A survey containing two questions on demographic characteristics of respondents and 16 questions on guideline adherence of nurses regarding chemotherapy administration was developed by two of the authors (KK, YK). Questions were designed to evaluate the guideline adherence of nurses relative to CASS. We selected components of CASS which pertained to nurses and formulated questions to evaluate the guideline adherence to selected components of CASS. In addition to selected questions based on CASS, one question regarding the identity of labels inside and outside of a shaded cover (question 5) was added to the survey. Respondents were asked to choose 'yes' or 'no' to each question. If a respondent considered both 'yes' and 'no' to be inappropriate for any given question, a separate space was provided for the respondent's opinion. The process examining the reliability and validity of the questionnaire in a separate population was not performed.

Survey sheets were printed and distributed to all in-patient departments in our hospital in which chemotherapy was performed, and all clinical nurses in the department (n=202) were asked to respond. The survey sheet contained no identification information about respondents and no incentive for survey completion was offered. We did not file for the approval of the Institutional Review Board because this study was a survey on nurses.

For responses which were neither 'yes' nor 'no,' two of the authors (KK, YK) independently evaluated the responses of the respondents and classified the responses into 'yes,' 'no,' or 'no analysis.' The 'no analysis' category included no responses and responses which could not be classified into 'yes' or 'no.' When there was a discrepancy in the classification of responses by the two authors, classification discussion between the two authors ensued and consensus was achieved. When a response was classified as 'no analysis,' the response was excluded from the analysis.

Descriptive analysis was performed using SPSS ver. 13.0 (SPSS Inc., Chicago, IL, USA). The percentage of 'yes' responses to each question were calculated, and was the basis for determining the guideline adherence rate. The association of demographic characteristics with guideline adherence to each question was evaluated using the chi-square test or Fisher's exact test with a statistical significance of 0.05.

Of 202 nurses surveyed, 123 responses were collected (61% response rate). The characteristics of respondents are summarized in Table 1. Nearly 80% of the respondents had >3 years of clinical nursing experience in nursing, and greater than one-half of respondents indicated that 10% to 40% of their patients were chemotherapy patients.

For most questions, the respondents reported that they adhered to guidelines very well. Specifically, for 13 of 16 questions, the guideline adherence rate was ≥85%. Only 3 questions (questions 6, 8, and 11) had guideline adherence rates <85%. Of the respondents, 29% indicated that they did not conduct routine bedside double-checking of the route and sequence of chemotherapeutic agent administration (question 6). Twenty-three percent of the respondents reported that they did not feel competent in performing CPR (question 8). Only 45% of the respondents reported the presence of a standard competency monitoring in the hospital or their departments (question 11).

Many responses to questions about intrathecal chemotherapy (questions 7 and 14) were classified a 'no analysis', because many respondents had no experience with intrathecal chemotherapy (Table 2).

The extent of experience as a clinical nurse was associated with the perceived competency in performing CPR. Nurses with ≥7 years of clinical nursing experience in nursing felt more competent in performing CPR than nurses with <7 years of clinical nursing experience (Table 3).