Patient Identification Procedure for Chemotherapy Administration

South Eastern Sydney Illawarra Area Health Service

This project was entered in the Baxter 2006 NSW Health Awards, Safety of Health Care category

Contact: Ann Tattle

Abstract

The administration of chemotherapy is usually conducted as an outpatient procedure (Cain & Tenni, 1996). The patients who receive chemotherapy in The Sutherland Hospital Outpatient Oncology Unit do not receive identification bands when they are booked in to the oncology day unit. All chemotherapy medications are checked according to the NSW Department of Health policy.

Two registered nurses check the patient’s name, the name of the drug, the body surface area calculation, the route of the drug and the expiry date of the drug.
A phone audit was conducted to ascertain what other oncology outpatient units used to verify the patients who were receiving chemotherapy. The author will demonstrate the implementation of a patient identification process into the Sutherland Hospital Oncology day unit, reduced risks to patient safety in the administration of chemotherapy.

Aim

• To improve the verification of identification process for our patients in the outpatient setting
• Staff to feel more confident in identifying the patients who were receiving chemotherapy

Background

Patients who receive chemotherapy are usually located in the outpatients department and therefore are not admitted into the hospital via the usual processes. A phone audit of five NSW metropolitan oncology day centres indicated that 100% of centres used verbal verification of identification. 75% of centres checked the chemotherapy with the patient at the chair whilst 25% checked the chemotherapy at the nurses’ workstation. The staff at the Sutherland Hospital Oncology Unit wanted to introduce a safer process for verifying their patients’ identification. We also wanted to implement a process that would be practical to implement and also a process that complied with Department of Health policy. (NSW Health, 2005)

Methodology

A brainstorming meeting was organized with the oncology outpatient nursing staff was conducted. The phone audit was conducted using 5 oncology outpatient clinics in metropolitan Sydney and the questions were part of the survey.

• How do you identify the patient once they have presented in the waiting area?
• 100% of centres used a verbal verification process to identify the patients.
• How is the chemotherapy checked?
• 100 % checked by 2 accredited Registered nurses. They checked patient name DOB, drug, route, dose, and expiry date. This was checked from a medication chart.
• Where is the chemotherapy checked?
• 75% took the chemotherapy to the patient.
• 25% checked the chemotherapy at the nurse’s workstation.
• What was used to verify the patient’s identity?
• 100% used verbal verification.

Planning and implementation

A team leader was assigned to the project to write a policy directive, and educate the appropriate staff as to the intervention undertaken. It was agreed that the verification procedure would be:

All Chemotherapy will be charted on a “Cytotoxic Medication Chart.” Both persons checking the chemotherapy prior to administration must sign the “Cytotoxic Medication Chart” in the space allocated for the drug checked

VERIFICATION PROCEDURE

• Before infusions of chemotherapy commence the drugs must be checked by two Registered Nurses who are accredited in the verification process.
• Checks must be made in front of the patient in the oncology clinic.
• The patient will present at oncology reception and the patient identification will be crossed checked with their Medicare card and an identity sticker will be given to the patient. The patient will place this on a visible position on their clothing.
• To verify the patients’ identification, the patient will be asked to state their:

1. Name, MRN, date of birth and address of the patient. The 2 Registered Nurses will then check:

• Name of the drug
• Dose of the drug
• Route of administration
• Date of expiry of the drug

In the event that any of the details do not match then the chemotherapy MUST NOT be infused until the discrepancy has been resolved.

Both Registered Nurses checking the chemotherapy prior to administration must sign the “Cytotoxic Medication Chart” in the space allocated.

Outcomes and Evaluation

A survey was conducted with the clinic nursing staff and the following results indicate there was improved safety in the checking procedure for chemotherapy drugs.

• Has the introduction of the verification process improved your confidence in identifying the patient who is receiving the chemotherapy?
• 100% nursing staff answered “YES”.
• Do you feel patient safety has been improved?
• 100% nursing staff answered “YES”
• Have all patients been correctly identified using this procedure since the introduction of the verification process 2 months ago?
• 100% YES.

Future Scope

A review of the outcomes of the 2 month trial indicated that this intervention should be introduced into the unit. It greatly improves the safety of chemotherapy administration.

References

Cain, M. and Tenni, P. 1996. Drug Therapy in Cancer. The Society of hospital Pharmacists, Victoria.

Medication Handling in NSW Public Hospitals – Policy: Doc number PD2005_206. 27th Jan. 2005.