Inpatient intravenous chemotherapy administration : nursing competence and confidence

Abstract

An estimated 40% of people in the United States will receive a cancer diagnosis in their lifetime. This illness may be managed with intravenous (IV) chemotherapy, which requires specialized training and expertise for staff nurses. A microsystem assessment was completed on an inpatient medical, surgical, oncology unit at a northwest Montana hospital. Nurses in the microsystem expressed the inability to maintain competency standards and expertise with infrequent IV chemotherapy administration. A review of the literature was conducted to identify best practices in competence and confidence in nursing IV chemotherapy administration. A root cause analysis was conducted to discover factors contributing to low levels of competency and confidence in IV chemotherapy administration. Comparisons were made between the standards, guidelines, and policies, and themes were analyzed. Solutions were identified and prioritized. A protocol utilizing just-in-time training was developed along with an implementation plan and an evaluation plan. Just-in-time training utilizes checklists, demonstration, peer review feedback, and self-assessment as a measure of competence and confidence assessment. Feedback about the protocol, implementation plan, and evaluation plan was solicited from a key administrator and stakeholders. The Clinical Nurse Leader (CNL) is well suited to implement this protocol due to their ability to integrate care with an interdisciplinary team to identify, develop, implement, and evaluate care practices.