Administration of Chemotherapy in University Clinical Center of Kosova by Nurses

Policy development on chemotherapy management has increased the demand for deeper knowledge in this field. In this way, there was a need to identify, recognize the consumption trends of chemotherapeutic and prioritize the interest of regulatory bodies, as well as to design programs for health education. In 1978 for the first time in Kosovo, a Hematology Department was established within the Internal Diseases Clinic by Dr. Shaban Geci. In 2013 it became a Clinic of Hematology. The Department of Clinical Hematology deals with the diagnosis of hematologic and hematopoietic diseases including eryt-hrocytes, leukocytes, platelets as well as malignant diseases. Within the department is also the location for puncture and biopsy of the bone marrow as well as for ultrasonography. Methods: The study was prospective and was conducted at University Clinical Center of Kosova (UCCK) and is based on an anonymous survey designed specifically for this purpose. The subject of the analysis was the available space for hospitalization and administration of chemotherapeutic at UCCK, the existence or not of written protocols, and available technical equipment. Results: Respondents were asked how many nurses handle the administration of cytostatic at the clinic where they work. 48% of respondents state that 1 - 5 nurses deal with cytostatic administration, 52% of respondents say 1 - 15 nurses deal with cytostatic administration, while alternatives 6 - 10 nurses and 16 and more nurses were not selected by no respondents.

DOI: 10.4236/ojn.2020.105035 514 Open Journal of Nursing for deeper knowledge in this field. In this way, there was a need to identify, recognize the consumption trends of chemotherapeutics and prioritize the interest of regulatory bodies, as well as to design programs for health education. What Rational Management (justified) of chemotherapeutics means for patients is that treatments with chemotherapeutics are consistent with their clinical needs; also, that they are given in appropriate doses, for as long as needed, and at the lowest possible financial cost to the patients.
Irrational Administration (unjustified) is the administration of chemotherapy in a way that does not comply with the therapeutic standard [1]. It is considered that worldwide, around 50% of drugs are administered, prescribed or used inappropriately, while 50% of patients fail to recover adequately.

Aim of Research
The main purpose of this research on the administration of chemotherapeutics is to rationalize the administration of chemotherapy by nurses to patients at the University Clinical Center of Kosovo. In more detail, the paper argues that it analyzes the good and bad sides of the work of nurses who are dedicated to the application of chemotherapeutics at UCCK. The study will describe the current situation, trends in prescribing chemotherapeutics and their application at different levels of the health system.
The study also assesses the suitability of chemotherapy administration and generally assesses the association between prescribing data and prescribing indications. This assessment aims to improve the quality of health care, given the growing interest in assessing the economic impact of healthcare and medical technology.
The common forms of unjustified administration of chemotherapeutics: Administration of many chemotherapeutics to the same patient; Inappropriate administration of chemotherapy, often in incorrect doses, or for non-bacterial infections; Failure to prescribe therapeutics according to clinical guidelines; Self-treatment, with chemotherapy to be given by prescription only [2].
suppression. These unwanted side effects occur not only in patients treated with chemotherapeutics, but also pose a risk to health staff, especially when they are involved in the preparation of the chemotherapeutic drug (pharmacy) and administration (Nursing). Moreover, it can affect personnel involved in the distribution, transportation, and disposal of chemotherapeutic drugs as well as the technical and laboratory staff [5] (for example, during maintenance of safety cabinets or the patient's blood or urine [6] analysis). At the Clinic for Hematology exists semi-intensive with four beds, where the Chemotherapy applies. The clinic has two employed professors of the Internal Medicine-Hematology, a hematologist and one specialist in internal medicine. This clinic has 15 nurses. In this clinic diagnosed, treated the sick with the pathology of various hematological and blood-oncology. Also the clinic treated patients with acute leukemia.

Methods
The study was prospective and was conducted in UCCK. The subject of analysis was the facilities available for hospitalization and administration of chemotherapists at UCCK, the existence or not of a written protocol, the available technical equipment and the availability of a consultant. Quantitative methods were used where we conducted surveys with nurses administering chemotherapists in different departments of the UCCK. Analytical methods were also used where we analyzed various documents and standards relating to the use of chemotherapists. A descriptive method was also used in this paper, where we described various theories of competent authors (Thomas Connor, Robert Mclauchlen, Mark Ba, Yk Change, Te Vaughn) [8] [9] [10] [11] on the application of chemotherapeutics and the role of nurses in this process.

