policies, procedures, guidelines and protocols · heparinising a central line or implanted port....

Policies, Procedures, Guidelines and Protocols

Document Details

Title Guideline for the administration of Cytarabine in Community Children’s Nursing Service

Trust Ref No 1801-49121

Local Ref (optional)

Main points the document covers

This policy details the administration of Cytarabine to children and young people in the community

Who is the document aimed at?

Community Children’s Nurses(CCN), Medicines Management Team

Owner Becky Salisbury

Approval process

Approved by (Committee/Director)

Clinical Policy Group

Approval Date 23/10/2015

Initial Equality Impact Screening

Yes

Full Equality Impact Assessment

No

Lead Director Director of Nursing and Quality

Category Clinical

Sub Category

Review date 31st May 2019

Distribution

Who the policy will be distributed to

All staff involved in the delivery of Cytarabine to children and young people

Method Email via clinical Leads and available to all staff on the staff intranet

Document Links

Required by CQC Yes

Other No

Amendments History

No Date Amendment

1 18.07.11 1st Draft Reviewed by POSCU

2 05.12.11 2nd Draft Presented Clinical Policies Team

3 06.12.11 3rd Draft Reviewed by Infection Control Team, Records management, Risk Management and Medicines Management.

4 12.04.12 4th Draft put into Shropshire Community Health NHS Trust policy format.

5 23.10.2015 5th Review and update

Guideline for the Administration of Cytarabine in Community Children’s Nursing Service

2

2 Shropshire Community Health NHS Trust

Contents

1 Introduction................................................................................................. 3 2 Purpose...................................................................................................... 3 3 Definitions.................................................................................................. 4 4 Duties......................................................................................................... 4

4.1 The Chief executive and Deputy Director...................................... 4 4.2 Managers....................................................................................... 4 4.3 Service Leads and Team Managers............................................................................................. 5 4.4 Clinical Staff................................................................................... 5

5 Administration of Cytarabine..................................................................... 5 5.1 Prescription.......................................................................................... 5 5.2 Procedure of Administration................................................................. 6

5.2.1 Objectives................................................................................... 6 5.2.2 Risk Assessment........................................................................ 6 5.2.3 Route of Administration............................................................... 6 5.2.4 Side Effects................................................................................. 7 5.2.5 Equipment................................................................................... 7

6 Consultation............................................................................................... 7 7 Dissemination and Implementation............................................................ 7

7.1 Training.......................................................................................... 7 8 Monitoring Compliance.............................................................................. 8 9 References................................................................................................. 8 10 Associated Documents.............................................................................. 8 Appendix 1...................................................................................................... 10 Appendix 2...................................................................................................... 11 Appendix 3...................................................................................................... 14 Appendix 4...................................................................................................... 18 Appendix 5...................................................................................................... 20 Appendix 6………………………………………………………………………… 21


3


1 Introduction

Cytarabine is a chemotherapy drug which has the potential to be carcinogenic, mutagenic and/or teratogenic and, as such, poses a potential risk to any person coming into contact with it. This guideline sets out steps that should be taken in order for the safe administration of Cytarabine to children and young people via a central line in the community.

The administration of Cytarabine medication need not be a reason for a child to remain in hospital. Cytarabine can be administered intravenously or sub-cutanously. With appropriate family training and the support of the Children’s Community Nurses, specific and approved treatment can be given safely and conveniently in the home. For intravenous route a central venous access device may be used if a child has poor venous access, if the drugs being used are extremely irritant or if the child’s treatment will span several weeks or months. The following procedures may be safely carried out in the patient’s home via a central venous access device.

Heparinising a central line or implanted port.

Administration of specified and agreed intravenous drugs by bolus. The West Midlands Children’s Cancer network Coordinating Group (WMCCNCG) reviews and approves which chemotherapy agents can safely be administered in the home in this region.

Blood sampling

Standard dose bolus Cytarabine is the only chemotherapy agent which is approved by the WMCCNCG as safe to administer to children in the home.

