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Conference News Continued from cover
CONFERENCE NEWS
Oncology Nurses Play Pivotal Role in Ensuring Proper Use of Oral Chemotherapy Medications
Ellie Flores of the University of California, San Diego, studies a poster.
Easy Measures Curb Falls in Hem/Onc/BMT Unit SAN ANTONIO—Boston clinicians report favorable results using a program involving hourly nursing rounds to prevent falls and injuries in adult patients in a hematology/oncology/ bone marrow transplant (hem/onc/BMT) unit. The program, in which pharmacists also reviewed medications daily for patients considered at high risk of falling, was implemented in a 777-bed urban tertiary teaching hospital.
Results showed a 100% reduction in falls with injuries during the 3-month trial period. Results showed a 100% reduction in falls with injuries during the 3-month trial period, Lana Callahan, RN, OCN, with Brigham and Women’s Hospital/ Dana-Farber Cancer Center, announced at the 34th Annual Congress of the Oncology Nursing Society (ONS). The US Joint Commission National Patient Safety Goal states that hospitals must reduce the risk of patient harm resulting from falls and recommends that a fall-reduction program be implemented, Callahan pointed out. The Commission also recommends that the fall-reduction program be evaluated. In 2007, the hospital’s hem/onc/ BMT unit had a high rate of falls with an injury rate that exceeded national and local benchmarks for an adult medical population. Callahan and colleagues decided to test an intervention that featured comprehensive daily rounds as one of its key components. The program had been piloted 2 years earlier in a neuroscience unit. Nursing rounds involved assessing 16
each patient’s pain, positioning/comfort, toileting, personal needs, and safety. Each patient’s risk of falling was also assessed daily using the Morse Fall Scale, a widely validated tool to identify the fall-prone patient. A multidisciplinary team consisting of a quality manager, nursing staff, educators, and pharmacists met daily during weekdays to review medications in patients deemed to be at high risk of a fall and injury, and medications were adjusted when indicated. “We also had daily weekday huddles to evaluate the process and address barriers to the program in real time,” Callahan said. The hem/onc/BMT unit where the intervention was tested averages 12 adult inpatients per day. In addition to a complete absence of falls during the 3-month study period that was sustained at 9 months, the program provided additional benefits, Callahan said. These included a 1.9% increase in patient satisfaction with nursing care, a 2.0% increase in the amount of attention given to patient needs, a 3.7% increase in teamwork, and a 1.2% increase in pain control. There was also a one-third drop in the number of times patients activated their call lights. “We believe this program underscores the need to roll out patient comfort rounds in all areas that have high fall rates and to ensure that measures are in place that sustain the positive changes we found in our preliminary evaluation,” Callahan said.
SAN ANTONIO—Oncology nurses can help improve patients’ knowledge about and adherence to oral chemotherapy medications, a Houston group said at the 34th Annual Congress of the Oncology Nursing Society (ONS). Mary Vinson, RN, MSN, OCN, with Texas Oncology Simmons Cancer Center in Houston, and colleagues analyzed the results of surveys distributed to 135 cancer patients who had a prescription for an oral anticancer medication. The surveys aimed to determine patients’ knowledge about medications, barriers associated with adherence, and their medication-taking behavior. “In recent years, oral anticancer drugs have been increasingly used for the treatment of a range of cancers,” Vinson observed. “Oral medications are primarily self-administered in the community and offer several advantages over intravenous administration. Notably, oral regimens may be more convenient for patients, because patients can take them at home rather than solely at a hospital or infusion clinic.” However, the availability of oral chemotherapy agents has presented new challenges to the healthcare practitioner in managing cancer treatment, she added. Potential limitations include side effects and nonadherence to treatment. To date, there have been limited data on adherence to oral chemotherapy medications in a real-world setting. More than 90% of survey respondents indicated that they know why
they have been prescribed a particular medicine, how much to take each time, when to take it, where to store their medicine, if and when to obtain a refill, and whom to call with questions, concerns, or side effects. Likewise, more than 90% of respondents indicated that they do not forget their doctor’s instructions, take a lower dose than prescribed, or take a higher dose than prescribed (to see if the higher dose would provide additional benefit). More than 90% of survey participants also said that they did not stop taking a medication because they felt fine or experienced side effects. However, 17% of those surveyed said they were not certain they could cite the side effects of the oral chemotherapy drugs they were taking nor were they certain what to do in the event of a side effect. Nearly 40% omitted some doses, and more than 25% took their medication late. Finally, Vinson noted that the data show that patients consider the oncology nurse as their key source of information. For example, patients said that they were more likely to call an oncology nurse with questions about their medication than their oncologist or pharmacist. “Nurses can be instrumental in developing interventions that will help increase medication adherence as well as interventions that will help patients better understand and manage treatment-related side effects,” she said. —Jill Stein
—Jill Stein
Coverage of the ONS 34th Annual Congress Continues in the July/August issue of The Oncology Nurse.
G REEN H ILL H EALTHCARE C OMMUNICATIONS
Joyce Divanbeigi and Alicia Carmack of Siteman Cancer Center, St. Louis, Missouri, discuss their study with Laura Kobayashi also of St. Louis. June 2009