Congress Abstracts 2003

46

EVIDENCE-BASED PRACTICE GUIDELINES FOR PROACTIVE MANAGEMENT OF NEUTROPENIA. Jane Van Deusen-Morrison, MS, AOCN^®, APRN, and Jean Pupkes, RN, MS, AOCN^®, North Memorial Medical Center, Robbinsdale, MN; and Norma Munson, RN, MS, AOCN^®, Amgen, Thousand Oaks, CA.

Evidence-based practice guidelines are an important component of quality nursing care. Recently, several risk models for the evaluation and management of neutropenia have appeared in the literature. Since neutropenia is the most severe complication of myelosuppressive chemotherapy, the prevention and management of neutropenia and its complications represents an excellent opportunity for the development and implementation of evidence-based practice guidelines. As direct caregivers, oncology nurses are well situated to assess patients for potential risk factors for neutropenia and implement guidelines for the proactive management of this serious side effect. Our clinic reviewed various risk factors and risk models related to neutropenia in an effort to develop guidelines which we believe will ultimately decrease hospitalizations and maintain chemotherapy planned dose on time. Risk models of various states such as the Silber Risk Model for breast cancer and a model developed by Intragumtornchai for non-Hodgkin lymphoma (NHL) patients were evaluated. Studies by Lyman et al., Morrison et al., Gomez et al., and Caggiano et al. provided additional information regarding the risk of neutropenia in NHL patients. Important clinical risk factors identified by these models include first cycle absolute neutrophil count (ANC), age, chemotherapy dose, performance status, serum LDH, bone marrow involvement, and serum albumin of less than 3.5. We utilized risk factors and risk models developed for breast cancer patients, for NHL patients, and for elderly patients to develop evidence-based practice guidelines for the proactive management of neutropenia. Factors involved in guideline development and implementation included identification of a problem, review of available literature, a draft of guidelines, implementation of guidelines, and evaluation of the guidelines after use in the practice setting. Since development of the risk-based neutropenic guidelines, we have proactively implemented the guidelines on ten patients with breast cancer and NHL over the past eight months. Patient assessment since guideline implementation has been an ongoing evaluation of chemotherapy dose delivery and hospitalizations for febrile neutropenia. Follow-up of the first ten patients will be discussed.