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.

Demonstrating the Value of the Clinical Nurse Specialist: A "How-to" Guide.

PURPOSE/OBJECTIVES: The purpose of this article is to provide a guide to identifying measurements of value and how to calculate different types of return on investment (ROI). Exemplars of clinical nurse specialist (CNS) work efforts with ROI will be presented. DESCRIPTION OF THE PROJECT/PROBLEM: The CNS is the oldest advanced practice role; however, the role can be vague, making it difficult to articulate the value of the CNS in the organization. Functioning in 3 spheres of impact, the CNS can easily impact practice; however, demonstrating the value of this work is not always on top of mind and is rarely taught in academic programs. OUTCOME: This article describes the difference between revenue generation, cost savings, and cost avoidance, as well as various structural, process, and outcome measures that can be used to calculate ROI. Resources available for performing ROI calculations will be described and shared. CONCLUSION: Distributing work across the 3 spheres creates various opportunities for the CNS to demonstrate value; however, the CNS must be able to articulate that value to the organization. Developing the skill set to consistently identify metrics can be challenging; however, it is critical to the ongoing success and future of the CNS role. Utilizing these metrics to demonstrate the value and then disseminating the outcomes of these contributions will continue to promote the value of the CNS in the future.

Successful Clinical Nurse Specialist Recruitment: Creating a Talent Pipeline.

BACKGROUND: The future of the clinical nurse specialist (CNS) role depends on nurses enrolling in CNS programs and having access to clinical experiences. At 1 institution, challenges with CNS recruitment and variations in how students were precepted were noted. This article describes a successful CNS student program and its value in creating a talent pipeline. PROJECT: A revision to student placements was initiated to create a formalized program including enhanced academic partnerships, standardized expectations and goals, assigned clinical projects and end-of-semester presentations, appointment of a student coordinator, and structured preceptor preparation. OUTCOMES: Outcomes included 100 placements for 50 different students; the primary source of recruitment for the organization is now prior students, with 17 being hired since program inception. A 325% increase was also noted in qualified preceptors. Student productivity increased, and 11 students were accepted for national presentations. Academic sites have reported increased satisfaction. CONCLUSION: Organizations looking to increase CNS recruitment should consider the revision of their student program. A centralized CNS responsible for student experiences can ensure standardization and provide preceptor support. The CNSs have an essential role in securing their future nationally and can do so through growing new talent and aiding in preparation for practice.

Implementation of an Evidence-Based Practice Change Removing Heparin From Implanted Vascular Access Devices.

The objective of this article was to describe the implementation and outcomes of an evidence-based practice change to remove heparin from implanted vascular access device (IVAD) management. An extensive search of the literature was performed, and articles were appraised and synthesized to determine the best practice. A common theme emerged from the literature, showing that 0.9% sodium chloride alone can be as effective as heparin in preventing occlusion in IVADs. In this nurse-led initiative, heparin was successfully removed from the IVAD deaccess process and replaced with a 0.9% sodium chloride flush using a pulsatile flushing technique. Alteplase administration rates were used to measure success of the project, with no statistically significant change observed in alteplase rates 6 mo postimplementation. Successful implementation of this practice change demonstrates that 0.9% sodium chloride may be used for IVAD lock when deaccessing.

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.

An Evidence-Based Approach to Increasing Nurses' Publication Rates.

BACKGROUND: Writing for publication in peer-reviewed journals is one of the most important types of writing that nurses engage in. It is essential for advancing the nursing profession, health care organizations, and individual nurses. Despite its importance, however, the rate of publication remains very low among nurses. At one large academic medical center, a baseline assessment of dissemination practices found a low publication rate. To address this, an evidence-based writing-for-publication program was designed to support professional dissemination of scholarly work. METHODS: A 12-week workshop was designed and writers were matched with a mentor. The workshop started with a four-hour kickoff session on the process of getting published, including choosing a journal, querying an editor, drafting a manuscript, and working with coauthors. Participants also began developing an outline for their manuscript. Drafts were due to the mentor every four weeks for editing and feedback. At the end of the 12 weeks a wrap-up session was held for participants to read each other's manuscripts and give peer feedback. OUTCOMES: As of this writing, five cohorts have completed the program, and 89 nurses participated. Twenty-nine manuscripts were completed and submitted to peer-reviewed journals; of these, 22 (76%) were accepted, four (14%) are still under review, and three (10%) were recommended for submission to a different journal. Among the 89 nurse participants, 84% reported being likely or very likely to write for publication again, and 96% reported improvement in their writing skills. CONCLUSIONS: Without more nurses acquiring the skills to engage in writing for publication, the body of advancing knowledge that drives clinical decision-making may wane as aging, experienced nurse authors leave the profession. To protect the future of nursing, a continuous commitment to developing nurse authors across all generations is necessary. Nursing leaders and health care organizations must commit to ensuring novice nurse authors are provided with the resources to engage in disseminating knowledge.

