Standard 15: Oncology and Cancer Care (Version 11)

Why it matters. Cytotoxic drugs can harm the people who prepare and give them, and the environment. A verified safe-handling standard for preparation, administration and disposal protects everyone.

Sample. Observe cytotoxic preparation, administration and disposal on several days, and review the verification register for the last 6 months.

1. Cytotoxic and hazardous drugs are handled under a defined, verified safe-handling standard.

Method. Compare the standard with the procedure for preparation, giving and disposal.

Evidence to show. Cytotoxic drug safe handling (ONC-SOP-001).

Pass when. The standard covers preparation, giving and disposal and is verified.

2. Protective equipment is worn for each task.

Method. Observe a sample of tasks and record the equipment worn.

Evidence to show. Cytotoxic handling verification register (ONC-REG-001).

Pass when. Equipment is worn for every observed task.

Immediate fail (any one means the criterion is not met). A nurse prepares a cytotoxic drug without gloves or a safety cabinet, and a spill exposes staff.

Why it matters. Chemotherapy doses are high and mistakes are severe. An independent second check by a second trained person catches the error before it reaches the patient.

Sample. Review every chemotherapy dose record for the last 3 months, and observe the check on several days.

1. Every chemotherapy dose is independently verified by two qualified people before administration.

Method. Check each sampled dose for two recorded independent checks made before administration.

Evidence to show. Chemotherapy two-person check record (ONC-FRM-002).

Pass when. Every sampled dose has two recorded independent checks before administration.

2. The check covers the drug, dose, route and infusion rate.

Method. Check the record for each element in the sample.

Evidence to show. Chemotherapy two-person check record (ONC-FRM-002).

Pass when. Every sampled check records all four elements.

Immediate fail (any one means the criterion is not met). A dose is checked by one nurse only, and an overdose is given because the second check was never made.

Why it matters. Chemotherapy lowers the white cells that fight infection. A patient with fever in that state can die within hours. Giving antibiotics within a set time is what saves them.

Sample. Review every suspected neutropenic fever case in the last 12 months, against the time target and the register.

1. A patient with suspected neutropenic fever is treated as an emergency at triage.

Method. Check the triage record for each sampled case.

Evidence to show. Neutropenic fever response (ONC-SOP-003).

Pass when. Every sampled case is flagged as urgent at triage.

2. First-dose antibiotics are given within the time target.

Method. Compare the presentation and antibiotic times in the register with the target.

Evidence to show. Neutropenic fever time register (ONC-REG-002).

Pass when. Every sampled case had antibiotics within the target, or a recorded reason.

3. The time target is current against guidance.

Method. Check the target against the current guidance and the date of the last review.

Evidence to show. Neutropenic fever response (ONC-SOP-003).

Pass when. The target was reviewed within the last year.

Immediate fail (any one means the criterion is not met). A febrile neutropenic patient waits 4 hours for antibiotics in the waiting room, and no reason is recorded.

Why it matters. If a drug that damages tissue leaks into the skin during an infusion, it can cause severe injury. Staff who recognise it early and act at once limit the harm.

Sample. Review extravasation events and staff training for chemotherapy giving, for the last 12 months.

1. A written immediate management protocol is followed at the first sign.

Method. Check each recorded extravasation for the protocol steps and times.

Evidence to show. Extravasation management record (ONC-FRM-003).

Pass when. Every recorded extravasation has the protocol started at once.

2. Antidotes and equipment are available at the chair.

Method. Check the chair kit on each sampled day.

Evidence to show. Extravasation recognition and immediate management (ONC-SOP-004).

Pass when. The kit is complete on every sampled day.

Immediate fail (any one means the criterion is not met). A vesicant leaks at the cannula, and the nurse continues the infusion for 10 minutes before stopping.

Why it matters. Complex cancer cases are best decided by a team of specialists together. A tumour board that reviews the case before treatment starts improves the decision.

Sample. Review the tumour board records for newly diagnosed and complex cases in the last 12 months.

1. Complex or newly diagnosed cases are reviewed by the board before the plan is finalised.

Method. Compare the list of eligible cases with the board records for the sample.

Evidence to show. Tumour board decision register (ONC-REG-003).

Pass when. Every eligible case in the sample has a board review before the plan.

2. The board includes the relevant specialties and records its input.

Method. Check each board record for the specialties present and the input recorded.

Evidence to show. Tumour board decision register (ONC-REG-003).

Pass when. Every board record lists the specialties and the input.

3. The board input is in the treatment plan.

Method. Check the plan for each reviewed case.

Evidence to show. Tumour board decision register (ONC-REG-003).

Pass when. Every reviewed case has the board input in its treatment plan.

Immediate fail (any one means the criterion is not met). A new breast cancer is started on surgery without a board review, and the board later recommends a different plan.

Why it matters. Cancer patients need palliative care alongside treatment, not only at the end. Bringing it in early controls symptoms and supports the patient through treatment.

Sample. Review the palliative care referrals and symptom records for patients with serious cancer diagnoses in the last 12 months.

Immediate fail (any one means the criterion is not met). A patient with metastatic disease gets no palliative input until the last week of life.

Why it matters. High-alert medicines cause serious harm when given wrongly. An extra independent check and separate storage prevent the most common errors.

Sample. Check the high-alert medicine list, the storage of concentrated electrolytes and insulin, and the second-check records on several wards.

Immediate fail (any one means the criterion is not met). Concentrated potassium is stored with routine stock and is given in error.

Why it matters. Triage decides who is seen first. Without a recognised tool, the sickest patient can wait behind the least sick, and nobody can show why.

Sample. Review triage records for a random sample of emergency and urgent arrivals in the last 3 months.

Immediate fail (any one means the criterion is not met). A patient with chest pain is triaged as non-urgent and waits 90 minutes.

Why it matters. Sepsis is time critical. Each hour of delay to antibiotics adds risk, so the time from recognition to treatment must be measured.

Sample. Review every suspected sepsis case in the sepsis register for the last 12 months.

Immediate fail (any one means the criterion is not met). A sepsis case is recognised at 9 am and antibiotics are given at 6 pm, with no record of the delay.

Why it matters. Pain and other symptoms such as breathlessness, nausea and agitation drive most of the suffering in serious illness. Assessing them on a schedule, and acting on the scores, is what keeps patients comfortable.

Sample. Review pain and symptom assessments and symptom plans for a sample of patients with cancer in the last 6 months.

Immediate fail (any one means the criterion is not met). A patient with severe nausea has no plan for 3 days, and the nausea is not reassessed.

Why it matters. Patients with serious illness have goals and wishes that shape their care. If they are not asked and written down, care is given according to what the team assumes they want.

Sample. Review patient goals and wishes records for patients with serious cancer in the last 12 months.

Immediate fail (any one means the criterion is not met). A patient with advanced cancer is never asked about goals, and an intensive procedure is started against their wishes.