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<pre>
 
 

 

 

 

Standards for 
Chemotherapy Services 

in South Australia 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

November 2010 



 2 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The South Australian Cancer Clinical Network Steering Committee has overseen 
the development of the Standards for Chemotherapy Services in South Australia 
2010 with the view that their statewide implementation will support a common 
framework for safe, high quality practice. The standards will also enable 
monitoring of competence and benchmarking of clinical services against 
identified minimal requirements for varying complexities of care. 
 

Prepared by Tracey Doherty: Deputy Chair, Cancer Clinical Network Steering 
Committee 
 

Endorsed by the Statewide Cancer Clinical Network Steering Committee on 5th 
November 2010 
 

 



 3 

Contents 
  

Executive Summary 4 
 

Scope and Purpose 6 
 

Glossary 8 
 

Background 10 
 

Development of Standards 12 
 

Workforce Implications 13 
 

Implementation and Governance 15 
 

Chemotherapy Risk Stratification 16 
 

Chemotherapy Service Delineation 18 
 

Standards Criteria 26 
 

 

Appendix 1   Consultations and contributions 45 
 

Appendix 2   Self evaluation and implementation matrix 48 
 

 



 4 

Standards for Chemotherapy Services in South 
Australia 2010 

Executive Summary 

South Australia has an aging population and as cancer is predominantly a 
disease of the aging, the number of people with cancer is increasing. This 
continues to be a growing challenge for our health system, workforce and 
community. The Standards for Chemotherapy Services in South Australia (the 
Standards) are one of the first in a group of planned documents designed to 
support the health system to meet this growing challenge and ensure that South 
Australians have equity of access to high quality cancer care as close to home as 
safely possible. 

The Standards for Chemotherapy Services in South Australia are designed to 
guide the continuous improvement of services by identifying and describing the 
minimum workforce, infrastructure and support services necessary to deliver 
safe, high quality chemotherapy. They have developed through the review and 
incorporation of a range of state, national and international reference documents 
and guidelines combined with broad multi-disciplinary consultation across the 
South Australian health care system. The South Australian Cancer Clinical 
Network Steering Committee has overseen the development of these Standards 
with the view that their statewide implementation will support a common 
framework for safe, high quality practice and enable monitoring of competence 
and benchmarking of clinical services against identified minimal requirements for 
varying complexities of care. 

The delivery of safe, high quality chemotherapy is reliant on ensuring provision of 
care in the most appropriate service setting which has capacity and capability to 
meet the individual patients  current and anticipated health needs and risks. 
These needs and risks are identified through comprehensive clinical assessment 
of the patient and in consideration of the known risks and complexities in the 
delivery and supportive care requirements of low, medium and high risk 
chemotherapy. Service requirements are supported by a chemotherapy service 
delineation model to better enable safe and effective cancer care as close to the 
patients home as possible. Risk stratification and service delineation are 
addressed in section 1 of this document. 

Utilisation of statewide chemotherapy standards aim to enable all current and 
developing chemotherapy services to meet, monitor and maintain minimum 
safety and quality requirements. These standards comprise section 2 of this 
document and cover ten key areas: 

1. Governance 

2. Workforce, education and competency 

3. Timely access, integration and coordination of care 



 5 

4. Multi-disciplinary care, comprehensive patient assessment and 
chemotherapy planning 

5. Patient/carer education and consent 

6. Chemotherapy prescribing 

7. Assessment and monitoring of patients on chemotherapy 

8. Provision of supportive care 

9. Safe handling, administration and disposal of chemotherapy 

10. Intrathecal chemotherapy and recommendations to reduce the risk of error 
with vincristine 

To support the Standards for Chemotherapy Services in South Australia, a self-
evaluation and implementation planning matrix has been developed (appendix 2) 
to enable identification and reporting of service improvement achievements and 
gaps. 

The Standards are intended as a living document and will be reviewed bi-
annually and as required by the Cancer Clinical Network Steering Committee. 



 6 

Scope 

For the purpose of this document the term  chemotherapy  is inclusive of all drugs 
including cytotoxic therapies and other hazardous substances used in the 
treatment of cancer such as monoclonal antibodies and kinase inhibitors. It does 
not include hormonal therapies. 

The scope of the Standards for Chemotherapy Services in South Australia covers 
chemotherapy provided to cancer patients of all ages and in any service setting. 
It also includes chemotherapy administered for a non-malignant diagnosis (e.g. 
Multiple Sclerosis) within a chemotherapy/cancer service. 
The underlying quality and safety principles of this document may also be 
applicable to other service settings where similar drugs are utilised. 

 

The purpose of this document 

The Standards for Chemotherapy Services in South Australia support the aim to 
increase the number of patients able to have chemotherapy closer to home whilst 
establishing the need for safety and quality as a priority over convenience. They 
are designed for services currently providing chemotherapy, as well as services 
planning to (re)commence chemotherapy provision. 
Standards offer a common framework for safe, high quality practice and enable 
monitoring of competence and benchmarking of clinical services against 
identified minimal requirements for varying complexities of care. 

The Standards of Chemotherapy Services aim to: 

&gt; facilitate planning and development of services to the level necessary to 
meet the needs of the relevant catchments  population 

&gt; define relevant areas of responsibility for individual health units within an 
integrated health care system 

&gt; define the necessary workforce skills within the health services or 
accessible to the health service to support the delivery of chemotherapy 

&gt; define the necessary infrastructure within the health service or accessible 
to the health service to support the delivery of chemotherapy 

&gt; define requirements relating to the establishment of  referral practices to 
facilitate shared care or  the timely transfer of care between different health 
services/ providers as determined by the patient s needs 



 7 

Standards may be useful when a regional health service or clinical unit: 

&gt; undertakes routine risk assessment, review, monitoring and benchmarking 
of its service 

&gt; plans to (re)commence providing chemotherapy services 
&gt; wishes to commence providing a higher complexity level of care or higher 

risk treatment 

It is recognised that currently not all sites within the South Australian health 
system providing chemotherapy services will completely meet all standards. To 
support the principle of providing services as close to home as safely possible, a 
self assessment tool has been developed (appendix 2). This tool is intended to 
assist sites to identify current capacity for safe service provision and also 
highlight areas for improvement initiatives over the following twelve months to 
maximise their ongoing chemotherapy service capability. 

The Standards are intended as a living document and will be reviewed bi-
annually to reflect updated knowledge, criteria and feedback.  The usefulness of 
the chemotherapy service delineation, standards and tools outlined in this 
document will also be monitored and evaluated. 

 



 8 

Glossary 
Accreditation - Public recognition of achievement by an organisation, of 
requirements of a standard. 
 

Benchmarking - A systematic and continuous measurement process; by means 
of comparing and measuring an organization's processes against other 
organisations. 
 

Cancer journey - An individual s experience of cancer, from screening and 
detection, diagnosis and treatment, to recovery or  living with cancer  through to 
palliative care. 
 

Care coordination - The delivery of services by different providers occurs in a 
coherent, logical and timely manner, consistent with the person s medical needs 
and personal context. 
 

Credentialing - A formal process for defining the clinical responsibilities of 
medical practitioners and other health care providers within a particular health 
care institution or wider service. It serves to verify that clinicians are qualified and 
competent to undertake specific practices within explicit settings. 
 

Competency - The combination of skills, knowledge, attitudes, values and 
abilities that underpin effective and/or superior performance in a 
profession/occupational area. 
 

Governance - The set of responsibilities and practices, policies and procedures, 
exercised to provide strategic direction, ensure objectives are achieved, manage 
risks and use resources responsibly and with accountability. 
 

Infrastructure   The building blocks (such as information systems, workforce, 
policy and regulatory framework) necessary to accomplish the activities of health 
protection, illness prevention and health promotion. 
 

Intrathecal chemotherapy - Treatment with drugs that are injected into the fluid 
surrounding the brain and spinal cord (cerebrospinal fluid).  
 

Key performance indicators - quantifiable measurements to periodically 
assess the performances of organizations, business units, and their division, 
departments and employees.  
 

Monoclonal antibody  Highly specific, purified antibody (protein) derived from 
only one subset of cells and which recognizes only one antigen or cell binding 
site.  



 9 

Integrated health service   A network of specialised health service 
components within the general health system, coordinated across inpatient and 
community settings, to ensure continuity of care for consumers.  
 

Multidisciplinary care - An integrated team approach to health care in which 
Medical, nursing and allied health care professionals consider all relevant 
treatment options and develop collaboratively an individual treatment plan for 
each patient. 
 

Nurse Practitioner - a registered nurse educated and authorised to function 
autonomously and collaboratively in an advanced and extended clinical role.  
 

Performance status - Is an attempt to quantify cancer patients  general well-
being. 
 

Regimen - A plan of treatment, including doses, scheduling, and duration of 
treatment. 
 

Risk stratification   is a medical decision-making tool whereby a constellation 
of activities can determine the likelihood of a event or condition. 
 

Scope of clinical practice - The extent of an individual health professional s 
clinical practice within a particular organisation based on the individual s 
credentials, competence, performance and professional suitability, and the needs 
and the capability of the organisation to support the health professional s scope 
of clinical practice. 
 

Supportive Care - The prevention and management of the adverse effects of 
cancer and its treatment. This includes management of physical and 
psychological symptoms and side effects across the continuum of the cancer 
experience from diagnosis through anticancer treatment to post-treatment care. 
 

Vesicant - An agent capable of causing tissue destruction. 

 



 10 

Background 
One in three South Australians experience cancer during their lifetime. South 
Australians with cancer receive high quality cancer care. This is reflected in 
survival rates comparable with other parts of Australia that are not only at the 
high end of the international range but are improving progressively over time. 
Nevertheless, with South Australia s aging population and the increasing number 
of people with cancer, this continues to be a growing challenge for our health 
system, workforce and community1. Strategic service planning aims to better 
enable the health system to meet this growing challenge and ensure that South 
Australians have equity in access to high quality cancer care as close to home as 
safely possible. 

