Basis of inquiry: Our 32-bed inpatient oncology unit identified delays in initiating chemotherapy for scheduled patients. With an increased census and tightened staffing ratios, the chemotherapy admission process became increasingly inefficient. These delays resulted in frustration for both patients and healthcare providers.
Purpose/Objectives: The aim of this project was to devise and evaluate a more efficient and consistent admission process through the use of a resource nurse. We sought to develop a workflow to deliver “on time” chemotherapy, defined as prior to shift change at 7 pm. This would reduce delays and increase satisfaction of patients, families, and providers.
Methods: This clinical practice project began after a 3-month period of collecting pre-implementation audits completed by the admitting bedside nurse. Audits identified patient scheduled admission time, actual admission time, time of port access, labs drawn and fluids started, the time the patient was clinically ready for chemotherapy, and the actual chemotherapy start time. The audit form included a space for additional comments about perceived delaying factors or barriers to care. Audit results were presented to the management team along with a proposal to implement a resource nurse to standardize admission workflow. This project was trialed during Monday through Friday day shifts over 3 months. Initially the resource nurse was identified as the secondary charge nurse who was chemotherapy/biotherapy trained, and no additional full time employees were required. The month prior to implementation, the resource nurse role was outlined and presented at the monthly leadership meeting for charge nurses, educators, and management. The role included preparing pumps, tubing, and labs for each admission that shift, obtaining initial height, weight, and vital signs, accessing the port, obtaining laboratory specimens, and initiating the first fluid bolus. The resource nurse would transfer the patient to the bedside nurse, using a designated handoff tool and pass on the audit. The bedside nurse initiated chemotherapy when the patient was clinically ready, using the resource nurse for assistance and to perform double checks. Project efficiency was measured using the same audit that was completed during pre-implementation.
Findings or Outcomes: The pre-implementation audit showed that 17.5% of chemotherapy agents were initiated after change of shift (7 pm). Nurse identified delaying factors included chemotherapy not made despite patient being clinically ready, patient not having anesthetic cream in place at admission and refusing numbing spray, and the admitting nurse being busy and unable to attend to patient promptly after arrival to unit. At the conclusion of the trial period 9.3% of agents were started after change of shift. The most frequently reported delaying factor remained chemotherapy not being made despite patient clinical readiness. These results show an overall improvement in the measures taken to increase efficiency of chemotherapy admissions and start times. Introduction of the resource nurse role was successfully implemented as a budget neutral project. The role has been retained for over 1 year and recently was approved for a clinical shift title by the hospital. The role also has been extended to nurses other than charge nurses, and has opened the door for many new unit practices, staffing, and workflow adaptations.
Disclaimer: [1 CH] will be awarded for attending all three paper presentations presented during this timeslot. Partial credit is not available.
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