Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
Ho WMS(1), Kong WS(1), Lam CY(1), Lee WKP(1), Chong WMY(1), Yeung NM(1), Cheung SSJ(1)
Affiliation :
(1) Department of Paediatrics and Adolescent Medicine (Haematology and Oncology), Hong Kong Children's Hospital
Introduction :
Safe administration of chemotherapy included prescribing, dispensing & administration. Administration of intravenous (IV) chemotherapy in Paediatric oncology patients is high risk and required accurate, consistent safe manner. Currently, pre-priming the infusion tubing with diluent is the recommended practice to prevent nurses from exposure to hazardous drugs. However, the pre-priming practice required multiple steps before reaching the prescribed rate to patients. It may increase the opportunity of error. A safe initiative targeted administration procedure was piloted. Circle-priming of infusion set directly by IV chemotherapy with the 'Closed System Transfer Device' (CSTD) was initiated. It creates a closed loop system which minimizes the steps in administration and further prevents nurses from exposure to hazardous substances.
Objectives :
To enhance medication safety in administration of chemotherapy in paediatric oncology setting To streamline nursing procedure on administrating IV chemotherapy To maintain occupational safety for staff handling chemotherapy
Methodology :
The pilot started in April 2023, including literature searching, preparation, implementation and evaluation. A literature search was conducted by keywords, “safe chemotherapy administration”, “circle priming”, “paediatric oncology”, “guidelines” and “Closed System Transfer Device (CSTD)” by databases PubMed, Cochrane, Medline, etc. Besides, hand search of journals and guidelines from overseas was done. Nursing guideline on “Infusion of Chemotherapy for Paediatric Haematology & Oncology Patients” was reviewed and revised preparation by using CSTD for circle priming in administration of chemotherapy. Further, six identical clinical skills and knowledge training sessions with individual assessment were arranged for all nurses in Paediatric Haematology and Oncology Centre. The initiative was piloted in an oncology in-patients ward from 20 June 2023 till present. Proficiency in performing the circle priming technique was assessed and onsite support was provided throughout the process. Circle priming was applied for chemotherapy infusions with a volume exceeding 30 ml in bags. The number of chemotherapy infusions using the circle priming, nursing time and special events were collected. Staff satisfaction, and competency regarding the use of circle priming were evaluated at one and six months following the implementation.
Result & Outcome :
There were total 660 IV chemotherapy administered by using circle-priming for the first six months. The administration guideline was streamlined. The nursing procedure time used for administration was reduced by around 30%. At the first and sixth month evaluation survey, 100% participants were satisfied with circle-priming administration. Positive feedback collected with “easy to learn”, “user friendly” and “less manipulation”. And more than 90% participants agreed circle priming was benefit to patients and time saving. Conclusions: Circle priming in IV chemotherapy support safe and efficient nursing administration of chemotherapy. It delivers the best possible patient outcome. The pilot could be extended to all oncology in-patient wards. Limitation: The CSTD used for circle priming was new to staff and required enhancement work for remedy. Continuous staff support and education was provided to enhance the safety operation.