South Australia s Health Care Plan  

South Australia s Health Care Plan 2007-20162 has been built on a strong 
commitment from Government to ensure the future sustainability of quality health 
services across the continuum of care from within hospitals extending to 
community facilities in South Australia.  South Australia s Health Care Plan has 
provided the framework and the guiding principles for both health system reform 
and reorientation of services to meet growing population demand as well as the 
future challenges of health service delivery. 

Clinical Service Delineation 

The Clinical Service Delineation for Planning of Health Facilities in South 
Australia3 document was prepared by SA Health in 2008 to support the 
implementation of South Australia s Health Care Plan and to guide the 
continuous development within hospital facilities of safe and quality health care 
services. It is a living document, responsive to the developing service systems, 
new evidence and technologies, and the changing population demands for 
services across the continuum of care. The document details the proposed level 
of clinical services that may apply within a health facility. The six (6) Clinical 
Service Levels provide the descriptors for essential service requirements 
dependent on the type of facility, specialty, catchment area and funding, together 
with workforce availability currently and into the future. The descriptors outline 
the levels of resource requirement across the continuum of care to support a 
clinical function with Level 1 services identifying the least complex service in 
terms of resources required, up to Level 6 representing the most complex 
service. Each clinical service is to be planned and developed within these 
parameters, which are specific to the service and the regional services context.  

                                                 

1 Cancer Council South Australia and the South Australian Department of Health (2009),  State-wide cancer control plan 2010-2015 , 
Government of South Australia, Department of Health and the Cancer Council South Australia: Adelaide 
2 South Australian Department of Health (2007),  South Australian Health Care Plan 2007-2016: The South Australian Governments plan 
for health care over the next 10 years , Government of South Australia: Adelaide 
3 SA Health. Clinical  Service Delineation for Planning of Health facilities in South Australia. Adelaide: Government of South Australia; 
2008 

 



 11 

 

Statewide Cancer Control Plan 

The Statewide Cancer Control Plan 2006 -2009 was developed in response to 
the Generational Health Review by the SA Department of Health (SA Health) in 
collaboration with the Cancer Council South Australia (CCSA). This plan has 
recently been reviewed and the revised Statewide Cancer Control Plan 2011   
20154 continues to promote the systematic application of current knowledge and 
investment to generate new knowledge and to reduce the impact of cancer. It 
articulates principles and sets goals against which strategies in cancer control 
should be considered and measured. It recommends priority programs and 
services which will accelerate cancer control by reducing cancer incidence, 
improving cancer survival and improving the quality of experience and life for 
people with cancer, their carers and families. Recommendations of the plan focus 
on six (6) key areas: 
1. Cancer prevention and early detection 

2. Optimising cancer care 

3. Infrastructure planning and service development 

4. Workforce planning for cancer control 

5. Cancer control research 

6. Cancer information 

Cancer Clinical Network 

Clinical Networks were established to increase the level of clinician involvement 
in the planning of health services, to find ways to better coordinate the delivery of 
those services, to ensure better health outcomes for all South Australians and to 
ensure a strong, sustainable health workforce5. 

The Cancer Clinical Network is one of the first networks developed within South 
Australia (SA) to link doctors, nurses, allied health professionals, pharmacists, 
GPs, non-government organisations and consumers to work together to assist in 
fully integrating cancer service provision.  Implementation of the Statewide 
Cancer Control Plan is the primary objective of the cancer network and all 
strategies developed and recommended for implementation are in-line with this 
plan.  

The Cancer Clinical Network Steering Committee has overseen the development 
of the Standards for Chemotherapy Services as a first step in cancer quality 
improvement planning. 

                                                 

4
 
SA Health. Statewide Cancer Control Plan 2011-2015. Adelaide: Government of South Australia; 2008

 
5
 
Government of South Australia, South Australia s Health care Plan 20007 -2016

 

 



 12 

Development of the South Australian Standards for 
Chemotherapy Services 
The Standards for Chemotherapy Services have been created in line with South 
Australia s Health Care Plan6, the Statewide Cancer Control Plan 2011 - 20157 
and Clinical Service Delineation for Planning of Health Facilities in South 
Australia8.  The standards are also reflective of two recent major reviews of 
cancer services within South Australia.  

The quality and safety requirements associated with chemotherapy are generally 
consistent across the world and tools such as standards, guidelines, and quality 
frameworks have been developed by multiple national and international expert 
groups. These documents have provided a sound basis for development of the 
SA Standards for Chemotherapy within the context of the SA health system.  

It is recognised that not all cancers and/or cancer treatments present the same 
level of risk and therefore chemotherapy provision should be delineated within 
the health regions to ensure that care is provided in an environment that has 
adequate infrastructure, workforce, resources and support services to provide 
consistent and sustainable care.  

It is recommended that these standards be considered by service planners and 
clinicians as a companion document to South Australia s Health Care Plan and 
Clinical Service Delineation for Planning of Health Facilities in South Australia 
when considering provision of sustainable, accessible, safe and quality 
chemotherapy services within an Integrated Cancer Service model for South 
Australia. 

Implementation of these standards will be the responsibility of the each of the SA 
Health Regions and oversight of standards implementation will be through the 
Cancer Clinical Network Steering Committee to the Clinical Senate. 

Chemotherapy provision within an Integrated Cancer Service model 

Formalised and clearly defined links between service providers within an 
Integrated Cancer Service model will better enable all patients to have timely, 
accessible, streamlined, comprehensive and high quality care as close to home 
as safely possible.  

Chemotherapy treatment will be evidence based and supported through the 
implementation of an electronic patient management, decision support and 
prescribing system.  

 

                                                 

6
 
South Australian Department of Health (2007),  South Australian Health Care Plan 2007-2016: The South Australian Governments plan 

for health care over the next 10 years , Government of South Australia: Adelaide
 

7
 
SA Health. Statewide Cancer Control Plan 2011-2015. Adelaide: Government of South Australia; 2008

 
8
 
SA Health. Clinical  Service Delineation for Planning of Health facilities in South Australia. Adelaide: Government of South Australia; 

2008
 

 



 13 

Anticipated outcomes from an integrated model include: 

&gt; Access to well coordinated, safe, high quality chemotherapy at a location 
as close to home as possible  

&gt; Maximised access to chemotherapy in most rural and metropolitan 
communities for common cancers and patients requiring low risk treatment, 
monitoring and support. 

&gt; Maximised access to chemotherapy in general hospitals and sites identified 
as having necessary specialist workforce and infrastructure for common 
cancers requiring moderate risk treatment, monitoring and support.  

&gt; Streamlined, well coordinated access to chemotherapy within specialist 
cancer services for rare cancers and those requiring high risk or complex 
treatment, monitoring and support.  

Workforce Implications 

The workforce employed to provide chemotherapy services must be credentialed 
and/or educated and assessed as competent according to current SA Health 
policies, standards and endorsed guidelines or frameworks. Governance and 
monitoring of credentials, scope of practice, clinical privileges, education and 
competency maintenance remains the responsibility of the employing health 
service9. It is anticipated that continuous development of services in-line with the 
chemotherapy standards will support progress towards a sustainable and robust 
cancer workforce. 

In addition to professional qualifications, credentialing and authorisation 
requirements, workforce related competency factors that must be considered in 
provision of chemotherapy services include, but are not restricted to: 

&gt; level of and currency of knowledge and education in cancer, cancer care 
and chemotherapy including supportive care (side effects, symptom 
management and psychosocial care to address the emotional, social, 
spiritual, informational and financial needs of the patient and carer/family) 

&gt; level of skill and experience in assessment of the cancer patient, 
particularly the patient receiving chemotherapy 

&gt; level of and currency of skill, experience and competency in administration 
and monitoring of cancer treatment 

&gt; access to adequate number and skill mix of staff to consistently provide 
required care or service 

                                                 

9
 
South Australian Department of Health (2009), The Policy for Credentialing and Defining the Scope for Clinical Practice for Medical and 

Dental Practitioner, April 2009: Adelaide
 

 



 14 

&gt; convenient and immediate access to up-to-date evidence based policies, 
procedures and guidelines 

&gt; level of skill and/or experience in communication and networking within a 
multi-disciplinary framework and across a variety of sites and services  



 15 

Implementation and governance of the Standards for 
Chemotherapy Services in South Australia 
Implementation of the Standards within health sites will be the responsibility of 
health regions and the Directors of Cancer Services within those regions, with 
specific implementation arrangements to be developed by the regions according 
to local requirements and processes. 

Oversight of this implementation will be by the Cancer Clinical Network Steering 
Committee, who will report to the SA Health Clinical Senate. The Cancer Clinical 
Network will require health regions to submit a self assessment (as outlined in 
appendix 2) within one year of the endorsement of these standards for each site 
that is delivering chemotherapy. Each site must demonstrate at least partial 
compliance with all standards within this timeframe, and plans for improvement to 
progress to full compliance within a further 12 months. An annual review/ 
confirmation of compliance will be required to be provided to the Cancer Clinical 
Network thereafter. 

Sites wishing to (re)commence chemotherapy after the endorsement of these 
standards will be required to demonstrate at least partial compliance with all 
standards before the (re)commencement of chemotherapy service provision, with 
a plan to progress towards full compliance within a further 12 months.  

An informal review of the usefulness of the chemotherapy service delineation, 
standards and tools outlined in this document will be conducted 12 months after 
their formal endorsement. A formal review and updating of the chemotherapy 
service delineation, standards and tools will occur 2 years after their formal 
endorsement, and bi-annually (or as required) after that to ensure they reflect 
updated knowledge, criteria and feedback. The review, evaluation and updating 
of the standards will be overseen by the Cancer Clinical Network Steering 
Committee. 

