- Email: [email protected]
Patient safety and the power of nursing presence
Annals of Oncology 30 (Supplement 5): v825–v828, 2019 doi:10.1093/annonc/mdz274
CANCER NURSING: PATIENT AND OCCUPATIONAL SAFETY CN31
Adverse events in oncology and haemato-oncology inpatients of Swiss hospitals: A descriptive study
Background: The occurrence rate of adverse events (AEs) in hospitalised cancer patients in Switzerland remains unknown. The Institute for Healthcare Improvement (IHI) Global Trigger Tool (GTT) is among the most used methods to identify AEs. However, the GTT lacks oncology-specific triggers. Therefore, we developed a GTT-based Swiss Oncology Trigger Tool (SOTT), which included two modified GTT modules (“Cares” and “Medication”) and a new “Oncology” module. Objective We applied the SOTT to describe the occurrence rate, nature, level of harm and preventability of AEs reported in health records of four Swiss inpatient oncology and haemato-oncology units. Methods: We reviewed records of discharged patients over a 6-week period using the method recommended by the IHI for the GTT. To identify documented AEs, two nurse reviewers analysed records using the SOTT. Identified AEs were subsequently validated by physician reviewers, and those occurring during hospitalisation were classified regarding the incurred level of harm and their preventability. Results: We reviewed 224 records, 150 for oncology and 74 for haemato-oncology. Ninety-four of them (42%) contained at least one AE. In total we identified 169 AEs 100 for oncology and 69 haemato-oncology. Overall, we calculated a rate of 76 AEs/100 admissions and 108 AEs/1000 patients-days. “Pain related to care” was the most frequent AE reported (n ¼ 29), followed by “Constipation” (n ¼ 17) and “Anaemia” (n ¼ 9). Most AEs were categorized as having caused temporary harm, either requiring an intervention (n ¼ 98) or prolonging the hospital stay (n ¼ 25). Two required an intervention to sustain the patient’s life. Exactly 78/125 (61%) were considered non-preventable, 28/125 (22%) preventable and 19/125(15%) undetermined. Conclusions: This is the first Swiss study to identify and categorise AEs in the oncology setting. The application of the SOTT showed a relatively high rate of harm related to care, but only 22% were considered as preventable. The description of AEs with the SOTT might be an opportunity to prioritize the development of novel interventions to avoid or limit the impact of AEs on cancer patients’ lives. Legal entity responsible for the study: Manuela Eicher. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
CN32
Safe administration of 5-fluorouracil with elastomeric pumps 1
P. Sessink , H. Levert2, N. Jourdan2, O. Albert3 Management, Exposure Control Sweden AB, Bohus-Bjo¨rko¨, Sweden, 2Pharmacy, University Hospital Saint-Louis, Paris, France, 3Nursing, University Hospital Saint-Louis, Paris, France
1
Disclosure: All authors have declared no conflicts of interest.
CN33
L. Fennimore Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA Background: The goal of patient safety is to reduce and eliminate preventable harm resulting from processes of care including the safe delivery of medication. Patient and occupational safety challenges are increasing in cancer care with the expanded use of oral chemotherapy, immunotherapy, and other novel treatments. In the United States, the Food and Drug Administration approved 59 novel drugs in 2018 including 19 applications of new cancer drugs and biologics as well as 38 supplemental indications and four biosimilars. Many of these novel agents will be delivered in settings that may not include the presence of a cancer nurse. Presence is a fundamental concept of nursing practice that involves active listening to facilitate understanding and meaningful connection between the patient and family and other members of the healthcare team. The safe delivery of cancer treatment is a critical component of the EONS Cancer Nursing Education Framework which defines the pivotal role of the presence of the cancer nurse in educating patients and caregivers about the safe use of cancer and symptom management medications, early recognition of side effects, and appropriate self-management approaches. As cancer care moves from traditional settings of the hospital, ambulatory clinic, or oncology provider’s office, nurses will be confronted with the need to redefine nursing presence in an era of increasingly complex healthcare delivery systems. Methods: A literature search will be presented drawn from a review of PubMed, CINAHL, and EBSCO data bases using search terms related to “patient safety”, “nursing presence”, “vigilance”, and “medication safety”. Results: Not applicable. Conclusions: This presentation will explore current literature related to the role of presence of the cancer nurse in safeguarding patient outcomes and quality cancer care. The session will include discussion and recommendations to increase the effective use of nursing presence and intentional communication by cancer nurses in diverse settings. Legal entity responsible for the study: The author. Funding: Has not received any funding. Disclosure: The author has declared no conflicts of interest.
