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Antineoplastic therapy ordering protocol allows APPs to ‘expand their scope of practice’
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APPs have become an integral and fundamental part of interdisciplinary oncology care.
Having worked in oncology for nearly 10 years alongside many APPs and oncologists at academic centers, it is evident that a team-based approach helps provide high-quality care to patients every day.
According to a report published in 2014 in Journal of Oncology Practice, there is a projected significant shortage of oncologists by 2025. The aging and growing population, as well as the increasing number of cancer survivors, will lead to a 40% increase in demand for oncology services, whereas supply is only expected to grow 25%.
This lends itself well to expanding the services and clinical support provided by APPs; however, we must ensure that APPs are trained and functioning at the top of license.
At University of California San Diego Moores Cancer Center, one of 71 NCI-designated comprehensive cancer centers, oncology APPs work in partnership with medical oncologists to provide excellent specialized care to patients and their families.
Historically, our antineoplastic therapy ordering protocol has been limited in scope, with restrictions on APP authorization of IV antineoplastic therapy. With a multidisciplinary provider team, we developed a program including a standardized protocol, competency assessment and ongoing performance evaluation of APP authorization of IV antineoplastic therapy to ensure safe and efficient care delivery while expanding the scope of practice of APPs at Moores Cancer Center.
Program design
We developed and formatted the program based on national guidelines and standards of practice established at other NCI-designated comprehensive cancer centers that privilege APPs to authorize oral and IV antineoplastic therapies.
Our program stipulates that APPs granted privileges can demonstrate knowledge of the specific antineoplastic treatments, perform pretreatment evaluations of each patient for whom they are signing orders, and communicate with the medical oncologist when a dose modification is made to a treatment plan. To ensure safety of our care delivery, the protocol’s foundation includes a competency assessment and annual recredentialing.
Competency, safety
Evaluation for competency includes a requirement that APPs have at least 3 years of oncology experience and/or chemotherapy biotherapy certification through the Oncology Nursing Society (ONS). They also must complete 20 antineoplastic therapy orders under direct supervision of a medical oncologist prior to receiving privileges formally through our medical staff office.
Once privileged, APPs undergo annual review with their supervising medical oncologist for reassessment of competency to establish ongoing safety evaluations for the program.
One consideration we had while developing this protocol was trying to identify the best advanced practice oncology education platform for antineoplastic therapy ordering for APPs who have fewer than 3 years of experience. Our institution employs both nurse practitioners (NPs) and physician assistants (PAs). However, ONS — the gold standard for oncology nursing education — has a chemotherapy and biotherapy certification that is not available to PAs, as they do not hold a nursing license. ASCO has developed an advanced practice certification program for both NPs and PAs for oncology care that could be an alternate option for APPs seeking additional specialty training in oncology.
Also, several institutions have developed advanced practice oncology fellowships, which are an excellent option for a graduate APP.
Goals
Based on the collaborative work done by our multidisciplinary team, Moores Cancer Center oncology APPs will practice using an approved antineoplastic therapy ordering protocol. The intent is that establishing this program will facilitate an improved workflow for the clinic and infusion center, thereby improving patient satisfaction.
This protocol can be implemented in any oncology specialty care setting, allowing APPs to expand their scope of practice while supporting safe and efficient care delivery for our patients.
Reference:
Yang W, et al. J Oncol Pract. 2014;doi:10.1200/JOP.2013.001319.
For more information:
Archana Ajmera, MSN, ANP-BC, AOCNP, is a board-certified adult nurse practitioner and advanced oncology certified nurse practitioner at University of California San Diego Moores Cancer Center. She can be reached at UC San Diego Health — Koman Family Outpatient Pavilion, 9400 Campus Point Drive, La Jolla, CA 92037; email: aajmera@ucsd.edu.
Disclosure: Ajmera reports no relevant financial disclosures.