 



 16 

Section 1 
Risk Stratification &amp; Chemotherapy Service Delineation 
Chemotherapy Risk Stratification 

Risk assessment of both the patient and the planned treatment is critical to the 
safe provision of chemotherapy services. Risk matrices can aid in the 
identification and stratification of anticipated risks (Table 1) and enable the key 
factors of patient safety to be considered in a structured and consistent way.  
Factors to be considered in the risk assessment for the patient planned for 
chemotherapy include: 

&gt; patient age, comorbidities and performance status 

&gt; patients  current and anticipated disease and treatment risks 

&gt; ongoing review and monitoring requirements  

&gt; route of planned treatment and risks relating to administration 

&gt; risk of significant toxicity relating to high dose and/or combination therapy 

&gt; complexity of supportive care drugs and/or fluid requirements relating to the 
chemotherapy protocol 

&gt; patient and clinician familiarity, education and recent experience with 
planned chemotherapy protocol 

A focus group of South Australian cancer clinicians held in June 2009 aimed to 
articulate and clarify the essential factors which contribute to a chemotherapy 
protocol being considered as low risk, medium risk or high risk.  The following 
risk stratification table was initially developed utilising outcomes from the focus 
group and then further edited in response to multi-disciplinary feedback on the 
draft chemotherapy standards during their development. It is anticipated that this 
table will be further refined through utilisation and subsequently revised during 
the first planned review of these standards. The table relates to chemotherapy 
administration for adults and it is expected that the supervising consultant 
oncologist/haematologist would evaluate these risk factors in combination with 
individualised clinical assessment of the patient when considering the safety and 
appropriateness of chemotherapy administration in various locations.  

The vast majority of chemotherapy for paediatrics is considered as high risk at 
this point in time. 



 17 

Table 1 Risk Stratification Matrix 

Low Risk Medium Risk High Risk 
Chemotherapy regimen 
suitable for monitoring via 
general practitioner between 
less frequent reviews (may be 
via telemedicine) by 
supervising 
haematology/oncology 
service 
&gt; Patient stable, with 

performance status 
equivalent to ECOG10 0, 1 
or 2. 

&gt; Patient not considered at 
increased risk due to age or 
comorbidities 

&gt; No concerns regarding 
patients ability to comply 
with treatment  

&gt; Uncomplicated vascular 
access requirements 

&gt; Non-vesicant agents 
&gt; Single agent chemotherapy 
&gt; Standard or low dose 

chemotherapy 
&gt; Low risk of grade 3 and 4 

toxicities 
&gt; Low risk of dose limiting 

side effects requiring dose 
adjustment 

&gt; Low risk of  adverse drug 
reactions 

&gt; Low complexity of 
premedications, 
supplementary treatments 
and hydration requirements 

&gt; No planned requirement for 
blood results within a 24 
hour timeframe 

Chemotherapy regimen 
suitable for monitoring via 
general practitioner, nurse 
practitioner or general 
physician with alternate 
reviews (may be via 
telemedicine) by supervising 
haematology/oncology 
service 
&gt; Patient stable, with 

performance status 
equivalent to ECOG 0, 1 or 
2 

&gt; Vascular access device 
(VAD) required 

&gt; Vesicant agents included 
&gt; Combination chemotherapy 
&gt; Standard or low dose 

chemotherapy 
&gt; Moderate risk of grade 3 

toxicities, low risk of grade 4 
toxicities 

&gt; Moderate risk of dose 
limiting side effects 
requiring dose delay or 
modifications. 

&gt; Risk of  adverse drug 
reaction requiring medical 
emergency management 

&gt; Complex premedications, 
supplementary treatments 
and hydration requirements  

&gt; Requirement for standard 
blood results within 24 
hours 

Chemotherapy regimen only 
suitable for monitoring and  
supervision by specialist 
haematology/oncology service  
&gt; Patient may be medically 

unstable with variable 
performance status 

&gt; Intrathecal chemotherapy 
&gt; Intracavity or intravesical 

chemotherapy 
&gt; High dose chemotherapy 
&gt; Moderate to High risk of 

grade 3 or 4 toxicities and 
side effects 

&gt; High risk of requirement for 
dose modifications 

&gt; High risk of  adverse drug 
reactions requiring 
emergency management 

&gt; Complex premedications, 
supplementary treatments 
and hydration requirements 
which may require inpatient 
stay 

&gt; High intensity phase of 
treatment 

&gt; Uncommon and highly 
specialised drugs 

&gt; Anticipated requirement for 
urgent blood/pathology 
results 

 

                                                 

10
 Eastern Cooperative Oncology Group 



 18 

 

Chemotherapy Service Delineation 
Within the six service delineation levels described in Clinical Service Delineation 
for Planning of Health Facilities in South Australia11, haematology and oncology 
services are categorised as medical sub-specialties. To support medical sub-
specialties, general medicine services and clinical support services such as 
pharmacy, pathology, emergency department and critical care services at the 
relevant level also need to be in place.  

Building on the concept of low, medium and high risk chemotherapy as described 
in table 1, a clinical service delineation for chemotherapy services (table 2) has 
been developed which recommends clinical service delineation levels that may 
be better equipped to manage the various levels of chemotherapy risk.  

Within the table it is recommended that low risk chemotherapy be provided by 
level 1-3 services, medium risk chemotherapy may be provided by Level 4 
services and high risk chemotherapy may be provided by level 5   6 services. 

All chemotherapy services irrespective of their level must also meet the minimum 
chemotherapy standards as outlined in section 2 of this document.  

                                                 

11
 
SA Health. Clinical  Service Delineation for Planning of Health facilities in South Australia. Adelaide: Government of South Australia; 

2008
 

 



 
 19 

Table 2   Clinical Service Delineation for Chemotherapy Services 
 Level 1-3  

Chemotherapy Services 
Level 4  
Chemotherapy Services 

Level 5-6  
Chemotherapy Services 

General 
description/summary 

&gt; Manage low risk chemotherapy for common 
cancers in stable patients 

&gt; Standard infrastructure 
&gt; General workforce with additional chemotherapy 

competencies 

&gt; Manage medium risk chemotherapy for 
common cancers in stable patients  

&gt; Moderate to highly developed 
infrastructure 

&gt; Specialist workforce 
 

&gt; Manage high risk/complex chemotherapy, 
uncommon/rare or high risk cancers and 
unstable patients 

&gt; Highly developed infrastructure 
&gt; Highly specialised workforce 

Service setting 
examples 

&gt; Community Hospitals 
&gt; Inner Country Health services 
&gt; Local Area hospitals 
&gt; Primary health care settings 
&gt; Nursing homes 
&gt; Patient homes 

&gt; General Hospitals  
&gt; Community hospitals with well developed 

cancer specialist workforce and 
infrastructure requirements 

 

Tertiary Hospital providing comprehensive 
cancer services with dedicated multi 
disciplinary haematology and/or oncology 
specialty and supportive care services. 

Governance 
requirements 

Outpatient/community chemotherapy provision must 
be under the supervision of a level 5 or 6 
Haematology or Oncology service. 

Outpatient/community chemotherapy 
provision must be under the supervision of 
a level 5 or 6 Haematology or Oncology 
service. 

&gt; Provides supervision of chemotherapy for 
other rural and metropolitan services. 

&gt; May have state-wide referral and 
coordination role 

&gt; Some complex and rare cancers and cancer 
treatments will be treated / available in level 
6 services only. 

Types of chemotherapy 
provided 

Outpatient/community chemotherapy for common 
solid tumours and low grade haematological 
malignancies 

As for level 1-3 plus: 
Outpatient chemotherapy for common 
solid tumours, some lymphomas and other 

As for level 4 plus: 
Complex and or high risk inpatient and 
outpatient chemotherapy by cancer specialist 



 
 20 

 Level 1-3  
Chemotherapy Services 

Level 4  
Chemotherapy Services 

Level 5-6  
Chemotherapy Services 

&gt; Low risk oral chemotherapy 
&gt; Single agent, non-vesicant, low toxicity parenteral 

chemotherapy  

common low grade/low risk 
haematological malignancies 

&gt; Medium - High risk oral chemotherapy 
&gt; Combination and/or vesicant parenteral 

chemotherapy with moderate complexity 
and low to moderate toxicity. 

workforce 
&gt; Most malignant haematology (acute 

leukaemia, high risk lymphomas)  
&gt; Bone marrow transplant services 
&gt; Majority of acute paediatric oncology &amp; 

malignant haematology 
&gt; Clinical trials program 
&gt; Can provide concurrent radiotherapy 
 

Clinical review and 
medical consultation 
requirements 

&gt; Access (on site, visiting or tele-medicine) to 
general practitioner (GP) or cancer nurse 
practitioner (NP) or oncologist/haematologist for 
clinical review prior to each cycle of 
chemotherapy.  

&gt; Access (on site, visiting or tele-medicine) to 
general practitioner (GP) or cancer nurse 
practitioner (NP) or oncologist/haematologist for 
surveillance, clinical review and management of 
low complexity symptoms of disease and toxicities 
of treatment. 

&gt; Access (on site, visiting or tele-medicine) to 
general practitioner (GP) or cancer nurse 
practitioner (NP) or oncologist/haematologist for 

As for level 1-3 plus: 
&gt; Access (on-site, visiting or tele-medicine) 

to a general physician, paediatrician (for 
all paediatric patients), haematologist or 
oncologist  for consultation, supportive 
care and outpatient treatment  

&gt; Areas of responsibility include monitoring 
and surveillance for most cancers 

&gt; Inpatient management of chemotherapy 
toxicity 

As for level 4 plus: 
&gt; Onsite oncology and/or haematology 

consultants for provision of comprehensive 
chemotherapy service and supervision of 
care provided at level 1-6 chemotherapy 
services (visiting or tele-medicine). 

&gt; Onsite paediatric oncology or haematology 
consultant for provision of comprehensive 
paediatric chemotherapy service and 
supervision of paediatric cancer care 
provided at level 1- 6 services (visiting or 
tele-medicine). 

&gt; Onsite access to advanced trainees 
(oncology or haematology registrars),   



 
 21 

 Level 1-3  
Chemotherapy Services 

Level 4  
Chemotherapy Services 

Level 5-6  
Chemotherapy Services 

surveillance, monitoring and survivorship care for 
low risk, common cancers. 

