An Evidence-Based Review of the Safety and Efficacy of Remote Chemotherapy Verification

In response to the nursing shortage and the emergence of telehealth opportunities, the Oncology Nursing Society used an evidence-based approach to examine current literature and trends for the two-person independent double ch.

Penicillin Allergy Testing: An Outpatient Nurse-Driven Program for Patients With Cancer

BACKGROUND

Penicillin allergy testing (PAT) can decrease the use of unnecessary antibiotics by clarifying who is truly allergic.

OBJECTIVES

This article describes the development and implementation of an oncology outpatient nurse-driven PAT program.

METHODS

A nurse-driven program, initiated with allergy screening at the first encounter, was designed to identify patients with oncologic diagnoses eligible for PAT. Once verified eligible, patients undergo a three-step testing process (scratch test, intradermal injection, and IV challenge dose) administered by the infusion nurse.

FINDINGS

From November 2018 to December 2019, 82 outpatients with reported penicillin allergies were screened; 90% were eligible for PAT, and 97% of patients tested were negative for penicillin allergy. A significant reduction in aztreonam use among patients admitted for hematopoietic stem cell transplantation was also noted as compared to before PAT was offered.

Reducing the Incidence of Amiodarone-related Phlebitis Through Utilization of Evidence-based Practice

BACKGROUND

Intravenous (IV) amiodarone has multiple indications including treatment of hemodynamically unstable patients and the prevention of atrial or ventricular arrhythmias after thoracic surgery. Inflammation of the vein, or phlebitis, is the most common adverse event associated with peripherally administered amiodarone. In 2017, a rise in reported phlebitis incidents was occurring at one large academic medical center.

AIM

This evidence-based quality improvement initiative aimed to decrease and enhance early detection of phlebitis in patients receiving amiodarone.

METHODS

Due to the variation in assessment and management standards, evidence-based practice (EBP) methodology was utilized to establish a process for quality improvement. A thorough literature search was completed, identifying evidence-based interventions to decrease phlebitis and enhance early detection. Thorough critiques of the literature and synthesis of the evidence were completed. Multidisciplinary guidelines based on the literature were created. The guidelines included interventions such as an increase in IV assessment frequency, vein selection criteria, and the utilization of a standardized grading tool for assessment.

RESULTS

Phlebitis was reduced by 30%-88%. In the first 6 months post-intervention, there was a 48% reduction in phlebitis cases. In addition, the severity of phlebitis and the quality of reporting also improved dramatically.

LINKING EVIDENCE TO ACTION

This evidence-based quality improvement process led to identifying relevant knowledge gaps in care that could be streamlined into everyday nursing practice to decrease patient harm. This paper describes an in-depth process of how EBP helped to quickly take a clinical inquiry and adapt change based on findings from the evidence. Other organizations can utilize EBP to solve patient safety concerns using similar processes.

Extremity Cooling: A Synthesis of Cryotherapy Interventions to Reduce Peripheral Neuropathy and Nail Changes From Taxane-Based Chemotherapy

BACKGROUND

Taxane-based chemotherapies are frequently used to treat solid tumor cancers. Two significant side effects include nail changes and/or peripheral neuropathy. These side effects can cause pain, infections, dose reductions, and treatment delays, all of which negatively affect quality of life.

OBJECTIVES

This article synthesizes the literature on efficacy and tolerability of extremity cryotherapy during taxane administration to identify if it is an intervention that can be provided to patients to mitigate these symptoms.

METHODS

A literature review was performed using PubMed®, the Cochrane Database of Systematic Reviews, Ovid, Web of Science, and CINAHL®. 46 articles were initially identified, and 10 articles were reviewed (5 related to nail changes and 5 related to neuropathy).

FINDINGS

Larger, powered studies are needed on these topics; however, existing data suggest this intervention as a promising low-risk option for mitigating the severity of nail changes and peripheral neuropathy related to taxane chemotherapy.

Patient Education Issues and Strategies Associated With Immunotherapy

OBJECTIVE

To provide education strategies to health care providers caring for patients receiving immunotherapy and who are managing the various potential adverse events related to these treatments.

DATA SOURCES

Peer-reviewed literature.

CONCLUSION

Delivering patient education on immunotherapy based on a thorough educational needs assessment and identification of learning barriers may contribute to effective patient outcomes and patient safety.

IMPLICATIONS FOR NURSING PRACTICE

It is a critical role of the nurse to educate and empower patients and caregivers with the ability to identify early signs of impending toxicities related to immunotherapy regimens. With continuous learning and clinical experience, oncology nurses are at the forefront for providing high-quality immunotherapy education to patients and caregivers.

Consumer demand and implementation of a scalp cooling program at a multi-site organization

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Background: Alopecia is so feared that patients may opt to forgo treatment or elect for a less effective treatment to prevent it. Consumer demand for scalp cooling has been on the rise recently and has escalated since the Food and Drug Administration cleared the use of scalp cooling machines to minimize chemotherapy-induced alopecia. This organization required a clinical support model to implement this unique intervention and to establish its own benchmarks for safety and quality. Methods: With no precedent for implementation, nursing, administration, facilities, information technology, finance and legal collaboratively established a process for integrating scalp cooling into current practice. Policies, patient education, staff training programs, billing codes and electronic documentation were created; technological solutions for tracking and scheduling patients at multiple sites were established; infection control and biomedical machine management systems were put into place. Results: Initially, eight sites offered scalp cooling for female breast cancer patients receiving alopecia-inducing chemotherapy. After expanded approval for all solid tumor patients, the program grew to all sites (n = 13) providing chemotherapy using one standard process. All sites implemented scalp cooling utilizing existing treatment space and schedules. To date, more than 800 cooling treatments have occurred. Conclusions: Patient priorities must be clinician priorities. A multi-site organization must respond to new research and consumer demand. Successful integration into the patient experience depends on alignment between providers, nursing, and support departments and forward thinking for scalability.

