July 2006, Volume 33,
Oncology Nursing Society Position
Oncology Services in the
Ambulatory Practice Setting
Economic, technologic, and social forces have combined to create
an environment in which increasingly complex cancer therapies are administered
in the ambulatory care setting. New roles, responsibilities, and challenges for
oncology nurses have evolved accordingly (Ireland, DePalma,
Arneson, Stark, & Williamson, 2004). The Oncology
Nursing Society (ONS) has published statements on the scope and standards of
oncology nursing practice (Brant & Wickham, 2004)
and developed guidelines and recommendations for caring for patients with
cancer that can be applied in the ambulatory practice setting (Camp-Sorrell,
2004; Polovich, White, & Kelleher, 2005).
However, some considerations are unique to the ambulatory practice setting,
such as staff qualifications; telephone triage of patients’ problems; nurses’
involvement in coding and billing documentation; chemotherapy and biotherapy
preparation, handling, administration, and disposal; emergency preparedness;
and the use of conscious sedation. In addition, many patients receive long-term
follow-up in the ambulatory practice setting following treatment completion.
Follow-up includes monitoring patients for possible sequelae
of cancer and its treatment, such as secondary cancers and the development of
It Is the Position of ONS That
care for individuals with cancer is accomplished
best by RNs who have been educated and certified in the oncology specialty
(ONS, 2005b, 2005c).
- Patient safety must be the
priority in planning and providing care.
- Patients should receive
information about the risks and benefits of treatments and their impact on
quality of life, including financial implications, to make an informed
decision to undergo treatment in the ambulatory practice setting.
- Patients and caregivers should
be given verbal and written self-care instructions and have access to
resources to prevent and manage side effects of cancer and its treatment.
- In accordance with
institutional guidelines, oncology nurses practicing as triage nurses
independently or collaboratively should assess and direct patients to
appropriate treatment areas such as emergency departments, inpatient units,
home care, or hospice care (Buchsel & Glennon, 2005; Hickey & Newton, 2004).
- Nurses and ambulatory practice
setting staff members are responsible for documenting care provided and
processing accurate billing codes for services rendered.
- Chemotherapy and biotherapy
administration in the ambulatory practice setting requires that
prepare, handle, administer, and dispose of all antineoplastic,
biologic, and hazardous medications in accordance with recommendations
for the safe handling of cytotoxic drugs
published by ONS (Polovich et al., 2005), the
National Institute for Occupational Health and Safety (2004), and the
Joint Commission on Accreditation of Healthcare Organizations (2005).
- RNs who
administer chemotherapy and biotherapy should successfully complete the
ONS Chemotherapy and Biotherapy course or complete a course with
comparable didactic content (ONS, 2005a, 2005b).
- An appropriate
emergency response can be readily activated and all clinical staff
members are certified in basic cardiac life support.
medications and equipment are readily available for use.
appropriate for providing quality oncology nursing care are written and
followed for the management of cardiac or respiratory arrest,
anaphylactic reaction, seizures, vesicant extravasations, chemical
spills, and other emergency situations that may occur.
- Prior to
treatment, an RN who has experience in oncology nursing assesses
patients’ and their caregivers’ access to transportation and home
environment, ability to identify and report untoward or adverse effects,
ability to engage in self-care (patients) or provide care (caregivers),
and willingness to participate in and adhere to the treatment plan.
receiving continuous infusion therapy have an appropriate vascular access
device in place and are under the care or supervision of a home infusion
or homecare agency or have 24-hour access to ambulatory or office
- Use of conscious sedation in
the ambulatory practice setting requires that
guidelines and policies are followed.
governmental, and Joint Commission on Accreditation of Healthcare
Organizations (2005) regulations are enforced.
- Oxygen and
sedation-reversal medications are readily available for use. Monitoring
of the patient is done before, during, and after the procedure and is
documented. Education is provided to the patient and family, and
discharge occurs when specific written criteria are met.
assessment is closely maintained by RNs who have experience monitoring
patients receiving conscious sedation.
Brant, J.M., & Wickham,
R.S. (2004). Statement on the scope and standards of oncology nursing
practice. Pittsburgh, PA: Oncology Nursing Society.
Buchsel, P., & Glennon, C. (2005). Ambulatory care administrative
concepts: An overview. In P.C. Buchsel & C.H. Yarbro (Eds.), On-cology care
in the ambulatory setting (2nd ed., pp. 1–32). Sudsbury, MA:
Jones and Bartlett.
Camp-Sorrell, D. (Ed.). (2004). Access device
guidelines: Recommendations for nursing practice and education (2nd ed.). Pittsburgh, PA:
Oncology Nursing Society.
Hickey, M., & Newton, S. (2004). Telephone triage for
oncology nurses. Pittsburgh,
PA: Oncology Nursing Society.
Ireland, A.M., DePalma, J., Arneson, L., Stark,
L., & Williamson, J. (2004). The
oncology nursing society ambulatory office nurse survey [Online exclusive]. Oncology
Nursing Forum, 31, E147–E156.
Retrieved January 10, 2006, from
Joint Commission on Accreditation of Healthcare
Organizations. (2005). Comprehensive accreditation manual for ambulatory
care. Oak Brook Terrace, IL: Author.
National Institute for Occupational Health and
Safety. (2004). Preventing occupational exposures to antineoplastic
and other hazardous drugs in health care settings (NIOSH Publication No.
2004-165). Retrieved January 7, 2006, from
Oncology Nursing Society. (2005a). Chemotherapy
and biotherapy update course. Retrieved June 10, 2005, from http://onsopcontent.ons.org/education/distanceeducation/chemoupdate/index.shtm
Oncology Nursing Society. (2005b). Education
of the RN who administers and cares for the individual receiving chemotherapy
and biotherapy [Position statement]. Pittsburgh,
Oncology Nursing Society. (2005c). Quality
cancer care [Position statement]. Pittsburgh,
Polovich, M., White, J.M., &
Kelleher, L.O. (Eds.). (2005). Chemotherapy and biotherapy guidelines and
recommendations for practice (2nd ed.). Pittsburgh, PA:
Oncology Nursing Society.
Approved by the ONS Board of Directors
3/98; revised 11/00, 9/02, 3/06.
To obtain copies of this or any ONS position,
contact the Customer
at the ONS National Office at 125
Enterprise Drive, Pittsburgh, PA 15275-1214
(866-257-4ONS; email@example.com). Positions also may be downloaded from
the ONS Web site (www.ons.org).