Open Forum

 View Only

  • 1.  Scope Question: LPN Administration of Chemotherapeutic Agents via Bladder Instillation

    Posted 02-06-2024 15:02

    Currently our urology department administers Mitomycin and Gemcitabine (chemotherapeutic agents) via bladder installation. In our organization this is performed by a RN or higher. I am looking for information around the level of clinician that other organizations utilize for this task.

    The BON in NH does not have a clear stance in the LPN scope regarding the administration of BCG via the intravesical route. 

    Thank you! 

    Sara 



    ------------------------------
    Sara Burgess, BSN RN
    Core Physicians
    Exeter, NH
    (603)580-6910
    ------------------------------


  • 2.  RE: Scope Question: LPN Administration of Chemotherapeutic Agents via Bladder Instillation

    Posted 02-07-2024 06:39
    Per the BON in Ohio, LPNs are prohibited to administer chemotherapeutic medications.  Only RNs provide this therapy at our organization.

    Erin

    Sent from Workspace ONE Boxer
    Visit us at www.UHhospitals.org.

    The enclosed information is STRICTLY CONFIDENTIAL and is intended for the
    use of the addressee only. University Hospitals and its affiliates disclaim
    any responsibility for unauthorized disclosure of this information to anyone
    other than the addressee.

    Federal and Ohio law protect patient medical information, including
    psychiatric_disorders, (H.I.V) test results, A.I.Ds-related conditions,
    alcohol, and/or drug_dependence or abuse disclosed in this email. Federal
    regulation (42 CFR Part 2) and Ohio Revised Code section 5122.31 and
    3701.243 prohibit disclosure of this information without the specific
    written consent of the person to whom it pertains, or as otherwise permitted
    by law.



    Original Message


  • 3.  RE: Scope Question: LPN Administration of Chemotherapeutic Agents via Bladder Instillation

    Posted 02-07-2024 10:21

    You may want to check with your regulations on this first. There are state to state differences on what an LPN can and can't do. 

     

    Description: Description: colorbar

     

     

     

    Judith Puzon, RN, MSN

    Director of Outpatient Nursing Services|Clinic Network Administration

    17910 Talbot Rd S|Renton, WA 98055| (o) 425-690-3373

    M/S:  PRC-8316

    UW Medicine | Valley Medical Center

    Judith_Puzon@valleymed.org | Lita_Gill@Valleymed.org">www.valleymed.org

    She/Her

     

    Non-urgent emails received after 4pm, will be responded to the next business day.

     

     

    IMPORTANT: This communication contains information that may be confidential or privileged, and is intended solely for the entity(s) or individual(s) to whom it is addressed.  If you are not the intended recipient, you should delete this message, and are hereby notified that any disclosure is strictly prohibited.  If you received this communication in error, please notify the sender and delete the message.

     




    Original Message


  • 4.  RE: Scope Question: LPN Administration of Chemotherapeutic Agents via Bladder Instillation

    Posted 02-07-2024 10:29
    Edited by Jaime Weimer 02-07-2024 10:29

    The Oncology Nursing Society's current position statement on the Education of the Registered Nurse Who Administers and Cares for the Individual Receiving Antineoplastic Therapies states: 

    • RNs are responsible for all aspects of administering and monitoring cancer therapies, including chemotherapy, targeted therapy, and immunotherapy.
    • State practice acts should be consulted when developing institutional policies and procedures.
    • Educational programs for nurses administering chemotherapy, targeted therapy, and immunotherapy are comprehensive, current, and evidence-based, and appropriate for the person, population, and setting. They consist of didactic learning followed by the successful completion of a clinical practicum under the auspices of the nurses' institution or supporting agency.
    • Competency is assessed and reinforced annually.

    It is important to recognize that assessment, as part of the process of administration of antineoplastic medications regardless of route or indication, involves comprehensive awareness of appropriateness of therapy, validation of frequency and schedule of administration, evaluation of pre-administration testing results, and thorough discussion with the patient of symptoms or side effects occurring in-between cycles.  This scope of practice should be delineated by your state board of nursing.  Assessment often falls outside the scope for LPN practice.



