Congress Abstracts 2005

39

CHEMOTHERAPY SIDE EFFECTS: DEVELOPING A RISK ASSESSMENT TOOL FOR USE WITH PATIENTS PRIOR TO THEIR FIRST CYCLE OF CHEMOTHERAPY. Alice Quargnenti, RN, BSN, CCRC, The West Clinic, Memphis, TN, and the AIM Higher Task Force, AL.

While risk factors for several chemotherapy-induced side effects are known, little work has been done to develop tools that assist the nurse in efficiently identifying and documenting risk factors. Development of such a tool would be helpful in determining early interventions that could prevent or reduce the severity of chemotherapy side effects.

The purpose of this project was to develop a practical risk assessment tool for use with chemotherapy-naive patients. The tool was developed to assist in individualizing care, thereby focusing appropriate patient education and primary prophylactic measures. The tool was developed by the AIM Higher Risk Assessment Task Force consisting of nurse champions participating in the AIM Higher Initiative.

The following eight side effects of chemotherapy treatment were selected based on relevance to the chemotherapy-naïve patient: neutropenia, anemia, nausea and vomiting, constipation and diarrhea, anxiety and depression, oral mucositis, neurotoxicities, and hand-foot syndrome. Associated risk factors were identified from published literature and incorporated into the tool. The risk assessment was piloted in 6 community oncology clinics, evaluating the form for ease of use, time required for completion, and clarity. Thirty consecutive patients were followed at one site to examine the potential impact of the tool on clinical interventions.

Time to completion ranged from 10–20 minutes, including time for both chart review and patient interview. Several barriers to collecting the risk information were identified including lack of complete information in the chart, scheduling of lab tests, and the time involved in obtaining information. In the 30 consecutive chemotherapy patients with whom the risk assessment tool was utilized, 65% received medical intervention (anti-emetic changes and/or cytokine therapy) related to their chemotherapy regimen.

Comprehensive and systematic risk assessments can be facilitated by nurses through the incorporation of clinically sensitive documentation tools. Identification risk factors will encourage use of established guidelines emphasizing proactive management and may assist clinical investigators in defining the role of predictive risk models in directing patient care.