Congress Abstracts 2006

123

A DECISION TREE FOR ANEMIA INTERVENTION: NURSES ARE KEY TO IMPROVING CLINICAL PRACTICE. Maureen Buckner, RN, MSN, CNP, AOCN^®, and Melissa Nelson, RNC, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH.

Anemia is a common complication for patients undergoing chemo-therapy. Anemia-directed interventions are useful if routinely implemented; however, new and emerging data on erythropoietic therapies represent challenges for oncology clinics and drive the need to update their evidence-based anemia-treatment guidelines. As primary supportive care providers, nurses are ideally situated to evaluate new guidelines and associated patient outcomes. Here we describe one center's pharmacist-led project where nurses were key to implementing new anemia guidelines in the clinic and educating staff.

To evaluate an educational tool for staff describing new guidelines for the treatment of chemotherapy-induced anemia at Ohio State University Medical Center by measuring treatment and practice efficiency. To evaluate a reminder/educational tool for patients as measured treatment compliance.

A multidisciplinary team reviewed the literature and National Comprehensive Cancer Network guidelines on treatment of anemia before drafting guidelines specific to our clinic and study objectives. Data supported using darbepoetin alfa every 2 weeks (Q2W), or every 3 weeks (Q3W) with earlier intervention. In the new guidelines, hemoglobin <11g/dL vs <10g/dL was the new threshold for starting on-time. Recommended darbepoetin alfa dosing was 200 mcg Q2W SC or 300 mcg Q3W titrated to maintain hemoglobin levels between 11 and 12 g/dL. Physicians, nurses, and pharmacists were instructed on the efficacy and indications for each administration. To help, a dosing guideline decision-tree pocket card for staff and a treatment-reminder card for patients and caregivers were developed.

The decision-tree and treatment-reminder cards will be presented. Final results (in progress) will focus on physician/nurse-practitioner compliance to the new anemia guidelines and patient compliance to treatment visits from December 2004 (guideline implementation date) to December 2005. Preliminary results indicate that the treatment-reminder cards helped to minimize the number of missed appointments.

Oncology nurses and pharmacists partnered to develop and implement new anemia therapy guidelines. Nurses played an essential role in guideline implementation and education of clinic staff. Our decision-tree pocket card helped increase familiarity with new guidelines and paved the path to physician acceptance. These guidelines were easy to understand and have empowered nurses to become more active providers of supportive care.