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Ukons Book PDF
Ukons Book PDF
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
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
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
September 2017
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.
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.
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.
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
Figure 1
Systemic Anti-Cancer Therapy (SACT) Handling and Administration
Competency Pathway
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.
Clinician Name
Clinician Designation
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)
Cleaning up a spillage
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)
Contaminated linen
(sweat, vomit, stool,
blood)
Sealed unwanted/
unused items that have
not left the clinical
environment.
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)
2.1.2.1 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?
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)
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
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?
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)
Neo-adjuvant
Adjuvant
Curative
Palliative
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)
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)
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
2.1.3.1 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)
Increased
risk of
infection and
susceptibility
to bruising
(Please
ensure you
mention the
NADIR and
when this
occurs)
Risk of
deep vein
thrombosis
development
24 January 2018
Fatigue
General skin
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)
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?
Hand washing
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 SACT spillages
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)
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)
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)
Neutropenic
sepsis
Immediate interventions:
(as prescribed/ necessary):
Severe
nausea and Immediate Interventions
vomiting (as prescribed/ necessary):
32 January 2018
On-going assessment/monitoring of:
Immediate interventions
(as prescribed/ necessary):
Severe
mucositis
Tumour lysis
syndrome
(TLS) Immediate interventions
(as prescribed/ necessary):
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)
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
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 Administering oral SACT
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)
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
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)
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)
Patient
Relative/
Carer
2.2.8 Describe how patients should dispose of left over oral SACT at home. (Clinical Reasoning; Waste
Management Policy)
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/
disease Usual Significant &
Name of Parameters
group treatment frequently occurring
drug assessed
prescribed schedule toxicities
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)
Advantages Disadvantages
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)
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/
disease Usual Significant &
Name of
group treatment Parameters assessed frequently occurring
drug
prescribed schedule toxicities
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).
2.4.1.5 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)
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
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.
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:
2.4.3 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%)
2.4.4.1 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
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
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.
State drug(s) in
the regimen and Emetogenic Neutropenia Extravasation
Mode of action
specify route of risk risk risk (if IV)
administration
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?
52 January 2018
Long-term Nursing management
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
Date:
Date:
56 January 2018
Clinical Practice Assessment Section
Practice Assessment Criteria
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
Administration
58 January 2018
3.3 Route Specific: Intramuscular and Subcutaneous
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
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
Date:
Date:
62 January 2018
3.7.2 Administering oral SACT
Date:
Date:
Date:
Date:
Date:
64 January 2018
3.7.4 Administering intravenous SACT
(Complete the administration type relevant to role)
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
66 January 2018
Minimum Requirement: On at least four administrations via bolus
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
68 January 2018
3.7.7 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)
Signed: Date:
Name:
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)
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)
Intravenous (Infusion)
Intravenous (Ambulatory device)
Intramuscular/subcutaneous injection
Oral
Other (please state):
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:
Position: (Clinician)
Signed: Date:
Name:
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)
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Further Reading
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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.
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.
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.
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
The Assessor/Marker is signing to indicate that the Passport has been completed to a satisfactory standard
and the Clinician has achieved theoretical competence.
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.
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.
2.4.3 Hypersensitivity/anaphylaxis
• To ensure knowledge about which SACT drugs cause hypersensitivity/anaphylaxis and the likelihood
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.
I am a registered, band 6/above, clinician e.g. nurse with more than 12-month practice in
administering SACT.
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 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:
Position: (Clinician)
Signed: Date:
Name:
Your name will be removed from the register at Name on: DD/MM/YYYY
(Original of assessment record to be kept by the Clinician and a copy made for the manager)
82 January 2018
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