Ukons Book PDF

Systemic Anti-Cancer
Therapy (SACT)
Competency Passport
Oral, intravenous, subcutaneous
and intramuscular SACT
administration for adult patients
January 2018
Version 1 Developed by
The Wales Cancer Network
Rosie Roberts, Velindre Cancer Centre and Wales Cancer Network
Kerie Morris, South West Wales Cancer Centre
Version 2 and 3 Developed by

Dr Catherine Oakley, Guy’s and St Thomas’ NHS Foundation Trust and UKONS
Ruth Hammond, The Royal Marsden NHS Foundation Trust and Cancer Lead, CapitalNurse
Contributors
Wendy Anderson, South Tees NHS Foundation Trust and UKONS
Mary Tanay, King’s College London
Alison Hill, University College London Hospitals NHS Foundation Trust
Rebecca Johl, Imperial College Healthcare NHS Trust
Shirley Carey, University College London Hospitals NHS Foundation Trust
Karen Phillips, Barking, Havering and Redbridge University Hospitals NHS Trust (formerly Whittington Health
NHS Trust)
Rosie Roberts, Velindre Cancer Centre and Wales Cancer Network
Dr Verna Lavender, Oxford Brooks University and UKONS
Dr Elaine Lennan, University Hospital Southampton NHS Foundation Trust
Natalie Holbery, Clinical Lead, CapitalNurse
Jane Fish, Project Manager Retention Workstream, CapitalNurse
Lorraine Hyde, The Royal Marsden NHS Foundation Trust
Edited by
Dr Lisa Dougherty, Independent Nurse Consultant
Acknowledgements
Claire Paxman, Director of Sales and Training, Paxman Scalp Cooling Ltd
Carol Pitches, Service User (Patient)
Melanie Dalby, Pharmacist, Guy’s and St Thomas’ NHS Foundation Trust
Mark Evans, Pharmacist, The Royal Marsden NHS Foundation Trust
Acknowledgements: Pilot Sites

Barts Health NHS Trust, Laura Applegate
Guy’s and St Thomas’ NHS Foundation Trust, Lucy Johnston
Imperial College Healthcare NHS Trust, Rebecca Johl
King’s College Hospital NHS Foundation Trust, Kevin Saltmarsh
The Royal Marsden NHS Foundation Trust, Ruth Hammond
University College London Hospitals NHS Foundation Trust, Shirley Carey
London North West Healthcare NHS Trust, Lesley Ashton
Lewisham and Greenwich NHS Trust, Julie Baker
Publication date: September 2017

Review date: September 2018
This document was developed from the All Wales Clinical Competencies for the Safe Handling and
Administration of Cytotoxic Chemotherapy. This version was initiated by the London Lead Cancer Nurses and
led by Dr Catherine Oakley on behalf of the Pan London SACT Nurses Group and UKONS. The document has
been sponsored by CapitalNurse and is owned by UKONS©.
Foreword
We are delighted to introduce this Systemic Anti-Cancer Therapy (SACT)
Competency Passport. We believe that it will transform the way cancer nurses are
trained to administer SACT in London.
This passport was initiated by London’s lead cancer nurses, led by Catherine Oakley, Chemotherapy Nurse
Consultant, from Guy’s and St Thomas’ NHS Foundation Trust; in partnership with United Kingdom Oncology
Nursing Society (UKONS) and Capital Nurse.
Different training and assessment standards for roles in SACT across London, meant that training was often
inconsistent and valuable time and money was spent retraining nurses.
This exciting passport is a first for a nursing specialism in London. The potential benefits are substantial. The
passport will ensure SACT training is consistent, up-to-date and will standardise knowledge and best practice
across London, as well as giving nurses a professional confidence boost and greater job satisfaction.
Once nurses have their passport training they can then move freely between employers, without the need for
any retraining, which may result in savings and could help reduce waiting times for patients to be treated.
SACT treatments can be a very frightening time for patients, their families and friends. This passport will
ensure that patients will benefit from high quality nursing care that is equally focused on safe drug delivery
and supportive care – helping patients and their families manage both the psychological and the debilitating
physical effects of SACT.
Flo Panel-Coates
Chief Nurse, University College London Hospitals NHS Foundation Trust
Eamonn Sullivan
Chief Nurse,The Royal Marsden Hospital NHS Foundation Trust
Dame Eileen Sills

Chief Nurse, Guy’s and St Thomas’ NHS Foundation Trust
September 2017
Systemic Anti-Cancer Therapy (SACT) Competency Passport 3

Contents
1.1 Introduction............................................... 5 3.0 Step Two: Clinical Practice Assessment
Section...................................................... 56
1.2 Scope.......................................................... 6
3.1 All clinicians/all routes............................ 57
1.3 Glossary of terms....................................... 6
3.2 Route specific – oral SACT....................... 58
1.4 Pre-requisite competencies....................... 7
3.3 Route specific – intramuscular (IM)
1.5 Pre-requisite theoretical learning............. 7 or subcutaneous (S/C) SACT.................... 59
1.6 Professional responsibility........................ 7 3.4 Route specific – intravenous (IV) SACT..... 59
1.7 Assessment process................................... 8 3.5 Pre-treatment consultation all routes.... 60
1.8 Sections to be completed.......................... 9 3.6 Pre-treatment consultation – additonal
Figure 1. SACT administration elements for oral SACT............................ 61
training pathway....................................... 9 3.7 Clinical Practice Assessment Section:
Signature pages and competency
2.0 Step One: Theoretical Assessment certificate.................................................. 62
Section (The Passport)............................. 10
3.7.1 Safe handling and administration..... 62
2.1 Safe handling and administration
3.7.2 Administering oral SACT................... 63
2.1.1 Safe handling................................... 11
3.7.3 Administering intramuscular (IM)
2.1.2. Safe administration / fitness to treat.. 14 or subcutaneous (S/C) SACT............. 63
2.1.3. Patient education, preparation, 3.7.4 Administering intravenous SACT....... 65
and self-care..................................... 23 3.7.5 Pre-treatment Consultation:
2.1.4 SACT spillages.................................. 31 All Routes......................................... 68
2.1.5 Oncology emergencies..................... 32 3.7.6 Pre-treatment Consultation:

Additional elements for oral SACT.... 68
2.2 Administering oral SACT............................. 37
3.7.7 SACT safe handling and
2.3 Administering intramuscular (IM) or administration certificate.................. 69
subcutaneous (S/C) SACT............................ 40
4 Step Three: Re-accreditation
2.4 Intravenous SACT.................................... 42
Competency Certificate........................... 70
2.4.1 Administering intravenous SACT........ 42
5 References................................................ 72
2.4.2 Infiltration and extravasation
(oncology emergency)...................... 44 6 Appendices............................................... 78
2.4.3 Hypersensitivity/anaphylaxis.............. 48 Appendix 1: Guidance for
2.4.4 Hair loss/scalp cooling competency assessors....................... 78
(optional questions/role specific)....... 48 Appendix 2: Theoretical objectives
2.5 Regimen exercise: Commencement of for Step One..................................... 80
theory to practice.................................... 51 Appendix 3: Assessor
2.6 Reflective account.................................... 54 competency certificate...................... 82
2.7 Theoretical assessment signature page.... 55 7 Disclaimer................................................. 83
4 January 2018
1.1 Introduction
Welcome to the UK Oncology Nursing Society (UKONS) Competency Passport for
the Safe Handling and Administration of Systemic Anti-Cancer Therapy (SACT).
This document provides a competency and There are three steps to competency attainment:
assessment framework for the administration of
• Step one involves completion of the relevant
oral, intramuscular, subcutaneous and intravenous
theoretical sections, which serves as ‘The
SACT for adult patients. It was initiated by
Passport’, and is not required to be repeated.
London Lead Cancer Nurses and supported by
The theoretical section is designed to be marked
CapitalNurse to standardise theoretical knowledge
either by a clinician in practice e.g. practice
and competency of SACT nurses who may move
educator or a course module leader.
between service providers.. The purpose is to
provide a high quality tool that is recognised as
• Step two requires completion of the relevant
a passport between participating organisations.
clinical practice competency sections.
Developed by an expert nursing panel, feedback has
been incorporated from educationalists, oncology • Step three involves completion of the annual
pharmacists, a patient and SACT nurses (assessors reaccreditation certificate.
and those in training) from eight London trusts who
piloted the competency passport during August
2017. Consultation suggests the current version is UKONS welcomes feedback on any element of this
applicable to radiographer practice. UKONS intends document, as we recognise SACT care continuously
to review and develop the document within a evolves and patients’ needs change. The feedback
year of implementation. This will include further mechanism is via the UKONS SACT Members
exploration of application to nursing, radiographer Interest Group (MIG).
and pharmacist practice.
SACT treatment can be complex and put patients

at risk of significant and potentially fatal toxicities.
There are also risks to those who handle SACT
from occupational exposure if control measures
are inadequate (HSE 2017). It is essential that staff
are trained and assessed as competent to safely
administer SACT (HSE 2017). Supporting patients
and their carers during SACT is as important as
safe drug delivery. Patients are often fearful of a
cancer diagnosis and of SACT treatments. Many
struggle to manage the physical and psychological
consequences of SACT and the associated
disruption to normality (home and work lives).

