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On each treatment day a nurse checks how you are, your temperature, pulse, blood pressure, allergies and side effects. Before the drip starts, two trained staff check the bag against your prescription and against you, using two identifiers such as your name and date of birth, and follow the tubing from bag to line. You will be told the drug's name, how long it takes and what to report at once.
The ASCO-ONS Antineoplastic Therapy Administration Safety Standards (2024) replaced the 2016 ASCO/ONS standards' three verifications with four: before preparation (order elements and dose calculation), at preparation (a second clinician checks vials, concentration, volume, diluent and tubing), after preparation and before administration (two licensed clinicians independently verify drug, dose, volume, rate, route, expiry and appearance), and a new fourth verification in the presence of the patient, in which two licensed clinicians, at least one on site and the other in person or by approved video, check two patient identifiers, the drug, dose, rate and duration, route, administration set and pump settings. The panel added the fourth check because drugs are now often prepared away from where they are given, and added visual inspection of the administration set ('tracing the lines').
On each treatment day staff assess and record performance status, vital signs, date of birth, allergies and previous reactions, toxicities and pain, and update the medication list; the nurse confirms the drug, infusion time, route and symptoms to report with the patient before starting. A practitioner certified in basic life support must be present and a licensed practitioner on site, with hypersensitivity, extravasation and, where relevant, cytokine release order sets and drugs to hand.
The standards are not graded. The panel notes that remote video verification looks feasible but that no well-designed research has evaluated its effect on safety.
Why: A patient who is unwell on the day may need treatment delayed or the dose changed, whatever the prescription says.
“On each clinical encounter or day of treatment, staff performs and documents a patient assessment that includes at least the following six elements and takes appropriate action:”
ASCO and the Oncology Nursing Society (JCO Oncology Practice; Oncology Nursing Forum) 2024
Why: A new medicine or supplement started since the last cycle can interact with the treatment.
“The patient's medication list inclusive of prescribed and over-the-counter medications, herbal products, and supplements is updated and documented in the medical record at every encounter and reviewed by a licensed practitioner when a change occurs”
ASCO and the Oncology Nursing Society (JCO Oncology Practice; Oncology Nursing Forum) 2024
Why: The chair-side check confirms what was prepared matches the order; it does not replace the clinical check of the order itself.
“SACT must not be administered by a HCP, or taken by a patient until an appropriately trained RPP has verified the prescription.”
Why: Most preparation errors are a wrong vial strength, a wrong volume drawn up or a wrong diluent.
“Upon preparation of the antineoplastic medication, a second licensed clinician approved by the health care organization to prepare antineoplastic therapy verifies:”
ASCO and the Oncology Nursing Society (JCO Oncology Practice; Oncology Nursing Forum) 2024
Why: Two people checking separately are less likely to share the same mistake than one person checking twice.
“After preparation and before each antineoplastic therapy administration, at least two licensed clinicians approved by the health care organization to administer or prepare antineoplastic therapy independently verify and document the accuracy of the following elements in the patient's medical record:”
ASCO and the Oncology Nursing Society (JCO Oncology Practice; Oncology Nursing Forum) 2024
Why: This last check, with the patient present, catches a right drug going to the wrong person or a pump set to the wrong rate.
“In the presence of the patient: At least two licensed clinicians approved by the health care organization to administer or prepare antineoplastic therapy in person or through appropriate institutionally approved video-enabled technology, with at least one person on site, verify the patient's identification using at least two identifiers and document accuracy in the patient's medical record.”
ASCO and the Oncology Nursing Society (JCO Oncology Practice; Oncology Nursing Forum) 2024
Why: Following the tubing finds clamps left closed, loose connections, the wrong drug on the wrong pump and the wrong filter.
““Tracing the lines” immediately prior to administration reduces errors related to unclamped tubing, loose or disconnected lines, ensures multiple lines are infusing at the prescribed rate, the right drug is connected to the right pump, and the proper tubing or filters are used.”
ASCO and the Oncology Nursing Society (JCO Oncology Practice; Oncology Nursing Forum) 2024
Why: The patient is the last check, and often the first to notice a reaction or a leak into the tissues.