Scalp Cooling: Implementation of a Program at a Multisite Organization

BACKGROUND

Chemotherapy-induced alopecia is a well-known side effect of some types of cancer treatments. With U.S. Food and Drug Administration clearance of two scalp cooling machines, patients with cancer now have the opportunity to minimize this hair loss. However, multiple barriers can exist for organizations when establishing a scalp cooling program.

OBJECTIVES

This article describes the experience of a large multisite organization that implemented a machine-based scalp cooling program.

METHODS

Nursing staff led an interprofessional team that addressed components of the program. As a result, eight sites within the authors' organization simultaneously began offering scalp cooling via machine using a single unified process. This approach was then successfully replicated one year later to prepare six additional sites to launch scalp cooling for other solid tumor types beyond breast cancer.

FINDINGS

Using a structured, collaborative, and interprofessional approach to the implementation of a scalp cooling program at the authors' institution allowed for standardization of care across sites. This approach can be replicated at other healthcare institutions.

Checkpoint Inhibitors: Common Immune-Related Adverse Events and Their Management

BACKGROUND

Immunotherapy, specifically the use of checkpoint inhibitors, offers patients with cancer an alternative to chemotherapy, targeting different pathways to destroy cancer cells. The side effects of immunotherapies, as well as their impact on normal tissue, need to be assessed and managed based on their mechanisms of action.

OBJECTIVES

This article presents an overview of immune-related adverse events (AEs). 
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METHODS

Common immune-related toxicities, as well as rare and refractory toxicities, are reviewed. 
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FINDINGS

Immunotherapy treatment is an option for many patients with cancer, and nurses must understand the distinct side effect profile of these agents. Prompt identification and expert management are the cornerstones of success when dealing with immune-related AEs, and oncology nurses play a key role in improving patient care.

CE: A Review of Common Oral Treatments for Breast Cancer: Improving Patient Safety in Nononcology Settings

: Breast cancer patients are living longer with the disease than ever before. According to the National Cancer Institute, more than 3 million women in the United States are currently living with a breast cancer diagnosis, and many seek care in nononcology settings, whether for treatment, acute symptoms and complaints related to their cancer diagnosis, or unrelated concerns. Yet many nononcology providers are unfamiliar with the various oral agents used to treat breast cancer, and their possible adverse effects and drug interactions. It is imperative that all providers be aware of these agents and know when a patient is currently taking or has taken them. This article provides an overview of the most common oral treatments for breast cancer and discusses common adverse effects and management.

Nipple-Areola Tattoos: Making the Right Referral

PURPOSE/OBJECTIVES

To examine oncology care providers' knowledge of tattooing options for patients who have elected to have breast reconstruction as part of their breast cancer treatment. 
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DESIGN

Cross-sectional survey.

SETTING

A large metropolitan cancer center in New York and various locations across the United States
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SAMPLE

68 oncology care providers who work with women with breast cancer, distributed into two groups.

METHODS

Descriptive statistics were used to summarize online survey responses for the two groups, with inferential comparisons made with logistic regression models
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MAIN RESEARCH VARIABLES

Healthcare profession, discussion of reconstructive tattoo options with patients, knowledge of providers of reconstructive tattoos outside of traditional healthcare settings, and recommendations made to patients
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FINDINGS

RNs were significantly less likely to recommend a professional tattoo artist to a patient than non-RNs, despite a similar proportion of both groups believing that a tattoo artist would provide the patient with a better tattoo than healthcare providers (HCPs).

CONCLUSIONS

Additional research is needed to identify education deficits in HCPs regarding tattoo reconstruction options. HCPs are recommending potentially substandard options for nipple-areola tattooing, even though many believe that tattoo artists, who are outside of the traditional healthcare setting, could provide better outcomes for patients.

IMPLICATIONS FOR NURSING

Nurses and other HCPs require additional education about nipple-areola tattoo options for patients following breast cancer surgery
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Increasing certification through unit-based education

Certification has been identified by multiple organizations as an important component and means of elevating the level of nursing care provided to patients and demonstrating to the public that the nursing staff has subspecialty knowledge. Certification may lead to improved patient satisfaction and outcomes as well as increased nurse satisfaction and retention. Despite the known potential benefits associated with certification, institutions struggle to improve certification rates. One possible method to overcome system barriers to certification is the implementation of a unit-based study course to prepare nurses for the Certified Breast Care Nurse (CBCN) examination. Data collected by an author-developed tool as one institution created and executed a unit-based study course suggest that such an approach increased certification rates and improved disease-specific knowledge and confidence among the staff, despite no official data existing on the tool's reliability and validity. Implementation of similar programs may be successful in improving certification at other institutions seeking to raise certification rates.