    ------------------------------
    Jaime Weimer MSN, RN, AGCNS-BC, AOCNS

    Manager of Oncology Nursing Practice

    Oncology Nursing Society

    ------------------------------

    Original Message


  • 5.  RE: Scope Question: LPN Administration of Chemotherapeutic Agents via Bladder Instillation

    Posted 02-10-2024 22:18

    We follow OCN standards in our outpatient clinics for administration. I also agree with the comment about monitoring requirement after Intravesical administration that is outside the scope of practice for an LPN. 



    ------------------------------
    Amber Nealy
    Chief Nursing Officer
    OU Health
    Yukon OK
    ------------------------------

    Original Message


  • 6.  RE: Scope Question: LPN Administration of Chemotherapeutic Agents via Bladder Instillation

    Posted 02-07-2024 10:48

    Hi Sara,

     

    Here is an excerpt from our Ambulatory Mitomycin policy.

    Installation is limited to our providers.

     

    Antineoplastic bladder instillation can only be administered by a Licensed Independent Practitioner (LIP refers to MD, NP, PA) who is credentialed/privileged to administer chemotherapy.

    • Nursing staff and Ambulatory medical assistants caring for this population must annually complete the assigned HealthStream course and post test entitled "-The Care of the Patient Receiving Intravesicular Bladder Instillation of Antineoplastic

     

    Lisa

    _____________________

    Lisa C. Dutton, MSN, RN, AMB-BC, NE-BC

    Professional Development Manager, BWH Department of Ambulatory Nursing 

    Clinical Director, MGB Nurse Hotline

    Operations Lead, MGB COVID Outpatient Therapies

     

     

    Brigham and Women's Hospital

    75 Francis Street, Boston, MA 02115

    M: 603-479-7468 T: 617-525-7789

    brighamandwomens.org

     

     

     

    The information in this e-mail is intended only for the person to whom it is addressed.  If you believe this e-mail was sent to you in error and the e-mail contains patient information, please contact the Mass General Brigham Compliance HelpLine at https://www.massgeneralbrigham.org/complianceline .


    Please note that this e-mail is not secure (encrypted).  If you do not wish to continue communication over unencrypted e-mail, please notify the sender of this message immediately.  Continuing to send or respond to e-mail after receiving this message means you understand and accept this risk and wish to continue to communicate over unencrypted e-mail. 




    Original Message


  • 7.  RE: Scope Question: LPN Administration of Chemotherapeutic Agents via Bladder Instillation

    Posted 02-07-2024 15:26
    My question for RN vs LPN is assessment and oversight. Does the patient need to be continually or routinely assessed throughout the administration? (If yes, RN or RN available). Who is available to supervise the LPN? (If RN available locally to provide oversight, yes). How is the skill set competencied on a regular basis?

    These are the dividing lines.

    Amy

    Sent from my iPhone


    Original Message


  • 8.  RE: Scope Question: LPN Administration of Chemotherapeutic Agents via Bladder Instillation

    Posted 02-07-2024 15:48

    Here is the NH BON Scope of Practice Advisories for LPNs: https://www.oplc.nh.gov/sites/g/files/ehbemt441/files/inline-documents/sonh/lpn-scope-practice.pdf

    This document clearly states that LPNs may perform BCG installation in the bladder so long as the facility has policies and procedures in place. However, BCG is not a chemotherapeutic agent – it is derived from the bacteria that causes tuberculosis. 

    1. The NH BON does have a clear stance regarding an LPNs ability to administer BCG via the intravesical route.
    2. BCG is not a chemotherapy agent, but Mitomycin and Gemcitabine are – BCG and intravesical chemotherapy are not the same thing
    3. LPNs are prohibited from administering IV chemotherapy agents, but the NH BON does not have a clear stance on an LPNs ability to administer chemotherapeutic agents via other routes of administration

    I will also say that we give both of these drugs in Infusion via the intravesical route. It is a complex procedure. The potential for hazardous drug spill is significant due to leakage from the foley catheter and patient incontinence, the patient requires close monitoring and follow-up for signs and symptoms of reaction, and, at a minimum, the nurse would need to hold an active Chemotherapy Immunotherapy provider card, etc. For all those reasons, I would imagine it falls outside the scope of practice for an LPN since they are limited to caring for patients with stable conditions only; our policy does not cover LPNs.



    ------------------------------
    Susanna Gadsby MSN, MBA, AMB-BC, NPD-BC
    Clinical Educator, Ambulatory
    AAACN Certified
    Nursing Professional Development Specialist
    susanna.m.gadsby@hitchcock.org
    ------------------------------

    Original Message


Related Content