Congress Abstracts 2006

119

THE ROLE OF THE ONCOLOGY NURSE IN PRECHEMOTHERAPY NEUTROPENIC RISK ASSESSMENT AND PATIENT OUTCOMES. Anne Doyle, RN, MSN, Kathryn Keegan, ARNP, Kristin Mullen, ARNP, Gabrielle Zecha, PA, C, Charles Boyd, PA, C, and Janice Hutson, RN, BSN, Puget Sound VA Medical Center, Seattle, WA.

Myelosuppressive chemotherapy regimens often result in neutropenia, which can lead to febrile episodes requiring hospitalization. Identifying patients at high risk for neutropenia before the initiation of treatment enables providers to make decisions about the need for proactive growth factor support.

To assess the effect of pretreatment neutropenic risk assessment on patient outcomes.

A neutropenic risk assessment, which was consistent with the recently published evidence-based guidelines of the National Comprehensive Cancer Network, was completed by the clinic nursing staff for all new patients beginning chemotherapy in the Cancer Care Clinic. Based on the results of this assessment, appropriate patients received growth factor support starting in the first cycle of chemotherapy. The effect of the implementation of a risk assessment tool was evaluated in a review of chart records; patient outcomes in 2004, before the tool had been implemented, were compared to outcomes in 2005, after the tool had been routinely used on every patient initiating a new chemotherapy regimen.

The implementation of the risk assessment tool significantly reduced the number of hospitalizations for febrile neutropenia (FN) by 78%, from 9.7% in 2004 to 2.1% in 2005 (P = .003 [Fisher Exact Test]). The total number of hospital days also decreased from 117 days to 24 days. In 2005, the proactive use of growth factor support increased from 26% in the first 6 months to 51% in the last 6 months. Reactive growth factor use also decreased from 10% to 6%. The number of patients given growth factor support proactively (51%) corresponded to the proportion of patients treated with myelosuppressive chemotherapy regimens associated with >20% incidence of FN (49%). These data support the appropriate use of colony-stimulating factors based on chemotherapy risk.

The completion of a neutropenic risk assessment before the initiation of chemotherapy has a positive effect on patient outcomes, with fewer incidences of FN and hospitalization, as well as fewer total inpatient days. This study demonstrates the feasibility of implementing risk assessment tools; oncology nurses can routinely evaluate patient risk for chemotherapy-induced neutropenia, which can result in a substantial improvement in patient outcomes.