Rethinking the need for a platelet transfusion threshold of 50 × 109 /L for lumbar puncture in cancer patients.

BACKGROUND: Lumbar puncture (LP) is a frequently performed diagnostic and therapeutic procedure in oncology patients. Transfusing to a minimum preprocedural platelet threshold of 50 × 109 /L is widely upheld without good quality evidence. The objective was to compare the outcomes of LPs performed with platelets above and below this threshold. An increased risk of adverse events in patients with lower platelet counts was not expected. As a corollary, transfusion reaction rates incurred by transfusing to this recommended threshold are also reported. METHODS: A total of 2259 LPs performed on 1137 oncology patients (adult, n = 871, and pediatric, n = 266) were retrospectively analyzed between February 2011 and December 2017. The incidence of LP-related complications for groups above and below the minimum platelet threshold was compared. Traumatic tap was defined as 500 or more red blood cells per high-power field in the cerebral spinal fluid. Groups were compared using the 2-Proportion Z-test and Fisher exact test. RESULTS: At time of LP, the total number of events with platelets less than 50 × 109 /L and 50 × 109 /L or greater were 110 and 2149, respectively. There were no significant differences in LP-associated complications between patients with platelet counts above or below 50 × 109 /L (P = .29). Patients with a pre-LP platelet count of less than 50 × 109 /L had a higher proportion of traumatic taps (P < .001). Three patients developed transfusion-related adverse events. CONCLUSION: Patients with platelet counts less than 50 × 109 /L did not have a higher incidence of clinically significant post-lumbar puncture complications (P = .29).

Effectively Communicating Practice Changes to Frontline Nurses.

PURPOSE/OBJECTIVES: Communication of practice changes to frontline nurses across an organization can be difficult. Frequent daily communication to all nursing staff can be ineffective and lead to email fatigue and information overload. The purpose of this article is to further describe the communication intervention developed to disseminate practice changes and the critical modifications made over time to ensure its continued success and sustainability. DESCRIPTION OF THE PROJECT/PROGRAM: In 2019, this team from a multisite institution developed a monthly email correspondence, called the Evidence-Based Practice Update, sent to local leaders to disseminate important policy and practice updates and reminders to more than 3400 nurses. This strategy was initially successful in reaching the nurses yet lacked a method to ensure accountability that each nurse has read the content. A quick response code was added to track monthly readership, and clinical nurse specialists were leveraged to ensure practice changes reached, reviewed, and understood by nurses across the institution. OUTCOME: Metrics were tracked for quick response code scans and demonstrated an increase in readership over time. By combining various alerts into the single correspondence, fewer daily notifications to staff were sent. The EBP Update email dissemination structure involving local leaders was well received. CONCLUSION: This article describes how a standardized communication strategy coupled with thoughtful leadership engagement improved uptake of important practice information by nurses across a vast institution.

Oncology Clinical Nurse Specialists Practice in the Outpatient Setting.

PURPOSE/OBJECTIVES: With rapidly evolving oncology care, the role of the outpatient clinical nurse specialist is most valuable and essential. The purpose of this article is to describe the role of the clinical nurse specialist in the ambulatory oncology settings and highlight the clinical nurse specialists' unique influence across the spheres of impact. DESCRIPTION OF THE PROJECT/PROGRAM: This article shares several contributions of an outpatient clinical nurse specialist, which include ways this role impacts nursing practice, patient care, and standardizing organizational guidelines. A method of recording the clinical nurse specialists' encounters or indirect consults was also utilized to provide a process to log consultation received in the day-to-day practice. Work exemplars were included to further demonstrate the impact of this role in this setting. CONCLUSION: Outpatient clinical nurse specialist need is rising especially in the oncology setting where the majority of cancer care and treatment is delivered. It is important to continue to disseminate and highlight the value it brings to the organization.

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.