 

cancer nurse practitioners (NP) or nurse 
practitioner candidates (NPC) for clinical 
review prior to each cycle of chemotherapy.  

&gt; Onsite access to advanced trainees 
(oncology or haematology registrars),   
cancer nurse practitioners (NP) or nurse 
practitioner candidates (NPC) for 
surveillance, clinical review and 
management of low complexity symptoms of 
disease and toxicities of treatment. 

&gt; Monitoring, surveillance and survivorship 
care for rare or high risk cancers 

 

Staff chemotherapy 
competency 
requirements 

Chemotherapy competency (see Standard 2) is 
essential for all clinicians involved in the 
administration of chemotherapy 

As for level 1-3 plus: 
&gt; On-site access to specialist cancer 

nurses with comprehensive 
chemotherapy competency 

As for level 4 plus: 
&gt; Dedicated, on-site specialist cancer 

workforce with comprehensive 
chemotherapy competency including 
medical staff with competency in 
administration of intrathecal chemotherapy 

 



 
 22 

 

Clinical Support Service requirements 

Pharmacy 
services 

&gt; Access to drugs supplied on individual 
prescription required 

&gt; Service provided on-site, or overseen by 
pharmacist located elsewhere 

&gt; Community based medication review services 
available 

 

On-site or visiting pharmacy service 
available and includes 

&gt; Pharmacy controlled drug distribution to 
inpatients and outpatients 

&gt; On-site or regional access to general 
clinical pharmacy service for inpatients and 
outpatients 

&gt; On-site, visiting or remote access to 
cancer clinical pharmacist. 

&gt; Access (on-site or external contract) to 
chemotherapy production services 

&gt; Access to drug information. 
&gt; Provision of chemotherapy drug 

monitoring, utilisation review and adverse 
drug reaction reporting 

&gt; Additional requirements for moderate-high 
risk treatment regimes within this category 
include: 

&gt; Pharmacist on call for 24 hours 

&gt; Clinical pharmacy service provided  7 days a week 
including participation in ward rounds, MDT 
meetings and outpatient services 

&gt; Services include specialist cancer clinical 
pharmacists (on-site or visiting) 

&gt; Provides clinical consultation to other hospitals as 
required 

&gt; Has access to sterile manufacturing and IV 
admixture service including cytotoxic drug and 
parenteral nutrition (on-site or external contract).  

&gt; May provide production pharmacy service for other 
sites. 

Pathology 
services 

Minimum access requirements include: 
&gt; Local access to specimen collection  
&gt; Specimens transferred to referral laboratory with 

frequency dependant upon available transfer 

Minimum access requirements include: 
&gt; Testing performed by health workers using 

suitable  point of care  testing devices 
&gt; Blood storage facilities available with some 

&gt; Comprehensive pathology service providing 24 hour 
on-site services 

&gt; On-site or visiting Pathologists and Haematologists 
 



 
 23 

schedules 
&gt; Storage and packaging for transport in 

accordance with regulation and guidelines 

on site stock of O negative blood 
&gt; QA activities in place under the 

supervision of a RCPA/NATA accredited 
laboratory 

Additional requirements for moderate-high 
risk treatment regimes within this category 
include: 

&gt; On-site core pathology services available 
with on  call arrangements over 24 hours 

Emergency 
services 

Minimum access requirements include: 
&gt; Basic resuscitation equipment and drugs 
&gt; Able to resuscitate and provide limited 

stabilisation prior to transfer to a higher level of 
care 

&gt; Have identified referral/transfer pathways for 
cancer emergencies  

 

 

Minimum access requirements include: 
&gt; Local GPs rostered to provide 24 hour 

cover or on-site medical staffing (subject to 
volume) 

&gt; Access to a range of specialist 
consultation 

&gt; Appropriate skilled and experienced 
workforce to support service 

&gt; Designated Emergency Service with 
assessment and treatment area and 
separate resuscitation facilities 

&gt; Have local policies procedures and 
guidelines for management of cancer 
emergencies 

&gt; Have identified referral/transfer pathways 
for cancer emergencies 

&gt; Designated emergency extended care service 
&gt; Standardised policies , procedures and guidelines 

for management of cancer emergencies 
&gt; Designated spaces with negative pressure capacity 
&gt; Medical staffing provided by experienced 

Emergency Medical Officers 24 hours 
&gt; Access to on-site specialist services 
&gt; On-site IC/HD &amp; CC service capacity 
&gt; Capacity for invasive monitoring and assisted 

ventilation 
&gt; Accepts transfers of appropriately triaged crucial 

care retrieval patients from other hospitals  
&gt; On-site skilled and experienced multidisciplinary 

workforce 
&gt; If a combined adult/paediatric service, designated 

paediatric treatment area with resuscitation facilities 



 
 24 

Critical care 
services 

Minimum access requirements include: 
&gt; Capacity to provide appropriately skilled and 

experienced workforce for  specialling  services 
until appropriate transfer can be arranged.  

&gt; Identified referral/transfer pathways for critical 
care services 

Minimum access requirements include: 
&gt; Inpatient area suitable for patients 

requiring observation over and above that 
in general ward area 

&gt; 24 hour medical cover to site 
&gt; Access to a range of visiting Specialists 

including general physician  
&gt; Appropriately skilled workforce available to 

support service as determined 
Additional requirements for moderate-high 
risk treatment regimes within this category 
include: 

&gt; A designated HD Service 
&gt; Ability to provide basic, multi-system life 

support usually for less than a 24 hour 
period 

&gt; Ability to provide immediate resuscitation 
and short term cardio-respiratory support  

&gt; Ability to monitor and prevent 
complications in moderate-high risk 
chemotherapy patients 

&gt; On-site medical staffing 

&gt; Has an integrated ICU Service &amp; HD service 
&gt; Has a designated CC Service  
&gt; Capacity to provide multi-system support 
&gt; Extra-corporal renal supports 
&gt; Has access to support invasive cardiovascular 

monitoring  
&gt; Medical staffing provided by on-site medical staff 

and Specialists 

Supportive 
care services 

Supportive care services provided on-site or via 
partnership arrangement (local or virtual service) 
See standard 8 

Supportive care services provided on-site or 
via partnership arrangement (local or virtual 
service) See standard 8 

Supportive care services provided on-site and within 
community for inpatient and outpatient care See 
standard 8 



 
 25 

Palliative care 
services 

Palliative care services provided on-site or via 
partnership arrangement (local or virtual service) 

Palliative care services provided on-site or 
via partnership arrangement (local or virtual 
service) 

&gt; Palliative care services provided on-site or via 
partnership arrangement with local hospital. 

&gt; Must include ability to access inpatient palliative 
care 

 

 



 
 26 

 

Section 2: 
Standards Criteria 
Utilisation of statewide chemotherapy standards aim to enable all current and 
developing chemotherapy services to meet, monitor and maintain the minimum 
safety and quality requirements necessary to ensure that known risks relating to 
chemotherapy are minimised and safety is maintained for all patients, staff and the 
community. 

Services providing chemotherapy require a common framework for safe, high quality 
practice.  The review of state, national and international reference documents and 
guidelines has led to the development of quality and safety standards covering ten 
key areas.  

1. Governance 

2. Workforce, education and competency 

3. Timely access, integration and coordination of care 

4. Multi-disciplinary care, comprehensive patient assessment and chemotherapy 
planning 

5. Patient/carer education and consent 

6. Chemotherapy prescribing 

7. Assessment and monitoring of patients on chemotherapy 

8. Provision of supportive care 

9. Safe handling, administration and disposal of chemotherapy 

10. Intrathecal chemotherapy and recommendations to reduce the risk of error with 
vincristine 

To support the Standards for Chemotherapy Services in South Australia, a self-
evaluation and implementation planning matrix has been developed (appendix 2) to 
enable identification and reporting of service improvement achievements and gaps.  



 
 27 

 

1. Governance 

1.1. Chemotherapy services have clearly documented local and regional 
governance arrangements consistent with the South Australia s Health 
Care Plan, the Statewide Cancer Control Plan and recommendations of 
the Statewide Cancer Clinical Network. 

1.2. In line with clinical service delineation for chemotherapy services, all 
services meet the core specialty and clinical support services 
recommended to manage the risk level of chemotherapy provided within 
that service.  

1.2.1. Directors of cancer services oversee and endorse formal links 
and memorandums of understanding within and across health 
regions to: 

&gt; maximise the provision of specialty and support services 
as close to home as safely possible 

&gt; enable timely access to distant services when required 

1.3. Directors of cancer services oversee the continuous development and 
implementation of consistent/standardised protocols, procedures and 
models of care that support chemotherapy delivery within and across SA 
Health regions and service providers. 

1.4. There are processes in place to enable monitoring of clinical and service 
outcomes including key performance indicators as outlined in the 
Performance Indicator Framework for South Australian Cancer Services12.  

1.5. Reports on the safety and quality of chemotherapy services are provided 
to local and regional clinical governance and contribute to planning for 
continuous service development. 

1.5.1. Services utilise the Australian Incident Monitoring System 
(AIMS) or equivalent to enable risk-free reporting of error or 
near misses13. 

1.5.1.1. Error and near miss reports are reviewed and evaluated 
regularly (bi-monthly) at service level and summary reports are 
communicated via clearly identified regional governance 
processes. 

                                                 

12
 The South Australian Department of Health and The South Australian Cancer Network 2010, 

Performance Indicator Framework for South Australian Cancer Services Version 1.0, September 2010 
13

 Clinical Oncology Society of Australia (2008), Guidelines for the Safe Prescribing, Supply and 

Administration of Cancer Chemotherapy, November 2008 



 
 28 

 

1.5.1.2. All serious adverse events are formally reviewed via clearly 
identified local and regional governance processes. 

1.5.2. Strategic planning for service development occurs in line with 
the South Australia s Health Care Plan and the Statewide 
Cancer Control Plan. 



