Developing a Consistent, Evidence-Based Approach for G-CSF (Filgrastim) Administration: Implementing a Quality Improvement Process to Improve Neutropenia Management

2.50
Hdl Handle:
http://hdl.handle.net/10755/165724
Category:
Abstract
Type:
Presentation
Title:
Developing a Consistent, Evidence-Based Approach for G-CSF (Filgrastim) Administration: Implementing a Quality Improvement Process to Improve Neutropenia Management
Author(s):
Budzinski, Nancy
Author Details:
Nancy Budzinski, Joliet Oncology-Hematology Associates Ltd., Joliet, Illinois, USA
Abstract:
The purpose of this clinical practice project was to develop guidelines for hematopoietic colony-stimulating factor (CSF) administration in order to more consistently and effectively manage chemotherapy-induced neutropenia. Joliet Oncology Hematology Associates is a six-physician community oncology practice treating an average of 1,000 outpatients per month. Specialty trained nurses administer chemotherapy and assume a primary role in toxicity assessment and symptom management. Nurses identified that variations in physician practice with respect to myeloid CSF administration resulted in an inconsistent approach to neutropenia management. The nursing staff used a quality improvement approach to address this clinical practice issue. The assessment process began with a retrospective chart review of chemotherapy administration for aggressive NHL (n = 15) and adjuvant breast cancer (n = 20) patients. Data was collected regarding dose delays, dose reductions, use of hematopoietic CSF, and incidence of febrile neutropenia. Analysis of data revealed that neutropenia was one of the primary causes for dose delays and reductions. Inconsistencies in CSF dosing and initiation and duration of therapy were found. The quality improvement plan involved developing a more consistent approach to the use of hematopoietic CSF in the proactive management of neutropenia. Two members of the nursing staff partnered with a physician to draft guidelines for growth factor administration based upon the ASCO 2000 Update of Recommendations for the Use of Hematopoietic Colony-Stimulating Factors. Guidelines addressed the key components of CSF administration such as appropriate dosing by weight, initiation and duration of therapy, frequency of laboratory monitoring, management of bone pain, and patient selection criteria for primary and secondary prophylactic administration. Guidelines were implemented in August 2001 after presentation to all six physicians for input, consensus, and approval. The nursing staff will conduct an ongoing evaluation of adherence to guidelines through periodic chart audits. Outcomes selected for monitoring include appropriateness of CSF dose, initiation and duration of CSF therapy, frequency of laboratory monitoring, management of bone pain, patient selection criteria, incidence of febrile neutropenia, and neutropenia related dose delays and reductions. These guidelines have further enhanced the nursing staff's ability to provide autonomous, evidence-based, proactive symptom management to minimize the impact of neutropenia in their 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.titleDeveloping a Consistent, Evidence-Based Approach for G-CSF (Filgrastim) Administration: Implementing a Quality Improvement Process to Improve Neutropenia Managementen_GB
dc.contributor.authorBudzinski, Nancyen_US
dc.author.detailsNancy Budzinski, Joliet Oncology-Hematology Associates Ltd., Joliet, Illinois, USAen_US
dc.identifier.urihttp://hdl.handle.net/10755/165724-
dc.description.abstractThe purpose of this clinical practice project was to develop guidelines for hematopoietic colony-stimulating factor (CSF) administration in order to more consistently and effectively manage chemotherapy-induced neutropenia. Joliet Oncology Hematology Associates is a six-physician community oncology practice treating an average of 1,000 outpatients per month. Specialty trained nurses administer chemotherapy and assume a primary role in toxicity assessment and symptom management. Nurses identified that variations in physician practice with respect to myeloid CSF administration resulted in an inconsistent approach to neutropenia management. The nursing staff used a quality improvement approach to address this clinical practice issue. The assessment process began with a retrospective chart review of chemotherapy administration for aggressive NHL (n = 15) and adjuvant breast cancer (n = 20) patients. Data was collected regarding dose delays, dose reductions, use of hematopoietic CSF, and incidence of febrile neutropenia. Analysis of data revealed that neutropenia was one of the primary causes for dose delays and reductions. Inconsistencies in CSF dosing and initiation and duration of therapy were found. The quality improvement plan involved developing a more consistent approach to the use of hematopoietic CSF in the proactive management of neutropenia. Two members of the nursing staff partnered with a physician to draft guidelines for growth factor administration based upon the ASCO 2000 Update of Recommendations for the Use of Hematopoietic Colony-Stimulating Factors. Guidelines addressed the key components of CSF administration such as appropriate dosing by weight, initiation and duration of therapy, frequency of laboratory monitoring, management of bone pain, and patient selection criteria for primary and secondary prophylactic administration. Guidelines were implemented in August 2001 after presentation to all six physicians for input, consensus, and approval. The nursing staff will conduct an ongoing evaluation of adherence to guidelines through periodic chart audits. Outcomes selected for monitoring include appropriateness of CSF dose, initiation and duration of CSF therapy, frequency of laboratory monitoring, management of bone pain, patient selection criteria, incidence of febrile neutropenia, and neutropenia related dose delays and reductions. These guidelines have further enhanced the nursing staff's ability to provide autonomous, evidence-based, proactive symptom management to minimize the impact of neutropenia in their practice setting.en_GB
dc.date.available2011-10-27T12:23:46Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T12:23:46Z-
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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