2 Purpose

To give clear guidelines for administration of Cytarabine to children and young people via a central line and subcutaneous route in the community with evidence based practice and best practice and to comply with Principal Treatment Centre (PTC) and Paediatric Oncology Shared Care Unit (POSCU) guidelines.

This policy applies to all healthcare professionals who are routinely involved with children and young people in administration of intravenous medication via central venous access device or subcutaneous injection and have completed the training package compiled by Birmingham Children’s Hospital (BCH) and Birmingham City University, for administration of Cytarabine and assessed by competent practitioner.

The indication for administration must be within the WMCCNCG Community Children’s Nurses List of Low Risk Regimes (See appendix 1).


4


3 Definitions

Term / Abbreviation

Explanation / Definition

BCH Birmingham Children’s Hospital NHS Trust. Tertiary Children’s Hospital

CCN Community Children’s Nurse

CVAD Central Venous Access Device - A central venous access device (CVAD) is a catheter that is inserted into the central venous system with the internal tip sitting within the superior/inferior vena cava or right atrium.

INSUFLON Subcutaneous injection port

NPSA National Patient Safety Agency - The National Patient Safety Agency leads and contributes to improved, safe patient care by informing, supporting and influencing the health sector.

PDP Personal Development Plan

POONs Paediatric Oncology Outreach Nurses

POSCU Paediatric Oncology Shared Care Unit ie: ward 20, Shrewsbury and Telford Hospital NHS Trust.

PTC Principle Treatment Centre ie: Birmingham Children’s Hospital NHS Foundation Trust.

SATH Shrewsbury and Telford Hospital NHS Trust

SCHT Shropshire Community Health NHS Trust

SENDS Safety Engineered Needle Device Systems

WMCCNCG West Midlands Children’s Cancer Network Coordinating Group

4 Duties

4.1 The Chief Executive and Deputy Director

Must ensure that:

All staff to have access to this evidence based policy document

To ensure that appropriate training and updates are provided to all relevant staff groups

Staff are to be made aware of any policy changes and new skills update to follow by the appropriate training

All relevant staff are to have access to appropriate equipment that complies with safety and maintenance requirements according to Shropshire Community Health NHS policies


5


4.2 Managers

Managers need to ensure that staff are aware and have access to policy and guidelines and that appropriate education, supervision and mechanisms are in place to ensure safe practice. Training needs must be highlighted and addressed. This can be done through appraisal or supervision and a record of competencies kept for audit and standard.

4.3 Service Leads and Team Managers

The Service Leads have overall responsibility for ensuring that their staff follow the system in place.

Provide advice and guidance about the policy

Ensure their staff have received specific training regarding policy

Ensure staff are up to date with current guidance and aware of best practice

4.4 Clinical Staff

All healthcare professionals are responsible for their own actions and must exercise their own judgement at all times. However, any decisions to vary from the agreed Shropshire Community NHS Trusts procedure and guidelines should be discussed with their line manager and documented in the patient care plan, this should include the reason for variance and the subsequent action plan. Clinical staff are responsible for maintaining their competencies and work within their professional boundaries.

5. Administration of Cytarabine

5.1 Prescription

Prior to initial visit:

Two Registered nurses to check drug, dose, date, time and route of administration on a faxed prescription (NMC 2008a).

NB: If Community Children’s Nurse is not happy to undertake single nurse visit, alternative arrangements must be made.

A signed copy of the patients’ prescription will be given to the patient/parent for use in the home setting.

The parents will be advised that if the child is admitted to hospital during the course of the Cytarabine treatments, that they should take that copy with them and give it to the nurse in charge.

On completion of the course of treatment both the original prescriptions and the signed copy utilised in the community will be filed together in the patients notes.


6


The Cytarabine will be given in a pre-prepared luer lock intravenous syringe to the parents in a carrying case along with a spillage kit and a cytotoxic sharps bin (purple lid).

On completion of the course of treatment the parents or community nurse will deliver these items back to the designated ward area i.e. POSCU.

