Verification Nurse Provides ‘Significant Contribution to Patient Safety’ During Chemo Administration

Verification Nurse Provides ‘Significant Contribution to Patient Safety’ During Chemo Administration

A verification nurse role may add a layer of safety in the administration of high-risk medications like chemotherapy, according to a poster presented at the 49th Annual ONS Congress.

“[The verification nurses] contribute to our operational process and flow, overall institutional culture of safety, and our organizational reputation,” Erin McGarry, B.S.N., RN, OCN, LMSW, nurse leader, said during the presentation. “Their work helps to increase patient confidence, in addition to our clinical research protocol, integrity, and sponsor confidence. Institutions that do not have this role should consider implementing it based on the success of it at [Memorial Sloan Kettering Cancer Center] and its significant contribution to patient safety.”

As a result of highly publicized events related to chemotherapy overdoses, such as an event that happened in 1994 that led to a patient’s death and the permanent injury of another patient, Memorial Sloan Kettering Cancer Center (MSK) in New York, New York, evaluated its chemotherapy processes. It is through this evaluation that the verification nurse role was created to identify and resolve treatment errors before it reaches a patient.

“These nurses are the first step in the chemotherapy/biotherapy order verification process,” Lisa Caltieri, M.S.N., RN, OCN, a clinical nurse IV and a verification nurse at MSK said during the presentation. “They are some of the most experienced and senior oncology nurses at MSK and have developed expert knowledge that enhance their ability to verify orders. They also possess leadership and communication skills that allow them to effectively and confidently question in order.”

Nursing executive leadership commissioned a task force in 2017 to review and standardize the verification nurse role to ensure consistent practices across the institution. This task force also aimed to demonstrate and quantify the value of a verification nurse. This took place in 13 sites across 2 states and included both inpatient and outpatient settings.

The task force performed a comprehensive literature review of the verification nurse role.

“The review revealed a limited number of published articles directly studying the role,” Mary Schumann, MA, RN, AOCN, a clinical nurse IV and verification nurse/infusion nurse at MSK, said during the presentation. “However, evidence supported strategies to prevent chemotherapy errors that included interprofessional checks by nurses and pharmacists, as well as the independent double checks at the chair or bedside prior to administration.”

The review also showed that an environment free from distractions—also known as a sterile cockpit—can contribute to error reduction, in addition to a checklist to promote safety in the healthcare setting. During this project, the task force also defined the workflows of a verification nurse, updated nursing policy, and developed an annual competency, an orientation pathway, and an orientation checklist.

Event reporting data were reviewed before and after verification nurse education, which allowed the task force to illustrate the benefit of the verification nurse’s role by identifying errors, uncovering systemic problems that can lead to serious events, and evaluating near misses, Katie Hambright, B.S.N., RN, OCN, a clinical nurse IV and verification nurse, said during the presentation.

Before the education, the team noticed one variation in practice related to reporting errors. “Many of the [verification nurses] were not reporting errors because they felt that catching mistakes was just part of the role,” Hambright said.

As a result, all verification nurses were reeducated on the importance of real-time event reporting, which was implemented towards the end of 2018. After this was completed, the task force noted a significant increase in the number of errors identified and reported by verification nurses, particularly before pharmacy verification and before drug preparation.

In 2018, before the nurses were reeducated, there were 744 reported events, which increased to 3036 in 2023. Most of the chemotherapy-specific event types reported in 2023 were related to the wrong dose, followed by the wrong frequency/date/time and the wrong drug.

“Administering the wrong drug or the wrong dose could cause significant harm to our patients,” Hambright said. “This specialized nursing role is focused on increasing patient safety. Not only does this role provide an additional layer of safety, but can reduce hospitalization due to error, thus improving patient outcomes.”

The verification nurse role may also impact others beyond the patients themselves.

“It has demonstrated…improved efficiency, and decreased workload on pharmacy and infusion staff,” Hambright said. “In addition, by preventing drug waste prior to preparation, it has the potential for significant cost savings, resulting in a financial return on investment.”

McGarry added, “With the volume of patients we serve, the role allows us to premix orders and decrease wait times. The care team appreciates and relies on the work of this specialized nursing resource.”

Reference

Caltieri L, Schumann M, Hambright K, McGarry E. Critical Importance of the Verification Nurse Role in the Safe Delivery of High-Risk Medications. Presented at: 2024 Oncology Nursing Society Congress; April 24-28, 2024; Washington DC. Abstract P49.