Publishing in Oncology Nursing: A Look to the Past, Present, and Future.

OBJECTIVES: To review trends and issues in publishing and provide resources on publishing opportunities for oncology nurses. DATA SOURCES: Journal articles, publishers' information for authors, online publishing resources, discussions with journal and textbook editors, personal experience. CONCLUSION: Advances in oncology practice and publishing present new opportunities-as well as new challenges-for nurse authors. Nurses need to stay abreast of developments in oncology and be aware of trends and issues in publishing, including the emergence of publications with predatory practices. IMPLICATIONS FOR NURSING PRACTICE: To maintain the integrity of the oncology nursing knowledge base, nurse authors need to adhere to defined authorship criteria, disclose conflicts of interest, submit their work to reputable publishers that conduct a peer review of submissions, develop the skills needed to serve as reviewers and editors, and mentor the next generation of nurse authors.

A Pathway to Publishing an Oncology Nursing Book.

OBJECTIVES: To describe the process of book publishing, including authoring and revising book chapters, and provide resources on book publishing opportunities for oncology nurses. DATA SOURCES: Journal articles, book publishers' information for authors, online publishing resources, discussions with textbook editors, personal experience. CONCLUSION: Few published resources exist to guide nurses as they author and/or revise books and book chapters. In addition, book publishing presents unique considerations, such as authorship of subsequent editions, and new opportunities, such as self-publishing and electronic textbook formats. IMPLICATIONS FOR NURSING PRACTICE: Textbooks are enduring repositories of comprehensive information used by both students and clinicians. Oncology nurses have expert research and clinical expertise that can contribute to this body of published nursing knowledge and ultimately improve the care of people with cancer.

2016 Updated American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards, Including Standards for Pediatric Oncology

Purpose: To update the American Society of Clinical Oncology (ASCO)/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards and to highlight standards for pediatric oncology. Methods: The ASCO/ONS Chemotherapy Administration Safety Standards were first published in 2009 and updated in 2011 to include inpatient settings. A subsequent 2013 revision expanded the standards to include the safe administration and management of oral chemotherapy. A joint ASCO/ONS workshop with stakeholder participation, including that of the Association of Pediatric Hematology Oncology Nurses and American Society of Pediatric Hematology/Oncology, was held on May 12, 2015, to review the 2013 standards. An extensive literature search was subsequently conducted, and public comments on the revised draft standards were solicited. Results: The updated 2016 standards presented here include clarification and expansion of existing standards to include pediatric oncology and to introduce new standards: most notably, two-person verification of chemotherapy preparation processes, administration of vinca alkaloids via minibags in facilities in which intrathecal medications are administered, and labeling of medications dispensed from the health care setting to be taken by the patient at home. The standards were reordered and renumbered to align with the sequential processes of chemotherapy prescription, preparation, and administration. Several standards were separated into their respective components for clarity and to facilitate measurement of adherence to a standard. Conclusion: As oncology practice has changed, so have chemotherapy administration safety standards. Advances in technology, cancer treatment, and education and training have prompted the need for periodic review and revision of the standards. Additional information is available at http://www.asco.org/chemo-standards.

2016 Updated American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards, Including Standards for Pediatric Oncology.

Purpose To update the ASCO/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards and to highlight standards for pediatric oncology. Methods The ASCO/ONS Chemotherapy Administration Safety Standards were first published in 2009 and updated in 2011 to include inpatient settings. A subsequent 2013 revision expanded the standards to include the safe administration and management of oral chemotherapy. A joint ASCO/ONS workshop with stakeholder participation, including that of the Association of Pediatric Hematology Oncology Nurses and American Society of Pediatric Hematology/Oncology, was held on May 12, 2015, to review the 2013 standards. An extensive literature search was subsequently conducted, and public comments on the revised draft standards were solicited. Results The updated 2016 standards presented here include clarification and expansion of existing standards to include pediatric oncology and to introduce new standards: most notably, two-person verification of chemotherapy preparation processes, administration of vinca alkaloids via minibags in facilities in which intrathecal medications are administered, and labeling of medications dispensed from the health care setting to be taken by the patient at home. The standards were reordered and renumbered to align with the sequential processes of chemotherapy prescription, preparation, and administration. Several standards were separated into their respective components for clarity and to facilitate measurement of adherence to a standard. Conclusion As oncology practice has changed, so have chemotherapy administration safety standards. Advances in technology, cancer treatment, and education and training have prompted the need for periodic review and revision of the standards. Additional information is available at http://www.asco.org/chemo-standards .

