Congress Abstracts 2006

139

SUCCESSFUL INTEGRATION OF CRITICAL CARE NURSING ON A HEMATOLOGICAL MALIGNANCY UNIT. Lyle Baker, RN, BSN, Johns Hopkins Hospital, Baltimore, MD.

Hematological malignancy patient can present with leukostasis, tumor lysis syndrome and infections. Their illness and intensive chemotherapy regimens can cause them to become critically ill. In our comprehensive cancer center, a critical care is defined as mechanical ventilation, titration of vasopressors, and treatment of unstable dysrhythmias. Therefore, nurse caring for these patients must be critical care competent.

Training and maintaining competent critical care oncology nurses is challenging. The range of patient acuity levels includes acutely ill patients receiving intensive chemotherapy regimens, to critically ill patients on life support. Providing critical care frequently enough to retain competency is another challenge.

Once a nurse demonstrates competency in the care for acutely ill patients, he practices at this level for approximately six months. A critical care readiness exercise is used to determine if the nurse demonstrates effective critical thinking skills and can prioritize patients' needs in different clinical scenarios. Once the nurse is ready for critical care training, he attends the Hospital's generic critical care course. The Oncology Critical Care Clinical Nurse Specialist (OCCNS) provides the staff with textbooks and lectures for these courses. After completing the courses, the nurse must take and successfully complete three exams: pharmacology, electrocardiogram interpretation, and core that include organ system questions. The next step is two weeks of orientation in critically ill patients' room with a primary preceptor, who is responsible for assuring that the nurse can independently and safely care for critically ill patients, including clear articulation of patient assessments and care needs.

The OCCNS attends multidisciplinary morning rounds on all critically ill patients and is a resource to new critical care nurses. She provides critical care inservices and annual critical care competencies. Mock codes ensure competency in emergency situations. The Center's Multidisciplinary Intermediate and Critical Care Committee establish oncology critical care standards and protocols to monitor compliance.

Incorporating critical care into oncology nursing resulted in a higher level of skill for nurses, enhancing care for acutely and critically ill patients. Patient assignments are more varied resulting in increasing nursing satisfaction. And, continuity of care was enhanced, which is satisfying for the patient and their family.