5.2 Procedure for Administration

5.2.1 Objectives

To minimise distress by preparing the child physically and psychologically, and by preparing the family.

5.2.2 Risk Assessment

Prior to the use of central lines, trained clinicians should carry out a risk assessment and address any significant hazards identified before undertaking the procedure. It is recommended that armlets, eye protection (goggles), plastic aprons and gloves be worn when handling cytotoxic drugs

5.2.3 Route of administration

Intravenous administration – An aseptic non-touch technique should be used at all times (see appendix 3). It is possible to rupture a central venous catheter by the application of excessive pressure during the drug administration. Such pressures can be minimised by using 10ml or larger syringes.

Sub cutaneous administration – Cytarabine by subcutaneous injection is not given as frequently as intravenous but is a route of administration of Cytarabine in the home environment. It is noted in Birmingham Children’s Hospital Training package (2008) that it is worth remembering some children prefer to have local anaesthetic cream applied prior to their injection in which case you need to let parents/carers know the timing of your visit. Alternatively some children may have an Insuflon™ in situ which is an indwelling subcutaneous port. It is inserted like a subcutaneous injection and has a dressing supplied with it to keep it in place. The site around should be checked regularly and an insuflon™ needs to be changed every 5-7 days. It must be accessed with 27 gauge needle (see appendix 4)

5.2.4 Side Effects

Symptoms require discussion and/or referral to Principle Treatment Centre or the patients local designated POSCU – (see appendix 5).


7


5.2.5 Equipment Equipment will vary on the route of administration, see appendix 3 and 4

6 Consultation

In the writing of this guideline consultation has been with the professionals listed below, for their expert knowledge and information. Within SCHT consultation has been with Infection Prevention and Control Team, risk management, medicines management and other senior members of the CCN services. Consultation has been carried out in email format, face to face and attendance at the Clinical Policies Group

Julia Bottle. Paediatric Oncology Programme facilitator. BCH [email protected].

Jacqueline Hyne. Lead Cancer Nurse (Paediatric Macmillan Paediatric Oncology Outreach Nurses – SATH) [email protected].

Infection Prevention and Control Team – Shropshire Community Health NHS Trust.

Rita 0’Brien. Chief Pharmacist – Shropshire Community Health NHS Trust.

Peter Foord. Risk Manager – Shropshire Community Health NHS Trust.

7 Dissemination and Implementation

This policy will be disseminated by the following methods:

Managers informed via Datix who then confirm they have disseminated to staff as appropriate

Staff - via Team Brief and Inform

Awareness raising by the IPC team

Published to the Staff Zone of the Trust website

The web version of this policy is the only version that is maintained. Any printed copies should therefore be viewed as 'uncontrolled' and as such, may not necessarily contain the latest updates and amendments. When superseded by another version, it will be archived for evidence in the electronic document library

7.1 Training

All Community Children’s Nurses must undertake training on how to administer Cytarabine and use the competency assessment framework (see appendix 2), to complete their evidence of knowledge and training.

mailto:[email protected]

mailto:[email protected]


8


8 Monitoring Compliance

Peer review each others technique for administration of intravenous medication through a central line or subcutaneous injection as appropriate and adherence to the guideline

Review and update the individual children’s care plans

Review any reports of untoward events through the SCHT DATIX incident reporting system

9 References

Birmingham Children’s Hospital NHS (2001) Paediatric oncology Handbook for Nurses

Birmingham Children’s Hospital NHS foundation Trust (2010) Policy for the use of personal protective equipment when handling chemotherapy, spillage of chemotherapy, body waste and/or clinical samples from patients receiving chemotherapy

Dimond, B. (1995) Legal Aspects of Nursing. Prentice Hall International: London

Glasper.A. Aylott.M and Prudhoe.G. (2007) Fundamental Aspects of Children’s and Young People’s Nursing Procedures. Quay Books Division. London

National Institute for Health and Care Excellence (2014) Infection: Evidence Update 64. NICE. London.