1.2 Scope
The document provides a national standardisation of competence for the
fundamental skills and knowledge required to safely handle and administer SACT.
It is designed for clinicians handling and Clinicians only need to complete the aspect
administering SACT and treating adult patients, e.g. pertinent to their role. Assessor professional
nurses and radiographers. There is a particular focus discretion may be needed in certain instances, e.g.
on patient education/self-care. After completing this haematology nurses not completing optional scalp
work-based competency clinicians will continue to cooling questions. On transfer to another area the
develop their practice, which may include: Acute new employer has a responsibility to review the
oncology care following SACT, the management presented theoretical section and assess currency
of medium and longer-term toxicities, and more of answers and application in the new employment
detailed knowledge on drug modalities of action. setting. It is recognised that some clinicians will only
ever handle and administer a limited range of drugs
The following are not covered in this document via a single route, thus the document has been
(although they are due to be covered in future divided into the routes of administration.
publications): Specialised / less common routes
of administration, e.g. intravesical, inhalation, It is recommended (but not mandated) that if
isolated limb perfusion, intraperitoneal, topical, a clinician named on the SACT register has not
and participating in the checking of intrathecal already completed the theoretical component
chemotherapy. UKONS suggest that clinicians (Passport) this should be undertaken and marked by
administering via these specialised routes complete an assessor at the point of re-accreditation.
the theoretical component (Step One).
Objectives are provided for Step One: The
The management of potential SACT-related theoretical assessment section, to provide evidence
acute emergencies is covered in this document of the work-based learning expected (see appendix
(e.g. neutropenic sepsis, electrolyte imbalance, 2). Therefore, UKONS encourages academic
hypersensitivity/anaphylaxis, extravasation and providers to adopt this document, as a part of SACT
tumour lysis syndrome). UKONS expects clinicians related modules.
who administer SACT to have the knowledge and
skills to recognise and escalate presenting concerns
or commence treatment related to these areas.
1.3 Glossary of terms

Systemic Anticancer Therapy refers to all drugs, The term Assessor has been used throughout
irrespective of their route of administration, with and can be interpreted according to local practice,
direct anti-tumour activity, including traditional e.g. the Assessor or Marker for the Theoretical
cytotoxic chemotherapy such as cyclophosphamide, Section and the Clinical Practice Section may differ.
hydroxycarbamide, small molecule/antibody Guidance for assessors may be found at appendix 1.
treatments such as imatinib, rituximab,
immunotherapies such as nivolumab, ipilimumab The term Clinician has been used throughout and
and other agents such as interferon, thalidomide or refers to nurses and radiographers who complete
lenalidomide. It DOES NOT include hormonal or anti- the theoretical section (Step One) and are assessed
hormonal agents such as tamoxifen and anastrazole as competent to administer SACT (Step Two and
or intrathecal cytotoxic chemotherapy (ITC). Step Three).
6 January 2018
1.4 Prerequisite competencies
Prior to the administration of SACT by any route • Care and management of peripheral devices and
prerequisite competence, as identified in local central venous access devices (as applicable to
policies related to medicines management and role) including assessment of cannula gauge, and
SACT, should be completed. UKONS recommends length for planned treatment, as well as vascular
for intravenous SACT administration prerequisite access device site and patency.
competencies include:
• Infusion device usage relevant to skill Calculations
for medicines administration, i.e. correct dosing
and infusion rate.
1.5 Prerequisite theoretical learning

Before clinicians complete the Passport, they should • Toxicities of SACT
have received work-based education or attended
• SACT safe handling and administration
a locally designed training day/programme, or a
university module, which covers the following core • Legal and professional Issues
knowledge components:
• Prophylactic/supportive/rescue interventions
• What is cancer? • The psychosocial impact of SACT treatment
• How SACT drugs work • Patient education and self-care advice
• Routes of SACT administration • Advancing SACT practice – what is next?
• Patient assessment
1.6 Professional responsibility

Personal and professional accountability Midwifery Council (NMC 2015) should be adhered
surrounding medicines management as determined to when completing this document.
by the clinicians governing body e.g. Nursing and

1.7 Assessment process
Attaining Competence: Theoretical (The questioning points for the theoretical aspect of
Passport) and Clinical Practice the clinical practice assessment. The assessor
may expand during questioning to support their
Any registered clinician who is employed in a role decision in signing off the theoretical aspect of the
that requires them to administer SACT should competency assessment.
undertake the theoretical sections relevant to their
role (i.e. expected routes of SACT administration). If Step Two: Clinical Practice Assessment
a clinician’s role changes, requiring administration Section
via a different route, they should complete the
associated relevant route section. All registered The clinician is expected to initially practice
clinicians, regardless of level of practice, should SACT handling and administration under direct
demonstrate competency and maintain evidence of supervision to gain competence and confidence.
their SACT practice, including annual re-assessment. A clinician named on the SACT register should
The clinical practice assessment documents provide provide supervision, and be physically present,
evidence of learning and supervised practice. They able to observe the trainee clinician and assist as
will be kept by both the manager and clinician and required. Local policies will identify time frames
can be used to inform professional revalidation. for competency completion. There is an option
The steps to accreditation are detailed below and in for clinicians to complete the pre-treatment
Figure 1. consultation competencies after consolidating
SACT administration practice and understanding of
Step One: Complete the Passport patients’ experiences.
(Theoretical Section)
To practice competently clinicians should
The overall aim of the Passport is to ensure that demonstrate safety and skill in the handling and
clinicians involved in handling and administering administration of SACT underpinned by theoretical
SACT have a minimum level of knowledge knowledge. They should demonstrate ability to
prior to undertaking practice. The theoretical identify potential complications and propose action
section (Passport) should be completed during a plans in accordance with national guidelines.
probationary/supernumerary period and before the
clinical practice assessment, because the theory Following completion of the Theoretical Assessment
assessed in the theoretical assessment section (Passport) and Clinical Practice Assessments the
underpins clinical practice. Passport completion Competence Certificate will be completed and the
ideally would be conducted concurrently with clinician’s name can be added to the local SACT
supervised practice to enable application of theory register.
to practice. Pilot work shows completion of the
theoretical sections takes approximately 22.5 hours. Step Three: Annual Reaccreditation
The clinician should use a variety of resources, Annual competency is achieved by completing the
including local policies and learning materials, reaccreditation certificate with a locally approved
whilst also collaborating with experienced SACT SACT assessor. The Approved Assessor competency
staff to inform their answers. Signposting and certificates are found in appendix 3. The practice
resources are found after each question. The assessment criteria should be used to benchmark
completed theoretical section should be given to the practice against when reaccrediting.
assessor for marking and will be used as discussion/
8 January 2018
1.8 Sections to be completed
2.1, 2.5, 2.6 & 3.7.1 All clinicians regardless of route or specialty
2.2 & 3.7.2 Administering oral SACT
2.3 & 3.7.3 Administering intramuscular (IM) or subcutaneous (S/C) SACT
2.4 & 3.7.4 Administering intravenous (IV) SACT
3.7.5 Pre-treatment consultation all routes
3.7.6 Pre-treatment consultation oral
Figure 1
Systemic Anti-Cancer Therapy (SACT) Handling and Administration
Competency Pathway
New area of SACT practice New to trust or prolonged

e.g. clinician competent sabbatical or maternity
Clinician new to
to give oral SACT moving leave (over 6 months), with
SACT practice
to role where they need evidence of completing
to give IV SACT relevant elements of step one
Step two: Complete and pass

Complete pre-requisite *relevant elements in the Clinical
Step one: Complete and
theoretical learning e.g. Practice Assessment Section.
pass *relevant elements in
accredited chemotherapy Clinicians should use clinical
the Theoretical Assessment
course, local workshop or judgement on the number to
Section (the passport)
study day be completed. For new staff
follow minimum requirements
Step three:
Accreditation
Re-accreditation:
Completion of accreditation
Annual completion of re-
certificate (*for relevant
accreditation certificate (*for
practice elements)
Names will be removed from relevant practice elements)
signed by trust approved
the register 12 months after signed by trust approved
competency assessor
the date of certification, competency assessor
unless there is evidence of
successful re-accreditation.
* Relevant practice elements

include oral, intramuscular, Certificate issued and copy provided to the trust
subcutaneous, intravenous SACT register lead. Name added to the trust SACT
routes of administration. register (*for relevant routes/elements)

