Congress Abstracts 2006

9

PROTECTION OF PATIENT SAFETY AND IMPROVEMENT OF OUTCOMES THROUGH PRE-BISPHOSPHONATE DENTAL EVALUATIONS USING MULTIDISCIPLINARY COLLABORATION: PREVENTION OF OSTEONECROSIS OF THE JAW (ONJ). Cynthia Waddington, RN, MSN, AOCN^®, Christiana Care Health System, Newark, DE; and Constance Hill, APRN-BC, Medical Oncology Hematology Associates, Newark, DE.

The number of prostate, breast and lung cancer cases, all with a significant risk for boney metastasis continues to grow. Bisphosphonates are an important component of the management of boney metastasis. The use of these drugs significantly reduces skeletal-related events in patients with cancer. However, with long-term use and other risk factors, compromised healing within the jaw bone (ONJ) can result. This condition usually occurs after minor trauma such as dental procedures involving tooth extractions.

The purpose of this project is to establish a mechanism of communication and coordination that results in prevention of ONJ. Timely dental evaluations, appropriate interventions, and clearance by dental prior to initiation of therapy are key components of this process.

Quality nursing coordination and interventions have a positive impact on patient symptom experience and safety. Oncology referrals to a nurse coordinator initiates communication to and education of patients and dental staff and coordination of dental evaluations prior to starting bisphosphonates. Close follow up is maintained while interventions (thorough teeth cleaning, completion of necessary fillings, extractions of non-restorable teeth, and elimination of sepsis) are completed and clearance obtained. Continual communication regarding the status of these essential preventative measures is maintained with treating physician. Tools such as dental letter, supporting research, dental report form, and follow up form facilitate this process. Patients are then assessed for signs of osteonecrosis (oral cavity swelling, infection, pain, and exposed bone) every six months.

A data bank was developed to track number of referrals, risk factors, type of dental work completed, length of time to obtain dental clearance and results of follow up evaluations. Data is reviewed every six months. No new ONJ cases have been identified.

The nurse's role in patient education, supporting patient decision making, and coordination of pre-bisphosphonate dental evaluations is integral to patient safety and outcome management. Completion of thorough assessments and prompt recognition of complications during and post bisphosphonate therapy are also essential. The process used at this institution can be modified to facilitate efforts of prebisphosphonate dental evaluations at other institutions.