Technology and the Transformation of Oncology Care.

OBJECTIVES: To review different types of technology and technological advances applicable to oncology care. DATA SOURCES: Peer-reviewed studies and guidelines, magazine articles, books, websites, and online product-specific information. CONCLUSION: Technologies that have transformed oncology care include electronic health records, data analytics, operations-related technologies, oncology-related technologies, portable and wearable technologies, and emerging technologies. IMPLICATIONS FOR NURSING PRACTICE: Technological innovations have transformed health care from a paternalistic, physician-driven system to a system that focuses on and engages the patient.

Safe management of chemotherapy: infusion-related complications.

The following is a reprint from Chapter 8 in Chemotherapy and Biotherapy Guidelines and Recommendations for Practice (Fourth Edition) by Martha Polovich, PhD, RN, AOCN®, MiKaela Olsen, MS, RN, AOCNS®, and Kristine B. LeFebvre, MSN, RN, AOCN® (Eds.).

Quality Oncology Practice Initiative Certification Program: measuring implementation of chemotherapy administration safety standards in the outpatient oncology setting.

The Quality Oncology Practice Initiative (QOPI) Certification Program (QCP) evaluates individual outpatient oncology practice performance in areas that affect patient care and safety and builds on the American Society of Clinical Oncology (ASCO) QOPI by assessing the compliance of a practice with certification standards based on the ASCO/Oncology Nursing Society standards for safe chemotherapy administration. To become certified, a practice must attain a benchmark quality score on certification measures in QOPI and attest that it complies with 17 QCP standards. Structured on-site reviews, initially performed in randomly selected practices, became mandatory beginning in September 2011. Of 111 practices that have undergone on-site review, only two were fully concordant with all of the standards (median, 11; range, seven to 17). Most practices were subsequently able to modify practice to become QOPI certified. The QCP addresses the call from the Institute of Medicine to close the quality gap by aligning evidence-based guidelines and consensus-driven standards with requirements for oncology practices to develop and maintain structural safety components, such as policies and procedures that ensure practice performance. On-site practice evaluation is a high-impact component of the program.

2013 updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy.

In 2009, ASCO and the Oncology Nursing Society (ONS) published standards for the safe use of parenteral chemotherapy in the outpatient setting, including issues of practitioner orders, preparation, and administration of medication. In 2011, these were updated to include inpatient facilities. In December 2011, a multistakeholder workgroup met to address the issues associated with orally administered antineoplastics, under the leadership of ASCO and ONS. The workgroup participants developed recommended standards, which were presented for public comment. Public comments informed final edits, and the final standards were reviewed and approved by the ASCO and ONS Boards of Directors. Significant newly identified recommendations include those associated with drug prescription and the necessity of ascertaining that prescriptions are filled. In addition, the importance of patient and family education regarding administration schedules, exception procedures, disposal of unused oral medication, and aspects of continuity of care across settings were identified. This article presents the newly developed standards.

2013 updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy.

In 2009, the American Society of Clinical Oncology (ASCO) and the Oncology Nursing Society (ONS) published standards for the safe use of parenteral chemotherapy in the outpatient setting, including issues of practitioner orders, preparation, and administration of medication. In 2011, these were updated to include inpatient facilities. In December 2011, a multistakeholder workgroup met to address the issues associated with orally administered antineoplastics, under the leadership of ASCO and ONS. The workgroup participants developed recommended standards, which were presented for public comment. Public comments informed final edits, and the final standards were reviewed and approved by the ASCO and ONS Boards of Directors. Significant newly identified recommendations include those associated with drug prescription and the necessity of ascertaining that prescriptions are filled. In addition, the importance of patient and family education regarding administration schedules, exception procedures, disposal of unused oral medication, and aspects of continuity of care across settings were identified. This article presents the newly developed standards.