CN34 Background: Occupational exposure to cytotoxic drugs may cause adverse health effects. Nurses administrating cytotoxic drugs may face exposure risk when disconnecting infusion lines especially with elastomeric pumps as they are frequently disconnected during an infusion period of several days. Methods: Potential contamination when disconnecting infusion lines of elastomeric pumps containing 5-fluorouracil was monitored. Three different connections were evaluated: 1) Luer Lock Male þ Female 2) Luer Lock Male þ Needleless connector R ) 3) QimoMaleV R þ QimoFemaleV R The evaluation was performed on a (BD-Q-SyteV tissue mimicking patient’s arm. During disconnection, potential leakage will contaminate the tissue and the gloves used for personal protection. After disconnection, both end parts of the connection were cleaned with a wipe. The wipe, the pair of gloves, and the tissue were analysed separately for contamination with 5-fluorouracil usingLC-
Patient safety and the power of nursing presence
Introduction of a nurse-led Totally Implantable Vascular Access Device (TIVAD) service for patients with metastatic cancer
M.N. Fowler Department of Haematology and Oncology, University Hospitals Birmingham NHSFT, Birmingham, UK Background: Patients with metastatic cancer frequently require Peripherally Inserted Central Catheters (PICCs) to deliver chemotherapy in the ambulatory setting. PICCs have a higher incidence of Venous Thrombo-Embolism (VTE), infections, need to be removed when patients have a treatment break and also require weekly flushes. They also interfere with daily activities such as bathing and can preclude patients from swimming or going on long holidays. At the time, TIVAD’s were not available in our
C European Society for Medical Oncology 2019. Published by Oxford University Press on behalf of the European Society for Medical Oncology. V
All rights reserved. For permissions, please email: [email protected].
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz274.002/5578278 by guest on 15 October 2019
A. Gerber1, A.M. da Silva Lopes2, N. Szu¨ts3, V. Ribordy-Baudat3, A. Ebneter3, C. Perrinjaquet4, D. Betticher5, M. Cote4, M.A. Duchosal4, C. Brennan6, S. Decosterd7, S. Peters8, R. Koelliker9, F. Ninane4, M-M. Jeitziner10, S. Colomer-Lahiguera2, P-Y. Dietrich7, M. Simon11, M-E. Gaignard7, M. Eicher2 1 Faculty of Nursing, University of Applied Sciences (HESAV), Lausanne, Switzerland, 2 Institute of Higher Education and Research in Health Care, University of Lausanne, Lausanne, Switzerland, 3Internal Medicine, Regional hospital of Fribourg (HFR), Fribourg, Switzerland, 4Oncology, University hospital of Lausanne (CHUV), Lausanne, Switzerland, 5Internal Medicine and Oncology, Regional hospital of Fribourg (HFR), Fribourg, Switzerland, 6Nursing, National Institutes of Health Clinical Center, Bethesda, AL, USA, 7Oncology, University hospital of Geneva (HUG), Gene`ve, Switzerland, 8 Multidisciplinary Oncology Center, Centre Hospitalier Universitaire Vaudois - CHUV, Lausanne, Switzerland, 9Oncology, Regional hospital of Fribourg (HFR), Fribourg, Switzerland, 10Department of Intensive Care Medicine, University hospital of Bern (Inselspital), Bern, Switzerland, 11Institute of Nursing Science, University of Basel, Basel, Switzerland
R ) were used for each type of MSMS. Ten elastomeric pumps (Baxter-FolfusorV connection. All disconnections were performed by one trained nurse after about 40 hrs of infusion. Results: Contamination with 5-fluorouracil is found for all thirty pumps but the level of contamination differs a lot. The highest contamination is measured for the wipes (end parts). Contamination on the tissues and on the gloves is substantially lower. For the wipes, a significant difference is found between the three connections (p ¼ 0.007). Median contamination is 50% lower for connection 3 (76 lg; p ¼ 0.013) compared to connection 1 (152 lg) and 44% lower compared to connection 2 (135 lg; p ¼ 0.031). There is no difference in contamination between the connections 1 and 2. Conclusions: 1) The lowest contamination with 5-fluorouracil is found for connection 3. 2) Contamination with 5-fluorouracil does not differ between the connections 1 and 2. 3) The presence of 5-fluorouracil on the gloves supports the need of wearing gloves to protect nurses from exposure by skin contact during administration of cytotoxic drugs. Legal entity responsible for the study: Exposure Control Sweden AB. Funding: Vygon SA, Ecouen, France.
