Congress Abstracts 2006

10

BRINGING THE EVIDENCE TO PRACTICE: DEVELOPMENT OF GUIDELINES FOR MUCOSITIS PREVENTION AND MANAGEMENT IN PATIENTS RECEIVING CANCER THERAPIES. Megan Dunne, RN, MA, APRN-BC, AOCN^®, Joanne Kelvin, RN, MSN, AOCN^®, Sue Derby, RN, MA, CGNP, ACHPN, Mary Montefusco, RN, MA, CGNP, ACHPN, Kristin Cawley, RN, MSN, OCN^®, Jennifer Lucas, RN, BSN, and Jody Gilman, MS, RD, Memorial Sloan-Kettering Cancer Center, New York, NY.

Patients report mucositis as the most bothersome side effect of cancer therapies. It can result in pain, nutritional deficits, infection, and/or the need to alter the treatment plan. The management of oral complications of cancer therapies is integral to the role of the oncology nurse. A recent survey at this cancer center revealed discrepancies in practices and methods for assessment, prevention, and management of mucositis in populations most at risk. A need for change was consequently identified.

This project was implemented to review current mucositis evidence and create standard guidelines for the institution. Clinical questions were framed to focus primarily on identification of an optimal tool for assessment, an oral care protocol, potential use of cryotherapy, and pain management strategies. We anticipate that implementation of the recommendations will ensure consistent assessment and management of mucositis and diminish the incidence and severity of it in our patients.

Nurses at this institution were surveyed with a six-item questionnaire. A multidisciplinary team including ambulatory and inpatient nurses, dental and nutrition professionals, and a pharmacist was established. A literature review was performed using CINAHL and MEDLINE databases to identify systematic reviews (including Cochrane), guidelines (including those from ONS and MASCC), and expert opinion. Evidence was critiqued based on methodologic rigor and feasibility and a summary of the evidence was compiled. Standards were created reflective of this evidence and a series of in-services are planned to educate staff.

Outcomes will be measured in a repeat survey of nursing practice and it is expected that consistency in the assessment, prevention, and management of mucositis will be improved.

New guidelines developed for this institution are based on current evidence. Assessment and documentation of mucositis will be based on CTCAE v3.0 criteria for both objective and functional assessment. Revisions in patient education materials will reflect the standards and improve compliance of patients to an oral care protocol. Four aspects of oral care were defined including cleaning, flossing, rinsing, and lip care. Patient preference was incorporated as much as possible. Cryotherapy will be initiated in appropriate circumstances. Clinician guidelines for management of mucositis pain will be available.