Utilization of Evidence-Based Practice Model and Change Theory to Implement a Mucositis Pain Management Pathway in Bone Marrow Transplant Patients

2.50
Hdl Handle:
http://hdl.handle.net/10755/165750
Category:
Abstract
Type:
Presentation
Title:
Utilization of Evidence-Based Practice Model and Change Theory to Implement a Mucositis Pain Management Pathway in Bone Marrow Transplant Patients
Author(s):
Fine, Barbara
Author Details:
Barbara Fine, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
Abstract:
Background: Oral mucositis pain that requires the use of intravenous opioids for relief is experienced by up to 70% of patients undergoing bone marrow transplant (BMT). Prior to implementing this project, there was no standard of practice for the management of mucositis pain on our BMT units. Pain management was driven by individual nursing preference and experience. Often, continuous infusion Fentanyl was the modality and drug of choice. In addition, patients received antiemetics and anxiolytics. This use of polypharmacy resulted in 11 critical incidences in a seven-month period. Since each of these incidences involved continuous infusion opioids, a task force was convened to evaluate mucositis pain management practices. Project: The task force included staff nurses, nurse manager, nurse practitioner for pain, and symptom management and clinical pharmacists. An evidence-based practice approach was utilized to evaluate current practice and develop recommendations for practice change. Evidence was collected as follows: quality improvement and risk management related to the critical incidents, a review of current literature on mucositis pain management, consultation with experts in pain and stomatitis management, and benchmarking with other transplant centers. Based on this evidence, the task force recommended adoption of morphine PCA, with or without continuous infusion, as part of an algorithm to manage mucositis pain. Since this represented a major change in practice, precepts of change theory were used to convince the nursing staff that this was best practice. Packets of information from the evidence review were made available to the nursing staff. This was followed up by individual and small group feedback sessions to elicit and address their concerns. With tacit approval of the nursing staff, a two-month pilot of the algorithm with collection of data on patient/nurse satisfaction with pain control, pain intensity scores, and opioid utilization was completed. Interpretation: Success of this project is evident through the continued use of the algorithm to date as well as positive verbal feedback from staff. Discussion: Practice changes are often fraught with anxiety and resistance. The use of evidence-based practice strategy and change theory eases the process and creates opportunities for collaborative problem solving.
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.titleUtilization of Evidence-Based Practice Model and Change Theory to Implement a Mucositis Pain Management Pathway in Bone Marrow Transplant Patientsen_GB
dc.contributor.authorFine, Barbaraen_US
dc.author.detailsBarbara Fine, Dana-Farber Cancer Institute, Boston, Massachusetts, USAen_US
dc.identifier.urihttp://hdl.handle.net/10755/165750-
dc.description.abstractBackground: Oral mucositis pain that requires the use of intravenous opioids for relief is experienced by up to 70% of patients undergoing bone marrow transplant (BMT). Prior to implementing this project, there was no standard of practice for the management of mucositis pain on our BMT units. Pain management was driven by individual nursing preference and experience. Often, continuous infusion Fentanyl was the modality and drug of choice. In addition, patients received antiemetics and anxiolytics. This use of polypharmacy resulted in 11 critical incidences in a seven-month period. Since each of these incidences involved continuous infusion opioids, a task force was convened to evaluate mucositis pain management practices. Project: The task force included staff nurses, nurse manager, nurse practitioner for pain, and symptom management and clinical pharmacists. An evidence-based practice approach was utilized to evaluate current practice and develop recommendations for practice change. Evidence was collected as follows: quality improvement and risk management related to the critical incidents, a review of current literature on mucositis pain management, consultation with experts in pain and stomatitis management, and benchmarking with other transplant centers. Based on this evidence, the task force recommended adoption of morphine PCA, with or without continuous infusion, as part of an algorithm to manage mucositis pain. Since this represented a major change in practice, precepts of change theory were used to convince the nursing staff that this was best practice. Packets of information from the evidence review were made available to the nursing staff. This was followed up by individual and small group feedback sessions to elicit and address their concerns. With tacit approval of the nursing staff, a two-month pilot of the algorithm with collection of data on patient/nurse satisfaction with pain control, pain intensity scores, and opioid utilization was completed. Interpretation: Success of this project is evident through the continued use of the algorithm to date as well as positive verbal feedback from staff. Discussion: Practice changes are often fraught with anxiety and resistance. The use of evidence-based practice strategy and change theory eases the process and creates opportunities for collaborative problem solving.en_GB
dc.date.available2011-10-27T12:24:14Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T12:24:14Z-
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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