Nursing and Midwifery Council (2015) The Code: Professional standards of practice and behaviour for Nurses and Midwives. NMC. London

Nursing and Midwifery Council (2008a) Standards for medicines management. NMC.London

Royal College of Nursing (2007) Administering Intravenous Therapy to Children in the Community Setting

Pan London (2010) Competency Assessment Framework for Children’s Community Nurses to Administer Low Risk Cytarabine

National Professional guidelines:

Guidelines for Records and Record keeping. NMC (2009)

Standards for Medicines Management. NMC (2008a)

The Code: Professional standards of practice and behaviour for nurses and midwives.

www.nmc-uk.org/code.

NPSA Guidance – Safer use of injectables www.npsa.nhs.uk/health/alerts

Resuscitation Council (uk0

www.resusorg.uk/resuscitation-guidelines/

http://www.nmc-uk.org/code

http://www.npsa.nhs.uk/health/alerts

http://www.resusorg.uk/resuscitation-guidelines/


9


10 Associated Documents

This policy must be read in conjunction with following Shropshire Community Health NHS Trust policies:

Aseptic Technique

Cleaning and Disinfection Hand Hygiene

Medicine Policy Part 1: General Principles

Standard Precautions including surgical hand scrub, Gowning and Gloving

Waste Management

Appendix 1

CCN List of Low Risk Regimes (Measure 11-7A-136)

We have agreed in the Principle Treatment Centre that low dose bolus Cytarabine can be delivered by the Community Nursing teams within the West Midlands for the associated regimens below. This is routinely administered intravenously but, if needed, can be administered by the subcutaneous route. A community prescription will be completed by the referring hospital clinician.

Protocol Name Associated regimens Associated drugs

T-cell NHL (EuroLB 02 protocol) LB Induction Phase 1b Cytarabine only

LB Re-induction 2b Cytarabine only

ALL 2003 * ALL03 BFM CONSOL REG B Cytarabine only

ALL03 BFM CONSOL REG C Cytarabine only

ALL03 DI 1 Cytarabine only

ALL03 DI 2 Cytarabine only

EsPhALL ESPHALL PHASE 1B Cytarabine only

ESPHALL PHASE 2B Cytarabine only

B-NHL group C M2 and M4 courses Cytarabine only

Interfant 06 OCTADA, OCTADAD Cytarabine only

UKALL R3 Phase V Interim maintenance Cytarabine only

The Principal Treatment Centre Birmingham Children’s Hospital produces a Cytarabine CD-ROM for training children’s community nurses in low risk chemotherapy administration. *Please note the ALL 2003 protocol has now changed name to UKALL 2011 Protocol. Awaiting update from measures.


10


Appendix 2 Competency Assessment Framework for Administration of Low Risk Cytarabine

Aims of Training

Each practitioner will be able to competently administer low risk (e.g. low dose) intravenous Cytarabine to children and young adults with a diagnosis of cancer or other non-malignant condition.

Each practitioner will be able to demonstrate practical skills in the administration of low risk intravenous Cytarabine.

Attaining Competency

Each practitioner must work through the e-learning CD “Cytarabine - low risk chemotherapy training for Children’s Community Nurses” produced by Birmingham Children’s Hospital NHS Foundation Trust Oncology Department.

Complete three supervised practices in the administration of low risk Cytarabine.

Each practitioner must complete a competency-based practical assessment and oral assessment.

This competency assessment should be undertaken by a chemotherapy competent practitioner in your clinical area or the Lead Chemotherapy Nurse in your Paediatric Oncology Shared Care Unit. This document assumes that you have developed the following essential competencies during pre-registration training: 1. Medicine Management 2. Skills and knowledge of safe intravenous administration 3. Maintenance of a safe environment 4. Communication and principles of information giving 5. Clinical decision making 6. Infection prevention and control

If after your assessment it is identified that you need further knowledge or skill development, a development plan will be written with you. This will be at the discretion of the assessor and discussion with lead assessor if necessary. If you feel you are ready to be signed off as competent to administer low risk Cytarabine, you should identify an assessor with whom you will need to demonstrate your knowledge and skills in respect to the safe preparation, administration and disposal of low risk Cytarabine. It is your responsibility to demonstrate that you are competent. When you and your assessor agree that you are competent in all areas identified, please sign the form and give it to the Lead Chemotherapy Nurse, so that you can be recorded on the registrar as competent to administer low risk Cytarabine.