CANCER NURSING: PATIENT AND OCCUPATIONAL SAFETY CN31
Adverse events in oncology and haemato-oncology inpatients of Swiss hospitals: A descriptive study
Background: The occurrence rate of adverse events (AEs) in hospitalised cancer patients in Switzerland remains unknown. The Institute for Healthcare Improvement (IHI) Global Trigger Tool (GTT) is among the most used methods to identify AEs. However, the GTT lacks oncology-specific triggers. Therefore, we developed a GTT-based Swiss Oncology Trigger Tool (SOTT), which included two modified GTT modules (“Cares” and “Medication”) and a new “Oncology” module. Objective We applied the SOTT to describe the occurrence rate, nature, level of harm and preventability of AEs reported in health records of four Swiss inpatient oncology and haemato-oncology units. Methods: We reviewed records of discharged patients over a 6-week period using the method recommended by the IHI for the GTT. To identify documented AEs, two nurse reviewers analysed records using the SOTT. Identified AEs were subsequently validated by physician reviewers, and those occurring during hospitalisation were classified regarding the incurred level of harm and their preventability. Results: We reviewed 224 records, 150 for oncology and 74 for haemato-oncology. Ninety-four of them (42%) contained at least one AE. In total we identified 169 AEs 100 for oncology and 69 haemato-oncology. Overall, we calculated a rate of 76 AEs/100 admissions and 108 AEs/1000 patients-days. “Pain related to care” was the most frequent AE reported (n ¼ 29), followed by “Constipation” (n ¼ 17) and “Anaemia” (n ¼ 9). Most AEs were categorized as having caused temporary harm, either requiring an intervention (n ¼ 98) or prolonging the hospital stay (n ¼ 25). Two required an intervention to sustain the patient’s life. Exactly 78/125 (61%) were considered non-preventable, 28/125 (22%) preventable and 19/125(15%) undetermined. Conclusions: This is the first Swiss study to identify and categorise AEs in the oncology setting. The application of the SOTT showed a relatively high rate of harm related to care, but only 22% were considered as preventable. The description of AEs with the SOTT might be an opportunity to prioritize the development of novel interventions to avoid or limit the impact of AEs on cancer patients’ lives. Legal entity responsible for the study: Manuela Eicher. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
CN32
Safe administration of 5-fluorouracil with elastomeric pumps 1
P. Sessink , H. Levert2, N. Jourdan2, O. Albert3 Management, Exposure Control Sweden AB, Bohus-Bjo¨rko¨, Sweden, 2Pharmacy, University Hospital Saint-Louis, Paris, France, 3Nursing, University Hospital Saint-Louis, Paris, France
1
Disclosure: All authors have declared no conflicts of interest.
CN33
L. Fennimore Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA Background: The goal of patient safety is to reduce and eliminate preventable harm resulting from processes of care including the safe delivery of medication. Patient and occupational safety challenges are increasing in cancer care with the expanded use of oral chemotherapy, immunotherapy, and other novel treatments. In the United States, the Food and Drug Administration approved 59 novel drugs in 2018 including 19 applications of new cancer drugs and biologics as well as 38 supplemental indications and four biosimilars. Many of these novel agents will be delivered in settings that may not include the presence of a cancer nurse. Presence is a fundamental concept of nursing practice that involves active listening to facilitate understanding and meaningful connection between the patient and family and other members of the healthcare team. The safe delivery of cancer treatment is a critical component of the EONS Cancer Nursing Education Framework which defines the pivotal role of the presence of the cancer nurse in educating patients and caregivers about the safe use of cancer and symptom management medications, early recognition of side effects, and appropriate self-management approaches. As cancer care moves from traditional settings of the hospital, ambulatory clinic, or oncology provider’s office, nurses will be confronted with the need to redefine nursing presence in an era of increasingly complex healthcare delivery systems. Methods: A literature search will be presented drawn from a review of PubMed, CINAHL, and EBSCO data bases using search terms related to “patient safety”, “nursing presence”, “vigilance”, and “medication safety”. Results: Not applicable. Conclusions: This presentation will explore current literature related to the role of presence of the cancer nurse in safeguarding patient outcomes and quality cancer care. The session will include discussion and recommendations to increase the effective use of nursing presence and intentional communication by cancer nurses in diverse settings. Legal entity responsible for the study: The author. Funding: Has not received any funding. Disclosure: The author has declared no conflicts of interest.
