Standards › ASF Health Standards v10 › Standard 51
Standard 51
Oncology and Cancer Care
Oncology and cancer care: safe handling of cytotoxic drugs, independent two-person checks, neutropenic fever treated quickly, extravasation managed at once, tumour board review, palliative care alongside treatment, and goals and wishes recorded.
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.
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.
How the surveyor verifies this criterion
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.
3. Training is recorded for staff who handle cytotoxic drugs.
Method. Check the training matrix for each staff member who handles these drugs.
Evidence to show. Training matrix register (WRK-REG-001, existing, reused).
Pass when. Every staff member who handles cytotoxic drugs has recorded training.
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.
Documents
No documents yet.
E-learning
References
- National Institute for Occupational Safety and Health (NIOSH). NIOSH Alert: Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings. Publication No. 2016-161. Cincinnati, OH: NIOSH; 2016.
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.
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.
How the surveyor verifies this criterion
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 independent two-person check (ONC-SOP-002); 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.
3. A mismatch stops administration until resolved.
Method. Check any recorded mismatch for the resolution before administration.
Evidence to show. High-alert second-check record (HOS-FRM-005, existing, reused).
Pass when. Every mismatch is resolved before administration.
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.
Documents
No documents yet.
E-learning
References
- World Health Organization (2021). Global Patient Safety Action Plan 2021–2030: Towards Eliminating Avoidable Harm in Health Care. Geneva: WHO. https://www.who.int/publications-detail-redirect/9789240032705
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.
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.
How the surveyor verifies this criterion
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); triage on arrival (URG-POL-001, existing, reused).
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); sepsis recognition and antibiotic timing (HOS-SOP-003, existing, reused).
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.
Documents
No documents yet.
E-learning
References
- Taplitz RA, Kennedy EB, Bow EJ, et al. Outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America clinical practice guideline update. J Clin Oncol. 2018;36(14):1443-1453.
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.
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.
How the surveyor verifies this criterion
Sample. Review extravasation events and staff training for chemotherapy giving, for the last 12 months.
1. Staff giving vesicant or irritant drugs are trained to recognise early signs.
Method. Check the training record for each staff member who gives these drugs.
Evidence to show. Training matrix register (WRK-REG-001, existing, reused).
Pass when. Every staff member who gives these drugs is trained.
2. 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 recognition and immediate management (ONC-SOP-004); extravasation management record (ONC-FRM-003).
Pass when. Every recorded extravasation has the protocol started at once.
3. 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.
Documents
No documents yet.
E-learning
References
- National Institute for Occupational Safety and Health (NIOSH). NIOSH Alert: Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings. Publication No. 2016-161. Cincinnati, OH: NIOSH; 2016.
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.
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.
How the surveyor verifies this criterion
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. Multidisciplinary tumour board (ONC-POL-001); 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.
Documents
No documents yet.
E-learning
References
- World Health Organization (2021). Global Patient Safety Action Plan 2021–2030: Towards Eliminating Avoidable Harm in Health Care. Geneva: WHO. https://www.who.int/publications-detail-redirect/9789240032705
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.
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.
How the surveyor verifies this criterion
Sample. Review the palliative care referrals and symptom records for patients with serious cancer diagnoses in the last 12 months.
1. Palliative care expertise is involved early in serious cancer diagnoses.
Method. Check the date of the first palliative needs screen against the date of diagnosis for the sample.
Evidence to show. Palliative needs identification (PAL-SOP-001, existing, reused).
Pass when. Every sampled serious diagnosis has a palliative needs screen early in the course.
2. Palliative care is integrated with active treatment, not introduced only after it ends.
Method. Check that palliative care contact is recorded during the active treatment period.
Evidence to show. Symptom assessment and control (HSP-POL-001, existing, reused); family support record (HSP-FRM-003, existing, reused).
Pass when. Palliative contact is recorded during active treatment for every sampled patient.
