Safety First: Explaining the Process of Receiving Chemotherapy

When patients show up to their infusion center for treatment, they often question why it takes so long to receive their chemotherapy; however, much more goes into the process than they may realize.

At the Fourth Annual GI Cancer Patient Summit, three members of MedStar Georgetown University Hospital, Lombardi Comprehensive Cancer Center set out to explain to patients the pre-work up, chemotherapy administration and preparation processes that go into treatment for patients with gastrointestinal cancers.

Pre-Work Up

Kristin Ferguson, clinical operations manager/nurse manager at Lombardi Comprehensive Cancer Center in Washington, D.C., first offered background on the pre-workup process, which is “the process that occurs right after you make the decision with your team as to what type of treatment you’re going to move forward with,” she explained.

After selecting treatment, there is a “to do” list Ferguson recommends for patients to go through prior to beginning therapy: determining the need for labs, scans or mediports to be placed; figuring out insurance prior-authorization; determining personal obligations; and thinking ahead about scheduling.

Before beginning chemotherapy, there is a possibility that more scans, labs, central line placements or biopsies may be needed — pushing treatment back further.

The prior-authorization process may also prolong the start to treatment. “Unfortunately, most cancer treatments are expensive,” Ferguson said, explaining that hospitals must submit treatment information to insurance companies to ensure prior authorization is granted before treatment is administered. “The last thing we want to do is put pressure on you all who are paying for them.”

Outside of the hospital, personal obligations may play a role in delayed treatment. Patients must consider transportation to and from the infusion center, employment factors, childcare, support, and creating a shopping list of useful items such as a thermometer, hand sanitizer, Gatorade/ginger ale, mouthwash, hand lotion and rubber gloves.

Chemotherapy Administration

Next, Lisa Cusaac, nursing director at MedStar Georgetown University Hospital, offered background on the pre-administration, administration and post-administration processes that patients don’t see firsthand.

“I assure you, our goal is to get you into the infusion center, treated safely, and get you home so we can get the next patient in the chair at the infusion center. But safety is our main priority,” she said.

With that, during pre-administration the nursing staff will focus on educating patients. “When a patient arrives during the pre-administration phase at an infusion center, the first thing we do is to educate the patient. A lot of this information is new to you and we know that repetition brings back familiarity — on the first visit, the fifth visit, we will educate, educate, educate,” Cusaac said, adding that this includes discussions around understanding treatment schedules, the treatment itself, any potential side effects and precautions that should be taken.

In addition, during pre-administration, the nursing staff will conduct ongoing assessments as well as tolerance to medications while double checking measurements, labs, parameters and physician orders.

During administration, the staff first ensures they are using appropriate vein selection. After receiving the medication from the pharmacy, the nursing staff once again double checks the medication to ensure the patient is receiving the correct therapy and dosage ordered. In addition, they continue assessment of the patient.

Lastly, post-administration consists of more ongoing assessment.

“The one medication, the chemotherapy agent or therapy, takes 15 minutes but all of the work beforehand and the post-administration may be longer. So, I like to call that time in the infusion center versus medication infusion time,” Cusaac said.

Chemotherapy Preparation

Last, Khang Ho, manager of pharmacy research and investigational drugs at MedStar Georgetown University Hospital, discusses the steps that the pharmacy takes:

• The pharmacy receives a notification of the chemotherapy order from the nurses.
• The chemotherapy pharmacist processes the medication order.
• The medication is mixed in a hood specially made for mixing hazardous medication that is in a clean, sterile room.
• Infusion bags and orders are checked.
• The infusion bags are delivered for administration.

As do the nursing staff, all orders are reviewed and processed by the pharmacist to ensure patients are receiving the correct medication and dosage. In addition, the medications are mixed in a safe, accurate and timely manner. And, once again, the medication is double checked against the order as well as against the final bag that is delivered for administration.