Evaluation of an Interprofessional Training Program to Improve Cancer Drug Therapy Safety.

PURPOSE: Drug therapy for cancer is a high-risk, high-volume clinical intervention that requires interprofessional teams. Given the complexity of anticancer drug therapy and safety concerns, an interdisciplinary team developed a novel training program for oncology registered nurses and pharmacists to improve cancer drug safety. METHODS: Participants completed preworkshop learning assessments and received access to web-based modules on six topics: hazardous drug handling, drug extravasation, hypersensitivity reaction management, sepsis recognition, immune checkpoint inhibitor toxicities, and oral oncolytic adherence. In a 7-hour workshop, participants applied module content in interactive exercises and high-fidelity simulations. Preworkshop and postworkshop questionnaires assessed changes in knowledge and confidence in each topic. Program satisfaction and changes to clinical practice or policies were assessed 3 months after the workshop. RESULTS: Two hundred ninety-two nurses and 82 pharmacists applied to participate, and 103 (35%) and 44 (54%) have participated, respectively. Long-term follow-up data were available on 133 (90%) participants. Change scores in confidence to meet program objectives increased between pre- and postworkshop (range of increase 0.6-0.8, P < .01). Knowledge scores increased significantly between pre- and postworkshop (average improvement of 3.2 points, P < .01). Overall program satisfaction was high (mean 5.0, standard deviation [0.2] on a five-point scale). Seventy-seven (60%) reported that they had made at least one clinical practice or institutional policy change at 3 months. CONCLUSION: An interprofessional education program with online modules, in-person interactive sessions, and simulation activities is a promising strategy to deliver cancer drug safety content to practicing oncology clinicians.

Hemophagocytic Lymphohistiocytosis.

Hemophagocytic lymphohistiocytosis is a life-threatening condition associated with hyperinflammation and multiple organ dysfunction. It has many causes, symptoms, and outcomes. Early recognition is critical for treatment. Fever, cytopenias, coagulopathy, and hepatosplenomegaly are hallmark findings. Identifying the trigger event is crucial but challenging because of the varied presentations and infrequent provider experience. Diagnostic features include anemia, thrombocytopenia, neutropenia, elevated ferritin, hypertriglyceridemia, hypofibrinogenemia, hemophagocytosis (in bone marrow, spleen, or lymph nodes), low or absent natural killer cells, and elevated soluble interleukin 2 receptor assay. Primary treatment goals are eliminating the underlying trigger and suppressing hyperinflammation with steroids, immunoglobulins, or immunomodulators. Specific treatment includes corticosteroids, etoposide, and antithymocyte globulin followed by hematopoietic stem cell transplantation in patients with refractory or relapsing disease. Prompt immunochemical therapy is essential but often complicated by a high risk of treatment-related morbidity and disease recurrence. Despite these challenges, improvements in diagnostic technology and treatment have enhanced survival.

An observational study of patient handover communications among nurses on an oncology critical care unit.

BACKGROUND: Breakdown in communication is a common cause of errors in hospitals. Aim/Objectives: To evaluate the feasibility and utilization of evidence-based recommendations for nurse-to-nurse shift handover on an oncology critical care unit. DESIGN: Observational study. METHODS: Nurses were provided education that integrated evidence-based recommendations for handover of care. Nursing shift report was observed for one month in 2015 and for one month in 2016. Results were evaluated for inclusion of 24 evidence-based essential elements for handover communication. RESULTS: Total completeness of handover increased with 86.64% (N = 38) in 2015 and 88.68% (N = 35) in 2016. Interruptions during handover were positively correlated with length of handover (r = 0.587, n = 18, p = .010), thus confirming the need for structured, more effective handover methods. CONCLUSIONS: Providing education, mentoring, and real-time feedback to motivated staff may lead to improvements in handover communication methods, yielding positive patient outcomes.

Implementing the Surviving Sepsis Campaign in an Ambulatory Clinic for Patients With Hematologic Malignancies.

BACKGROUND: Infectious complications can occur in patients receiving cancer treatment and are the most common cause of death not directly related to malignancy. Established international best practices for recognition and management of early sepsis with bundled interventions reduce sepsis-related morbidity and mortality in many patient populations. Integration of these practices is common in emergency departments but has not been documented in ambulatory oncology clinics, where many patients with cancer present for evaluation of infectious symptoms. OBJECTIVES: The current quality improvement project embedded sepsis best practices into routine care for ambulatory clinic patients receiving chemotherapy or undergoing hematopoietic stem cell transplantation for hematologic disease or malignancies. METHODS: An interprofessional protocol was implemented that included guideline-based universal screening, nurse-activated standing orders for recommended interventions, and clinician-supported decision making for the first six hours. FINDINGS: Evaluation of implementation of the protocol showed improved timeliness and adherence to sepsis practice guidelines. Postintervention adherence to threshold times for obtaining blood cultures and blood lactate and start of antibiotics showed improvement. All recommended interventions were completed within the target time frame for the majority of patients.