Building Evidence-Based Practice Competency Through Interactive Workshops.

BACKGROUND: Consistent implementation of evidence-based practice (EBP) leads to high-quality care, improved patient outcomes, and reduced costs. Increased job satisfaction, decreased turnover, and increased autonomy are reported when nurses use evidence for practice decisions. It is essential that clinical nurse specialists have strong EBP skills and enculturate these skills into bedside staff. PROJECT DESIGN AND IMPLEMENTATION: Interactive 90-minute workshops were developed to review the steps of EBP. The participants were nurses at the bedside and were encouraged to cultivate a spirit of inquiry. OUTCOME EVALUATION: Twenty-three workshops were held with 349 participants. Pre and post surveys were used to assess changes in knowledge and self-perceived confidence. A moderate to large effect size was noted in all areas measured. The largest change in knowledge was in correct identification of use of Boolean operators, which showed a 71% improvement. Overall mean knowledge improved by 29%, which was statistically significant (P < .0001). IMPLICATIONS FOR PRACTICE: Clinical nurse specialists can enact culture change by understanding the needs of their stakeholders and applying concepts to find creative ways to bring change to staff. This workshop successfully taught EBP concepts and implemented culture change in a way that was low cost and easy to replicate.

Clinical Nurse Specialists on the Night Shift.

BACKGROUND: Night-shift nurses care for complex and acutely ill patients but are frequently more junior compared with day shift. They often have less access to support resources such as educators and clinical nurse specialists (CNSs). This article describes the addition of night CNS positions, their roles, and associated outcomes. INTERVENTION: The night CNSs were implemented to perform a highly flexible set of activities including proactive rounding on high-risk patients and medications; code/rapid response support; education; nursing practice/policy reinforcement; providing psychosocial support to nurses, patients, and families; and responding to consults. To capture work effort at night and truly define the role of the night CNS, a shared consultation log was created. OUTCOMES: Between October 2017 to April 2019, 6053 CNS encounters were captured in 24 different categories. The top 5 reasons for consultation included policy/procedure education or change, education/in-service, nursing practice review/reinforcement, medication/blood administration, and clinical assist. Five hundred sixty-nine rapid response/codes have been responded to. There was also a 17% increase in event reporting on the night shift. Outcomes have continued to support additional budgeted positions for the nights and weekends. IMPLICATIONS: Night CNS expertise and knowledge are vital to offsetting novice nurse deficits in advanced assessment, which is paramount to patient outcomes. They provide support with on-the-spot education and empower individual development. Organizations should strongly consider implementation of this role or, if that is not possible, consider flexible scheduling into evening hours to support night staff.

Building a Renowned Clinical Nurse Specialist Team: Recruitment, Role Development, and Value Identification.

PURPOSE: This article will describe the outcomes associated with restructuring clinical nurse specialists (CNSs) into a centralized model with dedicated efforts focused on team and individual development. METHODS: A multiphase journey was undertaken to rebuild a team of CNSs after years of open vacancies and role confusion. After restructuring to a centralized model, a multiphase approach was taken that included innovative recruitment strategies, development of a talent pipeline through enhancement of student clinical placements, team and individual development activities, and value identification. Description of methods used for individual and team development is discussed in depth within this article, including achieving role standardization and optimization. OUTCOMES: Numerous outcomes were associated with this effort and are described within this article. Among them were the hiring of 21 CNSs, increased representation on hospital-wide committees and councils, quantification of the work contribution of CNSs within the organization, and a $1 568 229.36 cost avoidance associated with CNS work efforts, all in the first 24 months. CONCLUSION: As challenges facing the role put it at risk and healthcare becomes increasingly value based, the need for expert clinicians who can demonstrate their value becomes essential. Clinical nurse specialists and hospital leadership can benefit from exploring successful interventions to rebuild CNS teams to achieve these goals.

