What I Learned During Oral Chemotherapy Orientation

Debi Fischer, MSW, BSN, BA, LCSW, RN

I recently received orientation/training in administering oral, known as “PO chemotherapy,” at the hospital where I work. This was a formalized training where my only responsibility that day was to administer chemotherapy while I was supervised by an experienced nurse. Like many other nurses, I have an oral chemotherapy card from the Oncology Nursing Society which is renewable every 2 years.

The first thing I had to do was go through the patient census and see which patients were scheduled to receive oral chemotherapy. There were 6 patients who needed chemotherapy hospital-wide that day.

I was given a worksheet with my responsibilities. What I will go over here seems like basic information, but it is all vital data.

Prior to Administration

The RN will look at the patient profile, consider their diet, and any potential allergies, diet, and the dose that is planned for the day.

Then, the RN will look at the lab values. The RN will ascertain that the white blood count and platelet counts are within acceptable parameters to give therapy. The third key consideration is that the RN should check is under what conditions this pill is to be given. Will the patient be nothing by mouth (NPO), or do they need to take the pill with a meal? Will it be given before the patient goes to radiation or with a second oral drug?

Then, the RN will log onto Micromedex, a drug search engine. This is to determine if there are any possible interactions with the patient’s other medications they are taking, in addition to food or supplements that could possibly interfere with this chemo.

Most importantly, the RN will check to see if the patient can swallow by not only asking this question, but by giving them water to drink. There are 2 more steps. The nurse will give any pre-medication that is indicated and spend time on patient education—explaining the name and purpose of this specific drug, and any pre-medication that might have been ordered.

Actual Administration

The RN will first verify the patient indicators of name and date of birth. The RN will have a second nurse present in the room and will read the patient’s medical record number out loud. This is similar to the protocol for giving a blood transfusion. The RN giving the pill will wash his or her hands and put on a pair of personal protective equipment (PPE), which are gloves used for chemotherapy administration. This is usually a purple nitrile glove. If this is not available, then two latex gloves will be worn. The RN verifies the name of the drug, order, dose, and route (oral) as well as how frequently the drug is to be given with a second RN.

The chemotherapy pill package is opened and dropped into a medicine cup. The RN hands the cup to the patient who swallows it in front of them. The RN takes off their gloves and washes their hands again.

Afterwards

The RN will be aware to look out for any side effects such as nausea and vomiting. They will also be monitoring the patient’s urine output. The RN will monitor this with the primary nurse taking care of the patient that shift.

Take Away From The Day

Although I have been a nurse for many years, I appreciated this training and time that the chemo nurse took with me to explain my responsibilities for the day. It definitely went beyond placing a pill in a cup and scanning a barcode. There was more patient interaction and greater attention to detail such as lab values and patient education in this expanded RN role.

Reference

Chemotherapy/biotherapy oral administration competency record. University of Miami. Accessed September 23, 2023.