2.0 Step One
Theoretical Assessment Section (The Passport)
Date Passport Commenced
Clinician Name
Clinician Designation
2.1 Safe Handling and administration

2.1.2 Safe administration/Fitness to treat
2.1.3 Patient education, preparation, and self-care
2.1.4 SACT spillages
2.1.5 Oncology emergencies
2.2 Administering oral SACT
2.3 Administering intramuscular or subcutaneous SACT
2.4 Intravenous SACT
2.4.2 Infiltration and extravasation (oncology emergency)
2.4.3 Hypersensitivity/Anaphylaxis
2.4.4 Hair loss/scalp cooling (optional questions/role specific)
2.5 Regimen exercise: Commencement of theory to practice
2.6 Reflective account
2.7 Theoretical assessment signature page
10 January 2018
2.1 Safe handling and administration
2.1.1 Safe handling
2.1.1.1. Describe what cytotoxic waste is and the safe handling precautions you would take when storing
and handling cytotoxic drugs. (Local policies related to Waste and Personal Protective Equipment; HSE 2015;
HSE 2017; Polovich et al. 2014)
Cytotoxic waste is waste associated with cytotoxic drugs which contain chemical toxic to the
cells. This includes materials, equipment, and residue that are contaminated by cytotoxic drugs.
Cytotoxic Waste
Precautions
Handling:
Personal
Protective
Equipment
2.1.1.2 State the four main routes of absorption of SACT for staff when handling SACT.
(HSE 2017; Department of Health and Human Services 2004)
2.1.1.3 Identify tasks when a clinician could be potentially exposed to cytotoxic agents. Please tick any that
apply. (Local Chemotherapy/SACT Treatment Policy; Department of Health and Human Services 2004)
Handling waste e.g. vomit, urine, stool, blood
Transporting and waste disposal
Cleaning up a spillage

2.1.1.4 Outline the three ways in which cytotoxic agents have been reported to be toxic to treated patients
and in animal models, i.e. the reason personal protective equipment must be worn for handling hazardous
drugs. (Local Chemotherapy/SACT Treatment Policy; Department of Health and Human Services 2004)
2.1.1.5 Explain why SACT that requires reconstitution is performed in a pharmacy department as opposed to
a patient treatment area. (HSE 2015; Polovich et al. 2014)
2.1.1.6 Outline how SACT made in pharmacy should be transported and where cytotoxic drugs should be
stored on the ward/unit. (HSE 2015)
Transporting Storing
2.1.1.7 Identify the key actions that limit exposure and ensure safe disposal of waste.
(Clinical Reasoning)
12 January 2018
2.1.1.8 Describe how cytotoxic waste/unused drugs and patient excreta should be disposed of in a clinical
setting. How should they be labeled and where should they be stored prior to collection? (Local Waste Policy;
Department of Health and Human Services 2004)
Type of waste, labeling

Where do you place, when to replace, and how to secure/ close?
and storage
All sharps, syringes and

unused/unwanted/
expired cytotoxic
medication (including
infusion bags that
contain a volume of
SACT)
All other items used

in the preparation,
administration and
handling of SACT,
e.g. intravenous
administration sets AND
waste contaminated with
cytotoxic medicines which
is of a disposable nature,
e.g. incontinence pads
Contaminated linen
(sweat, vomit, stool,
blood)
Sealed unwanted/
unused items that have
not left the clinical
environment.
Labeling cytotoxic waste

bags and sharps boxes

Storage of waste
2.1.1.9 Outline what is recommended for staff who are pregnant in terms of safe handling.
(Local SACT Treatment Policy; Gilani and Giridharan 2014)
2.1.2 Safe administration/fitness to treat.
2.1.2.1 Describe below, as if to a new member of staff, what cytotoxic chemotherapy is, why it may be given
in combination, and potential common toxicities. (Cancer Research UK 2014b; Macmillan Cancer Support
2017b; Morgan 2003; Perry 2008; Franks & Knowles 2005; Stein and Pardee 2004)
What is cytotoxic
chemotherapy?
Why cytotoxic drugs may

be given in combination
(Please refer to the cell

cycle and describe the five
phases)
14 January 2018
Common toxicities
2.1.2.2 Describe why cytotoxic chemotherapy affects healthy cells, e.g. bone marrow, gastro intestinal tract
or hair follicle cells. (Rahma & Khleif 2011; King 2006)

2.1.2.3 Describe the symptoms a patient may experience due to bone marrow depression following systemic
chemotherapy. (Local Haematology Parameters; Cancer Research UK 2014d; Goldie 2008)
Dose Limiting Toxicity Effect on patient Normal Blood Parameters
Female Male
Anaemia: Reduced
haemoglobin (Hb)
Thrombocytopenia:
Reduced platelets
Leukopenia: Reduced
total white blood cells
(WBC)
Neutropenia: Reduced
neutrophils
2.1.2.4 Describe the significance of assessing the physiological function of the organs prior to administering
SACT. (Canadian Cancer Society 2017; Livshits et al. 2014; Barrett and Linebaugh 2008; Park et al. 2013;
Armstrong et al. 2005)
What test or
Organ
Why do we need to assess? investigation is
function
often requested?
Liver
function
Cardiac
function
16 January 2018
Renal
function
Lung
function
Reproductive
function
Neurological
function
(Include cold
dysenthesia
and
peripheral
neuropathy)
Blood
haematology
functioning

2.1.2.5 Describe below, as if to a patient, how the following SACT targeted biological/ immunotherapies
work and their common toxicities. (Cancer Research UK 2014a; Cancer Research UK 2017; Davey 2015;
Macmillan Cancer Support 2012a; Macmillan Cancer Support 2012b; Mayo Clinic (2016); Melosky 2014;
National Cancer Institute 2011; National Cancer Institute 2017a; National Cancer Institute 2017b; Murphy
2011; Young et al. 2006)
Modality of Action Basic

Category Common Toxicities
Description
Immunotherapies
(Checkpoint
inhibitor drugs)
Monoclonal
antibodies
18 January 2018
Anti-angiogenics
e.g. vascular
epidermal growth
factor inhibitors
Cancer growth
blockers (small
molecule
inhibitors) e.g.
tyrosinekinase
inhibitors
Cancer vaccines
2.1.2.6 Describe who is responsible for gaining consent for patients receiving SACT. State how long consent
is valid, how long this lasts, and which treatment(s) it covers. Indicate why consent is a continual process.
(Local policies related to Consent and SACT Treatment; Treleaven et al. 2005)
Who is
responsible?
How long does

consent last
and which
treatment(s) is
covered?

2.1.2.7 Describe the process you would follow immediately prior to commencing treatment before you sign
the confirmation of consent (either manually or electronically). Include how the patient is involved in each
aspect of the process. (Local Consent Policy and SACT Policy; Treleaven et al. 2005)
Patient checks when confirming Consent form/documentation checks
When and who should confirm consent?
2.1.2.8 Describe how you would explain to a patient what the following words might mean for them and the
treatments purpose. (National Chemotherapy Board 2016)
Definition Explanation and Meaning
Neo-adjuvant
Adjuvant
Curative
Palliative
Phase III clinical

trial
20 January 2018
2.1.2.9 State how many people should check SACT immediately prior to administration in your organisation,
and what qualifications they must have. (Per local SACT Treatment Policy)
Number of Clinicians to check
2.1.2.10 Describe the checks you make before administration of SACT via any route. (Local SACT Treatment
Policy)
The prescription
Patient identity
Patient fitness to
treat
(Specific to first
cycle only)
Patient fitness to
treat
(Each cycle)
The drug and the

dose

2.1.2.11 Describe what the abbreviations below stand for, explain what they mean, and using the
information in the boxes, determine the dose in milligrams the patient is due (in clinical practice this will also
then be dose-banded). (Mathijssen et al. 2006)
Stands for What is it means? Calculation
BSA
Height 170.6 cm / Weight
56.2kg =
BSA BSA = 1.6
Drug dose = 75mg/m2
Therefore, the drug prescribed
should be:
AUC
AUC GFR = Glomerular Filtration Rate
(e.g. used to AUC = 5
determine EDTA GFR 90ml/min
carboplatin Drug dose = (GFR+25)x5
dosing) Therefore, the drug prescribed
should be: 90 + 25 = 115
115 x 5 =
2.1.2.12 Describe how you confirm that the dose of chemotherapy you are due to administer is correct.
Outline your actions if the dose is incorrect. (Local SACT Treatment Policy; Gurney 2002)
2.1.2.13 Describe below the purpose of the Common Terminology Criteria for Adverse Events (CTCAE) and
explain what grades 0-5 mean in relation to a SACT toxicities (e.g. diarrhoea, nausea). (US Department of
Health and Human Services 2010; UKONS 2016)
Purpose
Grade 0
Grade 1
22 January 2018
Grade 2
Grade 3
Grade 4
Grade 5
2.1.3 Patient education, preparation, and self-care.
2.1.3.1 Describe the information/advice you would give a patient/carer concerning the following to
ensure their safety and help manage treatment complications when receiving SACT. Include the potential
psychological impact of each. (Bloomfield and Tanay 2012; Cramp and Byron-Daniel 2012; Cancer Research
UK 2015; Ikeda et al. 2017; Jones et al. 2015; Macmillan Cancer Support 2016; Macmillan 2017; Macmillan
2017a; UKOMIC 2015; Riola et al. 2010; Basch et al. 2011; Gracia et al. 2012)
Patient Recognition Advice

