Chemotherapy/Radiation Communication Report

Chemotherapy/Radiation Communication Report 

Goal 
To ensure continuity of care and improved outcomes for residents receiving oncology/chemotherapy and/or radiation treatment. 

Policy 
The facility and the Oncology/Physician Office/Radiation Center will communicate any concerns, issues, treatments provided, responses to treatment, and potential for negative outcomes prior to and after treatment. 

Protocol 

Chemotherapy: 

• Information to be obtained from the Oncology Center and kept available for staff to review includes: 

• Treatment schedule 

• Access device and protocol 

• Type of medication being administered 

• Potential side effects 

• Time frame for when side effects might occur 

• Management of side effects 

• Monitoring required 

• Any additional precautions 

Radiation: 

• Information to be obtained from the Radiation Center and kept available for staff to review includes: 

• Treatment schedule for the site radiated 

• Potential side effects 

• Time frame for when side effects might occur 

• Management of side effects 

• Monitoring required for the site being radiated 

• Any additional precautions 

Pre-Appointment Protocol: 

• Prior to a resident going for an Oncology appointment/Chemotherapy/Radiation, the Communication Sheet is completed by the nurse with resident vital signs and a brief summary of any changes in the resident’s condition since the previous visit. This includes: 

• Falls 

• Pain 

• Changes in medication 

• Episodes of vomiting/diarrhea 

• Changes in weight/appetite 

• Decline in physical functioning 

• Changes in behavior 

• IV issues 

• Any improvements 

Attachments: 

• Any laboratory or radiology reports since the previous visit 

• Resident face sheet 

• Resident’s Medication Administration Record (MAR) 

• Treatment Administration Record (if applicable) 

• Most recent Physician Progress note (if applicable) 

Post-Appointment Protocol: 

• Upon return to the facility, the Communication Record is reviewed by the nurse and any significant issues are communicated to the physician, responsible party, and other members of the Interdisciplinary Team. 

Documentation and Review: 

• The completed Chemotherapy/Radiation Communication Report must be reviewed and signed by the nursing supervisor. 

• All communication records are to be filed in the resident’s medical record. 

References: 

• Centers for Medicare & Medicaid Services (CMS), State Operations Manual (SOM) 

• Requirements of Participation for Nursing Homes, CMS