Congress Abstracts 2004

74

THE ROLE OF THE NURSE PRACTITIONER IN SYMPTOM MANAGEMENT OF COMMON PROBLEMS IN THE AFTER HOURS CLINIC. Veronica Smith, RN, MS, APRN-BC, and Rosalie Valdres, RN, MSN, University of Texas M.D. Anderson Cancer Center, Houston, TX.

Caring for patients in an oncology setting is very challenging. The patients are usually very sick, with multiple complaints that require frequent and timely interventions. Over the years, the treatment of cancer has changed. The infusion of chemotherapy has gone from being a hospital procedure, to what is now a common outpatient clinic procedure. As a direct result of this change in practice, there has been a dramatic influx in the number of patients being treated in the clinic setting. This has created a need to extend the clinic hours to accommodate the growing patient population.

For the past year, the number of calls to the emergency center from the after hours clinics began to increase steadily. The advanced practice nurses who were moonlighting in the emergency center began to keep a record of the calls and the types of problems and interventions required. After a three-month pilot period, the results were evaluated. The medical needs were classified as emergent, urgent, or routine. The most frequent calls were for chemotherapy reactions such as nausea and vomiting, fever, blood transfusion reactions, and pain medications. Hypersensitivity/anaphylactic reactions to chemotherapy or blood products happen quickly and require immediate interventions to prevent further decompensation or injury to the patient. The nurse practitioner (NP) is readily available to intervene in these situations. The skill and knowledge of the NP, as well as the quick response time, help to decrease anxiety of the patient and family members in this setting.

As a result of this study, a position was created for a NP who would see and evaluate the patients in the after-hours clinic, thus, freeing the emergency physician to see the patients in the emergency center. Guidelines and protocols were developed to guide the NP’s practice. The NP works closely with the emergency room physician and the primary oncologist. Patients requiring care that is outside the scope of practice of the NP are stabilized and transferred to the emergency center for further treatment.

The nursing staff in the after-hours clinics verbalized relief at having the nurse practitioner available to them. In the past, they complained of feeling nervous about giving complex chemotherapy regimens in the ambulatory setting when there was not a physician readily available to them. The emergency center physician was usually very busy and not able to come immediately to see the patient. They would usually give orders over the phone and come to see the patient as time allowed.

As cancer care has shifted from in-hospital to outpatient, patients often receive complex chemotherapy regimens in the ambulatory setting. This has created a need among caregivers that we have addressed at our institution with the implementation of NPs in the after-hours clinic setting. NPs are a valuable asset to the healthcare system. We are constantly developing ways to provide high-quality care to our patients. Since the utilization of NPs in our after-hours oncology clinic is a success, we would recommend that NPs would be instrumental in other after-hours settings.