When carrying out intravenous or subcutaneous medication administration it is the responsibility of staff to adhere to the anaphylaxis guidelines and ensure that they take the anaphylaxis kit with them to the child involved.


11


Intravenous syringes must be used and be clearly distinguishable from enteral syringes (purple), as recommended by NSPA Guidance on injectables i.e. Safety Engineered Needle Device System.

Prescriptions of injections of intravenous medication must clearly specify the patient’s name, medicine name, dose, frequency, route of administration and be signed by medical staff.

Competency should be assessed/discussed annually as part of Personal Development Plan review.

Competencies related to preparation and administration of low risk Cytarabine

Competent Not Competent

Date

Able to explain to the patient and/or their carer the risks and benefits of receiving low risk Cytarabine, and accurately answer any questions at a pace and level which is appropriate to:

Their needs

Their emotional state

Their level of understanding

Their culture and background

Their preferred ways of communicating

Understand the professional and legal responsibilities in respect of the consent process for chemotherapy

Knowledgeable of the route of administration and able to assess the suitability, patency and site of device prior to the administration of low risk Cytarabine

Knowledge and understanding about the specific drug, its mode of action, and any side effects, including management of these.

Demonstrate skills to safely prepare and administer low risk Cytarabine in compliance with local and national policy. This must include:

Identification of the patient

Body Surface Area

Handling of drug, preparation, administration, disposal and ability to deal with a spillage

Ability to recognise and respond to immediate side effects/complications of administration of Cytarabine: This should include:

Flare reactions

Extravasation

Allergic/hypersensitive reactions

Anaphylaxis


12


Supervised Practice

Date Supervised Signature

Low Risk Cytarabine Dose:





Competent to Administer Low Risk Cytarabine

I am competent to administer low risk chemotherapy Signature: Name: Date: I have observed ……………………………………………………. and consider them

competent to administer low risk chemotherapy

Signature:

Name:

Date:

Please keep one copy for your records and return one copy to the Lead Paediatric

Chemotherapy Nurse in your clinical area or Paediatric Oncology Shared Care Unit


13


Appendix 3 Aseptic Non-Touch technique

Equipment

Prescribed medication and appropriate flush

Sodium Chloride 0.9% injection

Heparin 100iunits/ml (2ml ampoule) per lumen prescription

Drug information sheet

Intravenous 10ml syringes

Needles including filter needles for glass ampoules

Swabs 2% chlorhexidine in 70% IPA to clean key parts before and after medication

Cytotoxic Sharps Bin (purple)

Single use disposable gloves - need to check procedure i.e. if need 2 pairs – one for drawing up and one for giving

Single use disposable apron

Closed system bung

Appropriate sterile dressing,(if to be changed)

Cleansing wipes 70% alcohol & 2% chlorhexidine.

Cytarabine in pre prepared individual dispensed and labelled luer lock intravenous syringes

Apron, single use disposable armlets and eye protection (e.g. visor; mask and goggles)

A three stage technique should be used for aseptic non touch technique:

Thorough hand decontaminationIdentification and non-contamination of key parts

Protection of yourself and the patient by wearing single use gloves, apron and eye protection

All syringes must be labelled immediately after drawing up. Exception to the rule is where the preparation and administration is one uninterrupted process and the unlabelled product does not leave the hands of the person who prepared it.

Action Rationale

1. Explain to the child and family what you are going to do using age appropriate language.

If child/family is going to assist with clamping and unclamping the line ensure they decontaminate their hands.

Minimise distress and encourage child and family co-operation.

2. Decontaminate hands using liquid soap and water and dry thoroughly with disposable paper towels or use alcohol hand gel on visibly clean hands.

