Setting Standards for Chemotherapy & Biologic Administration: Organizational Clinical Nurse Specialists Led Practice Change.

Abstract

Purpose: Because of the lack of institutional standards, variation in practice for administering chemotherapy and biologics, including clinical trial infusions, was detected. This article describes a National Cancer Institute-designated cancer center's successful education and training of nurses on a new standard method for administering small-volume infusion using the circle priming technique.

Description of the project: A team of clinical nurse specialists (CNSs) led a system-wide practice change to standardize the administration of chemotherapy and biologic treatments using the circle priming method. The CNSs partnered with an interprofessional group that included pharmacy staff, physicians, and nursing leadership to implement this new nursing practice for administering chemotherapy. Circle priming is a practice supported by literature for giving small-volume medications. The team secured approval from stakeholders and conducted a 2-week soft rollout in a high-volume acute care unit. Nursing policies and chemotherapy guidelines were updated, and a 20-minute education module with hands-on training was provided to nursing staff. After the rollout, CNSs supported nurses in real time by employing a train-the-trainer model to educate nurse champions and other staff members. Daily debriefs were held to address any issues and troubleshoot effectively.

Outcome: Fifteen CNSs educated 91% of frontline staff (643 out of 714 nurses) on circle priming for small-volume chemotherapy. The training included didactic and practical methods, focusing on safety, intravenous flushing, pump programming, handling practices, and patient education. Furthermore, this new standardized method was shared internally with various chemotherapy and biotherapy committees to raise awareness among the interdisciplinary team. Patients were also educated on the practice change with newly developed patient education materials.

Conclusion: Clinical nurse specialists are well equipped to define best practices and implement evidence-based recommendations, such as circle priming, which ensures full drug delivery and supports the highest-quality patient care.