How does a nurse become competent in antineoplastic administration?

The ONS position statement, Education of the Registered Nurse who Administers and Cares for the Individual Receiving Antineoplastic Therapies, states that there should be specialized education, hands-on training, and annual competency reassessment of the nurse who administers and monitors people receiving antineoplastic therapies. This ensures a safe level of care for individuals receiving, and the clinicians administering, these agents (ONS, 2020). Any individual administering these agents should receive this specific training regardless of the indication, route of administration, or patient population.

Each institution must determine its own policies and procedures that align with its state practice act regarding what nurses need to complete and how long they need to be in practice prior to antineoplastic therapy administration and associated responsibilities. ONS's position is that the nurse has completed didactic training as well as an antineoplastic therapy administration competency validation to be deemed competent and able to be involved in administration and verification. ONS recommends the education program be evidence-based and specific to the population and setting. The following content is recommended to be included in an education program developed for nurses administering antineoplastic therapies (ONS, 2020):

• Types of treatment, classification of agents, and routes of administration
• Pharmacology of agents, regardless of indications for use
• Pertinent molecular biomarkers, including genomic assays
• Chemotherapy and radiotherapy protectant
• Principles of safe preparation, storage, labeling, transportation, and disposal of agents
• Safe administration procedures
• Procedures for safe handling of hazardous drugs including spill management
• Appropriate use and disposal of personal protective equipment
• Use of engineering controls, if applicable to your practice setting
• Use of closed-system drug transfer devices
• Assessment, monitoring, and management of patients receiving therapy
• Medication safety and system safeguards, such as infusion pump safety features 
• Appropriate procedures for emergency preparedness to include infusion reactions and extravasation
• Appropriate documentation of treatment administration, patient education, and planned follow-up care and testing
• Patient and family/caregiver education for these agent(s), specific to side effects and related symptom management, and processes for urgent and ongoing follow-up
• Education and coordination of post-treatment care and testing, adverse events, and long-term side effects, physical and psychosocial impacts of a cancer diagnosis and treatment, and follow-up care during survivorship

Ongoing competency assessment is always a challenge, especially when any drug or procedure is given or performed infrequently. ONS recommends that competency is reinforced annually but does not dictate how to assess competency. Some institutions may choose to identify those high-risk, low-volume events or tasks and assess competency on these alone; others choose to fully reassess a complete checklist.

The Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (Second Edition) state that competency assessment is ongoing and provides ways to train staff and measure competency (see Chapter 1) (Olsen et al., 2023). Appendices A and B provide templates of competency validation forms that can be considered for use at your practice. Appendix D and G are additional administration checklists that could be used in training.

ONS does offer two different preparatory courses, depending on the depth and breadth of hazardous drug administration and care of specialized patients. This schema outlines the differences of these two didactic course offerings. ONS encourages all nurses who may give these drugs and/or care for this patient population to receive adequate training; these courses are endorsed as such didactic training.

The ASCO/ONS Chemotherapy Administration Safety Standards, also support the development of competencies that are specific to a population, the drugs administered, etc.

References:

Olsen, M., LeFebvre, K., Walker, S, Dunphy, E. P. (Eds). (2023). Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (Second Edition). Oncology Nursing Society: Pittsburgh, PA. 

Oncology Nursing Society (2020). Education of the registered nurse who administers and cares for the individual receiving antineoplastic therapies. Online Position Statement.