Revisions to the 2009 american society of clinical oncology/oncology nursing society chemotherapy administration safety standards: expanding the scope to include inpatient settings.

In November 2009, ASCO and the Oncology Nursing Society (ONS) jointly published a set of 31 voluntary chemotherapy safety standards for adult patients with cancer, as the end result of a highly structured, multistakeholder process. The standards were explicitly created to address patient safety in the administration of parenteral and oral chemotherapeutic agents in outpatient oncology settings. In January 2011, a workgroup consisting of ASCO and ONS members was convened to review feedback received since publication of the standards, to address interim changes in practice, and to modify the standards as needed. The most significant change to the standards is to extend their scope to the inpatient setting. This change reflects the conviction that the same standards for chemotherapy administration safety should apply in all settings. The proposed set of standards has been approved by the Board of Directors for both ASCO and ONS and has been posted for public comment. Comments were used as the basis for final editing of the revised standards. The workgroup recognizes that the safety of oral chemotherapy usage, nononcology medication reconciliation, and home chemotherapy administration are not adequately addressed in the original or revised standards. A separate process, cosponsored by ASCO and ONS, will address the development of safety standards for these areas.

Revisions to the 2009 American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards: expanding the scope to include inpatient settings.

In November 2009, the American Society of Clinical Oncology (ASCO) and the Oncology Nursing Society (ONS) jointly published a set of 31 voluntary chemotherapy safety standards for adult patients with cancer, as the end result of a highly structured, multistakeholder process. The standards were explicitly created to address patient safety in the administration of parenteral and oral chemotherapeutic agents in outpatient oncology settings. In January 2011, a workgroup consisting of ASCO and ONS members was convened to review feedback received since publication of the standards, to address interim changes in practice, and to modify the standards as needed. The most significant change to the standards is to extend their scope to the inpatient setting. This change reflects the conviction that the same standards for chemotherapy administration safety should apply in all settings. The proposed set of standards has been approved by the Board of Directors for both ASCO and ONS and has been posted for public comment. Comments were used as the basis for final editing of the revised standards. The workgroup recognizes that the safety of oral chemotherapy usage, nononcology medication reconciliation, and home chemotherapy administration are not adequately addressed in the original or revised standards. A separate process, cosponsored by ASCO and ONS, will address the development of safety standards for these areas.

Extravasation management: clinical update.

OBJECTIVE: To present a clinical update on the prevention, detection, and evidence-based management of vesicant chemotherapy extravasations. DATA SOURCES: Journal articles, published and unpublished case reports, personal experience. CONCLUSION: In the 4 years that have elapsed since the publication of the original article, much more is known about vesicant chemotherapy extravasation, and effective evidence-based treatments now are available. The antidotes sodium thiosulfate for mechlorethamine extravasations and hyaluronidase for plant alkaloid extravasations are recommended by the manufacturers of these vesicants and cited in nursing guidelines. The anthracycline extravasation treatment dexrazoxane for injection, the first and only extravasation treatment with proven effectiveness, is now available as Totect (dexrazoxane; TopoTarget USA, Rockaway, NJ, USA) in the US and Savene (SpePharm, Amsterdam, The Netherlands) in Europe. IMPLICATIONS FOR NURSING PRACTICE: Nurses who administer vesicant chemotherapy agents need to be aware of the most current evidence (or lack of evidence) for various types of extravasation treatment. Well-informed nurses are patient advocates and instrumental in detecting, managing, and documenting extravasations. Most importantly, nurses play a key role in preventing vesicant chemotherapy extravasations.

Preventing and managing vesicant chemotherapy extravasations.

Although vesicant chemotherapy extravasations cannot be entirely prevented, the risk of extravasation can be reduced by adhering to guidelines for safe vesicant administration. These include engaging patients in extravasation-prevention efforts, thoroughly assessing patients receiving vesicants, selecting an appropriate administration site for peripheral vesicant administration, and checking for a blood return prior to and during vesicant administration. In addition, whenever an extravasation occurs or is suspected, vesicant administration must immediately cease, and the appropriate antidote or treatment needs to be promptly administered.