 
 29 

2. Workforce, education and competency 

2.1. The Service has policies and procedures for provision and verification of 
credentialing and chemotherapy education and competency for all 
clinicians and support staff in line with SA Health policies, procedures, 
guidelines and frameworks. Alternatives from other jurisdictions may be 
used when a South Australian version is not available or is in need of 
review. 

2.1.1. Only chemotherapy competent health care professionals 
prepare or administer chemotherapy.  

2.1.1.1. The Clinical Oncology Society of Australia: 
Guidelines for the Safe Prescribing, Supply and 
Administration of Cancer Chemotherapy14 list 
suggested knowledge and skills applicable to all 
health care professionals. 

2.1.1.2. Pharmacists complete the SA health central 
training manuals for Pharmacy Services and 
Production Pharmacy Services as relevant to 
scope of work. These manuals are intended to 
provide a framework to ensure that all pharmacy 
staff receive appropriate levels of training and 
support to ensure the opportunity to learn and 
develop all the knowledge and skills necessary for 
them to fulfil their job role. The manuals are not 
intended to substitute the close supervision of 
staff undergoing clinical training. 

2.1.1.2.1. SA Health Central Training Manual   
Clinical Pharmacy Services - Cancer 
and Chemotherapy15. This manual is 
for all pharmacy staff working in 
clinical units caring for patients with 
cancer and / or receiving 
chemotherapy.  

2.1.1.2.2. SA Health Central Training Manual - 
Cytotoxic and other hazardous 
substances16. This manual is for all 
pharmacy staff working in units 
preparing parenteral cytotoxic and 
other hazardous substances.   

                                                 

14
 Clinical Oncology Society of Australia (2008), Guidelines for the Safe Prescribing, Supply and 

Administration of Cancer Chemotherapy, November 2008 
15

 South Australian Department of Health 2010, Draft SA Health Central Training Manual   Clinical 

Pharmacy Services - Cancer and Chemotherapy, October 2010 version 
16

 South Australian Department of Health 2010, Draft SA Health Central Training Manual- Cytotoxic 

and other hazardous substances, October 2010 version 



 
 30 

2.1.1.3. Nurses establish and maintain a minimum level of 
chemotherapy competence as outlined in the 
State-wide Framework for Chemotherapy 
Education and Assessment 201017  (currently 
under development).  
2.1.1.3.1. Continuing education programs for 

nurses in chemotherapy and cancer 
care are consistent with the EdCan 
framework18.  

2.1.1.4. All new clinicians commencing in, or transferring 
to, a chemotherapy service or cancer speciality 
area must undertake or verify credentialing, 
chemotherapy education and competency 
assessment relevant to the risk level of 
chemotherapy provided within that service or 
area.  

2.1.1.5. Services must ensure that further education is 
readily accessible when new or unfamiliar agents, 
protocols or equipment are utilised or when 
procedures change. 

2.1.2. The service has a standard mechanism for providing 
opportunity for, and monitoring of, continuing competency. 
Annual competency assessment or verification is 
recommended. 

2.2. Paediatric chemotherapy administration, especially in the acute phases of 
disease is managed by a specialised paediatric health facility, under the 
direct supervision of a paediatric oncologist/ haematologist. 

2.2.1. When it is in the best interest for a paediatric patient and their 
family to access care outside of a specialist paediatric health 
facility this must occur in close consultation with a paediatric 
consultant and involve education, mentoring and support from 
the specialist site. 

2.3. Services ensure there is sustainable access to nursing/clinical staff with 
skills and expertise in the use and care of Central Venous Access Devices 
(CVAD) such as Peripherally Inserted Central Venous Catheters (PICC) 
and Infusaports  relevant to clinical need.  

2.3.1. All services maintain protocols and procedures relating to 
insertion and management of CVADs that utilise evidence 

                                                 

17
 South Australian Department of Health 2010,  State-wide Framework for Chemotherapy Education 

and Assessment; an Integrated Model for South Australia, September 2010 version 
18

 Cancer Australia 2008, The National Cancer Nursing Education Project (EdCaN) (2008). National 
Education Framework   Cancer Nursing: A national professional development framework for cancer 
nursing, Canberra 2008 



 
 31 

based guidelines such as the Cancer Nurses Society of 
Australia CVAD guidelines19  and the eviQ Cancer Treatments 
Online protocols20 

                                                 

19
 Cancer Nurses Society of Australia 2007, Central Venous Access Devices: Principles for Nursing 

Practice and Education (2007) Guidelines 
20

 Cancer Institute NSW, eviQ Cancer Treatments Online, accessible online: www.eviq.org.au 



 
 32 

3. Timely access, integration and coordination of care 

3.1. Services have processes and rationale for care coordination that enables 
organised service delivery in accordance with the individual needs of the 
patient and in a manner consistent with quality and cost effectiveness 
principles. 

3.1.1. Processes should ensure a smooth patient journey and 
minimise duplication of effort by different health professionals  

3.1.2. Services utilise standardised guidelines and procedures to 
ensure adequate and timely patient access to clinical advice 
and clinical services within and after hours.  

3.2. Services enable access to appropriate and cost effective transport and 
accommodation facilities are available for those patients needing to 
relocate for treatment. 

3.3. The health service meets minimum operational and infrastructure 
requirements to enable reliable, sustainable and cost effective access to 
on-site services. This includes: 

3.3.1. Patient, carer and staff accommodation for those who are 
required to travel to access or deliver services 

3.3.2. Information and communication technology (ICT) services and 
processes to; 

3.3.2.1. Facilitate remote/virtual access, consultation, team 
meetings and networking between sites, regions and 
providers 

3.3.2.2. Support an electronic patient management system, with 
timely access to up to date treatment records and 
relevant pathology and radiology investigations for each 
patient. Where this is not available electronically, access 
to all recent hard copy medical records and results must 
be available at each patient presentation. 

3.3.3. Local blood and diagnostic collecting facilities with staff trained 
in collection and specimen handling techniques.  Results for 
routine blood tests are available within a 24-hour timeframe for 
all patients on medium to high risk chemotherapy and 
preferably within 48-hours for low risk chemotherapy. 

3.4. Services administering chemotherapy to paediatric patients comply with 
the Standards for the Care of Children and Adolescents in Health 



 
 33 

Services21  in provision of a child safe and appropriate physical 
environment including access to: 

3.4.1. natural light and age appropriate decorations/furniture as able 

3.4.2. open spaces within a secure environment where a child can be 
observed and supervised at all times 

3.4.3. provisions for parents to stay if required 

3.5. Services have well documented formal communication arrangements 
between local practitioners and consultative haematology/oncology 
clinicians available 24/7 for advice, consultation and referral. 

3.6. Services have standard procedures and processes for efficient and 
effective transfer of care to the most appropriate level service. 

3.7. Services that do not have an oncology or haematology clinical pharmacist 
on-site have documented formal links and agreements with a recognised 
oncology clinical pharmacy service within South Australia for clinical 
advice, education and remote support. 

3.8. Services that do not have specialist cancer nurses on site have 
documented formal links and agreements with a recognised level 4   6 
chemotherapy service within South Australia for clinical advice, education, 
mentoring and support. 

3.9. Services have standard communication processes for efficient and 
effective discharge planning, transition of care and follow up needs.   

3.9.1. Services have established procedures for documentation and follow 
up for patients who miss clinic visits and treatments 

 

                                                 

21
 Paediatrics &amp; Child Health Division, RACP, Standards for the Care of Children and Adolescents in 

Health Services, Nov 2008, accessible online: www.racp.edu.au 



 
 34 

4. Multidisciplinary care, comprehensive patient assessment and 
chemotherapy planning. 

4.1. All chemotherapy patients have the opportunity to have their case 
discussed by a cancer multi-disciplinary team. 

4.1.1. Cancer multi-disciplinary teams utilise the South Australian 
Cancer Clinical Network endorsed Cancer MDT Terms of 
Reference  

4.1.2. There is local or virtual access to tumour stream and other 
cancer multi-disciplinary teams 

4.1.3. Sites maintain up to date contact details and adhere to 
standardised  referral processes for multi-disciplinary teams 

4.2. Prior to prescribing or administering chemotherapy the following 
information is available or ascertained: 

4.2.1. Pathologic confirmation or verification of the initial diagnosis.  

4.2.2. Initial cancer stage or current cancer status.  

4.2.3. Complete medical history and examination that includes 
height, weight and assessment of organ specific function as 
appropriate for the planned regimen. 

4.2.4. Complete medication history of all current medications 
including over the counter and complementary and integrative 
therapies (CIT) 

4.2.5. Documentation of history of drug and non-drug allergies and 
other adverse drug reactions  

4.2.6. Current psychosocial issues which may impact on care 
decisions including assessment of patients  comprehension 
regarding medication regimens, knowledge of disease, ability 
to manage self care and knowledge of available carer support 
or support services. 

4.2.7. All recent investigations and pathology results to enable 
adequate assessment of patient response to and tolerability of 
previous chemotherapy. 

4.2.8. For patients taking oral chemotherapy, the expected frequency 
of clinic visits or remote consultation and monitoring that is 
appropriate for the drug and the individual needs of the patient. 

4.3. Final decisions on the initiation of a chemotherapy protocol or treatment 
plan are made at consultant level. 



 
 35 

5. Patient/Carer Education and Consent  

5.1. Before initiation of chemotherapy via any route, each patient 
(parent/caregivers/family as appropriate) is provided with verbal and 
written information. It is recommended that this includes the suggested 
content outlined in the Clinical Oncology Society of Australia: Guidelines 
for the Safe Prescribing, Supply and Administration of Cancer 
Chemotherapy22. Additional information recommended includes: 
5.1.1. Information regarding diagnosis of cancer23 

5.1.2. Current and/or long term goals of therapy 

5.1.3. Before initiation of oral chemotherapy, each patient (in 
paediatric cases - parent/caregivers/family) is provided with 
additional verbal and written information consistent with the 
Society of Hospital Pharmacists of Australia (SHPA) Standards 
of Practice for the Pharmaceutical Care of Patients Receiving 
Oral Chemotherapy24. The SHPA standards are also 
summarised in the COSA guidelines25 

5.1.4. Education materials must be appropriate for the 
patients/carers  reading level/literacy, language and 
understanding. Details of verbal and written patient education 
provided are documented in the patient record. 

