EFFECTIVE PRACTICES AND STANDARDS WHEN CARING FOR HEMATOLOGY/ONCOLOGY PATIENTS IN THE PICU

Transcription

1 EFFECTIVE PRACTICES AND STANDARDS WHEN CARING FOR HEMATOLOGY/ONCOLOGY PATIENTS IN THE PICU EVIDENCE BASED PROJECT NURSE RESIDENCY PROGRAM UC DAVIS MEDICAL CENTER DECEMBER 18, 2012 Nicole Cortez, BSN, RN Brooke Holoubek, BSN, RN Elizon Ramos, BSN, RN

2 OBJECTIVES To increase safety (reduce administration errors, provide patients with well-educated RNs through effective education, and standardize room set-up) and reduce complications (decrease infection rates and diminish exposure ) in hematology/oncology patients treated in the PICU Standardize room set-up by developing a lifewings checklist in accordance to standard PICU practice in utilizing lifewings in high-risk procedures and situations Further RN education in the neutropenic patient and/or patient receiving chemotherapy as many RNs express unfamiliarity with this population Demonstrate evidence to advocate for additional RNs trained in the administration of chemotherapy

3 FOUR AREAS REVIEWED Protective Isolation What type of protective isolation or if any protective isolation may beneficial to neutropenic patients? Protecting Skin and Oral Mucosa What type of hygiene measures are necessary to decrease patient s risk of developing and skin or oral mucosa problems? Diet What should a nurse know about the diet of an hem/onc patient? Reduction in Exposure When providing chemotherapy what is necessary for a nurse to use to reduce exposure to chemotherapy?

4 PROTECTIVE ISOLATION What is protective isolation? Negative Pressure Rooms Gowns, masks and gloves, eye protection used by medical staff and families Hand washing Protective Isolation is used depending on the illness or condition of the patient. In neutropenic patients, protective isolation is used to prevent infection being spread to immune compromised patients.

5 PROTECTIVE ISOLATION According to the Oncology Nursing Society (2009), No systematic evidence exists for the practice of protective isolation of the neutropenic patient with cancer. Such measures may be substituted with aggressive hygienic measures According to the Journal of Pediatric Oncology (2011), Protective Isolation should only used for recent Bone Marrow Transplant patients or patients that have known signs and symptoms of illness and have a likelihood of spreading the illness to others. As stated by the Infectious Disease Society of America (2010), Standard precautions should be followed and infection specific isolation should be used for patients with

6 PROTECTING SKIN AND ORAL MUCOSA In neutropenic patients and patients receiving chemotherapy, there can be breakdown to the skin and oral mucosa due to an compromised immune system and side effects of the chemotherapy. With skin and oral mucosa breakdown signs and symptoms of infection may begin if standard skin and oral care is not implemented. Nurses encourage and implement daily skin and oral hygiene in order to prevent infection.

7 PROTECTING SKIN AND ORAL MUCOSA Evidence suggests by Freifeld et al (2011): Shower daily; develop protocols for perineal care; restrict use of tampons, rectal thermometers, enemas, suppositories. Brush teeth x2 daily, utilize sterile water, normal saline, or sodium bicarbonate rinses

8 DIET One aspect of preventing signs and symptoms of infection in the neutropenic patient historically has been related to diet. Fresh fruit and vegetables were eliminated from the patient s diet due to the possible introduction of a bacterial organism that could not be appropriately treated in an immune compromised patient. Elimination of raw eggs, fish and uncooked meat is also part of the low bacterial diet.

9 Evidence Suggest: DIET No link between dietary restrictions with lower risk for infection, Kenny & Lawson (2000) Infection rates for children with cancer on the neutropenic diet were similar to those for patients following food safety guidelines, Moody, Finlay, Mancuso, & Charlson (2006) Eat fruits and vegetables if well washed with tap water. Avoid raw and/or unwashed meat, eggs, fish, and shellfish. Oncology Nursing Society (2009).

10 REDUCTION IN EXPOSURE To reduce nurses exposure to chemotherapy agents: Participate in training provided by employer, recognize sources of exposure, use appropriate PPE i.e. two pairs of disposable chemotherapy gloves and mask and gown when appropriate, use soap and water before and after donning PPE, dispose of hazardous waste separately, NIOSHA (2012) Use nitrile or neoprene gloves especially without powder, gowns, eye protection and respirators as necessary. Use disposable pads instead of laundering. Cover toilet when flushing. Use closed system products. Oncology Nursing Society (2004)

11 CONCLUSION Isolation Precautions should only be used if the patient is displaying signs and symptoms of infection. Neutropenia alone does not warrant the patient to be in protective isolation. To reduce the likely hood of possible infection daily personal and oral hygiene should strictly followed. Fruits and vegetables, when washed appropriately, should not be eliminated from a neurtopenic patients diet. RN exposure to chemotherapy can drastically reduced by encouraging department education and protective measures such gowns, chemotherapy gloves, mask and eye protection.

