Development of an Evidenced-Based Management Guideline for the Use of Premedication for Blood Products in the Oncology Population

2.50
Hdl Handle:
http://hdl.handle.net/10755/164761
Category:
Abstract
Type:
Presentation
Title:
Development of an Evidenced-Based Management Guideline for the Use of Premedication for Blood Products in the Oncology Population
Author(s):
Llerandi, Diane; Schardien, Kathleen; Sallustro, Jane; Staunton, Kathleen; Choo, Kathleen
Author Details:
Diane Llerandi, RN, AOCNS, Clinical Nurse Specialist, Memorial Sloan Kettering Cancer Center, New York City, New York, USA, email: llerand1@mskcc.org; Kathleen Schardien, RN, MSN, AOCN, MSKCC, NY, NY; Jane Sallustro, RN, MPA; Kathleen Staunton, RN, MSN; Kathleen Choo, RN, JD, BSN
Abstract:
Clinical/Evidence Based Practice: The most common transfusion reactions are febrile nonhemolytic and allergic reactions, although rarely do they cause significant morbidity. In our institution we noted the practice of routinely ordering premedications particularly acetaminophen and diphenhydramine to prevent these reactions was LIP dependent. Various opinions/practices exist among nursing and medical staff based on prior clinical experience. Both medications are relatively inexpensive, but each can cause numerous side effects and in studies to date their ability to prevent transfusion reactions is questionable. Having identified the need for a standardized approach for premedication for oncology patients receiving transfusions of packed red blood cells, platelets and fresh frozen plasma, our committee worked to develop an evidence-based guideline and define best practice for patients at our comprehensive cancer center. An exhaustive literature search was undertaken, and systematic reviews and randomized controlled trials were reviewed. Experts in bone marrow transplantation, clinical laboratories and hematology were consulted, and clinical resources and guidelines from outside institutions and professional organizations such as the New York Blood Center were gathered. Evidence suggests that although there is variation among institutions regarding premedication, the decision to premedicate patients must always be individualized to the patient. Acetaminophen and diphenhydramine are not without potential toxicity, and in studies we examined, they failed to consistently prevent reactions. Most transfusions reactions are mild and easily treated. Using the evidence, we developed a standard of care and revised the nursing procedure to reflect that premedications will no longer be given as a standard for all patients. Education of inpatient LIPs and RNs was conducted both formally and informally. A flag system was added to the computerized ordering system highlighting the policy changes and requiring caregivers to order hypersensitivity medications in the event of a reaction. Currently, we are working with the ambulatory care areas to ensure compliance with recommendations and identify areas for further review. This evidence-based project has helped nurses at our center provide patient care that meets current guidelines for best practice. Oncology nurses at other institutions can use this information to update their patient care standards and prevent unnecessary use of premedications in patients requiring transfusion.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2009
Conference Name:
34th Annual Oncology Nursing Society Congress
Conference Host:
Oncology Nursing Society
Conference Location:
San Antonio, Texas, 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.titleDevelopment of an Evidenced-Based Management Guideline for the Use of Premedication for Blood Products in the Oncology Populationen_GB
dc.contributor.authorLlerandi, Dianeen_US
dc.contributor.authorSchardien, Kathleenen_US
dc.contributor.authorSallustro, Janeen_US
dc.contributor.authorStaunton, Kathleenen_US
dc.contributor.authorChoo, Kathleenen_US
dc.author.detailsDiane Llerandi, RN, AOCNS, Clinical Nurse Specialist, Memorial Sloan Kettering Cancer Center, New York City, New York, USA, email: llerand1@mskcc.org; Kathleen Schardien, RN, MSN, AOCN, MSKCC, NY, NY; Jane Sallustro, RN, MPA; Kathleen Staunton, RN, MSN; Kathleen Choo, RN, JD, BSNen_US
dc.identifier.urihttp://hdl.handle.net/10755/164761-
dc.description.abstractClinical/Evidence Based Practice: The most common transfusion reactions are febrile nonhemolytic and allergic reactions, although rarely do they cause significant morbidity. In our institution we noted the practice of routinely ordering premedications particularly acetaminophen and diphenhydramine to prevent these reactions was LIP dependent. Various opinions/practices exist among nursing and medical staff based on prior clinical experience. Both medications are relatively inexpensive, but each can cause numerous side effects and in studies to date their ability to prevent transfusion reactions is questionable. Having identified the need for a standardized approach for premedication for oncology patients receiving transfusions of packed red blood cells, platelets and fresh frozen plasma, our committee worked to develop an evidence-based guideline and define best practice for patients at our comprehensive cancer center. An exhaustive literature search was undertaken, and systematic reviews and randomized controlled trials were reviewed. Experts in bone marrow transplantation, clinical laboratories and hematology were consulted, and clinical resources and guidelines from outside institutions and professional organizations such as the New York Blood Center were gathered. Evidence suggests that although there is variation among institutions regarding premedication, the decision to premedicate patients must always be individualized to the patient. Acetaminophen and diphenhydramine are not without potential toxicity, and in studies we examined, they failed to consistently prevent reactions. Most transfusions reactions are mild and easily treated. Using the evidence, we developed a standard of care and revised the nursing procedure to reflect that premedications will no longer be given as a standard for all patients. Education of inpatient LIPs and RNs was conducted both formally and informally. A flag system was added to the computerized ordering system highlighting the policy changes and requiring caregivers to order hypersensitivity medications in the event of a reaction. Currently, we are working with the ambulatory care areas to ensure compliance with recommendations and identify areas for further review. This evidence-based project has helped nurses at our center provide patient care that meets current guidelines for best practice. Oncology nurses at other institutions can use this information to update their patient care standards and prevent unnecessary use of premedications in patients requiring transfusion.en_GB
dc.date.available2011-10-27T12:06:31Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T12:06:31Z-
dc.conference.date2009en_US
dc.conference.name34th Annual Oncology Nursing Society Congressen_US
dc.conference.hostOncology Nursing Societyen_US
dc.conference.locationSan Antonio, Texas, 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.-
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