Oncologic Surgical Care Using an Enhanced Recovery Approach.

Enhanced recovery programs are multimodal, evidence-based perioperative programs designed to improve a patient's functional recovery after surgery. Enhanced recovery programs promote standardized, multidisciplinary care throughout the perioperative course to improve patient outcomes, rather than focusing on surgical technique. It is important for nurses working in acute and critical care to be aware of the paradigm shift created by the trend toward the enhanced recovery approach. By learning more about facets of the approach, the nurse will be better prepared to adopt whatever aspects of enhanced recovery their institution implements for the surgical oncology population. An overview is provided of the potential components of enhanced recovery.

Air-in-Line Alarms: Decreasing Alarms Through Antisiphon Valve Implementation.

The administration of 24-hour continuous chemotherapy infusions is common in certain regimens, such as EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin). Such regimens are notorious for clinically insignificant air-in-line (AIL) alarms because of the naturally bubbly composition of the drugs involved. An antisiphon valve, placed at the end of the IV tubing to pressurize the infusion and to minimize air bubbles, was found to decrease clinically insignificant AIL alarms. The positive outcomes of the current study could be applied to other infusions known for frequent clinically insignificant AIL alarms.

The Development of an Oncology Clinical Nurse Specialist Fellowship Program.

New graduate clinical nurse specialists (CNSs) face many challenges when starting their new role. To address this, a CNS fellowship program was developed to mentor new CNSs during their first year of practice. This CNS fellowship program would provide opportunities to increase skills related to each of the CNS spheres of influence, including nursing practice, patient care, and systems and organization. Experienced CNSs mentored CNS fellows and identified learning opportunities. The fellows completed an online self-assessment based on the National Association of Clinical Nurse Specialists CNS Competency Checklist during week one of orientation and again at months 3, 6, 9, and 12. The CNS fellows completed and presented three projects designed to explore the spheres of the CNS role, along with a formal onboarding. The results of the fellowship depicted significant competency development within all three CNS spheres at program completion. The CNS fellowship program provided structure and guidance to the newly graduated CNSs and clearly transitioned staff nurses to advanced practice nurses. The fellowship has demonstrated a positive effect on both the new CNSs and the organization in which it was developed.

Pain Assessment: Use of the Defense and Veterans Pain Rating Scale in Patients With Cancer.

BACKGROUND: Thorough, consistent pain assessment and reassessment are critical to guide and evaluate interventions designed to improve pain. OBJECTIVES: Based on a literature review about functional pain assessment, clinicians selected and then implemented the Defense and Veterans Pain Rating Scale (DVPRS) as a pain assessment instrument option in a comprehensive cancer center. METHODS: The DVPRS was added as a pain assessment instrument in clinical oncology practice. From postimplementation chart review and clinician satisfaction surveys, the DVPRS was evaluated for the following. FINDINGS: Seventy-eight percent of nurses surveyed (N = 64) preferred the DVPRS over any other pain assessment tool. Inpatient and ambulatory patients surveyed (N = 144) agreed that a Likert-type scale in the DVPRS was easier to understand, easier to use, and better in describing their pain than the numeric rating scale.

The effect of telephone reminders on attendance in respiratory outpatient clinics.

INTRODUCTION: Patient non-attendance is an area of concern for all health care providers. A randomized controlled trial was undertaken to investigate whether reminder telephone calls improved attendance at respiratory outpatient clinics in the English National Health Service (NHS). METHODS: Patients were randomly allocated into one of two groups, either telephone reminder group or usual care. The telephone reminder group received a reminder telephone call between 9 am and 5 pm during the week prior to their appointment. Attendance and demographic information (age, sex, diagnosis and home postcode) were recorded. RESULTS: A total of 504 patients were recruited, 258 patients were allocated to the control group and 246 patients were allocated to the telephone reminder group. Fifty-eight percent of the patients allocated to the telephone reminder group were not contactable. Within the telephone reminder group, of the 104 patients who could be contacted, 86% attended. There was a significant 15% increase in attendance in the contacted group (n = 104) when compared both with the control group (71%, n = 258) and with the patients who could not be contacted (68%, n = 142) (P = 0.007; P = 0.004). It was estimated that the cost of telephoning 200 patients could be offset by preventing one non-attendance. CONCLUSION: Routine telephoning of outpatients should become standard practice if reducing non-attendance is thought to be desirable, but general practitioner (GP) referral letters and hospital records of current hospital outpatients need to include an up-to-date telephone number. Consideration should be given to 'out-of-hours' reminder calls to maximize the contact rate.

Enhancing the accuracy of respiratory diagnoses in primary care: a report on the establishment of a Community Respiratory Assessment Unit.

AIMS: To establish a Community Respiratory Assessment Unit and to evaluate its role in enhancing the accuracy of respiratory diagnosis in primary care. METHODS: We established a central and peripatetic nurse-led service utilising semi-structured history taking, spirometry, oxygen saturation monitoring and semi-structured reporting, coupled with the provision of educational materials to both primary care physicians and patients. RESULTS: Phased access to the service was offered to 32 general practices. Use varied widely between practices and a total of 364 patients were referred in the first year. The single biggest diagnostic group consisted of patients with definite or suspected COPD, but the diagnosis was often not confirmed. Patient and GP satisfaction with the service was extremely high; without it misdiagnoses and inappropriate therapeutic trials are possible. CONCLUSION: A community respiratory assessment unit such as this is one way of offering a centrally-directed, quality-controlled, diagnostic support service for primary care physicians.