Prevention Advice
(Signs and Symptoms)
Increased
risk of
infection and
susceptibility
to bruising
(Please
ensure you
mention the
NADIR and
when this
occurs)

Tumour lysis
syndrome
Risk of
deep vein
thrombosis
development
24 January 2018
Fatigue
General skin
care

Mouth care
Nausea and
vomiting
Diarrhoea
Loss of
appetite and
taste changes
26 January 2018
Intimacy
and sexual
activity
Fertility
(Include
barrier
protection
and fertility
preservation
options)
2.1.3.2 Ask some of your patients how they felt about starting SACT (what worries or concerns did they
have). Consider the psychological and social impact of receiving SACT (use the topics above to guide your
thoughts). (Macmillan website patient stories; speaking to patients and clinical reasoning; Oakley et al. 2016)
Before starting treatment

Receiving treatment
2.1.3.3 Outline the local and national support services available to your patients and their carers. How can
you help patients to access these services? Discuss what is available with your assessor e.g. counselling,
cancer information, clinical nurse specialists, occupational therapy, physiotherapy, survivorship services.
(Patient support websites; e.g. Macmillan, CRUK, Lymphoma Association)
Local and national patient and carer support services and how to refer
28 January 2018
2.1.3.4 Outline the precautionary advice you would give a relative/carer about safe handling of body fluids/
waste, when doing the laundry/cleaning, contact with family members/children, and sexual activity/pregnancy
following cytotoxic chemotherapy. (Haddadin and Cook 2014)
Advice provided
How long do
precautions need
to be taken for?
Body fluids (urine,

stool, vomit,
saliva, sweat,
semen and vaginal
secretions)
Hand washing
Doing the laundry

Cleaning the
bathroom and
other surfaces
Wearing gloves
Family members
and children
2.1.3.5 Describe what you need to check with the patient before you or they leave the care environment, i.e.
discharged from hospital/sent home/you leave the home following SACT. (Clinical Reasoning; SACT Treatment
Policy; Discharge Policy)
30 January 2018
2.1.4.1 State where the SACT spillage policy and kit are located in your clinical area. How you would manage
a cytotoxic spillage? (Practical Orientation; Local Spillage Policy)
Where is the spillage kit found? Where is the policy found?
Management of a dry and wet (liquid) spillage
2.1.4.2 Describe the action you would take if staff are contaminated by SACT spillage. How would you
replace the spillage kit once it had been used? What documentation would you complete? (Local Spillage
Policy; Record Keeping / Documentation Policy; Waste Management Policy)
Actions Replacing spillage kit Documentation

2.1.5.1 Describe the effect the following SACT-related oncology emergencies could have on the patient. In
addition to patient reassurance, outline the immediate nursing management of the identified emergencies.
(BMJ Best Practice 2017; Jones et al. 2015; NICE 2012; UKONS 2015)
Oncology Potential life-threatening impact on

Immediate nursing management
Emergency patient
Ongoing assessment/monitoring of:
Neutropenic
sepsis
Immediate interventions:
(as prescribed/ necessary):
On-going assessment/monitoring of:
Severe
nausea and Immediate Interventions
vomiting (as prescribed/ necessary):
32 January 2018
Immediate interventions
Severe
mucositis
Tumour lysis
syndrome
(TLS) Immediate interventions
Ongoing assessment/monitoring of:
Severe Immediate interventions

diarrhoea (as prescribed/necessary):

2.1.5.2 Describe the effect the following immunotherapy related toxicities could have on the patient and the
immediate nursing management of each, in addition to patient reassurance. Please note immunotherapy
related emergencies can occur after treatment completion. (Friedman and Postow 2015; Naidoo et al. 2015)
Toxicity Potential impact on patient Immediate nursing management
Interventions
(as prescribed/necessary):
Pneumonitis
Interventions
(as prescribed/necessary):
Colitis
Skin
34 January 2018
Interventions (as prescribed/necessary):
2.1.5.3 State where the hypersensitivity/anaphylaxis policy is in your clinical area, and where the
hypersensitivity kit and arrest trolley are located. (Practical Orientation)
Policy location Hypersensitivity kit location Arrest trolley location
2.1.5.4 Describe how you would prevent, recognise and treat both a hypersensitivity reaction and
anaphylactic reaction to SACT. (Local Hypersensitivity and Anaphylaxis Policy; Local Desensitisation Policy
Resuscitation Council UK 2008; Rosello et al. 2017)
Hypersensitivity
Patient
prevention
advice/
reassurance
Patient
recognition
advice

Patient
emergency
treatment
Anaphylaxis
Airway:
Breathing:
Staff
recognition
Circulation:
Patient
emergency
treatment
2.1.5.5 Describe what actions you would take following hypersensitivity/anaphylactic reactions? (Clinical
Reasoning)
36 January 2018
2.2.1 Outline the four most frequently used SACT drugs administered orally in your area of practice and
explain how they work. Where possible, try and ensure examples include a range of SACTs with differing
modalities of actions. (Chemocare 2002-2017)
Name of SACT Modality of action
2.2.2 In relation to the four drugs named above, describe the conditions they are routinely prescribed for,
the parameters assessed (per protocol), and significant/frequently occurring toxicities of each. (Local Drug
Protocol; Chemocare 2002-2017)
Condition/
disease Usual Significant &
Name of Parameters
group treatment frequently occurring
drug assessed
prescribed schedule toxicities
for

2.2.3 Describe how would you assess and educate the patient (friends or family) to self-administer oral SACT.
(Cancer Research UK 2015a; MASCC 2012; Oncology Nursing Society 2016)
Patient assessment elements (consider suitability to take oral formulation and

contraindications)
Patient education elements
38 January 2018
2.2.4 Describe the risk factors for non-adherence with oral SACT and what helps patients to adhere.
(Oncology Nursing Society 2016; Oncology Nursing Society VOICE 2016; Oakley et al. 2010a; Oakley et al.
2010b; Regnier Denois et al. 2011; Verbrugghe et al. 2012; Walker 2016)
Risk factors for non-adherence Factors that help adherence
2.2.5 Describe your nursing actions if you suspect oral SACT medication adherence is poor/suboptimal.
Clinical Reasoning)
2.2.6 Describe your actions if you dropped an oral SACT drug prior to administration. (Clinical Reasoning;
Waste Management Policy)
Dropped in clinical environment Disposal of unwanted drugs

2.2.7 Describe what precautions patients and relatives should take when handling oral SACT. (Local
Chemotherapy/SACT Treatment Policy; HSE 2015 HSE 2017; Polovich et al. 2014)
Patient
Relative/
Carer
2.2.8 Describe how patients should dispose of left over oral SACT at home. (Clinical Reasoning; Waste
Management Policy)
Disposal of unwanted drugs
2.3 Administering intramuscular (IM) or

subcutaneous (S/C) SACT
2.3.1 Outline three of the most frequently used SACT drugs that are administered by intramuscular and/or
subcutaneous injection in your area of practice and explain how they work. Please ensure examples include a
range of SACT’s with differing modalities of actions (where possible). (Chemocare 2002-2017; EMC 2017)
Name of SACT Modality of action (How it works)
40 January 2018
2.3.2 Describe the conditions the three drugs named above are routinely prescribed for, the parameters
assessed (per protocol), and significant/frequently occurring toxicities of each. (Local Drug Protocol;
Chemocare 2002-2017; Young et al. 2006)
Condition/
Name of Parameters
group treatment frequently occurring
drug assessed
for
2.3.3 Describe how you would identify suitable patients to self-administer intramuscular/subcutaneous SACT.
How would you educate patients to self-administer and/or educate their friends/family to support self-
administration? (Clinical Reasoning; SACT Policy; Medicines Management Self-administration policy; Leveque
2014)
Identifying patients Education and documentation

2.3.4 Describe the advantages and disadvantages of the intramuscular or subcutaneous route for the
administration of SACT. (Leveque 2014)
Advantages Disadvantages
2.4 Intravenous SACT

2.4.1 Administering intravenous SACT
2.4.1.1 Outline the four most frequently used SACT drugs that are administered by intravenous route in
your area of practice and explain how they work. Where possible try and ensure examples include a range
of SACTs with differing modalities of actions (i.e. include a cytotoxic, an immunotherapy, and a monoclonal
antibody). (Local Drug Protocol; Chemocare 2002-2017)
Name of SACT Modality of action (How it works.)
42 January 2018
2.4.1.2 Describe the conditions the four drugs named above are routinely prescribed for, the parameters
assessed (per protocol), and significant/frequently occurring toxicities of each (Local Drug Protocol;
Chemocare 2002-2017)
Condition/
Name of
group treatment Parameters assessed frequently occurring
drug
for
2.4.1.3 Outline the specific measures needed to further reduce the risk of spillage when working with
intravenous SACT. (Local Chemotherapy/SACT Treatment Policy; HSE 2017; Polovich 2014).

