Page 19 Complete Your CE Test Online - Click Here Some practices use a consent form for cancer treatment and others do not, but a consent form cannot replace the process of informed consent. Informed consent starts well before the initiation of treatment, and is continued all the way through treatment completion. Whether or not a form is used, informed consent is an ongoing process over time [264]. For more detail, a modifiable informed consent discussion guide for cancer treatment can be downloaded at no cost from the American Society of Clinical Oncology (ASCO) website. The discussion guide has reminders of the main points that need to be covered and documented in the patient record. For practices that are interested in a consent form, a modifiable example can be found there also (see “Resources for Nurses”). Follow-up questions and unexpected problems It is also very important to be sure that the patient and family know how to reach their oncologist including nights, weekends, and holidays. This information, along with a list of what the patient should call regarding (and which concerns should be considered emergencies for immediate notice), should be given in writing. Nurses may have to emphasize this at each visit, as many patients are reluctant to “bother the doctor,” even if they have life-threatening complications. Drug interaction evaluation The full drug and supplement list from the history should be shared with the oncologist along with any new history information. The same list, along with cancer treatment medications and symptom control drugs proposed in the treatment plan should also be submitted to an expert on drug interactions who may be able to identify additional problem areas and propose possible solutions. Generally, the best consultant for this evaluation will be a clinical pharmacist. In some settings, the pharmacist is given time for direct patient teaching regarding medications and side effects, avoiding drug and food interactions, and more. Cancer treatment Treatment settings The majority of oncology services has shifted to from an historically inpatient model to outpatient care [114]. Patients can receive cancer treatment as inpatients, at home, or as outpatients at a clinic, doctor’s office, or hospital. No matter where treatment is given, the nurse and care team will need to check back with the patient often, watch for side effects and help the patient control or manage these [152]. This has a lot of implications for nurses. First, nurses have less time with the patient than with inpatient care, so s/he has less time to monitor, get feedback, assess, educate, or develop trusting relationships. Much of the time with the patient may be designated for tasks, which will be numerous and varied. Second, there is often less formal training for nurses and other staff, and less support toward this end due to smaller staff sizes and less funding. There may be less time alloted to patient preparation and monitoring [114]. Especially in smaller outpatient settings, healthcare professionals have lost some of the departments, procedures, and structures of support for basic patient safety. Professionals must bring the essential components forward, so that no matter where there are policies and procedures that delineate and support safe professional nursing practice. Given the high risks and difficult balances that come with cancer care, nurses and other healthcare professionals must be sure that there is a structure in place for outpatient facilities to maintain safe, effective, timely, and high- quality care. Safe and quality care requires the methods, means, and staff availability to assess and monitor the patient from beginning to end of cancer treatment, and even beyond. This is not just physical care; it is also imperative to have readily available tools to assess mental health and coping in patients and caregivers; prioritize for the most important educational needs; and set up straightforward methods for documenting those assessments and teaching. All cancer care facilities must meet standards of care for the protection of the patients. While hospitals have infection control departments that have policies, procedures, and resource professionals, the guidance is often less detailed, or even missing, in some outpatient settings. Outpatient facilities should have infection control and prevention policies and procedures as outlined by the Centers for Disease Control Basic Infection Control and Prevention Plan for Outpatient Oncology Settings: Minimum Expectations for Safe Care (updated November 2015) [65]. This document can be downloaded at no cost from the CDC website (see “Resources for Nurses”). The document includes a helpful checklist to be sure that everything is addressed. The Infection Control Plan covers everything from staff training to vaccines and personal protective equipment, from managing patients or staff with symptoms of contagious illness to cleaning blood glucose monitors. All of these standards are important to patient (and staff) safety [65]. Safety note: Always know the basics of a facility’s infection control plan and how to contact the infection control coordinator at all times. The plan should meet the standard of care, be regularly updated, and be consistent with CDC recommendations, both for the safety of the care providers and the patients [65]. Even though the nurse is typically not the one writing the prescriptions, nurses are licensed professionals with a scope of practice for which they are responsible and even liable. As such, nurses must know if the prescription or order is safe and appropriate for the patient, for example: if it is the right drug for the patient’s condition; if it is within the correct dosage range; if the drug might worsen the patient’s condition; likely side effects; and that it is not contraindicated for any reason. Given its expansion, there has been special attention to quality of care in outpatient oncology practices. In 2010, the American Society of Clinical Oncology (ASCO) launched an initiative to recognize oncology and hematology-oncology practices that were committed to offering quality cancer care. The Quality Oncology Practice Initiative (QOPI) Certification Program (QCP) evaluates the performance of outpatient oncology or hem-onc practices in areas that affect patient care and safety. The QCP is a voluntary program that is based on the ASCO/ ONS standards for safe chemotherapy administration. It certifies and enables practices to evaluate and improve the quality of care provided [94]. Since the initiative began, a good deal of observation and research on quality care and documentation in outpatient settings has been published. Calls have also been issued to standardize reporting and tracking of chemotherapy errors and events [118]. With data on the types of events that occur, it becomes possible to design new safety measures and prevention methods. No matter the setting, the nurse is responsible for safe handling of chemotherapy and other drugs. Home care nurses should be sure that patients know how to safely handle and dispose of chemotherapy at home [114]. This can be a challenge when juggling ways to promote adherence to home medications; this can often mean leaving reminders in visible locations, and ensure drugs are out of the reach of children and pets. Frequent follow-up, assessments, and check-ins are necessary to find out whether there are adherence problems or complications that could cause serious problems so that interventions can happen quickly. To remain competent and effective in the complex realm of oncology, nurses must actively keep informed on standards of care, changes in practice, guidelines for cancer care, drug dose ranges, medication toxicities, and an ever-changing array of equipment. According to the Oncology Nursing Draft Standards of Oncology Nursing Education, nurses must become and remain life-long learners [231]. Preparing for treatment: Pregnancy, fertility, and conception Treatment risks associated with pregnancy, fertility and conception must be addressed for women of childbearing age as well as men who might want to father a child before cancer treatment begins. Many cancer treatments can: ● ● Harm the fetus. ● ● Damage sperm. ● ● Cause temporary or permanent infertility.