Addressing Cancer Fatigue Across the Continuum of Care. St. Cloud Hospital. Evidence Based Practice Project

Transcription

1 Addressing Cancer Fatigue Across the Continuum of Care St. Cloud Hospital Evidence Based Practice Project 1

2 Project Leader Catherine Tieva, RN, OCN 2

3 Purpose and Rationale ONS identified a cluster of side effects experienced by nearly all cancer patients undergoing treatment. Cancer-related fatigue (CRF) is the most prevalent side effect of cancer treatment. It is also the least addressed. CRF is a distressing, persistent, subjective sense of tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning. Education is an important part of treatment. By understanding fatigue, patients can cope better as well as reduce distress 3

4 Purpose and Rationale Multidisciplinary team comprised of health care professionals from the inpatient Oncology unit, Coborn s Cancer Center, Radiation Oncology Dept., Home Care Services and Outreach Clinics worked together to become clinical experts on the subject of CRF. Improve care delivered to the oncology patient population by implementation of a formal process to provide assessment, education and interventions for CRF utilizing EBP. 4

5 Synthesis of the Evidence/ Level of Evidence Accomplished by synthesizing information available in both literature and guidelines. National Commission on Cancer (2005) developed Guidelines for the Management of Fatigue that summarized standards of care for fatigue assessment and management based on an extensive synthesis of evidence. (Level A). By familiarizing themselves with the evidence the team was able to develop methods to assist caregivers in supporting this particular patient population. 5

6 Synthesis of the Evidence/ Level of Evidence Further literature review was required when updated guidelines were released during work on the project as well as when the FDA released a change in recommended treatment. 6

7 Proposed Change in Practice Use, adapt and develop formal assessment tools based on available evidence. Develop patient and staff education materials appropriate for level of patient fatigue assessed. 7

8 Implementation Strategies Project Theme and Logo. Adopt Baseline Fatigue Assessment Tool. Comprehensive Fatigue Assessment Tool. Patient Education Sheet. Standard of Care. Policy. Standing Orders. 8

9 Implementation Steps 9

10 10

11 Implementation Strategies Pilot implementation in the inpatient setting 2/12/2007 which correlated with EMR go live. Coborn Cancer Center and Radiation Oncology Department went live 4/16/

12 Evaluation/Outcome Measures Pre-Measure Measure assessment, interventions and provision of patient education on fatigue through PI process. 12

13 Evaluation/Outcome Measures Pre-Measure Fatigue knowledge survey completed by staff providing care for oncology patients across the continuum. Baseline chart audits to assess documentation of assessment, education and interventions by caregivers of CRF. 13

14 Evaluation/Outcome Measures Pre-Measure Nursing Survey Response Rate: Inpatient 89% Homecare 59% Radiation/Onc 91% Outpt Chemo/Infusion 96% Outreach 10% 14

15 Evaluation/Outcome Measures Pre-Measure Chart Audits: 25% of Patients Seen in One Month Nursing: 77% No Documented Assessment 85% No Documented Education 86% No Documented Mgmt Strategies Physicians: 67% No Documented Assessment 47% No Documented Fatigue Specific Interventions 87% No Documented Treatment 15

16 Evaluation/Outcome Measures Post Measure Results showed providers possessed a fair amount of baseline knowledge of CRF. Limited documentation of assessment, education or interventions provided to patients. Nursing response rates to knowledge survey were indicative of success of initial project implementation by area. 16

17 Evaluation/Outcome Measures Post Measure Audit results Nursing Pre Post 1 Post 2 Post 3 Documented Assessments 23% 54.4% 64.3% 85.4% Documented Education 15% 48.4% 64.3% 73.2% Documented Management Strategies 14% 46.3% 59.5% 67.5% Physician Pre Post 1 Post 2 Post 3 Documented Assessments 33% 36.2% 42.1% 45% Documented Interventions 53% 62.7% 66.7% 57.5% 17

18 Next Steps Sustain the gains already made. Measure, measure and measure some more. Hold focus groups with all parties involved. Evaluate findings. Fine tune our project.. 18

19 Next Steps Go fishing to bring areas lagging behind back on board. Provide staff with education as needed. Continue to review the most current literature and guidelines available at regular intervals. Explore potential to carry out to other patient populations. 19

20 Special Recognition and Thanks Roxanne Wilson Internal Medicine Care Center Director EBP Advocate and Advisor, St. Cloud Hospital. Tracey Dearing-Jude RN BSN OCN, SCH Oncology Inpatient Unit Educator. CCHS Cancer Fatigue Project Team. CCHS Oncology Patient Care Staff. 20

21 Project team Tracey Dearing-Jude, RN, Inpatient Oncology Unit Educator Brenda Eveslage, RN, Outpatient Chemo Infusion Educator Sandy Johnson, RN, Oncology Clinical Nurse Specialist Derek Peterson, RN, Director Radiation Oncology Jane Vortherm, RN, Director Chemo Infusion Coborn Cancer Center Brian Unglaub, Oncology Nurse Practitioner Coborn Cancer Center Barb Burandt, RN, Director Home Care & Hospice Di Ann Loven, RN, Little Falls Outreach Stephanie Fyten, RN, Little Falls Outreach Linda Van Valkenburg, RN, Long Prairie Outreach Lynn Flesner, RN, Glenwood Outreach 21

22 References Quote taken from (National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology; Cancer Related Fatigue V.I p. FT-1). NCCN Clinical Practice Guidelines in Oncology; Cancer- and Treatment-Related Anemia V.S University of Iowa Hospitals and Clinics Department of Nursing Services and Patient Care; Toolkit for Promoting Evidence Based Practice, Quick & Fonteyn(2005), Clinical Journal of Oncology Nursing; Clinical Survey for Cancer-Related Fatigue Assessment, Vol. 9, Number 4(pgs ). Stricker et al (2004) Oncology Nursing Forum; EBP for Fatigue Management in Adults with Cancer: Exercise as an Intervention Midtgaard et al (2004) Transforming the nature of fatigue through exercise: qualitative findings from a multidimensional exercise programme in cancer patients undergoing chemotherapy; European Journal of Cancer Care, 2004, 13, Hickok et al (2005) Frequency, Severity, Clinical Course, and Correlates of Fatigue in 372 Patients during 5 Weeks of Radiotherapy for Cancer; American Cancer Society, Retrieved 1/