2.4.1.4 Describe what a ‘never event’ is concerning intrathecal chemotherapy administration, and outline who
can check intrathecal chemotherapy (Local Intrathecal Policy; NHS England 2015; NHS Improvements 2014)
Concerns Who can check intrathecal SACT
2.4.1.5 Describe what dose banding is and why it is necessary? (NHS England 2016)
2.4.2.1 Describe where the infiltration/extravasation policy is in your clinical area. Identify where the
management kit is located and list its contents? (Local Policy)
Where is the management Extravasation kit/pack

Where is the policy located?
kit located? contents
44 January 2018
2.4.2.2 Describe the difference between an infiltration, and an extravasation incident and outline four venous
access checks you make before and during administration, or if a patient reports discomfort during SACT
administration. (Dougherty 2008; Dougherty and Lister 2015; EONS 2007; Royal College of Nursing 2016)
Infiltration Extravasation
Check

2.4.2.3 Describe how you would prevent, recognise and treat both a SACT infiltration and extravasation
(consider both peripheral and central access) (Fidalgo et al. 2012; Doellman et al. 2009; EONS 2007)
Venous assessment /site:
Device:
Prevent
Administration:
Recognise
Extravasation Infiltration:
Emergency treatment:
Treat
46 January 2018
2.4.2.4 Outline four of the most frequently given SACT drugs in your clinical area for the classification
vesicant, irritant, or non-vesicant.
Classification SACT drug
Non vesicant inflammatory

or neutral drug
Vesicant
Irritant
2.4.2.5 Describe what factors/condition, other than extravasation, may cause discomfort/pain during
peripheral SACT administration and how would you prevent, recognise and treat them. (Dougherty and Lister
2015)
Factors/
Prevent, recognise, treat
Condition
Prevent:
Recognise:
Flare reaction
Treat:
Prevent – Chemical:
Prevent – Infective:
Prevent – Mechanical:
Phlebitis
(Chemical,
Infective
Mechanical) Recognise:
Treat All:
Treat Chemical/Mechanical:
Treat Infected:
Prevent:
Venous
spasm Recognise:
Treat:

2.4.2.6 Describe what actions you would take following emergency management of an infiltration/
extravasation. (Local Infiltration/Extravasation Policy)
2.4.3 Hypersensitivity/Anaphylaxis
2.4.3.1 State four drugs that have the potential to cause an infusion reaction and indicate the likelihood of
these events occurring. (ESMO 2017)
Likelihood
Drug
(High > 30% and Moderate Risk> 5%)
2.4.4 Hair loss/ Scalp cooling (optional questions/role specific)
2.4.4.1 How would you explain how scalp cooling works to a patient and how effective this is? (Local Scalp
Cooling Policy; Scalp cooling manufacturers guidelines; Breastcancer.org 2017; Cancer Research UK 2014c;
Nangia et al. 2017)
48 January 2018
2.4.4.2 Describe how you would explain to a patient the benefits/advantages and disadvantages of scalp
cooling and for whom it would be unsuitable or contraindicated. (Local Scalp Cooling Policy; Scalp cooling
manufacturers guidelines; Breastcancer.org 2017; Cancer Research UK 2014c; Rugo et al. 2017)
Unsuitable/Contraindicated
Patient Benefits Patient Risks
for
2.4.4.3 Outline which drugs would be appropriate for scalp cooling and the pre and post infusion time for
each (per local policy). (Local Scalp Cooling Policy; Scalp cooling manufacturers guidelines)
Suitable
drugs
Pre and post

infusion
times
2.4.4.4 Outline how you would apply the scalp-cooling cap to achieve maximum benefit and what self-care
advice you would provide. (Local Scalp Cooling Policy; Scalp cooling manufacturers guidelines)
On
application

On removal
Self-care
advice before
Self-care
advice
following
2.4.4.5 What advice/information would you give to patients to assist and alleviate any discomfort associated
with scalp cooling? (Breastcancer.org 2017)
2.4.4.6 Describe the potential psychological impact of hair thinning/loss, when this is likely to start and
suggestions/reassurance you can provide to patients. (Breastcancer.org 2017)
50 January 2018
2.5 Regimen exercise: Commencement of
theory to practice (Chemocare 2002-2017;
Local Protocol)
2.5.1 Use a true patient case to complete this table.
SACT Regimen/ Name of Protocol: Clinical Use/and treatment intention:
Cycle Length: Number of cycles:

Days in the Cycle:
State drug(s) in
the regimen and Emetogenic Neutropenia Extravasation
Mode of action
specify route of risk risk risk (if IV)
administration
List required pre-administration nursing checks

State the routine
pre medications State clinical reason Patient advice
Common toxicities
required e.g. for use and modality regarding pre-
of pre-medication
steroids, anti- of action medication
emetics
Name supportive
medication/TTOs required for
Rationale for use Modality of action
the patient e.g. GSCF/ Blood
Transfusion/anti-emetics
2.5.2 What short and long-term toxicities did you inform the patient about? How will these be managed?
Short-term Nursing management
52 January 2018
Long-term Nursing management

Please write a short reflective account, having holistically assessed a patient due to receive or receiving SACT,
specifically focusing on your assessment and actions relating to their psycho-social-emotional and spiritual
needs.
1. What was the nature of the event/experience? Think about: How you approached the assessment,
what questions you asked, what tools or documentation you used, how you established the patient’s
understanding and gained insight into their concerns, and how you attempted to develop a trusting
rapport, how you provided support throughout the assessment.
2. What did you learn from it or feedback and or experience? Think about what went well, what might
not have gone so well or could be done better in future.
3. How does your reflective learning relate to your Code of Professional Practice?
54 January 2018
2.7 Theoretical assessment signature pages
Assessor/Marker Signature
Name, signature and

Formative assessment Formative feedback
designation of Assessor
Date:
Summative assessment Name, Signature and Designation of Approved Assessor
Date:

3 Step Two
3.1 All clinicians/routes
3.2 Route specific – oral SACT
3.3 Route specific – intramuscular (IM) or subcutaneous (SC) SACT
3.4 Route specific – intravenous (IV) SACT
3.5 Pre-treatment consultation all routes
3.6 Pre-treatment consultation – additional elements for oral SACT
3.7 Clinical Practice Assessment Section: Signature pages and competency certificate
56 January 2018
Clinical Practice Assessment Section
Practice Assessment Criteria
3.1. All Clinicians / All Routes
Professional and legal accountability
Demonstrates knowledge of professional and legal accountability and responsibility in

relation to the administration of SACT
• Takes responsibility for the safety of self and others
• Ensures that the appropriate consent procedure has been completed/undertaken
• Can state responsibility in relation to the administration of SACT
• Care delivered is based on evidence and best practice guidelines
• Communicates effectively with other members of the multidisciplinary team in relation to patient care
• Communicates well both verbally and in writing
• Maintains accurate records
• Communicates effectively with patients and their carers
• Develops a rapport with patients and their carers
• Actively listens to patients and their carers
• Can detect both verbal and non-verbal cues
• Responds appropriately
Pre-treatment checks and discharge
Demonstrates competence in pre-treatment checks

• Ensures that the appropriate consent procedure has been completed/undertaken i.e. signed and
correct regimen/patient, and in date.
• Ensures pre-treatment checking of body surface area and drug dosages with in date weight/
bloods/investigations e.g. EDTA/MUGA/ECHO and confirms dose prescribed is correct, i.e. body
weight within 10% of initial prescription dosing or annotation explaining any variation.
• Correctly interprets dose modifications, delays or omissions and makes appropriate review plans
where needed.
• Outlines normal blood values and their relevance to fitness to treat or need for escalation.
• Assesses pre-treat clinical toxicity review and correctly interprets pre-treatment clinical
assessment and toxicity grading documentation, and relates to fitness to treat.
• Ascertains if any changes since toxicity review or uses a recognised toxicity-grading tool, pre-
SACT checklist or patient’s record book and relates to fitness to treat.
• Ensures that patient has appropriate advice to manage own post-treatment care. Checks patients/
carers understanding of how to take supportive medication, e.g. anti-emetics and what to do if any
problems are experienced