3. Symptoms are managed alongside treatment.
Method. Check the symptom chart for the sampled patients.
Evidence to show. Symptom assessment chart (HSP-FRM-001, existing, reused).
Pass when. Symptom plans are in place throughout active treatment.
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.
Documents
No documents yet.
E-learning
References
- Knaul FM, et al. Alleviating the access abyss in palliative care and pain relief: an imperative of universal health coverage. Lancet Commission. Lancet. 2017.
A defined list of high-alert medicines applies on every ward. Each one has a second check, and concentrated electrolytes and insulin are kept separate from general stock.
Why it matters. High-alert medicines cause serious harm when given wrongly. An extra independent check and separate storage prevent the most common errors.
How the surveyor verifies this criterion
Sample. Check the high-alert medicine list, the storage of concentrated electrolytes and insulin, and the second-check records on several wards.
1. A defined list of high-alert medicines applies on every ward.
Method. Compare the list with the ward stock and the policy.
Evidence to show. High-alert medicines (HOS-SOP-006, existing, reused).
Pass when. Every ward applies the same list.
2. Each high-alert medicine has a second check.
Method. Check the second-check record for a sample of high-alert doses on each ward.
Evidence to show. High-alert second-check record (HOS-FRM-005, existing, reused).
Pass when. Every sampled high-alert dose has a recorded second check.
3. Concentrated electrolytes and insulin are kept separate from general stock.
Method. Inspect the storage on each ward.
Evidence to show. High-alert medicines (HOS-SOP-006, existing, reused).
Pass when. Concentrated electrolytes and insulin are separate on every inspected ward.
Immediate fail (any one means the criterion is not met)
- Concentrated potassium is stored with routine stock and is given in error.
Documents
No documents yet.
E-learning
References
- World Health Organization (2021). Global Patient Safety Action Plan 2021–2030: Towards Eliminating Avoidable Harm in Health Care. Geneva: WHO. https://www.who.int/publications-detail-redirect/9789240032705
Every patient arriving for emergency or urgent care is sorted by clinical urgency, within a set time, using a recognised triage tool. The most urgent are seen first.
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.
How the surveyor verifies this criterion
Sample. Review triage records for a random sample of emergency and urgent arrivals in the last 3 months.
1. Every emergency or urgent arrival is sorted by clinical urgency within the set time.
Method. Check the triage time against the arrival time for each sampled arrival.
Evidence to show. Triage on arrival (URG-POL-001, existing, reused); triage record (URG-FRM-001, existing, reused).
Pass when. Every sampled arrival is triaged within the set time.
2. A recognised triage tool is used.
Method. Check the triage record for the tool used.
Evidence to show. Emergency triage (HOS-SOP-001, existing, reused).
Pass when. Every sampled triage record names the recognised tool.
3. The most urgent are seen first.
Method. Check the order of seeing against the triage category for the sample.
Evidence to show. Triage record and log (HOS-FRM-001, existing, reused).
Pass when. The most urgent patients in the sample were seen first.
Immediate fail (any one means the criterion is not met)
- A patient with chest pain is triaged as non-urgent and waits 90 minutes.
Documents
No documents yet.
E-learning
References
- World Health Organization. Emergency triage assessment and treatment (ETAT) manual. Geneva: WHO; 2005.
Staff recognise sepsis using a defined screening tool. Antibiotics are given within the time set by current sepsis guidelines, and the time is recorded.
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.
How the surveyor verifies this criterion
Sample. Review every suspected sepsis case in the sepsis register for the last 12 months.
1. Sepsis is recognised using a defined screening tool.
Method. Check each sampled case for the screening result.
Evidence to show. Sepsis recognition and antibiotic timing (HOS-SOP-003, existing, reused).
Pass when. Every sampled case has a recorded screening result.
2. Antibiotics are given within the time set by current guidance.
Method. Compare the recorded times with the target.
Evidence to show. Sepsis time-to-antibiotic register (SEP-REG-001, existing, reused).