To reduce the risk of infection

3. Put on apron, To protect the member of staff against spillage.


14


4. Collect all necessary equipment. Calculate all medication dosages; ensure correct patient, correct drug, correct dosage, correct route.

To reduce the risk of error

5. Establish a clean area e.g. tray/surface, with detergent wipe. After cleaning allow the area to dry and use as a clean work area.

To reduce the risk of error and infection

6. Wash hands, dry thoroughly and apply a small amount of alcohol based hand gel and rub in thoroughly.

To reduce the risk of infection. To ensure the alcohol based gel works effectively.

7. Put on eye protection, armlets and a pair of well-fitting non-sterile gloves straight from the box.

To reduce risk of infection.

8. Open equipment by carefully peeling back packaging. Place syringe ensuring key parts are uppermost/not in contact with tray.


9. Connect all needles to syringes and draw up and prepare all medication. Keep key parts free from contamination.


10. Check pre filled Cytarabine syringes against the prescription and the child – check name, address and date of birth with parent/carer that is present. The Cytarabine syringe will come pre-labelled. With scissors cut open the packet and carefully place syringe ensuring key parts are uppermost and not in contact with tray.

To comply with NMC (2008) Standards for Medicine Management

11. Discard needles directly into sharps bin. Ensure key parts free from contamination.

To prevent needle stick injury.

12. Encourage parent/carer to prepare their child as required. Help the child get into a comfortable position. Ask child/parent to expose line. Check the catheter, clamp and bung for damage or displacement. Check the catheter exit site for pain,

To encourage child and family participation.

To enable the detection of displaced damaged catheter. To ensure it is safe to proceed.


15


redness or swelling.

13. Clean the needle-free access device/bung attached to end of the CVAD with 2% chlorhexidine in 70% alcohol-impregnated swab for 15 seconds using friction. Allow to dry naturally for 30 seconds, visibly checking that it is dry.

To reduce the risk of infection.

14. Attach a 10 ml intravenous syringe and withdraw 2-3ml of blood. This blood is then discarded. Flush line with 0.9% sodium chloride with 2ml. Close clamp and remove syringe and replace on the edge of the sterile field. If there is any resistance or pain close clamp and seek advice.

To check the line patency and to expel previous heparin.

15. Administer the Cytarabine drug slowly according to recommendations. If more than one drug given, each should be clearly labelled and flush of 3-5ml 0.9% sodium chloride in between each one.

To ensure the correct administration of prescribed drugs.

To prevent the mixing of incompatible drugs.

16. Slowly administer heparin as prescribed, do not empty the syringe – when 1 ml left in the syringe continue to administer but at same time close the clamp – still exerting positive pressure.

To ‘Heplock’ the CVAD. To prevent occlusive clot formation.

17. Clean CVAD with 2% chlorhexidine in 70% alcohol-impregnated swab for 15 seconds using friction. Allow to dry naturally for 30 seconds, visibly checking that it is dry. Put clean bung on line.


18. Secure the central line. Make sure the child is comfortable and replace clothing.

To reduce the risk of line displacement.

19. Dispose of all equipment. Ensure needle and syringes have been disposed of in a cytotoxic sharps bin (purple lid). Remove gloves, and armlets and apron, decontaminate hands and remove, face protection

To maintain a safe environment and to reduce risk of infection.


16


and dispose as of SCHT policy.

20. Clean plastic tray after use with detergent wipe or wash with soap & water and dry thoroughly.


21. Decontaminate hands.


22. Ensure prescription is signed and care is record in the nursing documentation.

To comply with NMC (2008a) Standards for Medicine Management and NMC (2009) Record and Record keeping.


17


Appendix 4 Subcutaneous administration Equipment

23-25 G needle or 27G needle if accessing insulflon

Syringes

Single use gloves, eye protection and apron

Sharps bin (purple lid)

Plaster or small dressing

Action Rationale

1. Explain to the child and family what you are going to do using age appropriate language.

Minimise distress and encourage child and family co-operation.

2. Gain informed consent for procedure from child and/or parents as appropriate.

To ensure legal requirement completed.

