Assessment of knowledge of vincristine toxicities in outpatient pediatric hematology/oncology nurses: An educational intervention.

Abstract

231 Background: Vincristine (VCR) is a chemotherapeutic agent with a unique neurological side effect profile and is integral to the treatment of many pediatric hematological and solid malignancies. Side effects requiring VCR dose modification include peripheral neuropathies, intestinal ileus, cranial nerve abnormalities, hyponatremia and seizures. In our institution, orders for weekly VCR are written in advance by oncologists and administered by outpatient nurses independent of a provider physical examination. We sought to increase knowledge of VCR toxicities and improve pre-chemotherapy evaluation skills among outpatient Hematology/Oncology (Hem/Onc) nurses. Methods: A 23-question written quiz was given as a pre-test to 14 outpatient Hem/Onc nurses to assess their fund of knowledge regarding VCR toxicities. An educational intervention was then provided to the cohort as a lecture by a Hem/Onc fellow physician. The lecture was followed by the same quiz given as post-test to the nurses. Individual participant and group scores were tabulated comparing pre and post-test responses to assess improvement in identification and recognition of VCR toxicities. Results: 12/14 nurses demonstrated improvement in their fund of knowledge regarding VCR side effects (mean change in individual scores + 4.7). As a group, mean scores increased from 15.2 to 18/23 (the two-sample paired t-test was significant with a two-tailed p<0.005). Conclusions: An educational intervention significantly improved outpatient Hem/Onc nurses fund of knowledge regarding identification and evaluation of VCR toxicities. Future objectives include follow-up evaluation of retention of knowledge of VCR side effects and incorporating a VCR toxicity checklist into the electronic medical record outpatient nursing note.