Keeping you Safe During Treatment
July 16, 2020- 00:03Here at Smilow Cancer Hospital and
- 00:06at our care centers throughout the
- 00:09region providing high quality care
- 00:11and keeping you safe during your
- 00:14cancer treatment is our top priority.
- 00:17High quality means consistently
- 00:19providing exceptional care,
- 00:20keeping you safe means having in
- 00:22place and following the procedures
- 00:25necessary to avoid mistakes and errors
- 00:28that can potentially cause you harm.
- 00:30Safety is especially important
- 00:32when it comes to preparing.
- 00:35And administering chemotherapy
- 00:36and immunotherapy treatments.
- 00:37Safety requires all members of your
- 00:40health care team working together.
- 00:42And as the patient,
- 00:44you are the most important
- 00:46member of the team.
- 00:47We'd like to use this video to describe
- 00:51the procedures we have in place to
- 00:54keep you safe and at the same time
- 00:57give you an idea of what to expect when
- 01:01you receive your cancer treatments.
- 01:03The procedures apply to all chemotherapy.
- 01:05And immunotherapy medications
- 01:07that you receive regardless of
- 01:09how long you are on treatment.
- 01:11These safety steps will be followed every
- 01:14time and at every location across the smilow.
- 01:18Cancer hospital delivery network.
- 01:19The first element of our safety procedures
- 01:22occurs even before your actual treatment.
- 01:25Start.
- 01:25Your treatment plan is entered into the
- 01:28computer only by your primary oncologist.
- 01:31That is the cancer specialist
- 01:33who knows you well.
- 01:35And is responsible for making your
- 01:38chemotherapy treatment decisions.
- 01:39Your oncologist usually enters the plan
- 01:41before your first day of treatment,
- 01:43or what we call cycle one.
- 01:46This treatment plan is the one that
- 01:48you discussed with your oncologist,
- 01:50and agreed was right for you.
- 01:52Your oncologist will also ask you
- 01:55to sign a consent form before
- 01:57you begin your treatment,
- 01:59and whenever you start a
- 02:00new treatment regimen,
- 02:02your treatment plan is made up of cycles.
- 02:05A cycle means a period of
- 02:07treatment with chemotherapy.
- 02:08And medications to prevent side effects
- 02:11followed by a period of rest or no treatment.
- 02:15Each cycle also includes pretreatment
- 02:17blood work and other tests to monitor how
- 02:21you are responding to the treatment plan.
- 02:24Treatment plans are like a complex
- 02:26recipe with instructions for each cycle.
- 02:29These instructions are also
- 02:31referred to as orders like a recipe.
- 02:34They are exact instructions for
- 02:36pretreatment blood work for the specific
- 02:38medications you'll be receiving.
- 02:41And how they are to be given on
- 02:43the first day of each treatment
- 02:46cycle you will be seen an examined
- 02:48by your oncologist or another team
- 02:51member such as an oncology fellow
- 02:54or an advanced practice provider,
- 02:56sometimes called an APP,
- 02:57meaning a nurse practitioner
- 02:59or physician assistant.
- 03:00If there are no abnormal findings and
- 03:03your blood work is in an acceptable range,
- 03:06your Oncologist fellow or a PP
- 03:09clears you for treatment.
- 03:11And you will head to the infusion area
- 03:14during all steps of your infusion.
- 03:16Nurses and pharmacists will use a
- 03:19procedure called independent verification.
- 03:20Independent verification can be
- 03:22thought of as a double and triple
- 03:25check on the treatment plan orders.
- 03:27They're called independent because
- 03:29two clinicians separately alone
- 03:31an apart from each other,
- 03:32check the instructions and
- 03:34then compare results.
- 03:35The results must match and make sense
- 03:38in order to proceed with treatment.
- 03:40This separation ensures that.
- 03:42Each clinician thinks for themselves
- 03:44and removes the opportunity for
- 03:46another person to unintentionally
- 03:48influence what they read or hear.
- 03:50Two people are unlikely to make the same
- 03:53mistake if they work independently.
- 03:56You may be wondering why it is necessary
- 03:59to double check the doctors orders.
- 04:01Basically, these safety steps are
- 04:04standards to prevent medication errors
- 04:06that the American Society of clinical
- 04:08oncology and the Oncology Nursing
- 04:10Society require of all cancer centers.
- 04:13And on Koleji practices,
- 04:14there are three points at which
- 04:16independent verification is required
- 04:19prior to medication preparation
- 04:21during medication preparation in
- 04:23the pharmacy and right before
- 04:25your medication is administered,
- 04:27before your medication is prepared
- 04:29in the pharmacy on each and
- 04:32every day of your treatment,
- 04:34two nurses in dependently double check
- 04:36the orders entered by your Oncologist.
- 04:39Note that in some circumstances
- 04:42this may be a nurse.
- 04:44And pharmacist,
- 04:45the nurse that will be treating
- 04:47you first checks that your weight
- 04:49and height are accurate.
- 04:50Reviews.
- 04:50Results of your blood work and
- 04:52assess is that you are not having
- 04:55any side effects that would
- 04:56prevent you from being treated.
- 04:58Your treatment nurse then checks
- 05:00that the medication dosages
- 05:01are calculated correctly,
- 05:02that the order includes the correct
- 05:04administration root meaning,
- 05:06for example by Ivy injection or pill.
- 05:08The correct length of time and
- 05:10the correct treatment date.
