Presentations focus on nurse-driven measures to improve patient care

  • New inpatient admission process designed by Transplant & Cellular Therapy team
  • Critical-care nurse rounding reduces rapid responses, codes
  • Nurses create tool to identify patients who would benefit from palliative care

SAN ANTONIO, Texas — Evidence-based practice changes led by nurses from Roswell Park Comprehensive Cancer Center will be highlighted – and a longtime Roswell Park nurse recognized – at the 48th annual Oncology Nursing Society (ONS) Congress April 26-30, 2023, in San Antonio, Texas.

Hector Tirado, BSN, AAS, CPhT, will present “Standardized Transplant and Cellular Therapy Patient Education Upon Admission,” describing a new admissions protocol developed by nurses for inpatients in Roswell Park’s Transplant and Cellular Therapy (TCT) Center. The protocol centers on a checklist designed to ensure consistency and comprehensiveness in every inpatient admission.
“The admissions process can be very overwhelming,” explains Tirado, first author of the paper. “There are a lot of moving parts. We created a system to make the experience uniform and standardized so every patient is getting the same education. It’s a great tool.”

“There is a lot that has to be communicated and documented when we’re admitting someone for transplant or cell therapy, because we know these patients will be admitted for at least 30 days,” adds Amanda Blackburn, BSN, RN, co-author of the paper. Although patients and their caregivers attend an orientation together prior to the patient’s admission, Blackburn says repeating some of the information during admission is essential because so much is introduced during the orientation. “It’s information overload. People can’t remember everything.

“Research shows that repetition improves outcomes in patients. So we go over the timeline of what to expect: ‘This is your preconditioning chemotherapy. Here’s what to expect on Day 0, Day 7, Day 10, and at discharge.’ ”

Tirado and Blackburn created the new admissions checklist as a project for their nursing residency training at Roswell Park. They began with an electronic survey distributed to TCT nurses in March 2022, using software to consolidate responses. After receiving input from their colleagues, the team sent nurses a first draft of the checklist and then revised it based on their feedback. The team developed a separate template for nursing aides who set up rooms for new TCT inpatients. The lists cover a range of instructions, from what to do if the patient has tested positive for COVID-19 to placing precautions signage on the door, verifying allergies and educating patients about how to use the call bell.

The list also reminds nurses to encourage patients to use an incentive spirometer to clear mucus from their lungs to help prevent pulmonary infection. Blackburn notes that since the checklist became standard practice, she has noticed more patients using spirometers throughout their stay. “It helps prevent pneumonia, which is a big risk factor for our patients,” she says.

Tirado notes that the team paid close attention to the language used for the patient-education sections of the tool. “That’s important because of healthcare literacy,” he says. “We need to use words that patients understand.”

Blackburn adds that along with increased patient safety and comfort, the new protocol has resulted in an added benefit: “Our nurses are more confident while doing an admission.”

Tirado will outline the new system and its impacts in a podium presentation Friday, April 28, from 3-4 p.m.

Reducing rapid responses and codes through critical-care nurse rounding

Today, most cancer treatment is provided on an outpatient basis. Inpatient care is required mostly for complex procedures, the administration of biotherapies and some types of chemotherapy, and dealing with treatment complications and symptom management. Michael Martonara, BSN, BS, RN, will discuss the implications of this need for a higher level of nursing care during a poster presentation, “The Effects of Proactive Critical-Care Nurse Rounding with High-Risk Patients in a Dedicated Cancer Hospital,” Thursday, April 27, from 6:10-6:20 p.m.

Martonara, first author of the presentation, developed a proactive “SWAT” model of rounding at Roswell Park and successfully advocated for its funding, leading to a 12-hour-per-day increase in critical-care nurse staffing for high-risk patients at the 142-bed dedicated cancer hospital. Over a trial period of seven months, SWAT nurses rounded daily to each inpatient unit, where staff identified patients at risk of clinical deterioration and those discharged from critical care the previous day. The SWAT nurses then assessed those patients for needed interventions.

Thanks to early intervention, the need for rapid responses involving staff outside the Critical Care Unit fell from 4.5 per 1,000 patient days in the seven months prior to the SWAT program to 3.5 in the seven months after the program began. Codes outside the Critical Care Unit, signaling that a patient was in medical distress, dropped from .48 per 1,000 patient days in the seven months before implementation to .16 in the following seven months. The reduction in rapid responses and codes resulted in less disruption and the use of fewer resources, the nurse researchers note.

The poster presentation was co-authored by Andrew Storer, PhD, DNP, RN, NP-C, A, FAANP, Vice President and Deputy Chief Nursing Officer.

Palliative care screening tool delivers multiple benefits

Heather Huizinga, MSN, RN, OCN, Director of Nursing Professional Development, Professional Practice, and Research, assisted a team of nurse residents — Kayla Redmond, BSN, RN; Christina Haidar, BSN, RN; Evgenii Ryzhkov, BSN, RN; and Carly Andriaccio, AAS, RN — in creating a poster presentation about their independently designed screening process to identify patients who would benefit from palliative care. The team will present “Creation of a Nurse-Driven Palliative Oncology Screening Tool,” outlining the benefits of making early introduction to palliative care services the standard of care for oncology inpatients: reduced symptom burden, better communication with healthcare providers, reduced emotional distress and greater patient satisfaction.

A nurse survey informed the development of the screening tool. The team’s pilot analysis in 18 inpatients identified that a majority would benefit from palliative and supportive care, but had not yet been scheduled for a consult based on existing assessment aids.

“Many palliative care screening tools are not specific enough to triage the needs of oncology patients with metastatic disease,” the authors note in their presentation. “The final tool can appropriately discern medical and surgical oncology patients who could benefit from palliative care.”

The poster presentation is scheduled for April 28, from 5:50-6 p.m.

Roswell Park nurse honored with Mara Mogensen Flaherty Memorial Lectureship Award

During the Congress, Roswell Park nursing leader Suzanne Carroll, RN, MS, AOCN, Clinical Nurse Manager for Inpatient Administration, received a 2023 Mara Mogensen Flaherty Memorial Lectureship Award and participated in the panel discussion “Current Challenges: Nursing Sustainability.” The Mogensen Flaherty Memorial Lecture award supports an annual lecture on a topic related to the psychosocial aspects of cancer diagnosis, treatment and care, presented by an individual who is an inspiration in the field.