CN34 Background: Occupational exposure to cytotoxic drugs may cause adverse health effects. Nurses administrating cytotoxic drugs may face exposure risk when disconnecting infusion lines especially with elastomeric pumps as they are frequently disconnected during an infusion period of several days. Methods: Potential contamination when disconnecting infusion lines of elastomeric pumps containing 5-fluorouracil was monitored. Three different connections were evaluated: 1) Luer Lock Male þ Female 2) Luer Lock Male þ Needleless connector R ) 3) QimoMaleV R þ QimoFemaleV R The evaluation was performed on a (BD-Q-SyteV tissue mimicking patient’s arm. During disconnection, potential leakage will contaminate the tissue and the gloves used for personal protection. After disconnection, both end parts of the connection were cleaned with a wipe. The wipe, the pair of gloves, and the tissue were analysed separately for contamination with 5-fluorouracil usingLC-
Patient safety and the power of nursing presence
Introduction of a nurse-led Totally Implantable Vascular Access Device (TIVAD) service for patients with metastatic cancer
M.N. Fowler Department of Haematology and Oncology, University Hospitals Birmingham NHSFT, Birmingham, UK Background: Patients with metastatic cancer frequently require Peripherally Inserted Central Catheters (PICCs) to deliver chemotherapy in the ambulatory setting. PICCs have a higher incidence of Venous Thrombo-Embolism (VTE), infections, need to be removed when patients have a treatment break and also require weekly flushes. They also interfere with daily activities such as bathing and can preclude patients from swimming or going on long holidays. At the time, TIVAD’s were not available in our
C European Society for Medical Oncology 2019. Published by Oxford University Press on behalf of the European Society for Medical Oncology. V
All rights reserved. For permissions, please email: [email protected].
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz274.002/5578278 by guest on 15 October 2019
A. Gerber1, A.M. da Silva Lopes2, N. Szu¨ts3, V. Ribordy-Baudat3, A. Ebneter3, C. Perrinjaquet4, D. Betticher5, M. Cote4, M.A. Duchosal4, C. Brennan6, S. Decosterd7, S. Peters8, R. Koelliker9, F. Ninane4, M-M. Jeitziner10, S. Colomer-Lahiguera2, P-Y. Dietrich7, M. Simon11, M-E. Gaignard7, M. Eicher2 1 Faculty of Nursing, University of Applied Sciences (HESAV), Lausanne, Switzerland, 2 Institute of Higher Education and Research in Health Care, University of Lausanne, Lausanne, Switzerland, 3Internal Medicine, Regional hospital of Fribourg (HFR), Fribourg, Switzerland, 4Oncology, University hospital of Lausanne (CHUV), Lausanne, Switzerland, 5Internal Medicine and Oncology, Regional hospital of Fribourg (HFR), Fribourg, Switzerland, 6Nursing, National Institutes of Health Clinical Center, Bethesda, AL, USA, 7Oncology, University hospital of Geneva (HUG), Gene`ve, Switzerland, 8 Multidisciplinary Oncology Center, Centre Hospitalier Universitaire Vaudois - CHUV, Lausanne, Switzerland, 9Oncology, Regional hospital of Fribourg (HFR), Fribourg, Switzerland, 10Department of Intensive Care Medicine, University hospital of Bern (Inselspital), Bern, Switzerland, 11Institute of Nursing Science, University of Basel, Basel, Switzerland
R ) were used for each type of MSMS. Ten elastomeric pumps (Baxter-FolfusorV connection. All disconnections were performed by one trained nurse after about 40 hrs of infusion. Results: Contamination with 5-fluorouracil is found for all thirty pumps but the level of contamination differs a lot. The highest contamination is measured for the wipes (end parts). Contamination on the tissues and on the gloves is substantially lower. For the wipes, a significant difference is found between the three connections (p ¼ 0.007). Median contamination is 50% lower for connection 3 (76 lg; p ¼ 0.013) compared to connection 1 (152 lg) and 44% lower compared to connection 2 (135 lg; p ¼ 0.031). There is no difference in contamination between the connections 1 and 2. Conclusions: 1) The lowest contamination with 5-fluorouracil is found for connection 3. 2) Contamination with 5-fluorouracil does not differ between the connections 1 and 2. 3) The presence of 5-fluorouracil on the gloves supports the need of wearing gloves to protect nurses from exposure by skin contact during administration of cytotoxic drugs. Legal entity responsible for the study: Exposure Control Sweden AB. Funding: Vygon SA, Ecouen, France.