5.1.5. The education plan includes family, caregivers, or others 
based on the patients  preference26, age and their ability to 
assume responsibility for managing therapy independently. 

5.2. The service maintains a policy for obtaining and documentation of consent 
for chemotherapy.  

5.2.1. The consent process follows appropriate professional and legal 
guidelines27. 

5.2.2. Informed consent includes details of both common and serious 
toxicities of treatment which have been discussed with the 
patient (in paediatric cases - parent/caregivers/family).  

                                                 

22
 Clinical Oncology Society of Australia (2008), Guidelines for the Safe Prescribing, Supply and 

Administration of Cancer Chemotherapy, November 2008 
23

 Australian Government: Cancer Australia (2010), Assessment of Cancer Care Perceptions and 

Experiences of People Affected by Cancer, August 2010 

24 Society of Hospital Pharmacists of Australia Committee of Speciality Practice in Cancer Services 

(2007), SHPA Standards of Practice for the Provision of Oral Chemotherapy for the Treatment of 

Cancer, Journal of Pharmacy Practice and Research, vol. 37, no. 2 

25 Clinical Oncology Society of Australia (2008), Guidelines for the Safe Prescribing, Supply and 

Administration of Cancer Chemotherapy, November 2008 
26

 Australian Government: Cancer Australia (2010), Assessment of Cancer Care Perceptions and 

Experiences of People Affected by Cancer, August 2010 
27

 South Australia, Consent to Medical Treatment and Palliative care Act 1995, Version: 1.7.2010 



 
 36 

6. Chemotherapy prescribing 

6.1. Services comply with the 2009 SA Health Policy Directive to implement 
the Australian Commission on Safety and Quality in Health Care National 
Standard for Terminology, Abbreviations and Symbols to be used in the 
Prescribing and Administering of Medicines in Australian hospitals28 
including; 

6.1.1. Principles for consistent prescribing terminology 

6.1.2. Acceptable terms and abbreviations 

6.1.3. Error prone abbreviations, symbols and dose designations to 
be avoided. 

6.2. The service defines standard chemotherapy regimens by diagnosis with 
references readily available29 and/or identifies source(s) for chemotherapy 
regimens and approved clinical research protocols. Utilisation of eviQ   
Cancer Treatments on-line protocols30 for adults with cancer is a 
recommended  example 

6.2.1. For orders that vary from standard regimens, practitioners 
document both the nature of the variation and the supporting 
reference and/or rationale for necessary modifications.  

6.2.2. The service maintains and utilises standard, regimen-level, 
pre-printed or electronic forms for all chemotherapy prescribing 
(including oral chemotherapy) including supportive care 
medications. Use of a chemotherapy electronic management 
system is preferred.  

6.2.2.1. Handwritten prescribing of chemotherapy is 
replaced as soon as possible by  pre-printed 
forms or preferably by electronic prescribing 
systems 

 

6.3. Original prescribing of a chemotherapy protocol /treatment plan is signed 
by a specialist oncologist/haematologist with access to all relevant patient 
information. The Clinical Oncology Society of Australia: Guidelines for the 
Safe Prescribing, Supply and Administration of Cancer Chemotherapy31 
are recommended as an appropriate reference in the development of 
local/regional standardised prescribing processes. 

                                                 

28
 Australian Committee for Safety and Quality in Health Care, Recommendations for Terminology, 

Abbreviations and Symbols used in the Prescibing and Administration of Medicines, December 2008 

accessible online www.safetyandquality.gov.au 

29 NHS National Cancer Action Team, Chemotherapy Services in England: Ensuring Quality and 
Safety A report from the National Chemotherapy Advisory Group Draft for Consultation, November 
2008 
 
30

 Cancer Institute NSW, eviQ Cancer Treatments Online, accessible online: www.eviq.org.au 
31

 Clinical Oncology Society of Australia (2008), Guidelines for the Safe Prescribing, Supply and 

Administration of Cancer Chemotherapy, November 2008 



 
 37 

6.3.1. Only paediatric haematology/oncology consultants prescribe 
chemotherapy for paediatric patients.  

6.3.2. All orders for chemotherapy are verified by an appropriately 
skilled clinical pharmacist with access to the patient information 
relevant to the treatment.  The Clinical Oncology Society of 
Australia: Guidelines for the Safe Prescribing, Supply and 
Administration of Cancer Chemotherapy32 provides a suitable 
guideline to aid development of local/regional policies and 
procedures for verification of chemotherapy orders. 

6.3.3. Subsequent orders for administration of parental and oral 
chemotherapy cycles or doses are signed by an appropriately 
qualified medical practitioner or authorised nurse practitioner 
working in collaboration33 with a specialist 
oncologist/haematologist. 

6.3.4. Verbal orders are not recommended except to hold or stop 
chemotherapy administration. New orders or changes to orders 
must be made in writing. Signed electronic, fax and email 
orders are considered written orders. 

6.3.5. All services maintain a centralised register of staff who have 
formally demonstrated competency to prescribe (either first or 
subsequent cycles), verify prescriptions and supply 
chemotherapy.  
6.3.5.1. There is a defined centralised process and 

identified personnel within the service and region 
for register development and maintenance. 

 

                                                 

32
 Clinical Oncology Society of Australia (2008), Guidelines for the Safe Prescribing, Supply and 

Administration of Cancer Chemotherapy, November 2008 
33

 National Health (Collaborative Arrangements for Nurse practitioners) Determination 2010, 

accessible online: http://www.frli.gov.au. 



 
 38 

7. Assessment and Monitoring of Patients on Chemotherapy 

7.1. The service maintains standardised protocols that determine the 
appropriate time interval for regimen specific laboratory and radiological 
tests that are: 

7.1.1. Evidence based when national guidelines or protocols exist 
(eg, NHMRC guidelines, Cancer Clinical Pathways, eviQ 
Cancer Treatments Online protocols34) or 
7.1.1.1. Determined by consensus of practitioners within the 

service.  

7.1.1.2. Determined by a treatment protocol within a clinical 
trial 

7.2. The service has policies and procedures that clarify the roles and 
responsibilities of doctors, nurses and pharmacists in patient assessment 
and monitoring. These policies and procedures are relevant to workforce 
education, knowledge, skills and scope of practice within the local and 
virtual/remote environment.  

7.2.1. Prior to each cycle of chemotherapy, a chemotherapy 
competent clinician (see standard 2) must perform and 
document a pre chemotherapy history and clinical assessment 
including the following information;  

7.2.1.1. Diagnosis and current chemotherapy protocol 

7.2.1.2. Current cycle and day of scheduled treatment  

7.2.1.3. Relevant changes to  height, weight and body 
surface area (BSA) 

7.2.1.4. Changes in performance status. Use of the 
Eastern Cooperative Oncology Group (ECOG) 
tool is recommended. 

7.2.1.5. Allergies, sensitivities, reactions, and treatment 
related toxicities that may impact on the safety of 
treatment to proceed or require changes to 
supportive care strategies within the 
chemotherapy protocol.  

7.2.1.6. Effectiveness of prescribed or patients  self-
management strategies on symptoms, side 
effects and toxicities 

                                                 

34
 Cancer Institute NSW, eviQ Cancer Treatments Online, accessible online: www.eviq.org.au 



 
 39 

7.2.1.7. Compliance with oral chemotherapy and/or pre-
medications prescribed as part of the 
chemotherapy protocol. 

7.2.1.8. Relevant pathology and radiology results that may 
impact on the safety or appropriateness for 
treatment to proceed. 

7.2.1.9. Clinical evidence of response to treatment or 
suspected disease progression. 

7.2.1.10. Patients  psychosocial concerns and need for 
support including use of a validated tool such as 
the   Distress Thermometer  35  

7.2.1.11. Cumulative doses of those chemotherapy agents 
associated with a risk of cumulative toxicity. 

7.2.1.12. Confirmation that patient is fit to proceed with 
treatment or notification that patient is not fit to 
proceed with treatment 

7.2.1.13. Ongoing management plan including next review 
by specialist oncologist/haematologist. 

                                                 

35
 National Comprehensive Cancer Network Inc. 2010, Clinical practice Guidelines in Oncology. 

Distress Management V1.2010, accessible online:   

http://www.nccn.org/professionals/physician_gls/PDF/distress.pdf 



 
 40 

8. Provision of Supportive care  

8.1. Services have local, community or remote access to resources that may 
be required to support people with cancer and their families and/or 
caregivers. This includes management of physical symptoms and the 
identification and assessment of psychosocial issues at critical points 
along the pathway from diagnosis through treatment to post-treatment 
care, survivorship or palliation.  

8.1.1. All services maintain or recommend standard, evidence based 
protocols (such as eviQ Cancer Treatments Online36) for 
managing symptoms of disease and side effects of treatment 
including response to haematology/oncology emergencies 
(e.g. febrile neutropenia). It is recommended that  protocols are 
reviewed annually and must include: 

8.1.1.1. Documented process on provision of or access to 
24/7 triage for advice or clinical review (e.g. hot-
line, on-call practitioner, emergency department) for 
management  of chemotherapy toxicities 

8.1.1.2. Documented process on access to emergency 
medicine, infectious diseases unit, acute medicine 
and haematology/oncology disciplines 

8.1.1.3. Documented processes for efficient and effective 
transfer of care to appropriate health services for 
those patients deemed to be at risk of serious 
adverse events 

8.1.1.4. Documented formal protocols to guide staff on 
contacting the state-wide retrieval services as 
required. 

8.1.2. The service has in place validated tools such as the  Distress 
Thermometer  37 to enable and promote routine assessment 
regarding psychosocial concerns and need for support: 

8.1.2.1. Staff have access to education locally or remotely in 
identifying and responding to supportive care needs 
of patients (such as the learning activities and 
resources available on Cancer Learning38) 

                                                 

36
 Cancer Institute NSW  eviQ Cancer Treatments Online access www.eviq.org.au 

37
 National Comprehensive Cancer Network Inc. 2010, Clinical practice Guidelines in Oncology. 

Distress Management V1.2010, accessed online   

http://www.nccn.org/professionals/physician_gls/PDF/distress.pdf 
38

  Australian Government Cancer Australia , Cancer Learning, accessed on-line  

http://www.cancerlearning.gov.au/find/suppcare.php 



 
 41 

8.1.3. The service has referral processes for timely access to 
interpreter, liaison, coordination and support services for 
Aboriginal and Torres Strait Islander people 

8.1.4. The service has referral processes for timely access to 
interpreter services for people from a culturally and 
linguistically diverse background. 