Management of non-infectious central venous access device complications.

OBJECTIVES: To review the central venous access device (VAD) complications of inadvertent device damage, device malfunction, and various causes of mechanical occlusion and to describe the limitations of VAD complication data. DATA SOURCES: Journal articles, legal cases, case reports, manufacturers' product information, personal experience. CONCLUSION: The available data on VAD complications are difficult to interpret and apply in practice because of the many limitations of the studies that have been conducted (eg, single-institution, mixed patient populations, inconsistent measurement of complications). However, considerable information is known about the signs and symptoms of non-thrombotic, non-infectious VAD complications and their management. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses routinely use central VADs and are on the frontline for detecting VAD complications. Well-informed nurses can serve as patient advocates and help ensure that patients' VADs are functional and safe to use.

Development of the MASCC Teaching Tool for Patients Receiving Oral Agents for Cancer.

BACKGROUND: Oral agents for cancer treatment commonly are prescribed throughout the world. Since oral agents usually are self-administered or administered by lay caregivers, patient education is vital to help ensure that the oral agents are being stored, handled, and taken correctly. When oral agents are taken as prescribed and patients are well informed about signs and symptoms to report, patient outcomes are optimized. Patient education varies globally; consequently, there is a need for a consistent and comprehensive approach to educate patients about oral cancer treatment. GOAL OF WORK: To create a teaching tool to be used with patients receiving oral cancer agents for worldwide use. MATERIALS AND METHODS: Six oncology nurse experts conducted a literature review and convened as an expert panel to draft a teaching tool for patients receiving oral cancer agents. The tool includes key assessment questions, generic education discussion points, drug-specific education, and evaluation questions to help ensure that patients/caregivers understand the information provided. Eighteen healthcare providers from 15 countries reviewed the tool for clarity and usefulness in practice by scoring each item in the teaching tool on a 0-10 scale ("0 = not at all to "10" = most clear/useful"). Items that scored 5 or below required comments. At the Multinational Association for Supportive Care in Cancer (MASCC) Symposium in 2008, the healthcare providers who reviewed the teaching tool met with the oncology nurse experts who had developed the tool to review the item scores and revise the tool as necessary. RESULTS: All items on the teaching tool received high scores, with the exception of items on refilling prescriptions and insurance issues, which vary from country to country. There was consensus that the MASCC Teaching Tool for Patients Receiving Oral Agents for Cancer was ready to be used and further evaluated in clinical practice. CONCLUSIONS: The MASCC Teaching Tool for Patients Receiving Oral Agents for Cancer is an available resource to assist healthcare providers assess and teach patients about oral cancer treatment.

Granisetron transdermal system: a new option to help prevent chemotherapy-induced nausea and vomiting.

Transdermal medication delivery systems provide systemic therapy by passive diffusion through the skin. They offer an alternative route of medication administration and may be well suited for patients who are unable to take or retain oral medications. Granisetron transdermal system (Sancuso(R), ProStrakan, Inc.) is the first transdermal medication patch indicated for the prevention of nausea and vomiting in patients receiving moderately or highly emetogenic chemotherapy. As with all transdermal medications, safety considerations exist with respect to storing, handling, applying, and disposing of the granisetron transdermal system. Oncology nurses should be aware of new developments in the management of chemotherapy-induced nausea and vomiting and knowledgeable about transdermal medication delivery.

Vesicant chemotherapy extravasation antidotes and treatments.

Oncology nurses and pharmacists often are given the responsibility of developing or updating institutional policies to manage vesicant chemotherapy extravasations. Antidote and treatment recommendations of vesicant chemotherapy manufacturers, antidotes and treatments approved by the U.S. Food and Drug Administration (FDA), and guidelines and recommendations made by professional oncology organizations are useful resources in this process. This article describes manufacturers' recommendations, lists antidotes and treatments approved by the FDA, and reviews published guidelines and recommendations. Available antidote and treatment formulations and their preparation and administration also are discussed.