3. Decontaminate hands and dry thoroughly


4. Put on single use disposable apron, eye protection and armlets.

To protect the member of staff against spillage.

5. Collect all necessary equipment. Calculate all medication dosages; ensure correct patient, correct drug, correct dosage and correct route.

To comply with NMC (2008a) Standards for Medicine Management.

To reduce the risk of error.

6. Establish a clean area e.g. tray/surface, clean with detergent wipe and allow to dry


7. Decontaminate hands thoroughly


To ensure the alcohol based gel works effectively.

8. Apply a pair of well-fitting non-sterile gloves straight from the box.


9. Identify the desired site for injection i.e. upper outer arms, the abdomen on either side of umbilicus or upper outer thigh.

To ensure the injection is administered safely and appropriately.

10. Observe skin to ensure visibly clean. If the skin is visibly soiled,



18


wash it with soap and water and dry.

11. Clean skin using 70% alcohol and chlorhexidine 0.5% swab for 30 seconds and allow to dry.


12. Inject at a 45 degree angle to the skin, while bunching up the skin.

To expose adipose tissue.

13. Administer the medicine slowly and once complete release the skin. Ideally wait for 10 seconds before withdrawing the needle.

To allow dissipation of medication.

14. Dispose of all equipment. Ensure needle and syringes have been disposed of in a cytotoxic sharps bin (purple lid).

To maintain a safe environment and minimise risk of infection.

15. If any bleeding is noted, apply gentle pressure and apply a small dressing such as a plaster if necessary.

To prevent haematoma formation

16. Remove gloves, apron and face protection dispose appropriately.


16. Alcohol hand rub gel may be used on visibly clean hands.


17. Ensure prescription is signed and care is record in the nursing documentation.

To comply with NMC (2008a) Standards for Medicine Management and NMC (2009) Record and Record keeping.


19


Appendix 5 Side effects Symptoms require discussion and/or referral to PTC or the patients’ regular local designated POSCU.

EARLY EFFECTS

Mild nausea and vomiting – a few children may require oral Ondansetron

diarrhoea

temporary decrease in blood cell count after 7-14 days, with recovery in 2-3 weeks

sore eyes/ skin rashes with high doses (not expected with dose administered in community)

pyrexia – mild low grade fever,

alopecia

chest pain - rare

bone pain and muscle pain - rare

urine retention - rare

Neurotoxicity is not expected with doses seen in the community, but review drug interactions and bear in mind that children with cancer & leukaemia may have had other nephrotoxic drugs.

Cytarabine syndrome – bone and muscle pain, chest pain, fever, general weakness, reddened eyes, and skin rash. Not expected with dose administered in the community. LATE EFFECTS

liver toxicity

kidney toxicity

Central Nervous System toxicity (not expected with dose administered in community)


20


Appendix 6 Roles and Responsibility for the Administration of Cytarabine.

Principle Treatment Centre

Informed consent to treatment with child, young person and/or carers.

Informing POSCU and CCN team

Competency support to clinical staff

Paediatric Oncology Shared Care Unit

(POSCU i.e. SaTH) and/or PTC

Identify patient is fit for chemotherapy (i.e. review bloods as required)

Prescribe medication on appropriate medication chart, making sure weight and surface area recorded. To include medication for phase of treatment.

Inform CCN team dates Cytarabine due on.

Give child, young person and carers as appropriate Cytarabine medication for home setting with advice for storage.

Provide spillage kit and cytotoxic sharps bin

Competency support to clinical staff

Community Children’s Nurse Team Ensure competent to administer low dose Cytarabine and ensure updated.

Liaise with child, young person and carers date and time of visit.

To check prescription with another nurse who is competent prior to home visit.

To check prescription of medication in the home setting, prior to administration.

Administer Cytarabine as per guidelines.

Ensure all waste is disposed of correctly following SCHT policy.

Document and record administration appropriately.

Ensure documentation is returned to patients medical notes to be filed, keep a copy for CCN nursing notes.