Accréditation Sans Frontières · ASF Health Standards 9.0
Standard 12 · Oncology & Cancer Care
6 criteria · base standard
Base standard. 6 criteria, of which 3 non-negotiable. Each criterion is numbered 12.Y, with its classification and verification questions.
Criteria
- 12.1 Cytotoxic Drug Handling Follows a Verified Safe-Handling Standard (NON-NEGOTIABLE)
- 12.2 Chemotherapy Dose Is Verified by Independent Two-Person Check (NON-NEGOTIABLE)
- 12.3 Neutropenic Fever Triggers an Immediate, Time-Bound Response (NON-NEGOTIABLE)
- 12.4 Extravasation Is Recognised and Managed Immediately (CORE)
- 12.5 Multidisciplinary Tumour Board Informs Treatment Planning (CORE)
- 12.6 Palliative Care Integrated Alongside Active Treatment (STANDARD)
12.1 Cytotoxic Drug Handling Follows a Verified Safe-Handling Standard
NON-NEGOTIABLE
Preparation, administration, and disposal of cytotoxic and other hazardous drugs follows a defined, verified safe-handling standard — appropriate personal protective equipment, engineering controls, and disposal procedures — not informal practice that varies by individual staff member, including on inpatient wards where chemotherapy may be administered outside the dedicated infusion unit.
VERIFICATION QUESTIONS
- Is appropriate personal protective equipment used consistently for every stage of handling, including by inpatient ward nursing staff, not only dedicated infusion unit staff?
Consistent use at every stage and location, not only in the specialised infusion setting. - Are hazardous drugs prepared and stored using the required engineering controls, not standard pharmacy equipment?
Specific, required controls, not general pharmacy practice assumed to be sufficient. - Is hazardous waste disposed of through a defined, compliant pathway on every inpatient unit where it is generated, not general medical waste?
A specific, separate disposal pathway matched to the actual risk, available wherever cytotoxic agents are used.
12.2 Chemotherapy Dose Is Verified by Independent Two-Person Check
NON-NEGOTIABLE
Every chemotherapy dose, drug, route, and infusion rate is independently verified by two qualified individuals before administration, each forming their own judgement separately — not a single check followed by a second signature, and applied identically on inpatient wards as in the dedicated oncology unit.
VERIFICATION QUESTIONS
- Does every chemotherapy dose undergo independent verification by two qualified individuals before administration, on every unit where it is given?
Two people, every dose, without exception for perceived routine cases or off-unit administration. - Does each person form their own separate judgement, not simply confirm the first person's check?
Independence, not sequential confirmation of the same conclusion. - Does verification specifically cover drug, dose, route, and infusion rate together, not dose alone?
All four elements, since an error in any one carries risk.
12.3 Neutropenic Fever Triggers an Immediate, Time-Bound Response
NON-NEGOTIABLE
A patient with suspected neutropenic fever receives first-dose antibiotics within a defined, short time target from presentation, with staff trained to recognise the urgency and a protocol that bypasses routine triage queuing — not treated as a standard fever presentation.
VERIFICATION QUESTIONS
- Is there a defined, specific time target for first-dose antibiotics from presentation, tracked against actual practice?
A specific, measured target, not a general sense that treatment happens "promptly." - Do staff recognise neutropenic fever as a time-critical emergency distinct from routine fever, bypassing standard queuing?
Delay from routine triage treatment is a specific, well-documented risk for this patient population. - Can the facility show a recorded example of this protocol being used with actual time-to-antibiotic data recorded?
Evidence the protocol functions, not just exists on paper.
12.4 Extravasation Is Recognised and Managed Immediately
CORE
Staff administering vesicant or irritant chemotherapy agents are specifically trained to recognise early signs of extravasation, with a defined, immediate management protocol and appropriate antidotes available wherever these agents are administered, including inpatient wards.
VERIFICATION QUESTIONS
- Are staff specifically trained to recognise early signs of extravasation for the agents used here, including ward nursing staff?
Specific to the actual agents administered, not generic infusion complication awareness. - Is there a defined, immediate management protocol for suspected extravasation accessible on every unit?
A specific, known protocol, not improvisation in the moment, available wherever the agent might be given. - Are appropriate antidotes for the specific vesicant agents used available wherever administration occurs?
Immediately available and in date on the actual unit, not only in the dedicated oncology area.
12.5 Multidisciplinary Tumour Board Informs Treatment Planning
CORE
Complex or newly diagnosed cancer cases are reviewed by a multidisciplinary tumour board before the treatment plan is finalised, with documented board input shaping the plan, not a single treating physician's decision presented as though it were a team decision.
VERIFICATION QUESTIONS
- Does a multidisciplinary tumour board meet regularly and review complex or new cases, rather than existing in name only?
A board that meets but does not substantively review actual cases provides no value. - Is board input documented as having shaped the treatment plan, not just noted as having occurred?
A recorded case where discussion changed the plan is a test of whether the board functions. - Does the board include relevant specialties
surgery, oncology, radiology, pathology — not a single specialty consulting nominally with others? — Multidisciplinary input, not one discipline dominating with token representation from others.
12.6 Palliative Care Integrated Alongside Active Treatment
STANDARD
Palliative care expertise is integrated early in the course of serious cancer diagnoses, alongside active treatment, not introduced only once active treatment has been exhausted — with symptom management and goals-of-care conversations happening throughout, not as a late, separate referral.
VERIFICATION QUESTIONS
- Is palliative care introduced early, alongside active treatment, not only after active treatment options are exhausted?
Early integration provides symptom and quality-of-life benefit distinct from end-of-life care alone. - Are goals-of-care conversations happening at meaningful points throughout the course, not deferred to a single late conversation?
Ongoing, not a one-time discussion held only when options have narrowed. - Is palliative referral accessible and used, not a resource that exists on paper but is rarely accessed?
Verified against actual recent use, not only the existence of a palliative care service. ————————————————————