Hypersensitivity/anaphylaxis
Demonstrates ability to detect and manage hypersensitivity and anaphylactic reactions in

conjunction with other members of the multidisciplinary team
• Identifies potential risk factors, drug potential to cause hypersensitivity
• Systematically observes for occurrence of signs and symptoms when administering a SACT drug
• Explains the immediate actions to be taken in the event of both hypersensitivity and anaphylactic reactions
• Can state which members of the multidisciplinary team should be contacted to provide further
management – has the number ready in high risk patients/drugs
Handling
Demonstrates competence in handling SACT drugs to ensure the safety of patients, staff and
the environment
• Prepares equipment and the environment to reduce the risk of contamination
• Acts in accordance with local policies and procedures in the transport and storage of SACT drugs.
• Takes measures to assess risk and minimise exposure
• Handles SACT in a manner which reduces the potential for spillage, splashing, airborne or skin
contamination (NB oral SACT can be in liquid form e.g. Etoposide)
• Wears personal protective clothing in accordance with local policies and guidelines
Demonstrates knowledge of procedures for dealing with a spillage of SACT

• Can explain the actions to be taken in the event of a spillage
• Ensures equipment and personal protective clothing necessary to deal with spillage is readily available
in the area where the SACT are administered
• Can explain procedures for dealing with contaminated linen, equipment
• Can explain procedures for dealing with SACT contamination of skin or eyes
Administration
Demonstrates competence in the safe administration of SACT

• Takes measures to ensure 5 rights of drugs administration (right patient, right drug, right dose, right
time, right route)
• Reviews the patient’s allergy history, ensuring no previous reaction to drugs due to give as a part of regimen
• Documents episode of care in an appropriate manner conforming with employers’ and professional
bodies’ guidelines for records and record keeping, i.e. on e-prescribing system (if used)
• Disposes of waste according to local policy.
3.2 Route Specific: Oral
Demonstrates competence in handling oral SACT

• Handles oral SACT in a manner which reduces the potential for skin contamination and wears PPE per policy
• Can explain what information they would give to patients and carers about how to safely handle oral SACT
58 January 2018
3.3 Route Specific: Intramuscular and Subcutaneous
Demonstrates proficiency in administering SACT by IM and / or SC injection

• Identifies appropriate injection sites for IM and SC SACT, explains rationale for selection
• Selects the correct needle gauge/size
• Takes precautions to protect the health of patients, colleagues and self when administering SACT, i.e.
positioning of patient and sharps bin
• Administers IM injection using Z track technique and explains rationale
• Monitors the patient during and post administration
3.4 Route Specific: Intravenous
Demonstrates competency in the safe handling of IV SACT

• Takes precautions to protect the health of patients, colleagues and self when administering SACT,
i.e. high sided tray, flat surfaces, spike bag in tray, ensure not going to cut bag when opening outer
packaging, limit sharps near infusion bags, maintain closed system, consider priming with compatible
diluent (not always possible)
• Recognises any precautions to be taken with specific drugs e.g. IV fluid compatibility
Demonstrates proficiency in administering intravenous SACT via a peripheral or central

venous access
• Assesses the patency of venous access prior to administration
• Monitors the patient during administration
Demonstrates knowledge of the signs and symptoms of extravasation and the immediate
treatment
• Demonstrates the ability to detect and manage an extravasation in conjunction with other members
of the multidisciplinary team
• Can identify potential risk factors for extravasation
• Can identify irritant and vesicant drugs
• Observes for signs and symptoms of an extravasation
• Can state signs and symptoms of an extravasation from a peripheral device and distinguishes this
from other causes, e.g. flare reaction
• Can state signs and symptoms of an extravasation from a central venous access device (if appropriate)
• Can explain immediate actions to be taken if extravasation of a vesicant drug should occur
• Can state which members of the multidisciplinary team should be contacted to provide further
management
• Ensures that equipment and drugs necessary to deal with an extravasation are available in the area
where SACT is administered
• Can explain the procedure for documenting and reporting an extravasation

Demonstrates competence in administration of ambulatory continuous infusional SACT (for
clinicians using an ambulatory SACT device) (if ambulatory administration relevant to role)
• Ensures ambulatory infusion device is correctly set up and/or programmed as appropriate according
to device used
• Uses aseptic non-touch technique to access CVAD to connect and disconnect ambulatory infusion
device
• Demonstrates correct technique for flushing of CVAD following infusion device disconnection
• If receiving ambulatory SACT can clearly explain to patients or carers how to check and manage the
ambulatory infusion device, including when and who to contact if they have any concerns and how
to manage any leaks or spillage of SACT
• Ensures arrangements made for patient follow up for disconnection or renewal of ambulatory
infusion – if applicable.
3.5 Pre-treatment Consultation: All Routes
Demonstrates competence in pre-consultation preparation

Reviews the treatment order ensuring presence of:
• The SACT referral form that lists approved regimen, indication, planned number of cycles and
previous therapy.
• Medical history including medicines review and allergy status
• Prescription that is valid/legal/completed and signed by the prescriber
• Administration appointment scheduled if required
• Ensures availability of prescribed and dispensed SACT and/or pretreatment supportive agents (if
required)
Acquires pre-SACT consultation checklist (where utilised)
• Acquires appropriate written information to offer to patients including:
• 24-hour contact details and related alert cards/bands
• Risk of deep vein thrombosis development whilst on treatment and related alert cards
• Specific drug information sheets
• Patient treatment plan (if available)
• Traffic light symptom reporting tool (if available)
• Ensures appropriate environment accessible to perform consultation to maintain confidentiality
and dignity.
Demonstrates competence in initiation of consultation

• Establishes therapeutic relationship between clinician patient and carers.
• Greets and identifies patient in accordance with dignity guidelines.
• Introduces all clinicians present to the patient.
• Attains consent from patient for others to be present (i.e. family, friends, students)
• Outlines structure and estimated length of consultation
• Elicits, acknowledges and addresses concerns
• Assess patient’s existing understanding of disease, planned treatment, toxicities and provides
opportunities for questioning/discussion throughout the consultation
60 January 2018
Demonstrates competence in delivering the consultation
• Delivers a consultation that is interactive and encourages patients and carers to ask questions
• Actively listens to patients and their families
• Can detect both verbal and non-verbal cues
• Responds appropriately
• Addresses patient’s and carer’s immediate concerns at the outset.
• Assesses patient supportive care needs and refer on if required e.g. liaise with CNS, research nurse,
refer to counsellor (where necessary)
• Can advise patients/carers on how to access relevant information, advice and support
• Does not overwhelm the patient with information
• Provides information and educates according to patient/carer need regarding the treatment plan
Demonstrates competence in supporting patients and significant others in managing side-

effects of other drugs used in conjunction with SACT regimens
• Can explain side-effects of other drugs used in conjunction with specific drug regimens
• Plans and provides evidence-based care in relation to the side-effects of these drugs and individual
information needs
• Educates patient and carers about:
• Anticipated toxicities
• How to minimise toxicities (suggesting evidence-based self-care approaches)
• Who to contact with any problems.
• Check patients/carers understanding of how to take the supportive medication and what to do if
any problems experienced
• Advise patients/carers on how to access relevant information and support
• Checks patients’/carers’ understanding of what to do if any problems experienced.
3.6 Pre-treatment Consultation: Additional elements for Oral SACT
Demonstrates competence in supporting & educating patients and significant others in

managing side-effects of oral SACT
• Able to assess patient/carer ability to self-medicate:
• Cognitive and physical ability to take medication correctly and monitor toxicities
• Judge when to interrupt treatment and call the hospital if required
• Explain/discuss
• Regimen and intended number of cycles, including treatment gaps.
• How and when to take the tablets
• What to do in the event of a missed dose
• The need for and how to obtain further supplies
• The role of the GP in the treatment
• Principles of safe handling, storage and disposal
• The use of medicine spoons, oral syringes or cups

• Explains dose alteration i.e. doses will be individually adjusted to suit the patients and dosing may
be interrupted or modified during treatment. This will not be detrimental to treatment. Failure to
interrupt treatment appropriately could lead to longer delays.
Demonstrates competence in ending the consultation

• Refers patient to relevant disciplines, e.g. counsellor, community practitioners
• Ensures patient has been given future appointment for treatment
• Summarises the key points of the consultation.
• Documents episode of care in an appropriate manner conforming with employers and professional
bodies guidelines for records and record keeping
3.7 Clinical practice signature pages

and certificate
3.7.1 Safe handling and administration
Minimum Requirement: On at least two occasions: All Clinicians / All Routes
Name, signature and

