Using Evidence to Implement a Collaborative Neutropenia Management Protocol for Improving Chemotherapy Delivery

2.50
Hdl Handle:
http://hdl.handle.net/10755/165581
Category:
Abstract
Type:
Presentation
Title:
Using Evidence to Implement a Collaborative Neutropenia Management Protocol for Improving Chemotherapy Delivery
Author(s):
Michelson, Jennifer
Author Details:
Jennifer Michelson, University of Rochester Medical Center, School of Nursing, Rochester, New York, USA
Abstract:
Achieving a threshold relative dose intensity of greater or equal to 75% for adriamycin, contributes to disease free survival and overall survival in non-Hodgkin's lymphoma (NHL) (Kwak, 1990). In adjuvant breast cancer, delivery of greater or equal to 85% of total planned dose may improve overall survival (Bonnadonna, 1995; National Institutes of Health, Adjuvant Breast Cancer Consensus Conference, 2000). At a community oncology clinic, baseline chemotherapy dosing and febrile (FN) data were collected through a physician practice pattern data collection. Patients treated for adjuvant breast cancer and intermediate and high grade lymphoma were evaluated. Data demonstrated a FN rate of 0%. Sixty percent of the adjuvant breast cancer patients sampled received greater than 85% dose intensity and 66.6% of the NHL patients achieved greater than 80% planned dose intensity. Analysis of data and review of patient scenarios indicated that low FN rates were due to dose delays for neutropenia. A literature review was conducted to identify optimal neutropenia management. Models identifying patients at risk for the development of febrile neutropenia were found (Intragumchornchai, 2000; Weiner, 2000; Silber, 1998; Thomas, 2001). Age was found to be a risk factor (Dees, 2000; Morrison, 2000). Risk models, age considerations, and appropriate G-CSF support were collaboratively incorporated into a FN management protocol. The protocol recognizes the nurse role in assessment and emphasizes communication between physicians and the nurses administering the chemotherapy. A worksheet was developed to assist nurses in implementing the protocol. Educational programs related to dose intensity, continuous quality improvement, and neutropenia were provided to staff. Over time, the new policy is being implemented. The recent addition of a nurse practitioner will foster collaborative practice and consistent implementation of the protocol. Increased awareness of dose intensity, neutropenia, and clinical outcomes have been verbalized by clinicians. Repeat data collections are planned for fall of 2001 to evaluate progress in improving dose intensity in this practice setting.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2002
Conference Name:
27th Annual Oncology Nursing Society Congress
Conference Host:
Oncology Nursing Society
Conference Location:
Washington, D.C., 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.titleUsing Evidence to Implement a Collaborative Neutropenia Management Protocol for Improving Chemotherapy Deliveryen_GB
dc.contributor.authorMichelson, Jenniferen_US
dc.author.detailsJennifer Michelson, University of Rochester Medical Center, School of Nursing, Rochester, New York, USAen_US
dc.identifier.urihttp://hdl.handle.net/10755/165581-
dc.description.abstractAchieving a threshold relative dose intensity of greater or equal to 75% for adriamycin, contributes to disease free survival and overall survival in non-Hodgkin's lymphoma (NHL) (Kwak, 1990). In adjuvant breast cancer, delivery of greater or equal to 85% of total planned dose may improve overall survival (Bonnadonna, 1995; National Institutes of Health, Adjuvant Breast Cancer Consensus Conference, 2000). At a community oncology clinic, baseline chemotherapy dosing and febrile (FN) data were collected through a physician practice pattern data collection. Patients treated for adjuvant breast cancer and intermediate and high grade lymphoma were evaluated. Data demonstrated a FN rate of 0%. Sixty percent of the adjuvant breast cancer patients sampled received greater than 85% dose intensity and 66.6% of the NHL patients achieved greater than 80% planned dose intensity. Analysis of data and review of patient scenarios indicated that low FN rates were due to dose delays for neutropenia. A literature review was conducted to identify optimal neutropenia management. Models identifying patients at risk for the development of febrile neutropenia were found (Intragumchornchai, 2000; Weiner, 2000; Silber, 1998; Thomas, 2001). Age was found to be a risk factor (Dees, 2000; Morrison, 2000). Risk models, age considerations, and appropriate G-CSF support were collaboratively incorporated into a FN management protocol. The protocol recognizes the nurse role in assessment and emphasizes communication between physicians and the nurses administering the chemotherapy. A worksheet was developed to assist nurses in implementing the protocol. Educational programs related to dose intensity, continuous quality improvement, and neutropenia were provided to staff. Over time, the new policy is being implemented. The recent addition of a nurse practitioner will foster collaborative practice and consistent implementation of the protocol. Increased awareness of dose intensity, neutropenia, and clinical outcomes have been verbalized by clinicians. Repeat data collections are planned for fall of 2001 to evaluate progress in improving dose intensity in this practice setting.en_GB
dc.date.available2011-10-27T12:21:15Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T12:21:15Z-
dc.conference.date2002en_US
dc.conference.name27th Annual Oncology Nursing Society Congressen_US
dc.conference.hostOncology Nursing Societyen_US
dc.conference.locationWashington, D.C., 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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