Samples
Sample in this research are 33 health workers dealing with the administration of chemotherapy at UCCK. Although seemingly reflected by a small number of respondents, this number is the total of health workers who are engaged in the administration of chemotherapy at UCCK; therefore, there was no other option

Instrument
The measurement tool in this paper is a survey guide, containing 21 structured questions, which gives the respondent the opportunity to round out one of the alternatives given in each question. This means that each respondent had the same questionnaire, the same question, and the same alternatives to answer. The instrument was developed based on previous theories and standards of chemotherapy administration, where it was then formulated and finalized with the help of a mentor. For the construction of the questionnaire, we mainly relied on the title of the paper, the purpose and hypotheses of this paper, so that each question was related to the topic we were exploring.

Procedure
To conduct the survey first, I obtained permission from the Hematology, Oncology and Pediatrics Department. I then informed the respondents about the purpose of the research. The respondents were not pressured to provide the correct answers, and each one responded without bias, providing the deserved approval. After the survey, I collected and interpreted the data using the Excel application. Through this program, I generated charts and tables where I presented them as a percentage. Questionnaire administration time was 30 minutes.

Ethical Principles
After the topic was approved by the AAB College administration, I signed the Statement of Academic Honesty. I stated and always adhered to the principle that I would refer accurately to all sources of literature used in the work, and I was also aware of the consequences of false statements.
Even with respect to the survey, I adhered to ethical principles where I gave confidentiality to all respondents and promised them that the survey data would only be used for master purposes.

Results of the Quantitative Research
If we look a Figure 1, we can see that the age of the respondents in this survey is as follows: 12% belong to 21 -30 years, 40% 31 -40 years, 21% of those surveyed 41 -50 years. Years, 24% of respondents are 51 -60 years old, while 3% are 61 -65 years old.
When it comes to the gender of the respondents, 18% of the respondents are male and 82% are female. This clearly shows that in the departments or clinics Respondents were asked if they had received some training in the use of cytostatic. Out of the total number of subjects, 33% of them received training, while 67% did not receive training in cytostatic administration.
If they do regular check-ups because they give cytostatics, 100% of respondents say they do not do regular check-ups. None of the respondents stated this, which is a bit worrying.
Respondents were asked how many nurses administer cytostatics at the clinic where they work. 48% of respondents indicated that 1 -5 nurses were involved in cytostatic administration, 52% of respondents said that 1 -15 nurses were involved in cytostatic administration, while no alternatives were selected by 6 -10 nurses and 16 or more nurses. See Figure 2.
One of the questions that we asked the respondents was whether there is a dedicated space for administration of cytostatic. 55% of respondents confirm that they have the dedicated space, while 45% of respondents deny this.  Respondents were asked where the medication was stored before administration. 61% of respondents state that they are kept at a central pharmacy, 39% of respondents state that they are kept in a doctor's department, while none of the respondents state that they are in a patient.
Respondents were also asked where the medication was prepared before their administration. 18% of respondents declared in the central pharmacy, 58% of respondents declared in the pharmacy, while 24% of those declared in the hospital room.
Whether the drug is transported in specially marked containers, 42% of respondents state that, while 58% of the respondents state that the drug is not transported in specially marked containers.
One of the questions we asked respondents was whether there was a special space for the administration of cytostatic. 55% of respondents confirm this, while 45% deny it.
Respondents were asked if there were special locker rooms in which staff managing cytostatic changed before and after administration. 100% of respondents thus denied the conclusion that no clinic in the UCCK managing cytostatic has special changing rooms for staff administering cytostatic.
One of the questions we asked was what was the entrance to the room where the cytostatic were given. 64% of respondents say access is restricted to staff only, 15% of respondents say access is free for all healthcare professionals, while 21% of respondents say access is free for everyone.
Regarding the food and drink consumed in the room where the cytostatic are given, 39% of respondents say that they are allowed to eat and drink, while 61% deny it.
If there were written instructions on how to administer cytostatic, 82% of respondents stated that there were written instructions on how to administer cytostatic, while 18% denied it.
One question in our study related to where cytostatic are dumped after administration. 39% of respondents stated that they were thrown into ordinary baskets, while 61% said that they were thrown into baskets specifically intended for cytostatic waste management.
Subjects were asked whether they were preparing the patient before intramuscular or intravenous injection. In this question, 100% of the respondents stated that they were preparing the patient before intramuscular or intravenous injection.
Have the subjects ever been pierce during intramuscular or intravenous therapy, 64% of respondents claimed to have been pierce during intramuscular or intravenous therapy, while 36% denied.
Respondents were asked if they were mistaken for a lack of pharmacological knowledge. 58% of respondents admit this, while 42% of respondents deny this by suggesting that they did not make a mistake because of a lack of pharmaco-