Formative assessment Formative feedback designation of Clinician and
Supervisor
Date:
Summative assessment Name, signature and Name, Signature and

designation of Clinician Designation of Approved
Assessor
Date:
62 January 2018
3.7.2 Administering oral SACT
Minimum Requirement: On at least two Oral Administrations
Name, signature and

Supervisor
Date:
Final Assessment Name, signature and Name, signature and

designation of Clinician designation of Approved
Assessor
Date:
3.7.3 Administering intramuscular (IM) or subcutaneous (S/C) SACT
Minimum Requirement: on at least three occasions– one of which should be a subcutaneous

Rituximab (If administered in your area)
Name, signature and

Supervisor
Date:

Date:
Date:

Assessor
Date:
64 January 2018
(Complete the administration type relevant to role)
Minimum Requirement: On at least four administrations via an ambulatory device
Name, signature and

Supervisor
Date:
Date:
Date:

Assessor
Date:

Minimum Requirement: On at least four administrations via infusion device
Name, signature and

Supervisor
Date:
Date:
Date:

Assessor
Date:
66 January 2018
Minimum Requirement: On at least four administrations via bolus
Name, signature and

Supervisor
Date:
Date:
Date:

Assessor
Date:

3.7.5 Pre-treatment Consultation: All Routes
Minimum Requirement: On at least two Pre-Treatment Consultations – All Routes
Name, signature and

Supervisor
Date:

Competency Assessor
Date:
3.7.6 Pre-treatment Consultation: Additional elements for Oral SACT
Minimum Requirement: On at least two occasions
Name, signature and

Supervisor
Date:

Competency Assessor
Date:
68 January 2018
3.7.7 UKONS SACT Safe Handling and Administration Certificate
UKONS SACT Safe Handling and Administration Certificate
1.Personal Development
I have successfully completed a SACT training package
I have successfully completed pharmacy’s assessment and competency package to dispense
supportive medicine to chemotherapy patients (where relevant)
I have successfully completed UKONS Clinical Competence for the Safe Handling and Administration
of Systemic Anti-Cancer Therapy (SACT) Theoretical Section (Passport) OR provided evidence of
theoretical understanding i.e. accredited module/course transcript/previously completed a theory
workbook that assesses the same content to the same standard or above
2. Policies and Standards
I have read and understood the current /local/alliance
Medicines Policy and related Codes of Practice
Standards for the Safe Use of Oral Anticancer Medicines (where relevant to role)
Local SACT Policy: State name, number, and year of publication……………………………………..
Other (organisation specific): State Name, number, year of publication………………………………
3. Declarations
I declare that I am clinically competent to safely administer SACT and have successfully completed
UKONS Clinical Competence for the Safe Handling and Administration of Systemic Anti-Cancer
Therapy (SACT) Clinical Practice Assessments for the following route(s) of administration.
Intravenous (Bolus)
Intravenous (Infusion)
Intravenous (Ambulatory device)
Intramuscular/subcutaneous injection
Oral
Other (please state):
I declare that I am competent to conduct SACT Pre-Treatment Consultations
I declare that I am competent to electronically document on the local e-prescribing system (if used)
I understand that my name will be removed from the register 12 months after the date of
certification unless I successfully complete re-accreditation
I understand that if my name has been removed from the register, my rights to administer SACT
on the local e-prescribing system (if used) will be revoked unless I successfully complete re-
accreditation.
Signed: Date:
Name:
Position: (Clinician)
I certify that is deemed safe and competent to administer

SACT independently via the routes indicated above.
Signed: Date:
Name:
Position: (Approved SACT assessor)
Your name will be removed from the register at Named Service Provider on DD/MM/YYYY
(Original of assessment record to be kept by the Clinician and a copy made for the manager)

4 Step Three
Re-accreditation Competency Certificate
UKONS SACT Safe Handling and Administration Re-accreditation Certificate

(Annual Completion)
1. Personal Development
I have, within the previous 12 months, demonstrated continual professional development in relation
to SACT handling and administration, (e.g. through attending workshop, local SACT update session,
or conference presentations) and use evidence-based practice.
2. Policies and Standards
I have read and understood the current local:
Medicines Policy and related Codes of Practice
Standards for the Safe Use of Oral Anticancer Medicines (where relevant to role)
Clinical Chemotherapy Service Operational Policy
Other (organisation specific) please name:
3. Pre-treatment Consultation – Communication Assessment Skills
I conduct pre-treatment consultations in a holistic way through application of good communication
and information delivery skills (e.g. obtain concerns before delivering information about SACT and
check understanding)
I ensure patient/carers are aware of key SACT toxicities as listed within regimen consent forms.
I reconfirm patient consent to SACT.
4. Pre-treatment Checks
I ensure all pre-treatment investigations have been carried out and results are appropriate.
I ensure SACT is prescribed according to approved protocols.
5. Route of Administration
I am competent to safely deliver SACT via the following route(s) (tick as appropriate) according to
UKONs Clinical Competence for the Safe Handling and Administration of Systemic Anti-Cancer
Therapy (SACT) Clinical Practice Assessment Criteria
Intravenous (Bolus)
Oral
6. Post Treatment Checks
I remain competent to dispense supportive medicine (where applicable).
I ensure patient and carers can adhere with supportive medication administration requirements and I
can provide related patient education (where necessary).
I ensure patients and carers are aware of 24-hour acute oncology contact numbers.
7. Declarations
I wish my name to remain on the Register of Clinicians accredited to administer SACT as per route(s)
selected above
I remain competent to administer SACT
I remain competent to electronically document on the local e-prescribing system (where applicable).
I understand that my name will be removed from the register 12 months after the date of
certification unless I apply for re-accreditation.
I understand that if my name has been removed from the register, my rights to administer SACT on
the local prescribing system (where applicable) may be revoked unless I apply for re-accreditation
70 January 2018
Signed: Date:
Name:
I have observed handling and administration of SACT and

related assessment skills. I certify that s/he is safe to administer SACT independently (via the routes
indicated above) according to UKONs Clinical Competence for the Safe Handling and Administration of
Systemic Anti-Cancer Therapy (SACT) Clinical Practice Assessment Criteria.
Signed: Date:
Name:
Position: (Approved SACT assessor)
Your name will be removed from the register at Named Service Provider on DD/MM/YYYY

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6 Appendices
Appendix 1: Guidance for Assessors
1.1 Marking the Theoretical Section (Passport)
A copy of the Assessors’ Guide (answers) is available to any UKONS member whose role encompasses acting
as the Lead Chemotherapy Clinician for their organisation and who can distribute the document within their
organisation as appropriate.
The answers in the Assessors’ Guide are based on national/local policies, research and patient-friendly
resources. They are intended as a guide to support the marking process. It is recognised that local variations
will apply. The theoretical section is designed to be marked either by a clinician in practice, e.g. practice
educator or a course module leader. The term Assessor has been used throughout and can be interpreted
according to local practice e.g. the Assessor or Marker for the Theoretical Section and the Clinical Practice
Section may differ.
1.2 Regimen Exercise: Commencement of Theory to Practice.
This exercise is to support the clinician to transfer knowledge into clinical practice and build confidence. The
clinician should choose a SACT regimen commonly used in their clinical area and populate the table. If they
find this exercise helpful or the Assessor suggests it would be beneficial, further copies can be made. We
recommend a true patient case informs completion of this table.
1.3 Practicing under supervision
Clinicians can administer SACT under direct supervision as part of their SACT administration competency
training. Supervision may be given by any clinician who has been assessed as competent in the administration
of SACT, is regularly practicing and has experience of administering the particular regimen or agent and are
not personally involved in regaining competence, i.e. post drug error.
UKONS suggests a minimum practice requirement for clinicians new to SACT administration, which is
route specific and outlined in the Regimen Exercise and Clinical Practice Assessment section. The last of the
Minimum Practice Requirements is considered the final assessment and is conducted by the service approved
SACT Assessor.
For each practice requirement the relevant Practice Assessment Criteria should be used to measure
competence against.
1.4 Who can assess SACT competence?
SACT Assessors will be Band 6 or above clinicians who have attained SACT competency and are practicing
regularly. Assessors will have completed the mentorship preparation programme (or equivalent) and/or have a
recognised teaching qualification. A certificate for this role may be found at appendix 3.
There is usually a named person for the service who holds assumed competence, such as a lead or consultant
nurse e.g. lead/consultant chemotherapy nurse, lead/consultant cancer nurse. This professional is encouraged
to obtain peer assessment and feedback from a colleague performing the same role in another organisation.
The named person would subsequently assess day unit matrons, day unit/ward managers, and practice
educators to fulfill their role as an Approved SACT Assessor. They in turn can then train others to be assessors
only with the approval of their service providers named person.
78 January 2018
1.5 Assessor Signatures
1.5.1 The Passport (Theoretical Competence) Assessor/Marker Signature
The Assessor/Marker is signing to indicate that the Passport has been completed to a satisfactory standard
and the Clinician has achieved theoretical competence.
1.5.2 The Clinical Practice Assessment Signature
The clinician and assessor signatures indicates that:

