment for the ICON staff. It’s not only clinical protocols and formularies – we look carefully at the quality of care given to patients. Good clinical management is central to what we do.”

Dr Eedes explains that the decision to draw up the chemotherapy administration guidelines came from the discovery of an unmet need while doing a routine audit of ICON’s chemotherapy and radiation practices. One of ICON’s functions is as a recognised accreditation entity of such practices, which it is licenced to do by the relevant authorities. Its accreditation criteria are based on the Department of Health’s National Core Standards for medical institutions but with a pragmatic oncology practice-level slant.

The audit team observed that, although excellent work was being done in the individual practices, there were no national standards in place. This led to discrepancies in processes and competencies. Additionally, although there were guideline documents for cancer treatment internationally, there were no combined documents covering standards, staff competencies, and personnel safety at multiple levels.

“During these inspection visits, the chemotherapy personnel requested assistance in their day-to -day work in the form of standardised chemotherapy processes for all chemotherapy practices,” says Sister Belinda Bailey, a chemotherapy nurse with extensive experience in chemotherapy administration, who was instrumental in developing the guidelines.

“We saw an opportunity to close this gap, and draw on the combined expertise of the ICON network,” adds Dr Eedes.

The draft guidelines were presented at the ICON conference in August 2016 where Sister Bailey conducted a workshop with other professionals from both the private and state sector to gather their input. A follow-up workshop to finalise the document will take place in January 2017.

The central involvement of the chemotherapy nurses in developing these practical guidelines is critical says Eedes. In South Africa, as in most parts of the world, it is the chemotherapy nurses who plays the central role in this process. It is the nurses, believes Bailey, who are key in reducing administration and other errors, so improving outcomes and safety standards. The new guidelines, she says, will help them do their jobs better by providing them easy access to important, updated information.

Staff competencies and staff safety are some of the important chapters in these guidelines. “The more competent and focussed a chemotherapy nurse is, the more unlikely it is that errors will be made,” says Eedes. This is particularly crucial in some of the smaller medical practices where there is a small staff complement requiring the chemotherapy nurse to fill multiple roles – mixing and dispensing the medication and informing the patient. “If they are not adequately trained or supported this is a recipe for serious errors,” says Dr Eedes.

The finalised guidelines, will initially be released among the ICON clinical network, but later be made more broadly available to chemotherapy practices in general.

“It’s an exciting project,” says Dr Eedes. “Our aim is to improve the overall standards of chemotherapy administration in South Africa and so serve our cancer patients better.”