Discussion of the Results of Quantitative Research and Their Comparison with European Practices and Standards
According to ISOPP standards for the use of cytostatic, all personnel involved in the treatment of cytotoxic drugs, including transportation, storage and cleaning of facilities, must be trained in the use of personal protective equipment and safe treatment procedures. These staff members should be evaluated regularly to verify adherence to procedures. Cytotoxic drugs should be treated and stored by pharmacy-trained staff [12].
The other finding is that none of the subjects do regular screening because they apply cytostatic, which is quite worrying. According to ISOPP standards for the use of cytostatic, personnel responsible for engaging in parenteral cytotoxic drug manipulation should undergo basic testing that includes assessment of indicators such as complete blood screening, liver function tests, urea, creatinine and electrolytes.
These measurements can then be used to compare any of the following measures taken routinely or after accidental exposures. Regular follow-up, which includes a thorough blood test and differentiation, should be offered at least six months apart. Institutions should have a written policy for the initial and regular monitoring of staff involved in the preparation of cytotoxic drugs [13].
Generally speaking, the number of nurses involved in the administration of cytostatic in the clinic where they work is very small where there is a need for increased staffing.
It became clear that before their administration, drugs were stored in central pharmacies and partly in pharmacies. Even when these drugs are prepared before administration, they are generally prepared in the physician ward, with exceptions in the hospital room.
It is worrying that research results show that the drug is not transported in specially marked containers. However, the space dedicated to delivering cytostatic is solid. According to ISOPP standards for the use of cytostatic, primary containers and cartons should be designed to minimize the risk of fracture by the use of explosion-proof materials. These include bottles made of indestructible plastic material, glass bottles fixed in specially designed plastic containers, or glass bottles wrapped in plastic to prevent contamination in the event of glass breaking [14]. One thing to note in the research is that no clinic at UCCK that provides cy- tostatic has special wardrobes for staff applying cytostatic. Even for the conditions in which the cytostatic is given. Most of the respondents stated that the conditions were poor and did not even meet the minimum criteria for such a room.
The results show that in a room where cytostatic are administered, the entrance is restricted to staff only, in some small cases entry is free for all healthcare professionals, while very few state that entry is free for all.
It is a worrying finding that food and drink are allowed in these areas. This is despite the fact that there are written instructions on how to administer cytostatics. By ISOP standards, it is strictly forbidden to eat, drink, chew or use cosmetics. In addition, staff at the training center may not wear rings, earrings, bracelets or other jewelry.
The results show that nurses think that professional experience influences their mistakes. According to Mrayyn and others, although medications can be caused by the mistakes of all members of the healthcare team, mistakes in the nurse are most common. The reason is that nurses perform most of the medical orders and spend about 40% of their time in the hospital administering medication [15].
They also show that they are sometimes punctured during intramuscular or intravenous therapy. The results confirm that they made mistakes in the absence of pharmacological knowledge. According to Mason, nurses have little knowledge of drugs; especially in calculating drug dosage but also in managing pharmacological knowledge. Poor knowledge can be the result of deficiencies in nursing primary education or lack of ongoing maintenance training during work years [16].
Another issue that was observed in the study was that the subjects had an infection during the administration of chemotherapy. They claim that extended hours affect their work.

Verification of Hypotheses
In this thesis, two hypotheses have been put forward which we have been able to validate through quantitative research and literature review.
H1. Nurses' knowledge of chemotherapeutic administration affects their errors in working with the patient. This hypothesis is confirmed by quantitative research where respondents were asked if they had made mistakes in the absence of pharmacological knowledge. 58% of respondents admit this. Hypothesis is also supported by the theory of Marylin, who find that medication errors can be caused by all members of the health care team; medical nursing errors are the most common. The reason is that nurses carry out most of the medical orders and spend about 40% of their time in the hospital administering medications [17].
H2. Overtime negatively affect in nurse's performance in the admirations of cytostatic.
The second hypothesis is also tested by asking whether the overtime negative-  One thing found in the study is that no clinic at UCCK that manages cytostatic has special wardrobes for staff applying cytostatic. Even for the conditions in which cytostatic is given. Most of the respondents stated that the conditions were poor and did not even meet the minimum criteria for such a room. It is also worrying that food and drink are allowed in these areas.

Funding
The study was financed by author