Fast, safe, and effective care is a goal in all oncology treatment settings. During a session on Friday, April 12, 2019, at the ONS 44th Annual Congress in Anaheim, CA, Lisa Pittman, RN, MSN, MHA, NEA-BC, OCN®, of Cancer Treatment Centers of America in Zion, IL, Kerry Fuller, RN, BSN, OCN®, of Greenville Health System Cancer Institute in South Carolina, Cameron Carr, ADN, RN, of Duke Raleigh Hospital in North Carolina, and Lisa Ciafre, RN, MSN, of Allegheny Health Network Cancer Institute in Pittsburgh, PA, shared their work on preventing infections, improving recovery after surgery, and reducing response times to hypersensitivity reactions.
Oncologic Surgical Site Infection (SSI) Bundle
Patients with cancer are at increased risk for SSIs. Therefore, Pittman’s organization implemented an SSI bundle comprising evidence-based interventions such as chlorhexidine before and after operation, patient education, and a surgical checklist.
Pittman and her team found a correlation between bundle item compliance and a reduction in SSIs. The success of the bundle depended on a multidisciplinary approach. “It assists in getting all members of the team engaged and working towards one common goal,” Pittman said.
“If team members are involved from the start and help develop the plan, they become more invested and therefore, more accepting of process change. This approach creates collaboration, ownership, and improved accountability, which ultimately contributes to success,” Pittman said.
Prevention of Central Line-Associated Blood Stream Infections (CLABSI)
After detecting CLABSI rates were elevated in the oncology unit, Fuller’s organization implemented interventions that included monitoring, education for nurses and patients, and strategies such as multidisciplinary team huddles.
With monitoring in place, the team decided to act immediately, resulting in no CLABSIs occurring in outpatient oncology for 3 months. “By incorporating huddles on any CLABSI, we have been able to empower direct-care nurses to do a detailed review of all of the factors,” Fuller said.
The team also shares examples of excellent care from the CLABSI reviews. “Nurses need to see the impact of their nursing care and be encouraged that it does not go unnoticed,” Fuller said.
Implementation of Enhanced Recovery After Surgery (ERAS)
Carr discussed ERAS, a multidisciplinary approach that uses evidence-based practice to standardize surgical care. Carr’s practice implemented ERAS for urologic oncology procedures. Education was provided to nurses, doctors, dietitians, physical and occupational therapists, and nose assistance.
ERAS included minimally invasive approaches, avoidance or early removal of drains and tubes, early mobilization, and early resumption of food and drink on operative day. After implementation, patients had reductions in length of hospital stay, complications, readmission, and surgical costs.
“ERAS has made a huge positive impact on the surgical oncology population at Duke Raleigh Hospital. It is always a wonderful feeling to send my patients home with their pain being well controlled, tolerating a regular diet, and able to ambulate well,” Carr said.
Improving Response Time to Hypersensitivity Reactions
Ciafre’s institution wanted to improve time to initiation of treatments for hypersensitivity reactions. They examined the use of an automated dispensing cabinet (ADC) toolbox for hypersensitivity reactions compared to ADC alone, an ADC hypersensitivity drug trigger, and an emergency medication toolbox.
The ADC hypersensitivity and emergency medication toolboxes and had the best times (1.04 minutes each). The use of a toolbox allows oncology nurses to respond to hypersensitivity reactions quickly.
“Having a kit with all of the medications and supplies needed to treat the patient supports the clinical caregiver and ensures prompt treatment,” Ciafre said. “Staff nurses report feeling more in control of the situation and they can expend all of their critical thinking skills on the patient.”