Cumulative Dose Monitoring – Required for Course Completion
The nurse’s role in monitoring cumulative dose is an expected step in the safe administration verification process, as part of an assessment of the overall treatment plan. Yet, many nurses will rely on the dosage checks performed by others (physicians, pharmacists, etc.) or by systems (e.g., electronic health records) and will opt to play a passive role in monitoring appropriate doses and cumulative dose information. However, as the nurse administering the chemotherapy, they are the last line of safety defense for the patient who is receiving the agent(s).
Take a few minutes to read this classic New York Times article on a much-publicized error that went unnoticed by many oncology professionals. While this specific issue is not aimed at monitoring the cumulative dose of an agent, it does illustrate the risk of playing a passive role in administering what is ordered without your own confirmation that the dose successfully addresses the 5 rights of medication administration.
Now reflect on the risks of administering chemotherapy above the recommended cumulative dose.
For this discussion, post your findings on your role in monitoring cumulative dose then list 2-3 areas in your practice that could be improved related to monitoring, verifying and documenting cumulative doses of chemotherapy. Also, related to the New York Times article, do you feel your facility or practice has enough safeguards in place to prevent a lethal chemotherapy overdosage? Why or why not?
To help guide you in your discussion posting, research the following questions in your area of practice:
•Where is the cumulative dose documented in your institution or practice?
•What is your role in monitoring the cumulative dose and acting on an order if the maximum dose has been reached?
•What is your institution’s policy that addresses monitoring and documentation of cumulative doses of chemotherapy. Keep in mind the policy may not be in the nursing department.
•Are there opportunities for improvement in your own setting?