Chemotherapy Administration

Identify an RN who is about to give a chemotherapy medication


Which department are you completing this survey for?

Name of the employee observed:


Premedications documented given in electronic record

Blood return documented as verified in electronic record.

Two RNs verified the correct patient identification, drug, dose, route, rate and volume?

Two RNs monitored the pump and verified accuracy?

Two RNs verified that the pump is programmed with the correct rate and volume

Two RNs traced the lines, ensuring appropriate lines are clamped/unclamped

The closed system was maintained during entire preparation and infusion

RN visualized “dripping” in the drip chamber after starting infusion

Two RNs verified all subsequent doses were filled out on the chemo grid & rescheduled for their correct times in the EMAR

After the infusion, the end time was documented in the EMAR

All chemo/administration set was disposed of properly after completion