“Before initiation of antineoplastic therapy, personnel approved by the health care organization who is administering the antineoplastic(s) confirms the therapy with the patient, including, at a minimum, the name of the drug, the infusion time, route of infusion, symptoms to report, for example: hypersensitivity symptoms or pain at infusion site”
ASCO and the Oncology Nursing Society (JCO Oncology Practice; Oncology Nursing Forum) 2024
Why: Severe allergic reactions and leaks of drug into the skin need treatment within minutes.
“Hypersensitivity and anaphylactoid management policy is present and aligns with current literature and guidelines. Hypersensitivity order sets and medications are accessible within the appropriate timeframe for optimal treatment”
ASCO and the Oncology Nursing Society (JCO Oncology Practice; Oncology Nursing Forum) 2024
Why: The record shows each check happened and gives the next team a baseline if a reaction comes later.
“Documentation in the patient's medical record confirms the four verifications prior to parenteral antineoplastic administration and the patient's clinical status during and upon completion of antineoplastic therapy”
ASCO and the Oncology Nursing Society (JCO Oncology Practice; Oncology Nursing Forum) 2024
How care is usually carried out, read from the guidelines and standards cited. Your own team's protocol and their judgement come first; this page is for understanding it, not for doing it yourself.
The ASCO-ONS standards (2024): four separate verifications, the last two by two licensed clinicians independently, and the fourth at the patient's side with two identifiers, pump settings and the administration set traced; a day-of-treatment assessment; the drug, time, route and warning symptoms confirmed with the patient; a basic life support provider present and reaction drugs to hand. No other current standard covering the chair-side check could be read, so there is no disagreement to report; BOPA (2025) adds that nothing may be given before a trained pharmacy professional has verified the prescription.
ASCO and the Oncology Nursing Society (JCO Oncology Practice; Oncology Nursing Forum) 2024 · British Oncology Pharmacy Association 2025
Where it differs: The earlier standards required three independent verifications, at order verification, drug preparation and administration, without a separate check at the patient's side of a drug prepared elsewhere.
Evidence: Replaced in 2024. The panel added the fourth verification because many drugs are now prepared away from where they are given, such as at home or in a stand-alone unit.
ASCO and the Oncology Nursing Society (JCO Oncology Practice; Oncology Nursing Forum) 2024
Where it differs: One clinician is with the patient and the second joins the fourth verification by an approved video link, as at home.
Evidence: Allowed by ASCO-ONS 2024. The panel cites a review finding remote verification feasible and possibly similar to a live two-person check, but says no well-designed research has evaluated its effect on safety, and cautions that technology can still lead to errors.
ASCO and the Oncology Nursing Society (JCO Oncology Practice; Oncology Nursing Forum) 2024
Before chemotherapy is given, two trained staff check the drug, the dose and the patient. When treatment is given at home, the second person may now join by video. The 2024 US standards allow this but say no well-designed study has measured whether it is as safe.
| Recommendation | Grade, as printed | Source |
|---|---|---|
| Four separate verifications, in person or by approved video “Personnel approved by the health care organization to prepare or administer antineoplastic therapy perform four separate verifications in person or by institutionally approved video-enabled technology:” | Standard (not graded) | ASCO and the Oncology Nursing Society (JCO Oncology Practice; Oncology Nursing Forum) 2024 |
| A practitioner certified in basic life support present during administration “At least one practitioner who maintains current certification in (age-appropriate) basic life support is present during antineoplastic therapy administration” | Standard (not graded) | ASCO and the Oncology Nursing Society (JCO Oncology Practice; Oncology Nursing Forum) 2024 |
| Remote verification: effect on safety not yet studied “Authors of a review of literature and synthesis of practice interviews regarding remote verification of high-risk medications report remote verification at the point of administration is feasible and may be alike live two-person checks; however, no well-designed research has evaluated the impact on safety as of this writing.” | Panel statement (not graded) | ASCO and the Oncology Nursing Society (JCO Oncology Practice; Oncology Nursing Forum) 2024 |
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