8.1.5. The service maintains a referral list and referral processes for 
psychosocial, nursing, allied health, pharmacy, peer support, 
volunteer and other supportive care resources available within 
the service, the community or via remote access. 

8.1.5.1. There is a defined centralised process and 
identified personnel within the service for referral list 
development and maintenance. 



 
 42 

9. Safe Handling, Administration and Disposal of Chemotherapy 

9.1. All clinicians and support staff who may come in contact with 
chemotherapy drugs are educated on the safe handling of cytotoxic drugs 
and related waste39 as part of service or unit orientation. 

9.2. All chemotherapy services have policies and procedures to ensure the 
safe handling of cytotoxic drugs and related waste consistent with the 
Guidelines for the Safe Handling of Cytotoxic Drugs and Related Waste in 
South Australian Health Services  201140 (currently being developed). 
Policies and procedures must be relevant to the local care environment 
(e.g. hospital, community, patient home) and include: 
9.2.1. Legislative requirements 
9.2.2. Risk Management 
9.2.3. Staff Health 
9.2.4. Education &amp; training 
9.2.5. Production, labelling and dispensing of cytotoxic drugs 
9.2.6. Transport and storage of cytotoxic drugs  
9.2.7. Administration of cytotoxic drugs inclusive of all relevant routes 

of administration 
9.2.8. Personal Protective Equipment (PPE) 
9.2.9. Management of extravasation 
9.2.10. Management of spills 
9.2.11. Management/Transport of waste including contaminated body 

waste and laundry 

                                                 

39
  South Australian Department of Health 2010, Draft State-wide Framework for Chemotherapy 

Education and Assessment; an Integrated Model for South Australia, September 2010 
40

 SA Health, Guidelines for the Safe Handling of Cytotoxic Drugs and Related Wastes in South 

Australian Health Services , Draft version 1.3, October  2010
40

 



 
 43 

10. Intrathecal chemotherapy and recommendations to reduce the risk of  
error with vincristine 

10.1. Only level 5 and 6 chemotherapy services are to administer 
chemotherapy via the intrathecal route. 

10.2. Intrathecal chemotherapy for paediatric patients can only occur within a 
dedicated paediatric haematology/oncology service by senior clinicians 
formally assessed as competent to administer intrathecal chemotherapy. 

10.3.  Services have policies and procedures that comply with the 
recommendations of the 2005 Australian Council for Safety and Quality in 
Health Care Medication Alert41 to reduce the risk of error with vincristine. 
These recommendations include; 

10.3.1. Vincristine should be dispensed and administered in a minibag, 
not a syringe. Use of a minibag aims to  design out the error  by 
preventing connection to a spinal needle. 

10.3.2. All vincristine products, including outer wraps, should be 
labelled with a prominent warning label stating:  FOR 
INTRAVENOUS USE ONLY   Fatal if given by other routes . 

10.3.2.1. Negative labels, such as  Not for intrathecal use  
should NEVER be used. 

 

10.3.3. The timing and location of vincristine preparation, delivery and 
administration should be such that it is separate from all 
medicines intended for intrathecal administration. 

 

10.3.4. Medicines to be administered intrathecally must be packaged, 
transported and stored separate to intravenous medicines in 
specifically designated containers.  Vincristine and other 
intravenous medicines must have separate packaging and 
different containers.  

 

10.3.5. All medicines for intrathecal administration should be labelled 
with a prominent warning label, on the syringe and the outer 
wrap, stating  For intrathecal use .  

 

10.3.6. Only staff specifically trained and experienced in intrathecal 
cancer treatments should be designated to prescribe, prepare, 
dispense, deliver, receive or administer intrathecal 
chemotherapy. This includes senior registrars, consultants, 
cancer pharmacists and senior nurses. 

 

                                                 

41
 Australian Council for Safety and Quality in Health Care, Vincristine can be fatal if administered by 

the intrathecal route, Alert 2, December 2005 http://www.safetyandquality.gov.au/ 



 
 44 

 

10.3.7. Staff administering intrathecal medicines must use formal 
checking procedures. This should include a  time out  involving 
at least two health professionals, including an oncology trained 
nurse or pharmacist and a doctor. The patient identifiers, drug, 
dose, volume, route and rate should be verified against the 
medication order immediately prior to administration. Both 
health professionals should then sign the order. 

 



 
 45 

Appendix 1: Consultations and contributions 
 

Name Role 
Jodie Altshwager Ambulatory &amp; Primary Health Care Directorate, Central Northern 

Adelaide Health Service 
Mary Amanatidis Project Officer, Department of Health Nursing &amp; Midwifery Office 
Monique Anninos CSC Haematology/Oncology, Womens And Childrens Hospital 

Campus, Child Youth &amp; Womens Health Service 
Jacqui Adams* Clinical Head Oncology, Lyell McEwin Hospital &amp; 

Clinical Director of Cancer Services, Country Health SA 
Peter Bardy* Chief Medical Officer, Central Northern Adelaide Health Service, 

Specialist Haematologist RAH &amp; TQEH 
Carol Barnes Director of Nursing and Midwifery, Wallaroo Hospital, Yorke and 

Lower North Health Services, Country Health SA 
Julie Beaton Personal Assistant to Clinical Director Cancer Services, Adelaide 

Health Service,  
Jenny Beutel Chief Nurse, Nursing &amp; Midwifery Office, SA Health 
Steve Morris and the 
members of the Cancer 
Pharmacy Workforce 
Working Group  

Pharmaceutical Services and Strategy Branch, SA Health 

Peter Chapman* Chief Medical Advisor Country Health SA 
Alwin Chong* Aboriginal Health Council South Australia 
Lauren Civetta Senior Project Officer, Planning Unit, Adelaide Health Service, SA 

Health 
Greg Crawford* Palliative Care Specialist, Calvary North Adelaide Hospital      

Mary Potter Senior Lecturer in Palliative Care, University of 
Adelaide 

Deb Daulby** Senior Project Officer, CanNET SA, Statewide Service Strategy, 
SA Health 

Nino DiSisto* Executive Director, Country Health SA 
Member of the Cancer Clinical Network Steering Committee (frmr) 

Tracey Doherty*** Deputy Chair Cancer Clinical Network Steering Committee 
Clinical Practice Nursing Director, Cancer Services, Adelaide 
Health Service 

Cecily Dollman Team Leader, Cancer Services Team, Social Work and 
Counselling Service, Royal Adelaide Hospital 

Maeve Downes Senior Project Officer, Chemotherapy Administration State-wide, 
Nursing &amp; Midwifery Office SA Health 

Bev Drummond CSC Ceduna District Health Services, Country Health SA 
Lisa Elliott CSC Day Chemotherapy Unit, Royal Adelaide Hospital Cancer 

Centre 
Catherine Egal Acting Nursing Director, Functional &amp; Clinical Services, 

Noarlunga Health Service 



 
 46 

Appendix 1: Consultations and contributions 
 

Name Role 
Alice Every CSC Ward B6, Royal Adelaide Hospital Cancer Centre 
Juli Ferguson* Consumer representative, Cancer Voices SA &amp; Fleurieu Cancer 

Network 
Carolyn Garbett Smith Social Worker, Royal Adelaide Hospital 
Shandelle Hill Regional Outreach Oncology Clinical Practice, Child, Youth and 

Womens  Health Service 
Meryl Horsell Manager, Clinical Service Planning, Statewide Service Strategy, 

SA Health 
Ann Jackson A/g CSC Haematology/Oncology, Womens  and Children s 

Hospital, Adelaide 
Megumi Kanaike Clinical Oncology/Haematology Pharmacist,  

Flinders Medical Centre 
Dorothy Keefe* Chair Cancer Clinical Network Steering Committee 

Clinical Director Cancer Services, Adelaide Health Service 
Bogda Koczwara* Director Cancer Services, Southern Adelaide Health Service 
Sheila Lehman CSC Haematology/Oncology, The Queen Elizabeth Hospital 
Jude Lees* Senior Pharmacist, Royal Adelaide Hospital Cancer Centre 
Kristin Linke* CSC Haematology/Oncology Day Centre, The Queen Elizabeth 

Hospital 
Gerry Lloyd Director of Nursing/Midwifery, Gawler Hospital, Inner North 

Country Health Services, Country Health SA 
Melanie McMahon Rural  Cancer Care Coordinator, Central Northern Adelaide Health 

Service Cancer Services 
Ashleigh Moore* Consumer representative, Cancer Voices SA 
Steve Morris Chief Pharmacist, Pharmaceutical Services and Strategy Branch, 

SA Health 
James Moxham* GP Representative, Cancer Clinical Network Steering Committee 
Rahul Mukherjee* Radiation Oncologist, Central Northern Adelaide Health Service 
Kim Nicolson CSC Coober Pedy Hospital &amp; Health Services, Country Health SA 
Lyn Olsen and the 
CHSA Nursing and 
Midwifery Leadership 
Group  

Country Health SA 

Michael Penniment* Radiation Oncologist, Central Northern Adelaide Health Service 
Janette Prouse Geriatric Oncology Nurse, Royal Adelaide Hospital Cancer Centre 
Sharon Reinbrecht Rural  Cancer Care Coordinator, Southern Adelaide Health 

