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Best of ONS Abstracts: Successful Training to Impact Care

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Best of ONS Abstracts: Successful Training to Impact Care Best of ONS Abstracts: Successful Training to Impact Care 1. Using a Pediatric Radiation Therapy Training 2. A Successful Multifocal Team-Based Initiative to Pre- Program to Avoid the Use of Anesthesia in Pediatric vent CLABSI: Outcomes From the Engagement of Nurses, Patients ages 3-12 Years Nursing Assistants, Patients, Families, and Physicians Danielle Crump RN, BSN, OCN Jordan Oliver RN, BSN, OCN Nurse Clinician III/RN, BSN, OCN Assistant Nurse Manager Johns Hopkins Hospital UCI medical Center [email protected] [email protected] Best of ONS Abstracts: Successful Training to Impact Care Oncology Nursing Society 42nd Annual Congress Clinical Practice May 4–7, 2017 • Denver, CO 1 ONS 42nd Annual Congress Using a Pediatric Therapy Training Program to Avoid the Use of Anesthesia in Pediatric Patients ages 3-12 years Danielle Crump, BSN, RN, OCN Disclosures • The author has no financial relationships to disclose. Ethan’s Experience Clinical Practice (D. Crump) 1 ONS 42nd Annual Congress Past Practice • Craniospinal irradiation • General anesthesia for kids <10y (no standard) • 30-33 treatments • Immobilization device • NPO after midnight • Early arrival to clinic • Port access daily or weekly • Recovery • Time in the department ~2-3 hours daily The Vision • Literature Review – Behavioral Training (Scans) – Play Therapy – Audiovisual – Reward System • Best Practices of Other Hospitals – Child Life – Music Therapy/relaxation techniques – Technology – Reward System – Valium – Anesthesia Johns Hopkins Pediatric Anesthesia Training Program • Target age group: 3-12 yo • Treatment diagnosis: CNS tumors, neuroblastoma, Wilms tumor, ALL, lymphoma, sarcoma • Training program includes: assessment/screening, acclimation, play, practice Clinical Practice (D. Crump) 2 ONS 42nd Annual Congress The Team Consult: Screening • Multidisciplinary team meets with family • Build rapport • Specific questions asked: – Eating habits – Sleeping – blanket, pillow, stuffed animal – Favorite things (i.e. super hero, cartoon, fairy tale) – Coping • Tour of the Radiation Department • Tools for preparation and training Developmental Milestones For children 3-5 years of age: • Initiative; confidence • Questions things; ritualistic; magical thinking • Has conversations; masters new skills and tasks; can modify behavior with rewards, plays cooperatively • Use dolls or puppets to help explain procedures; reassure child; allow child to make reasonable choices; offer rewards (stickers); praise appropriate behavior; provide privacy Clinical Practice (D. Crump) 3 ONS 42nd Annual Congress Simulation Training Process • Education • Engagement – Time in clinic, treatment, and sim rooms – Time to play with materials • Encouragement • Training Tools – Mask painting – Manipulatives – Rewards – Use of dolls Training Process Complete Clinical Practice (D. Crump) 4 ONS 42nd Annual Congress Treatment • Routine • ‐Help patient maintain consistency • Reinforcement • ‐Child Life or Nursing presence daily • ‐Same therapy team daily Pediatric Patients Ages 3‐12y Receiving Radiation Therapy with or without Anesthesia 100% 90% 80% 70% 60% No Anesthesia 50% Anesthesia 40% 30% 20% 10% 0% 2011 2012 2013 2014 2015 2016 Pediatric Patients Receiving Radiation Therapy with no Anesthesia 100% 90% 80% 70% 60% 7‐12 y 50% 3‐6 y 40% 30% 20% 10% 0% 2011 2012 2013 2014 2015 2016 Clinical Practice (D. Crump) 5 ONS 42nd Annual Congress Financial Implications Approximate Cost Savings Anesthesia $40,000 RN Time $2,000 Approximate total $42,000 Note: This does not include cost of supplies, monitors, anesthesia cart/equipment, anesthesia tech, etc). Benefits of No Anesthesia Patient Benefits: – Eat anytime – Less time in the department – Less restrictions – No port access – Lower cost of treatment – Safer/less risk – Parent involvement/less stress on family – Relief In Conclusion Happiness All Around! Clinical Practice (D. Crump) 6 ONS 42nd Annual Congress References • Beagley, L., & Smith, R. (2014). A competency based orientation and credentialing program for the registered nurse in the perianesthesia setting. Cherry Hill, NJ: American Society of PeriAnesthesia Nurses. • Bucholtz, J. (1992). Issues concerning the sedation of children for radiotherapy. Oncology Nurses forum, 19(4), 649-655. • Bucholtz, J. (1994). Comforting children during radiotherapy. Oncology Nurses forum, 21(6), 987-993. • Haeberli, S., Grotzer, M., Niggli, F., Landolt, M., Linsenmeier, C., Ammann, R., & Bodmer, N. (2008). A psychoeducational intervention reduces the need for anesthesia during radiotherapy for young childhood cancer patients. Radiation Oncology, 3(17), 1-6. • Klosky, J. L., Tyc, V. L., Tong, X., Srivastava, D. K., Kronenberg, M., de