Pass when. Every sampled case had antibiotics within the target, or a recorded reason.
3. The time is recorded.
Method. Check the register for complete times.
Evidence to show. Review of deterioration, sepsis and VTE events (DET-SOP-002, existing, reused).
Pass when. Every sampled case has complete times.
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.
Documents
No documents yet.
E-learning
References
- Evans, L. et al. (2021). Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Critical Care Medicine. https://sccm.org/sepsisguidelines
Pain and other symptoms (breathlessness, nausea, anxiety, agitation) are assessed on a schedule with a validated tool, and treated with a written symptom plan that is reviewed when symptoms change.
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.
How the surveyor verifies this criterion
Sample. Review pain and symptom assessments and symptom plans for a sample of patients with cancer in the last 6 months.
1. Pain and symptoms are assessed on a schedule with a validated tool.
Method. Check the assessment record for the tool and the interval for each sampled patient.
Evidence to show. Pain assessment and management (MNP-POL-003, existing, reused); structured pain assessment and reassessment (MNP-SOP-002, existing, reused).
Pass when. Every sampled patient has scheduled assessments with a validated tool.
2. Each symptom has a written symptom plan.
Method. Check the symptom plan for each sampled patient.
Evidence to show. Symptom assessment and control (HSP-POL-001, existing, reused); symptom assessment chart (HSP-FRM-001, existing, reused).
Pass when. Every sampled patient has a written plan for each assessed symptom.
3. The plan is reviewed.
Method. Check the review dates in the plan.
Evidence to show. Symptom assessment chart (HSP-FRM-001, existing, reused).
Pass when. Every plan has a review date within the set interval.
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.
Documents
No documents yet.
E-learning
References
- World Health Organization. Palliative care: fact sheet. Geneva: WHO; 2020.
The patient’s goals, values and wishes are discussed and recorded, including advance directives, and are reviewed as the illness progresses.
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.
How the surveyor verifies this criterion
Sample. Review patient goals and wishes records for patients with serious cancer in the last 12 months.
1. The patient goals, values and wishes are discussed and recorded.
Method. Check each sampled record for the goals and wishes.
Evidence to show. Record of patient wishes for future care (ADV-FRM-001, existing, reused); goals, values and wishes record (HSP-FRM-002, existing, reused).
Pass when. Every sampled patient has recorded goals and wishes.
2. Advance directives are recorded.
Method. Check each sampled record for an advance directive or a recorded decision not to have one.
Evidence to show. Advance care planning conversations (ADV-POL-001, existing, reused); advance directive register (ADV-REG-001, existing, reused).
Pass when. Every sampled record shows an advance directive or a recorded decision.
3. The record is reviewed as the illness progresses.
Method. Check the review dates for each sampled record.
Evidence to show. Record of patient wishes for future care (ADV-FRM-001, existing, reused).
Pass when. Every sampled record was reviewed after a change in condition.
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.
Documents
No documents yet.
E-learning
- End-of-Life & Palliative Care (LTC-06)
References
- National Institute for Health and Care Excellence (NICE). End of life care for adults. NG31. London: NICE; 2016.
Additional resources: guidelines in the GMJ library
These guidelines are held in the GMJ guideline library (news.gmj.ge). WHO and PAHO are the issuing bodies; MSF guidelines are marked MSF.
- Guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention: use of HPV DNA genotyping · WHO · criteria: Whole standard
Cervical pre-cancer screening and treatment: HPV DNA genotyping strategies tailored to programme settings. - Evidence-informed guidance for the implementation of HPV-based cervical cancer screening programmes · WHO · criteria: Whole standard
Implementation of HPV-based cervical cancer screening and treatment programmes. - Considerations for the Reorganization of Cancer Services during the COVID-19 Pandemic · PAHO · criteria: Whole standard
Reorganisation of oncology services to maintain cancer care while protecting patients and staff (COVID-19).
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