Congress Abstracts 2006

147

METHOD USED TO EFFECTIVELY ADDRESS NURSING CHALLENGES ENCOUNTERED DURING IMPLEMENTATION OF EVIDENCE-BASED ONCOLOGY PROTOCOLS. Freda Barnes, RN, OCN^®, BSN, James Kocis, RN, BSN, and Debra Peter, RN, BC, MSN, Lehigh Valley Hospital, Allentown, PA.

Historically, signs and symptoms of hospitalized patients with cancer were exclusively managed by physicians. Nurses often made multiple calls to physicians to manage sometimes common symptoms (i.e. laxatives for constipation, antidiarrheal agents for diarrhea, blood products for low counts, antiemetics for nausea/vomiting). To avoid symptom treatment delay and to address variations in physician practice, a nursing team searched the literature for best practice guidelines related to symptom management. Recognizing that current evidence supports the implementation of an evidence-based framework to consistently and effectively guide practice, nurses on our 26-bed oncology unit implemented evidence-based oncology protocols based on current National Guidelines. These protocols included a diarrhea protocol, nausea/vomiting protocol, constipation protocol and a blood product protocol.

To implement effective nurse-driven oncology symptom-management protocols and to evaluate the bedside nurse's perceptions of oncology protocol use and impact on the care provided to oncology patients.

Oncology Clinical Nurse Specialists and an Oncology Nurse Practitioner developed the process for staff/physician utilization of oncology protocols. On-line references were developed, staff education was provided, unit resources were made available to staff, and on-going rounding was implemented to heighten awareness and further educate staff to the newly implemented process. An eight question survey was developed that addresses frequency of use of the protocols, timeliness of symptom treatment, nurse's anxiety related to the process, advantages and disadvantages to using oncology protocols and the nurse's perception of the effectiveness of use of protocols.

Challenges related to implementation of oncology protocols were encountered and addressed, including staff reluctance to independently use protocols and their unfamiliarity with grading system for nausea and constipation. A survey was developed to better understand nursing staff perceptions of oncology protocol use.

Implementing successful methods to expedite prompt symptom management/treatment through the development and use of nurse-driven protocols are essential to oncology nursing practice. Listening to the bedside nurse who may be unsure of protocol use has the potential to uncover perceptions that must be addressed to effectively empower the oncology nurse to act in a timely manner and to optimize the care of the oncology patient.