Admission criteria and prognostication in patients with cancer admitted to the intensive care unit.

Critical care for patients with cancer was once considered inappropriate because of a perceived poor prognosis for their long-term survival. Three decades of research has yielded evidence to support the use of critical care resources for many patients with cancer. A methodical approach to triage and evaluation of critically ill patients regardless of baseline medical diagnosis, coupled with an appreciation for the likely prognosis of their current cancer, is most likely to yield the fairest and most accurate appropriation of care. No clinical scoring system has emerged that accurately defines the severity of illness and likelihood for survival in patients with cancer. This article reviews the studies that have attempted to apply mortality prediction scales or scoring systems to these patients. Clinical judgment with incorporation of consensus opinions from the literature should be used to develop admission or restriction criteria for intensive care of patients with cancer.

Immune globulin IV therapy: optimizing care of patients in the oncology setting.

PURPOSE/OBJECTIVES: To review major clinical applications of immune globulin IV (IGIV) therapy, properties of currently available IGIV preparations, procedures for dosing and administration, management of infusion-related adverse effects, and strategies for effective patient education. DATA SOURCES: Published articles, abstracts, and textbook chapters. DATA SYNTHESIS: IGIV therapy supports immune function by providing immunoglobulin G antibodies for protection against pathogens and modulation of autoimmune and other potentially damaging host responses. Licensed uses include treatment of primary immune deficiencies and autoimmune conditions and prophylaxis against viral infection. CONCLUSIONS: The safety and effectiveness of IGIV therapy depend on selection of an appropriate product, dosage, and infusion rate; patient comorbidities and other risk factors; and patient education and treatment adherence. IMPLICATIONS FOR NURSING: Nurses have an essential role in the safe and effective use of IGIV, from educating patients about the rationale for and effects of therapy to administering the product and monitoring for adverse effects.

Respiratory syncytial virus in blood and marrow transplant recipients.

Nurses caring for blood and bone marrow transplant recipients need to understand the effects that respiratory syncytial virus (RSV) infection can have on transplant recipients, family members, and healthcare providers. With knowledge about the virulence and transmission of RSV, nurses are in a position to educate patients and family, reduce nosocomial spread of the infection, and influence clinical practice. By recognizing specific risk factors for infection, nurses can act as gatekeepers who identify candidates to screen and enhance early detection of infection. Nurses need to possess knowledge of early detection, implement clinical management strategies and precautions, and optimize delivery of appropriate therapy while maintaining a safe environment for all people involved. This article reviews RSV's clinical risk factors, transmission, signs and symptoms, diagnosis, treatment options, and impact on transplant recipients and candidates.

Evidence-based care for the neutropenic patient with leukemia.

OBJECTIVES: To provide an overview of risk factors for increased severity of infection, and a summary of neutropenic care guidelines based on the scientific literature. DATA SOURCES: Research studies, review articles, book chapters. CONCLUSION: Neutropenia is one of the most common and clinically significant toxicities of therapy for patients with leukemia. The risk of infection is extremely high and is associated with significant morbidity and mortality. Specific risk factors for serious or life-threatening infection must be identified in this patient population and abrogated when possible. IMPLICATIONS FOR NURSING PRACTICE: Implementation of evidence-based preventive and management strategies for patients with neutropenia can optimize patient outcomes. Internalization of these concepts into the nursing care we provide to patients with leukemia exemplifies best practice.

Nutrition in critical care.

Many hospitalized patients with cancer are malnourished. Some become critically ill and experience delayed wound healing, loss of muscle strength, and reduced infection fighting ability as a consequence of the loss of nutritional reserves. Complications of critical illness may cause interruption in normal gastrointestinal function and result in shock, sepsis, hypochlorhydria, systemic inflammatory response syndrome, and other disorders. As a result, critically ill patients may require nutritional support.

Introduction to colorectal cancer.

OBJECTIVES: To provide an overview of colorectal carcinoma (CRC), including current treatment strategies for various stages of the disease. DATA SOURCES: Research articles and textbooks. CONCLUSIONS: Despite screening methods for early detection of CRC, many patients present with late-stage disease and have a poor prognosis. The approval of irinotecan for CRC changed the approach to treatment, and there are numerous agents under clinical evaluation that may soon be available for the management of patients with CRC. IMPLICATIONS FOR NURSING PRACTICE: Recent advances in molecular targeting have led to the development of new treatments for CRC. Because nurses will ultimately administer these agents, it is important to understand how these agents target CRC.