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The use of chemotherapy within NHS Tayside must be in accordance with the standards stated in the guideline, Guidelines for the Safe Use of Cytotoxic Chemotherapy in the Clinical Environment. In addition to the general requirements for the safe and secure handling of medicines described elsewhere in this manual, the following standards apply specifically to cytotoxic chemotherapy. For all prescriptions for intrathecal administration, the NHS Tayside Policy for the Administration of Intrathecal Cytotoxic Chemotherapy must be followed.
24.1	Cytotoxic chemotherapy: Prescribing
24.1.1	The initial decision to prescribe cytotoxic chemotherapy must be made by a consultant or a senior specialist with appropriate experience (as defined by local policy). This person must record their decision and the proposed plan of treatment in writing.
24.1.2	Before each course of cytotoxic chemotherapy the patient must be reassessed as being fit to receive the prescribed treatment by an appropriately qualified, competent practitioner (as defined by local policy).
24.1.3	Cytotoxic chemotherapy must be prescribed by an appropriately qualified, competent practitioner (as defined by local policy). Prescribing must be in accordance with written local treatment protocols that are readily available in the ward, clinic and pharmacy department.
24.1.4	Cytotoxic chemotherapy regimens must, wherever possible, be prescribed on a standardised chemotherapy prescription form that has been designed for this purpose. It is recommended that each time a new protocol is used, a standardised prescription form is devised giving details of the regimen and the drug administration details. This may be designed by the pharmacist or doctor and must be verified by both the initiating consultant or the senior specialist (who will sign and date the prescription) and by the pharmacy department. Computer generated forms may be used.
24.1.5	The cytotoxic chemotherapy prescription form must provide sufficient patient and drug details to allow verification of the prescription. The information must include: patient name; date of birth; unit number; height and weight; diagnosis; haematology/biochemistry results (as required by the protocol).
24.1.6	For new regimens or ad-hoc cytotoxic chemotherapy, the prescription must be written by the patient’s consultant or a senior specialist with appropriate experience.
24.1.7	Prescriptions for oral cytotoxic chemotherapy and high dose steroids must make clear the time limit on treatment e.g. “for 5 days then stop”.
24.2	Cytotoxic chemotherapy: Verification
24.2.1	All prescriptions for cytotoxic chemotherapy must be verified by an appropriately qualified, competent practitioner (as defined by local policy) to ensure calculations, drug dose, route, timing and scheduling are correct.
24.2.2	Recommendations on dose reductions and criteria for delay or dose alterations relating to blood chemistry and toxicity must be readily available to both prescriber and verifier.
24.2.3	Prior to dispensing of any cytotoxic chemotherapy the prescription will be verified by a clinical pharmacist and aseptic pharmacist.
24.2.4	Prior to administration, the suitably qualified practitioner must verify that chemotherapy drugs to be administered are as detailed on the prescription forms; that the administration, route and schedule is correct and that the correct patient receives the drugs.
24.3	Cytotoxic chemotherapy: Preparation
	Cytotoxic chemotherapy must be prepared within the pharmacy department in accordance with national standards. Labelling and packaging will follow the Guidelines for the Safe Use of Cytotoxic Chemotherapy in the Clinical Environment.
24.4	Cytotoxic chemotherapy: Transport
	Persons transporting cytotoxic chemotherapy must be trained in the actions to be taken in the event of a spillage and the reporting of such an incident.
24.5	Cytotoxic chemotherapy: Storage
24.5.1	The product must be received by a staff member who will be responsible for opening the package and ensuring that it is stored safely and in an appropriate manner until required for use.
24.5.2	Storage of cytotoxic chemotherapy within the ward/clinic must be within a designated area. The physical storage requirements set out on the label must be met e.g. refrigeration between 2-8^oC.
24.6	Cytotoxic chemotherapy: Administration
24.6.1	Cytotoxic chemotherapy must be prescribed by the medical staff as described in Section 19
24.6.2	The procedure for the administration of medicines (Section 20) must be adhered to in all situations.
24.6.3	Whenever practicable, to minimise the risk of adverse incidents, cytotoxic chemotherapy must only be administered during normal working hours and in specialist units where support services and expert advice are available.
24.6.4	Patients must receive cytotoxic chemotherapy in designated wards or areas that are equipped to deal with any emergencies that may arise from the treatment.
24.6.5	All intravenous cytotoxic chemotherapy must be administered by medical or nursing staff who have received education and training in the administration of cytotoxic chemotherapy.
24.6.6	Staff must demonstrate their competency on a regular basis and keep written records of their training and competency reviews.
24.6.7	The local procedure for verifying and recording the administration of medicines must be adhered to throughout.
24.6.8	The pharmacy will provide information on the nature of the cytotoxic chemotherapy being administered. This will include toxicity, treatment of acute exposure and a COSHH (1994) risk assessment in addition to information required to ensure patient safety during therapy. This will be held in the pharmacy and in the clinical area.
24.6.9	The person administering the medication must be satisfied that the patient’s performance status to that seen by the prescribers when the prescription was written e.g. the patient has not suddenly deteriorated or developed an infection.
24.6.10	All staff who administer cytotoxic chemotherapy must be formally trained in the administration procedures including the use of infusion control equipment.
24.6.11	The Extravasation Treatment Policy (NHS Tayside) must be followed in the event of extravasation caused by cytotoxic chemotherapy.
24.6.12	The administration of cytotoxic intrathecal chemotherapy must be undertaken under the direction set out within the specific NHS Tayside Policy for the Administration of Intrathecal Chemotherapy.
24.6.13	The administration of non-cytotoxics must be administered under the direction set out within the specific NHS Tayside Policy for the Administration of Non-Chemotherapy Intrathecal Medicines.
24.7	Cytotoxic chemotherapy: Spillage of Cytotoxic Chemotherapy
	NHS Tayside guidelines for minimising the risk of spillage of cytotoxic chemotherapy and spillage management measures must be followed.
24.8	Cytotoxic chemotherapy: Disposal of Cytotoxic Chemotherapy
	NHS Tayside procedure for the disposal of cytotoxic chemotherapy, contaminated materials and waste must be followed.