12 PROPOSAL FOR PICU LIFE-WINGS CHECKLIST Protective Isolation Precautions (droplet, contact, resistant organism, neutropenia) Oral Hygiene PRN (assessment of need, necessary oral kits at bedside) Dietary Restrictions (assessment of patient needs/preferences)

13 REFERENCES Eaton, L., & Tipton, J. (Eds.), (2009), Putting evidence into practice: Improving oncology patient outcomes, Pittsburgh, PA: Oncology Nursing Society Freifeld, A., Bow, E., Sepkowitz, B., Ito, J., Mullen, C., Raad, I., Rolston, K., Young, J., &Wingard, J. (2011) Clinical Practice Guide for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America. ISDA Guidelines. Retrieved from Fox, N. & Frefield, A. (2012) The neutropenic diet reviewed: moving toward a safe food handling approach. Oncology, 26(6): 572-5, 580, 582. Retrieved from Fransman W; Huizer D; Tuerk J; Kromhout, H. (2007). Inhalation and dermal exposure to eight antineoplastic drugs in an industrial laundry facility. International Archives Of Occupational And Environmental Health, 80(5),

14 REFERENCES Friese, C., Himes-Ferris, L., Frasier, M., McCullagh, M., & Griggs, J. (2012). Structures and processes of care in ambulatory oncology settings and nurse-reported exposure to chemotherapy. BMJ Quality & Safety, 21(9), doi: /bmjqs Jubelire, S. (2011) The Benefit of the Neutropenic Diet: Fact or Fiction? Oncologist, 16(5): doi: /theoncologist Kenny, H. & Lawson, E. (2000). The efficacy of cotton cover gowns in reducing infection in nursing neutripeic patients: an evidence-based study. International Journal of Nursing Practice 6(3) Larson, E. & Nirenberg, A. (2004). Evidence-based nursing practice to prevent infection in hospitalized neutropenic patients with cancer. Oncology Nursing Forum, 31(4), Moody K., Finlay J., Mancuso C., & Charlson, M. (2006) Feasibility and safety of a pilot randomized trial of infection rate: neutropenic diet versus standard food safety guidelines. Journal of Pediatric Hematology/Oncology, 28(3): doi: /01.mph fb

15 REFERENCES New approaches in safe handling of hazardous drugs. (2004). ONS News / Oncology Nursing Society, 19(9 Suppl), Saria, M. (2011). Preventing and Managing Infections in Neutropenic Stem Cell Transplantation Recipients: Evidence-Based Review. Clinical Journal doi: /11.cjon Schlesinger, A., Paul, M., Gafter-Gvili, A., Rubinovitch, B., Leibovici, I. (2009). Infection-control intervenions for cancer patients after chemotherapy: a systemic review and meta-analysis. The Lancet Infections Diseases 9(2) Schwappach, D., & Wernli, M. (2010). Medication errors in chemotherapy: incidence, types and involvement of patients in prevention. A review of the literature. European Journal Of Cancer Care, 19(3), doi: /j x Sheridan-Leos, N. (2007). A model of chemotherapy education for novice oncology nurses that supports a culture of safety. Clinical Journal Of Oncology Nursing, 11(4), 545. doi: /07.cjon

16 REFERENCES Siegel, J., Rhinehart, E., Jackson, M., Chiarello, L., & the Healthcare Infection Control Practices Advisory Committee. (2007) Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings Van Dalen, E. Mank, A., Leclercg, E., Mulder, R., Davies, M., Kerseten, M., & van de Wetering, M. (2012). Low bacterial diet versus control diet to prevent infection in cancer patients treated with chemotherapy causing episodes of neutropenia. The Cochrane Library, 2012 (9). doi: / cd pub2 Zitella, L., Friese, C., Hauser, J., Gobel, B., Woolery, M., O'Leary, C., & Andrews, F. (2006). Putting evidence into practice: prevention of infection. Clinical Journal Of Oncology Nursing, 10(6), 739. doi: /06.cjon Google Images for Slide Pictures