Integrating nursing into oral chemotherapy education.

Abstract

81 Background:The shift of chemotherapy administration from the oncology infusion suite to the home has unwound systems and left patients vulnerable to errors. Many of the safeguards for parenteral chemotherapy, including education by an oncology nurse, are absent for oral chemotherapy. The 2013 American Society of Clinical Oncology/Oncology Nursing Society Standards served as the framework for improving the initiation of oral chemotherapy at Beth Israel Deaconess Medical Center. Methods: Clinicians caring for patients with melanoma and renal cell cancer were surveyed. A team of clinicians, nurses and pharmacist delineated a process map from writing an oral chemotherapy prescription to first follow-up appointment. A retrospective chart review of baseline data provided by a specialty pharmacy revealed 33 patients who initiated oral chemotherapy between July 2014 to July 2015, were not on a clinical trial and had at least two follow-up appointments. The team’s aim is by February 1, 2016 patients initiating oral chemotherapy receive nursing education by the first follow-up visit and at least 50% have documentation of a comprehensive education, including administration, safe handling and side effects. Results: The survey response rate was 9 of 9 (100%). The clinicians ranked patient education as the top priority. Second to time, lack of nursing involvement was identified as the most common contributing factor to patients not receiving a comprehensive education. At baseline, 1 of 33 (3%) patients initiated on oral chemotherapy received education from a nurse. Side effect education was documented in 21 of 33 (64%) clinicians’ notes, though education on safe handling only in 7 of 33 (15%), and education on administration was never documented. Plan-Do-Study-Act cycles are ongoing to implement varied approaches of nursing involvement, including telephone and in-person consultations. Conclusions: Lack of nursing involvement was identified as a missing element in oral chemotherapy care. Because clinicians were engaged, a survey to evaluate the current process succeeded with a high response rate. At baseline, there are significant gaps and variability in current practice, and interventions to provide patients with a comprehensive education are underway.