Congress Abstracts 2005

27

ONCOLOGY CLINICAL NURSE SPECIALISTS IMPLEMENT A CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING EVIDENCE-BASED PROJECT. Constance Donovan, RN, MSN, FAAN, AOCN^®, Yale New Haven Hospital, New Haven, CT; M. Tish Knobf, RN, PhD, AOCN^®, FAAN, Yale University School of Nursing, New Haven, CT; and Christine Denhup, RN, MSN, CPON^®, Karen Coombe, RN, AD, OCN^®, and Cindy Czaplinski, RN, MSN, Yale New Haven Hospital, New Haven, CT.

Knowledge of the patient’s experience with chemotherapy-induced nausea and vomiting (CINV) is of critical importance for effective management. Recent literature suggests that clinicians underestimate the incidence and severity of acute and delayed CINV. To address this problem at a university based NCI-designated cancer center, Oncology Clinical Nurse Specialists (CNSs) implemented a CINV Evidence-Based (EB) Project.

The purpose of the CINV EB Project was to influence nurse assessment/documentation of CINV in all oncology practice sites. Oncology CNSs play a key role in EB symptom management initiatives within their practice settings working with clinical staff. The literature identifies that simply providing evidence regarding best practice to clinical nurses is unlikely to result in desired practice changes. Thus, this presentation will describe the multifaceted processes used by the project CNSs with attention to such critical factors as organizational change, barriers related to CINV nurse assessment/documentation and strategies to overcome identified barriers.

The project was presented to and jointly accepted by standing oncology nursing committees. A representative workgroup from all practice sites was formed. Baseline staff needs assessment and CINV assessment/documentation data were collected which revealed practices and 2 key barriers: an inadequate nursing standard for CINV and inadequate documentation systems. Intervention strategies included: (1) literature review, (2) development of a new standard, (3) revision of the outpatient and inpatient flow sheets and (4) addition of a CINV section to the inpatient nursing admission assessment. Implementation strategies included: planning with nurse managers, sharing baseline data and small group educational discussions.

A nursing staff evaluation and chart audit will be used to evaluate the CINV EB Project. Data will be collected during month 3 (11/04) and month 6 (4/05) post implementation. The results will be compared to baseline data to determine trends in nurse practices and staff satisfaction.

Quality EP projects require a systematic approach and an understanding of the challenges of implementing change in contemporary health care settings. CNSs, who are embedded in the practice site and have established working relationships with clinical nurses, administrators, and key personnel in all departments, are in an ideal position to guide to practice change.