Administration (Infusion and Injection) of Antineoplastic Therapies in the Home

The administration (infusion or injection) of antineoplastic therapies in the home continues to gain momentum among healthcare facilities and third-party payers.

When considering the feasibility of home administration of antineoplastic therapies, the safety of patients, families, and healthcare workers is of prime importance. Healthcare facilities should take a programmatic approach to evaluate the ability to offer home administration of antineoplastic therapies, and not all facilities will have the capacity, staff, and resources to do so. Determining the feasibility of home administration of antineoplastic therapies requires careful patient selection, provider and patient education, and extensive planning (Gorski, 2020).

The Oncology Nursing Society and American Society of Clinical Oncology published joint antineoplastic therapy administration safety standards. Updated standards released in 2024 address home administration of antineoplastic therapies (Siegel et al., 2024). Healthcare facilities providing home administration of antineoplastic therapies should base practice, policies, and procedures on these standards to minimize risk for error and patient harm.

Healthcare facilities must consider the elements of antineoplastic therapies that make their administration a specialty, requiring focused training and competency validation of staff involved. Specialized education, preparation, and training of nurses who administer antineoplastic therapies is recommended (Oncology Nursing Society, 2024). The principles of antineoplastic administration that require additional training and specialty knowledge apply in the home setting as well. Although this position statement is in reference to nurses administering antineoplastic therapy in the home, any clinician who may be involved in the administration also requires additional training and specialty knowledge to safely provide care.

Antineoplastic therapies used for cancer treatment are often hazardous drugs (HDs) that demonstrate one or more of the following characteristics: carcinogenicity, genotoxicity, teratogenicity, reproductive toxicity, or organ toxicity. Any HD-handling activity, regardless of setting, may result in healthcare worker exposure (Oncology Nursing Society, 2022). With less control over the care environment, home administration of HDs may pose an additional level of complexity and challenge to exposure risk for the nurse and those in the home with the patient. There are well-documented complications that may occur as a result of surface contamination and exposure to HDs requiring great caution. Staff should receive thorough training on safe-handling principles, risk-reduction behaviors, and appropriate use of personal protective equipment (Olsen & Walton, 2024).

Just as complexities of antineoplastic administration require training and skill for oncology nurses, home infusion, a specialty within home care, necessitates a level of skill and expertise in elements such as home assessment, safety considerations, and resource utilization (Gorski, 2020). The administration of antineoplastic therapies in the home requires a careful synthesis of the oncology nursing and home infusion nursing specialties to yield optimal patient outcomes and quality care.

The decision to proceed with home administration of antineoplastic therapies should be made with caution and consideration of the risk of harm for nurses, patients, and other members of the household.

Interprofessional considerations from providers, nurses, pharmacists, patients, and families are required, and policies and procedures that reduce the risk for medication error and staff and family exposure to HDs must be established.

• It is the position of ONS that any healthcare organization providing or planning to provide antineoplastic therapy administration in the home setting must establish the following:
  • A model of care delivery in which:
  • The complexity and risk of antineoplastic therapy complications are evaluated to determine regimens suitable for home administration.
  • Patient and family readiness to have care delivered in the home is assessed. The patient’s home environment is conducive to home administration.
  • The compounding of antineoplastic therapies occurs in an approved setting that meets regulatory, licensure, and safety standards.
  • Antineoplastic therapies are transported inside of a durable container capable of spill containment. In addition, a spill kit is kept at the home.
  • Antineoplastic therapies administered in the home require the same verification steps as agents and regimens administered in a hospital or outpatient setting (Siegel et al., 2024).
  • Nurses caring for the patient have access to patient-informed consent and a full treatment plan.
  • In-person or institutionally approved video-enabled technology will be used for verification steps that are completed in the presence of the patient.
  • Order sets, protocols, and procedures are established for the emergency management of an adverse reaction. Emergency medications and supportive care measures are accessible.
  • Documentation guidelines are established for independent verification, treatment administration, patient education, and planned follow-up care and testing.
• Requirements for nurses who administer antineoplastic therapy in the home
  • Be approved as chemotherapy/immunotherapy competent within the nurse’s institution or supporting agency. Competency is obtained through the successful completion of didactic learning followed by a knowledge and clinical competency validation (Oncology Nursing Society, 2024).
  • Hold current basic life support certification and have access to a licensed practitioner (advanced practice provider, physician).
  • Undergo an annual competency assessment.
• Policies that comply with regulatory requirements for HDs as well as care standards for the home setting
  • Address the personal and occupational safety of the home infusion nurse.Ensure HD waste is disposed of in a manner that protects staff, the patient and household, and the environment.
  • Define required personal protective equipment.

Approved by ONS Board of Directors August 2020, August 2024

Download this position statement.

References

Gorski, L.A. (2020). Infusion therapy: A model for safe practice in the home setting. American Nurse Journal, 15(6), 8–11. https://www.myamericannurse.com/infusion-therapy-a-model-for-safe-practice-in-the-home-setting

Olsen, M.M., & Walton, A.L. (2024). Safe handling of hazardous drugs (4th ed.). Oncology Nursing Society.
Oncology Nursing Society. (2022). Ensuring healthcare worker safety when handling hazardous drugs [Position statement]. https://www.ons.org/make-difference/ons-center-advocacy-and-health-policy/position-statements/ensuring-healthcare

Oncology Nursing Society. (2024). Education of the nurse who administers and cares for the individual receiving antineoplastic therapies. Position statement]. https://www.ons.org/make-difference/ons-center-advocacy-and-health-policy/positionstatements/education-nurse-who

Siegel, R.D., LeFebvre, K.B., Temin, S., Evers, A., Barbarotta, L., Bowman, R.M., . . . Olsen, M.M. (2024). Antineoplastic therapy administration safety standards for adult and pediatric oncology: ASCO–ONS standards. Oncology Nursing Forum, 51(3), 1–24. https://doi.org/10.1188/24.ONF.1-24.AP