Service 
David Roder* Group Executive Research, Development and Statistics, Cancer 

Council SA 
Dianne Rogowski Executive Director of Nursing &amp; Midwifery Allied Health &amp; Patient 

Care, Central Northern Area Health Service 
Graham Rumsby Nursing Director, Royal Adelaide Hospital Cancer Centre 



 
 47 

 

Name Role 
Rural Divisions of 
General Practice 

Barossa, Division, Eyre Peninsula , Flinders and Far North, 
Limestone Coast, Mid North Rural, Murray Mallee, Riverland, 
Yorke Peninsula 

Megan Satenak* Director, Dietetics &amp; Nutrition, Repatriation General Hospital 
 

Senior Cancer Nurses 
Stakeholder Group 

CanNET SA, Statewide Service Strategy, SA Health 

Magda Simon Project Nurse Mental Health, Nursing &amp; Midwifry Office, Sa Health 
Heather Tapp* Director Cancer Services Children Youth &amp; Womens Health 

Service 
Suzanne Taylor CSC Haematology/Oncology, Womens And Childrens Hospital 

Campus, Child Youth &amp; Womens Health Service 
Kate Turpin Nurse Education Facilitator, Department of Clinical 

Haematology/Oncology, Womens and Childrens Hospital 
Metropolitan Divisions of 
General Practice 

Adelaide Hills, Adelaide Central and Eastern, Adelaide Northern, 
Adelaide Eastern, Southern Division  and Adelaide Western 

Terry Ventrice CSC Ward C6, Royal Adelaide Hospital Cancer Centre 
Ingrid Vogelzang* Network Development Manager, Statewide Cancer Clinical 

Network 
Alison Walsh CSC Ward B8, Royal Adelaide Hospital Cancer Centre 
Deb Warne CSC Surgical Centre, Repatriation General Hospital 
David Watson Head, Flinders University Department of Surgery 
Brenda Wilson* Chief Executive Cancer Council South Australia 
Graeme Young Professor of Gastroenterology and Academic Head of GI Services, 

Flinders University of SA 
 

*Member Cancer Clinical Network Steering Committee 
**Major contributor 
***Principal Editor and project chair 
 

 



 
 48 

Appendix 2: 
Self Evaluation and Implementation Matrix 
Key 

Full compliance means arrangements / processes exist and are documented and implemented. 

These arrangements are comprehensive, regular, formal and consider local, within-region and state-wide relationships. 

There is formal evidence and documentation, available including reports where appropriate, to support compliance. 

Partial compliance means arrangements/ processes exist, however there is opportunity to improve through one or more of the following: 

&gt; Formalising arrangements/ processes 
&gt; Documenting arrangements/ processes 
&gt; Implementing arrangement/ processes 
&gt; Increasing frequency/ regularity 
&gt; Increasing the comprehensiveness 
&gt; Gathering evidence and documentation to support compliance 

Non-compliance means there is work required to develop clear, consistent and documented roles, structures, policies, procedures and processes. 

Comments/plan provides supporting information to criteria compliance and plan to achieve as applicable. 



 
 49 

Self Evaluation and Implementation Matrix 
Standard 1: Governance 
 

Standard 

No 

Standard Criteria Full 

compliance 

Partial 

compliance 

 

Non 

compliance 

 

Comment/plan 

1 Clearly documented governance arrangements exist both locally and regionally.     

1.2 In line with clinical service delineation, core speciality and clinical support services exist to manage risk levels of 

chemotherapy. Formal MOU exist as required. 

    

1.3 Regional Directors oversee continuous development and implementation of standardised 

procedures/protocol/models of care that support chemotherapy delivery.  

    

1.4 Performance indicator framework KPIs are monitored and reported through identified governance processes.     

1.5 Safety and Quality complaints and incidents including AIMS reports are monitored and formally reviewed 

through identified governance processes.  These processes inform strategic planning. 

    

 

 



 
 50 

Standard 2: Workforce, training and competency 
 

Standard  Standard Criteria Full 

compliance 

Partial 

compliance 

 

Non 

compliance 

 

Comment/plan 

2.1 Policies and procedures for provision and verification of credentialing and chemotherapy education and 

competency exist and are adhered to. 

    

2.1.1 Only chemotherapy competent clinicians prepare or administer chemotherapy.      

2.1.2 Service has standard mechanism for providing opportunity for and monitoring continued competency     

2.2 Paediatric chemotherapy is managed by a specialised paediatric health facility unless recommended and well 

supported by paediatric specialist clinicians. 

    

2.3 Sustainable access to nursing/clinical staff with expertise in CVAD and PICC is available and care is consistent 

with evidence based guidelines 

    

 

 



 
 51 

Standard 3: Timely access, integration and coordination of care 
 

Standard  Standard Criteria Full 

compliance 

Partial 

compliance 

 

Non 

compliance 

 

Comment/plan 

3.1 Processes exist to ensure care is coordinated in a consistent and timely manner utilising quality and cost 

effective principles.  

    

3.2 Access to transport and accommodation is available for patients relocating for treatment.     

3.3 Minimum operational &amp; infrastructure requirements including accommodation and ICT are met to maximise local 

access to care. 

    

3.4 Services administering chemotherapy to paediatric patients comply with the Standards for the Care of Children 

and Adolescents in Health Services. 

    

3.5 Formal communication arrangements between GP s and consultants exist for 24/7 advice/consultation/referral.     

3.6 Procedures for efficient and effective transfer of patient care are standardised     

3.7 Services without oncology/haematology/pharmacy on site have formal links and agreements with recognised 

service for advice, education and support. 

    

3.8 Services without specialist cancer nurse on site have  formal links and agreements with recognised service for 

advice, education and support Formal links/agreements exist with a recognised L4-6 chemotherapy cancer 

nurse for remote support within SA 

    

3.9 Standard  processes exist for efficient and effective discharge planning/transition/follow up care     

 

 



 
 52 

Standard 4: Multidisciplinary care, comprehensive patient assessment and chemotherapy planning. 
 

Standard  Standard Criteria Full 

compliance 

Partial 

compliance 

 

Non 

compliance 

 

Comment/plan 

4.1 All patients have opportunity to have management discussed by a Cancer MDT      

4.2 Local policy identifies comprehensive patient information required to be available and documented prior to 

prescribing or administering chemotherapy 

    

4.3 Local policy identifies that final decisions on initiation of chemotherapy protocol/treatment plan are made at 

consultant level. 

    

 

 

Standard 5: Patient Education and Consent  
  

Standard  Standard Criteria Full 

compliance 

Partial 

compliance 

 

Non 

compliance 

 

Comment/plan 

5.1 Guidelines and resources are available to enable standardised and effective provision of verbal and written 

information to patients/parents/carers/family prior to initiation of chemotherapy via any route. 

    

5.2 Service maintains a policy for obtaining and documenting patient consent for chemotherapy.     

 

 



 
 53 

Standard 6: Chemotherapy prescribing  
  

Standard  Standard Criteria Full 

compliance 

Partial 

compliance 

 

Non 

compliance 

 

Comment/plan 

6.1 Service complies with the 2009 SA Health Policy Directive in regard to consistent prescribing terminology and 

use of acceptable abbreviations. 

    

6.2 Evidence based, standard chemotherapy regimens are defined and utilised.     

6.3 Local policies and procedures identify appropriate prescribing practices and maintain a centralised register of 

staff competent to prescribe, verify prescriptions and supply chemotherapy. 

    

 

Standard 7: Assessment of Monitoring of Patients on Chemotherapy. 
 

Standard  Standard Criteria Full 

compliance 

Partial 

compliance 

 

Non 

compliance 

 

Comment/plan 

7.1 Standard, evidence based protocols are utilised to determine appropriate time interval for regimen specific 

laboratory and radiological tests.  

    

7.2 Policy and procedures that clarify roles and responsibilities of doctors, nurses and pharmacists in patient 

assessment and monitoring exist and are relevant to local workforce education, knowledge and skill. Clear role 

delineation enables comprehensive patient assessment without duplication of effort. 

    

 



 
 54 

Standard 8 :  Provision of supportive care. 
  

Standard 

No 

Standard Criteria Full 

compliance 

Partial 

compliance 

 

Non 

compliance 

 

Comment/plan 

8.1 Services have local, community or remote resources that support patients with cancer and their 

families/caregivers.  

    

8.1.1 Standard evidence based protocols are readily accessible and utilised to manage symptoms and side effects 

including oncological emergencies.  

    

8.1.2 Evidence based tools to assess and monitor symptom and psychosocial distress are routinely utilised and staff 

are educated on responding to supportive care needs of cancer patients 

    

8.1.3 Referral processes to ATSI liaison, coordination and support exist     

8.1.4 Referral processes to interpreters and support for CALD peoples exist     

8.1.5 Referral processes to supportive care resources are identified and maintained     

 

 

Standard 9 :  Safe Handling, Administration and Disposal of Chemotherapy 
 

Standard 

No 

Standard Criteria Full 

compliance 

Partial 

compliance 

 

Non 

compliance 

 

Comment/Plan 

9.1 Service/unit orientation includes education on safe handling of cytotoxic drugs and related waste      

9.2 Services comply with SA Health guidelines on the safe handling, transportation, storage and management of 

cytotoxic drugs and related waste. 

    

 



 
 55 

Standard 10 :  Intrathecal chemotherapy and recommendations to reduce the risk of error with vincristine. 
 

Standard 

No 

Standard Criteria Full 

compliance 

Partial 

compliance 

 

Non 

compliance 

 

Comment/Plan 

10.1 Local policies and procedures identify that only Level 5 &amp; 6 chemotherapy services administer chemotherapy 

via the intrathecal route. 

    

10.2 Local policies and procedures identify that Intrathecal chemotherapy for paediatric patients occurs only within 

dedicated paediatric facilities 

    

10.3 Local policies and procedures exist and adhered to regarding intrathecal chemotherapy and the recognised  risk 

of error with vincristine. 

    

 



 
 56 

 


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