- 05:11The nurse also checks if there
- 05:13was any change in your dosage.
- 05:16From your previous cycle of treatment,
- 05:18if one was given a second nurse
- 05:20independently checks all of the same
- 05:23information when the check is completed,
- 05:25the second nurse signs of
- 05:27verification in the medical record
- 05:29to attest that the order is correct.
- 05:32If either nurse finds a difference
- 05:34in what the Oncologist is ordered
- 05:36or finds an incorrect order,
- 05:38the nurse consult with the doctor
- 05:40or oncology pharmacist.
- 05:42Once this first verification is completed,
- 05:44your order is sent or released
- 05:46to the pharmacy for preparation.
- 05:48The oncology pharmacy staff are
- 05:50critical members of your cancer health
- 05:53care team and oncology pharmacist
- 05:55is an expert in medications used to
- 05:58treat cancer and is an invaluable
- 06:00resource to doctors and nurses.
- 06:02The oncology pharmacist reviews
- 06:04your medical record and checks
- 06:06that the treatment plan chosen by
- 06:08your primary oncologist is correct
- 06:10for your diagnosis and stage.
- 06:12They check that all of the
- 06:14medications that you are currently
- 06:16taking are compatible with the
- 06:18treatment plan medications.
- 06:20They also work with the business staff
- 06:22to assure your cancer treatment plan is
- 06:25approved or authorized by your insurance.
- 06:28Working,
- 06:28independent of the nurse,
- 06:30the pharmacist performs the same
- 06:32safety checks and dose calculations
- 06:34that the nurse performed earlier.
- 06:36The pharmacist also overseas the
- 06:38activities of the pharmacy technicians
- 06:40who are highly skilled in preparing
- 06:42cancer treatment medications.
- 06:44Once the pharmacist verifies
- 06:45that the order is accurate,
- 06:47the order is electronically sent to a
- 06:50computerized Ivy com pounding system.
- 06:52Called dose edge to spell out
- 06:54the exact instructions for
- 06:56the pharmacy technician to
- 06:58prepare your medications.
- 06:59Dose edge generates a label which
- 07:01prompts the technician to gather
- 07:03the ordered medications and needed
- 07:05supplies like Ivy bag and tubing.
- 07:08The supplies are passed into
- 07:10the controlled environment.
- 07:11Clean room through an air sealed window.
- 07:14All medications are prepared in
- 07:16the clean room using state of
- 07:18the art equipment which is sure
- 07:21the sterility of the medication.
- 07:23And protects the pharmacy staff from
- 07:25any leaks or fumes every step of the
- 07:29preparation process is photographed and
- 07:31bar coded to assure the right drug dose,
- 07:34patient time and frequency
- 07:36and administration route.
- 07:37Also we have a record of every
- 07:40step of the process.
- 07:42Once prepared,
- 07:42the medication is checked by the
- 07:45pharmacist by reviewing all of
- 07:47the photograph preparation steps.
- 07:49Then a final dose label is
- 07:51applied with the bar code.
- 07:53That the nurse cans right before
- 07:55administering your medication.
- 07:57The whole pharmacy preparation process
- 07:59usually takes from 30 to 90 minutes.
- 08:01However,
- 08:02this time frame may vary depending upon
- 08:04the complexity of your treatment regimen.
- 08:07You probably wonder why your medication
- 08:09cannot be prepared ahead of time.
- 08:11The answer is that as you go
- 08:14through your cancer treatment,
- 08:15your dose may need to be adjusted
- 08:18or your treatment rescheduled.
- 08:20If you experience any side effect or
- 08:22change in your medical condition.
- 08:25The 3rd and final independent
- 08:26verification check is right before
- 08:28your treatment is administered.
- 08:29Your nurse will inform you that your
- 08:32chemotherapy is ready to be given and
- 08:34will ask you to turn off any electronics,
- 08:37not use your phone or speak to
- 08:39others with you during this check
- 08:41so that you as a team member,
- 08:44may participate fully in
- 08:45the verification process.
- 08:46You will be asked to state your first name,
- 08:49spell your last name,
- 08:50and tell us your date of birth.
- 08:53Their nurse will tell you the name of
- 08:55the medication you will be receiving.
- 08:58And will describe what you may experience
- 09:00during the infusion or injection.
- 09:02Then your nurse will silently
- 09:04check that the medication label
- 09:07on the Ivy bag syringe or pill
- 09:09matches the information in the
- 09:11computer and your ID bracelet.
- 09:13The nurse will program the pump
- 09:15if needed for the infusion and
- 09:17call in a second nurse to silently
- 09:20perform the final independent check
- 09:22of all of the same information
- 09:25and pump settings as before.
- 09:27If their check doesn't match.
- 09:29Your nurse will notify the pharmacy
- 09:31for clarification and Correction
- 09:32before starting treatment.
- 09:34We hope you found this video helpful
- 09:36in answering some of your questions
- 09:39and preparing you for what to expect.
- 09:41We understand and appreciate that this
- 09:44can be a challenging and sensitive
- 09:46time for you and your family.
- 09:48You can trust that all of us will do
- 09:51everything we can to keep you safe
- 09:53and comfortable during your chemo
- 09:56therapy or immunotherapy treatment.
- 09:58We thank you for choosing smilow.
- 10:00Oncology for your treatment and we are
- 10:03honored to be part of your health care team.