An Outcomes-Based Model To Evaluate The Impact Of Practice Guidelines For The Management Of Neutropenia Associated With Bone Marrow Transplantation

2.50
Hdl Handle:
http://hdl.handle.net/10755/163777
Category:
Abstract
Type:
Presentation
Title:
An Outcomes-Based Model To Evaluate The Impact Of Practice Guidelines For The Management Of Neutropenia Associated With Bone Marrow Transplantation
Author(s):
Davitt, Margaret
Author Details:
Margaret Davitt, Pennsylvania State University, The Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA, email: mdavitt@psu.edu
Abstract:
Purpose: To evaluate the impact of interdisciplinary evidence- and consensus-based practice guidelines for the assessment and management of neutropenia associated with peripheral blood stem cell transplant (PBSCT). Specific Aims: To outline decision-making criteria for managing neutropenic febrile episodes associated with PBSCT and to monitor outcomes to ensure quality and efficiency of patient care. Framework: A model that included patient outcomes and measures of institutional efficiency guided this work. Methods: Through an interdisciplinary process, a comprehensive clinical algorithm was developed to assess and treat neutropenia associated with PSCBT. Data were collected from 18 patients undergoing PBSCT in the pre-guideline phase (July 1998 to April 1999) and 19 patients during the development and implementation of the guidelines (May 1999 to February 2000). Target outcomes included the number of blood cultures, charges for anti-infective therapy, total pharmacy charges and length of hospitalization. All financial data from the fiscal year 99 were adjusted using a 3.4% inflation rate. A retrospective review of medical records was conducted for six patients randomly selected from each group. Comparisons were performed on the number of febrile days, febrile episodes, blood cultures associated with febrile episodes and days that absolute neutrophil count (ANC) remained < 500/uI. Results and conclusions: During the development and implementation phase of the clinical algorithm, the average number of blood cultures obtained during hospitalization decreased by 32% (11.5 +/- 8.3, n=18 vs. 7.8 +/- 4.5, n=19). This translated into savings of about $213.00 per patient. More cost efficient administration of anti-infective therapy was evident by a 26% reduction in charges ($2,880 +/- $1520 vs. $2,143 +/- $1118). There was no appreciable difference in the overall length of hospitalization (19.6 +/- 2.8 vs. 18.4 +/- 1.3). The average number of febrile days (days temperature > 38.3 C) decreased by 68% (7.3 +/- 7.8, n=6 vs. 2.3 +/- 2.2, n=6), which was attributed to more appropriate anti-infective therapy initiated earlier. The average number of febrile episodes was also markedly decreased (64%) even though the number of days that the ANC remained below 500/uI was very similar for both groups. Implications for nursing practice and knowledge development for nursing practice: Neutropenia is a serious and transient outcome of bone marrow transplantation. Interdisciplinary clinical algorithms that incorporate evidence- and consensus-based information define "best practices" which serve as the basis for guiding nursing assessment and interventions. Recent evidence suggests that the process for developing clinical care guidelines, such as algorithms, is an important determinant in practitioner acceptance and adherence to these practice guidelines; however, only a few published reports actually document their impact on patient care outcomes.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2001
Conference Name:
ENRS 13th Annual Scientific Sessions
Conference Host:
Eastern Nursing Research Society
Conference Location:
Atlantic City, New Jersey, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleAn Outcomes-Based Model To Evaluate The Impact Of Practice Guidelines For The Management Of Neutropenia Associated With Bone Marrow Transplantationen_GB
dc.contributor.authorDavitt, Margareten_US
dc.author.detailsMargaret Davitt, Pennsylvania State University, The Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA, email: mdavitt@psu.eduen_US
dc.identifier.urihttp://hdl.handle.net/10755/163777-
dc.description.abstractPurpose: To evaluate the impact of interdisciplinary evidence- and consensus-based practice guidelines for the assessment and management of neutropenia associated with peripheral blood stem cell transplant (PBSCT). Specific Aims: To outline decision-making criteria for managing neutropenic febrile episodes associated with PBSCT and to monitor outcomes to ensure quality and efficiency of patient care. Framework: A model that included patient outcomes and measures of institutional efficiency guided this work. Methods: Through an interdisciplinary process, a comprehensive clinical algorithm was developed to assess and treat neutropenia associated with PSCBT. Data were collected from 18 patients undergoing PBSCT in the pre-guideline phase (July 1998 to April 1999) and 19 patients during the development and implementation of the guidelines (May 1999 to February 2000). Target outcomes included the number of blood cultures, charges for anti-infective therapy, total pharmacy charges and length of hospitalization. All financial data from the fiscal year 99 were adjusted using a 3.4% inflation rate. A retrospective review of medical records was conducted for six patients randomly selected from each group. Comparisons were performed on the number of febrile days, febrile episodes, blood cultures associated with febrile episodes and days that absolute neutrophil count (ANC) remained < 500/uI. Results and conclusions: During the development and implementation phase of the clinical algorithm, the average number of blood cultures obtained during hospitalization decreased by 32% (11.5 +/- 8.3, n=18 vs. 7.8 +/- 4.5, n=19). This translated into savings of about $213.00 per patient. More cost efficient administration of anti-infective therapy was evident by a 26% reduction in charges ($2,880 +/- $1520 vs. $2,143 +/- $1118). There was no appreciable difference in the overall length of hospitalization (19.6 +/- 2.8 vs. 18.4 +/- 1.3). The average number of febrile days (days temperature > 38.3 C) decreased by 68% (7.3 +/- 7.8, n=6 vs. 2.3 +/- 2.2, n=6), which was attributed to more appropriate anti-infective therapy initiated earlier. The average number of febrile episodes was also markedly decreased (64%) even though the number of days that the ANC remained below 500/uI was very similar for both groups. Implications for nursing practice and knowledge development for nursing practice: Neutropenia is a serious and transient outcome of bone marrow transplantation. Interdisciplinary clinical algorithms that incorporate evidence- and consensus-based information define "best practices" which serve as the basis for guiding nursing assessment and interventions. Recent evidence suggests that the process for developing clinical care guidelines, such as algorithms, is an important determinant in practitioner acceptance and adherence to these practice guidelines; however, only a few published reports actually document their impact on patient care outcomes.en_GB
dc.date.available2011-10-27T11:13:39Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:13:39Z-
dc.conference.date2001en_US
dc.conference.nameENRS 13th Annual Scientific Sessionsen_US
dc.conference.hostEastern Nursing Research Societyen_US
dc.conference.locationAtlantic City, New Jersey, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.