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.

Integrating Peer Review into Nursing Practice.

: Clinical nurses develop a program to strengthen professional relationships and practice.

Nurse Practitioner-Driven Optimization of Presurgical Testing.

Nurse practitioners play a pivotal role as members of the perioperative team. This article outlines the evolution of presurgical testing from the vantage of generic testing to one that is tailored to the patient's clinical presentation and the type of surgery to be performed, whether it is high, intermediate, or low risk. Emphasis is placed on indicated testing, screening tools to identify patients at risk for perioperative complications, the optimization of patients before undergoing major cancer surgery, and enhanced recovery after surgery. The goal was to bring awareness to our colleagues that evidence-based practice defines the present role of the nurse practitioner in this setting and evidence will shape its future direction.

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.

CE: Breast Cancer Screening: A Review of Current Guidelines.

: Breast cancer accounts for more than a quarter million diagnoses each year in the United States. Routine screening is the primary method used to detect cancer in its earliest stages, before symptoms develop. Recent changes to national screening guidelines have resulted in a lack of consensus and confusion among health care providers and the public. This article reviews the guidelines of the American Cancer Society, the U.S. Preventive Services Task Force, and the National Comprehensive Cancer Network and provides guidance to nurses as they support and educate patients.

Scalp Cooling: A Literature Review of Efficacy, Safety, and Tolerability for Chemotherapy-Induced Alopecia
.

BACKGROUND: More than 75% of patients with cancer cite alopecia as the most feared side effect of treatment, with as many as 10% considering treatment refusal. Despite wide acceptance in other countries, scalp cooling to reduce chemotherapy-induced alopecia (CIA) has been uncommon in the United States because of longstanding concerns of scalp metastases and a lack of reliable efficacy data. 
. OBJECTIVES: This article reviews 40 years of efficacy, safety, and tolerability literature on scalp cooling to prevent CIA. â€©. METHODS: A systematic review was performed in PubMed and CINAHL®. Forty articles were reviewed, with 12 articles demonstrating high levels of evidence and meeting inclusion criteria. Comparative trials, systematic reviews, and one large single-arm trial were included. â€©. FINDINGS: Scalp cooling efficacy is dependent on many factors but demonstrates better hair preservation than no cooling. No increase in scalp metastases or statistically significant difference in overall survival was seen in retrospective safety data when cooling was used. Few patients discontinue cooling early because of adverse experiences.

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). 
. METHODS: Common immune-related toxicities, as well as rare and refractory toxicities, are reviewed. 
. 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.

The Big 3: An Updated Overview of Colorectal, Breast, and Prostate Cancers.

This article provides a current overview of colorectal, breast, and prostate cancers. For each cancer, data related to incidence and prevalence are discussed, as well as nonmodifiable and modifiable risk factors. Information about detection and evidenced-based screening guideline recommendations is reviewed, with the most common and recent treatment modalities emphasized. Current clinical and treatment-related issues are discussed along with nursing care and implications for cancer care. Future directions for these 3 cancers are addressed also.

Comparing Self-Injection Teaching Strategies for Patients With Breast Cancer and Their Caregivers: A Pilot Study.

BACKGROUND: A prospective, quasiexperimental pilot study with a sequential design was performed to compare two methods of teaching self-injection. OBJECTIVES: The study examined 50 patients with breast cancer undergoing adjuvant or neoadjuvant treatment and their caregivers to determine if simulation during the teaching experience affects patient/caregiver satisfaction, worry, and self-confidence, as well as nurse satisfaction. METHODS: Structured questionnaires were administered before the teaching, immediately after the teaching, and after the injection was performed at home. Nurses who performed the teaching also completed a questionnaire after the teaching. FINDINGS: Use of simulation did not affect patient/caregiver satisfaction, worry, or self-confidence. The largest impact on learner worry was the actual teaching experience, regardless of the methodology used. Nurses reported greater levels of satisfaction when simulation was part of the teaching. Patient/caregiver satisfaction with the teaching experience decreased after performing the injection at home. Additional research is needed to identify the best methodology for teaching patients and caregivers self-injection. Data from this study revealed that the addition of simulation during teaching does not always translate to better education. In addition, based on patient/caregiver reports, no substitution exists for actual injection administration.