• The Clinician has achieved theoretical competence, and practiced in line with the Practice Assessment
Criteria on their final assessment(s), and can therefore safely handle and administer SACT independently,
according to local policy and protocol.
• The Clinician will take accountability for their practice in line with their professional bodies code of
conduct.
1.6 New, Experienced, and Returning Practitioners
(See SACT handling and administration competency pathway figure 1. p 9).
1.6.1 New to SACT
Any Clinician new to SACT should have completed the prerequisite competencies and theoretical learning.
The theoretical and practice supervision sections of this document should be completed prior to undertaking
the final competency assessment.
1.6.2 Transferring employers or areas of practice
Clinicians transferring to a new employer or area of practice with existing evidence of training and theoretical
knowledge in SACT handling and administration will not be required to complete the theoretical sections of
this passport. The exception would be where the clinician is required to develop their portfolio of practice.
Evidence may consist of an accredited module/course or previously having completed a theory workbook
that assesses the same content as the theoretical sections of this passport and to the same standard. In the
absence of evidence of theoretical knowledge UKONS would recommend the theoretical section (Passport) is
completed.
The new employer should be satisfied that the individual is competent and can demonstrate awareness and
application of local procedure and policies. Therefore, ALL clinicians are required to complete/re-complete the
clinical practice assessment sections relevant to their new role
Local policy or clinical judgment will dictate the number of times a transferring, competent professional
should complete the Clinical Practice Assessments.
1.6.3 Returning to work after a break from practice or infrequently handling or administering.
Absence from work/not administering SACT for a period of over 6 months requires re-assessment of clinical
competence i.e. step two
All clinicians deemed competent in SACT safe handling and administration are expected to take responsibility
for maintaining/updating their knowledge and practice. However, clinicians that administer SACT on an
infrequent basis or do not feel competent in any aspect of handling or administration of SACT should seek
further training and re-assessment.

Appendix 2:
Theoretical Objectives for Step One
2.1 Safe Handling and Administration
2.1.1 Safe handling:

• To ensure the safe handling of SACT
2.1.2 Safe administration/fitness to treat:

• To ensure the safe handling and administration of SACT.
• To ensure understanding about how SACT drugs work/treatment intent.
• To ensure understanding of SACT toxicities, how to assess these and when to withhold treatment and
escalate concerns about fitness to treat.
2.1.3 Patient education, preparation, and self-care measures:

• To ensure correct processes for informed patient consent to SACT are followed.
• To ensure patients and carers understand potential SACT toxicities and how to manage and report these
when required.
• To understand and be able to support the psychological and social impact of SACT
• To ensure patients and carers are enabled to self-care following SACT administration. Through managing
supportive medications, safe handling of body fluids/waste, identifying and reporting toxicities

• To ensure knowledge about how to reduce the risk of a spillage and safely respond to a spillage incident.

• To ensure knowledge about oncological emergencies, including definitions and how to prevent, recognise
and treat these.
• To ensure the safe handling and administration of oral SACT.

• To understand core patient and carer education components for oral SACT
• To understand reasons for poor adherence and how these may be addressed
2.3 Administering intramuscular (IM) or subcutaneous (S/C) SACT
• To ensure the safe handling and administration of IM and S/C SACT.

• To ensure the safe handling and administration of intravenous SACT.

• To prevent, recognise and treat infiltration/extravasations, minimising risk to the patient
• Maintain patient safety and comfort
2.4.3 Hypersensitivity/anaphylaxis
• To ensure knowledge about which SACT drugs cause hypersensitivity/anaphylaxis and the likelihood
2.4.4 Hair loss/scalp cooling

• To demonstrate understanding of rationale for scalp cooling
• To ensure patients feel well supported with hair loss/thinning, and are given accurate information/advice
about scalp cooling procedures and hair care.
80 January 2018
2.5 Regimen Exercise: Commencement of Theory to Practice
• To ensure the ability to transfer knowledge into clinical practice and build confidence
• To ensure learning has occurred from experience and consideration is given towards planning and
delivering high quality care.

Appendix 3
UKONS SACT Safe Handling and Administration Assessor Certificate
I am a registered, band 6/above, clinician e.g. nurse with more than 12-month practice in
administering SACT.
I am authorised in my position according to the local Chemotherapy Treatment policy/Medicine

Management Policy to become an assessor in the following routes of administration and areas of
practice:
Intravenous (Bolus)
Oral
I declare that I am competent to assess Pre-Treatment Consultations
I will utilise UKONS Clinical Competence for the Safe Handling and Administration of Systemic
Anti-Cancer Therapy (SACT) Clinical Practice Assessment Criteria when conducting assessments
I have successfully completed the SACT training and competency package and/or have had my
SACT competency re-accredited in the last 12 months.
I have successfully completed an approved Mentorship training programme or equivalent.
I have read and understood the local Clinical Chemotherapy Service Operational Policy or equivalent.
I have read and understood the local Medicines Policy and related Codes of Practice
I understand that my name may be removed from the register 12 months after the date of
certification unless I apply for re-accreditation.
Signed: Date:
Name:
I certify that is capable of conducting a competency

assessment for clinicians in the safe handling and administering SACT.
Signed: Date:
Name:
Position: (Service Provider Approved Person Only)
Your name will be removed from the register at Name on: DD/MM/YYYY
82 January 2018
Copyright © The United Kingdom Oncology Nursing Society (UKONS) registered charity number 1136972.
This passport cannot be reproduced. All rights reserved. The authors and owners of this passport make no
representations or guarantees as to the accuracy, completeness or adequacy of any of the content of this
passport and make no warranties, expressed, implied or otherwise and cannot be held responsible for any
liability, loss or damage whatsoever caused by the use of this passport.

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Systemic Anti-Cancer

Version 2 and 3 Developed by

Acknowledgements: Pilot Sites

Publication date: September 2017

Dame Eileen Sills

Systemic Anti-Cancer Therapy (SACT) Competency Passport 3

2.1.5 Oncology emergencies..................... 32 3.7.6 Pre-treatment Consultation:

2.7 Theoretical assessment signature page.... 55 7 Disclaimer................................................. 83

SACT treatment can be complex and put patients

Systemic Anti-Cancer Therapy (SACT) Competency Passport 5

1.3 Glossary of terms

1.5 Prerequisite theoretical learning

1.6 Professional responsibility

Systemic Anti-Cancer Therapy (SACT) Competency Passport 7

2.2 & 3.7.2 Administering oral SACT

2.3 & 3.7.3 Administering intramuscular (IM) or subcutaneous (S/C) SACT

2.4 & 3.7.4 Administering intravenous (IV) SACT

3.7.5 Pre-treatment consultation all routes

3.7.6 Pre-treatment consultation oral

New area of SACT practice New to trust or prolonged

Step two: Complete and pass

* Relevant practice elements

Systemic Anti-Cancer Therapy (SACT) Competency Passport 9

Date Passport Commenced

2.1 Safe Handling and administration

Handling waste e.g. vomit, urine, stool, blood

Transporting and waste disposal

Systemic Anti-Cancer Therapy (SACT) Competency Passport 11

Type of waste, labeling

All sharps, syringes and

All other items used

Labeling cytotoxic waste

Systemic Anti-Cancer Therapy (SACT) Competency Passport 13

2.1.2 Safe administration/fitness to treat.

Why cytotoxic drugs may

(Please refer to the cell

Systemic Anti-Cancer Therapy (SACT) Competency Passport 15

Dose Limiting Toxicity Effect on patient Normal Blood Parameters

Systemic Anti-Cancer Therapy (SACT) Competency Passport 17

Modality of Action Basic

How long does

Systemic Anti-Cancer Therapy (SACT) Competency Passport 19

Patient checks when confirming Consent form/documentation checks

When and who should confirm consent?

Definition Explanation and Meaning

Phase III clinical

Number of Clinicians to check

The drug and the

Systemic Anti-Cancer Therapy (SACT) Competency Passport 21

Stands for What is it means? Calculation

2.1.3 Patient education, preparation, and self-care.

Patient Recognition Advice

Systemic Anti-Cancer Therapy (SACT) Competency Passport 23

Systemic Anti-Cancer Therapy (SACT) Competency Passport 25

Before starting treatment

Systemic Anti-Cancer Therapy (SACT) Competency Passport 27

Body fluids (urine,

Doing the laundry

Systemic Anti-Cancer Therapy (SACT) Competency Passport 29

Where is the spillage kit found? Where is the policy found?

Management of a dry and wet (liquid) spillage

Actions Replacing spillage kit Documentation

Systemic Anti-Cancer Therapy (SACT) Competency Passport 31