Armendi, A., & Merchant, T. (2007). Pediatric Distress during radiation therapy procedures: The role of medical, psychosocial, and demographic factors . Official Journal of The American Academy of Pediatrics, 119, 1159-1166 • Mcgee, K. (2003). The role of child life specialist in a pediatric radiology department . Pediatric Radiology, 33(7), 467-474. References • Pressdee, D., May, L., Eastman, E., & Grier, D. (1997). The use of play therapy in the preparation of children undergoing mr imaging. The Royal College of Radiology, 52, 945-947. • Schlund, M. et al (2011). Pediatric functional magnetic resonance neuroimaging: tactics for encouraging task compliance. Behavioral and Brain functions, 7(10), 1- 10. • Scott, L. (2002). Minimising the use of sedation/anaesthesia in young children receiving radiotherapy through an effective play preparation programme. European Journal of Oncology Nursing, 6(1), 15-22. • Slifer, K. J. (1996). A video system to help children cooperate with motion control in young children undergoing radiation treatment without sedation. Journal of Pediatric Oncology Nursing, 13, 91-97. • Tyc, V., Klosky, J. L., Kronenberg, M., De Armendi, A., & Merchant, T. (2002). Children's distress in anticipation of radiation therapy procedures . Children's Health Care , 11-2 • Willis, D., & Barry, P. (2010). Audiovisual interventions to reduce the use of general anaesthesia with paediatric patients during radiation therapy. Journal of Medical Imaging and Radiation Oncology, 54, 249-255. Clinical Practice (D. Crump) 7 ONS 42nd Annual Congress A Successful Multifocal Team‐Based Initiative to Prevent CLABSI : Outcomes From the Engagement of Nurses, Nursing Assistants, Patients, Families and Physicians Jordan Oliver BSN, RN, OCN, Assistant Nurse Manager ‐ Oncology Jennifer Hoff MSN, RN, OCN, CMSRN Medical‐Surgical Nurse Educator Deborah Boyle MSN, RN, AOCNS, FAAN, Oncology Clinical Nurse Specialist Jennifer Yim BSN, RN, CIC, Nurse Infection Preventionist Cynthia Reyes BSN, RN, OCN, Nurse Manager ‐ Oncology • No Disclosures UC Irvine Health • 400+ bed tertiary care academic medical center • Magnet‐designated • NCI Comprehensive Cancer Center • 30‐bed oncology and medical telemetry unit • Diverse patient population • > 50% of patients are hematology/ oncology Clinical Practice (J. Oliver) 1 ONS 42nd Annual Congress PROBLEM Initiative Development • Multidisciplinary Team Bedside staff Unit nursing leadership Oncology Clinical Nurse Specialist Nurse Educator Nurse from ‘Epidemiology and Infection Prevention’ (EIP) Hematology/Oncology physicians & fellows EIP physicians • Support from Leadership Nursing Administration • Developed bundled interventions rolled out in 3 phases Three Phase Plan Line Care & Assessment CHG Count Bathing with Me Clinical Practice (J. Oliver) 2 ONS 42nd Annual Congress Phase 1 : Central Line Assessment, Maintenance and Care Challenges and process gaps identified: Line care and dressing changes inconsistent RN to MD communication of problematic sites inconsistent Physicians unaware of high risk lines No standardized way to assess or respond to ‘At Risk’ lines Phase 1 : Central Line Assessment, Maintenance and Care Unit Central Line Champions RN peer‐peer evaluation of line care Central Line Rounds Daily Weekly Nurse/Physician Collaboration Team approach Hospital line assessment tool (CLISA) Central Line Insertion Site Assessment (CLISA) Score Clinical Practice (J. Oliver) 3 ONS 42nd Annual Congress Outcomes Improved quality of documentation Improved RN‐MD communication Facilitated early recognition of localized inflammation and removal of high risk lines Phase 2 : CHG Bathing Challenges and process gaps identified: Baths typically performed by NA Knowledge deficit of purpose Inconsistent technique Patient refusals Documentation challenging Phase 2 : CHG Bathing Improvements Comprehensive education and training for all nursing assistants (including documentation): ‘Hand’s On’ teaching format Small group or ‘One –One’ only to encourage discussion Daily compliance checks Patients who refused were visited/educated further by leadership Clinical Practice (J. Oliver) 4 ONS 42nd Annual Congress Outcomes Bathing participation improved to average > 83% per month (from 66%) Of the 2 CLABSIs in early 2016, only 1 was a skin organism (occurring early post intervention) Phase 3 : Scrub the Hub Initiative ‐ “1,2,3…Count with Me” Challenges in ‘Scrub the Hub’ practice identified: Variable compliance Difficult to monitor Patients unaware of best practice Phase 3 : Scrub the Hub Initiative ‐ “1,2,3…Count with Me” Adapted practice shared from Johns Hopkins Cancer Center* regarding engaging patients & families in scrubbing the hub Patients and families taught to count along when nurses scrub the hubs Engages patient’s active participation in their
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