Nurses' guide to understanding and implementing the National Comprehensive Cancer Network guidelines for myeloid growth factors

Febrile neutropenia risk assessment tool: improving clinical outcomes for oncology patients

PURPOSE

To develop, implement and evaluate the effectiveness of a nurse-led risk assessment tool to reduce the incidence of febrile neutropenia (FN) and evaluate the nurse's role in FN risk assessment in a hospital-based oncology unit.

METHODS AND SAMPLE

A FN risk assessment tool was developed, implemented and evaluated. A comparative prospective observational chart review was undertaken to evaluate the tool. Clinical data were collected from 459 patients' records from August 2008 through July 2009. Patients had no intervention during the first six months (n = 233). Patients in the following six months (n = 226) had the FN risk assessment completed and appropriate granulocyte-colony stimulating factor prescribed. A self-questionnaire was utilised to evaluate the nurses' role in FN risk assessment.

KEY RESULTS

The incidence of FN was reduced by 52% (p = 0.02). Hospital days, dose reductions and treatment delays were reduced. Nurses felt they were the most appropriate person to carry out the assessment.

CONCLUSIONS

Through consistent risk assessment, nurses could determine which patients were at high risk of developing FN leading to significant reduction in life-threatening infections, hospitalisations, dose reductions and delays. Nurses can be confident and competent in decision-making to reduce life-threatening infections through the use of an FN risk assessment tool.

Managing neutropenia in older patients with cancer receiving chemotherapy in a community setting

Older patients with cancer who may be more susceptible than younger patients to the myelosuppressive effects of chemotherapy undergo dose delays and reductions that can compromise treatment outcomes. Incidence of neutropenic complications and suboptimal chemotherapy delivery can be reduced with prophylactic colony-stimulating factors; however, their use in older patients with cancer has not been well studied. A randomized, multicenter, community-based trial was designed to compare prophylactic pegfilgrastim use (all cycles of chemotherapy) versus its more common reactive use (at clinicians' discretion) in patients aged 65 years or older with various cancers. Pegfilgrastim use in all cycles reduced the incidence of febrile neutropenia by about 60% and hospitalizations caused by neutropenia and febrile neutropenia by about 50% versus reactive pegfilgrastim use in later cycles. The study showed that older patients with cancer can be treated safely with optimal doses of chemotherapy with appropriate supportive care. Nurses, key collaborators in providing supportive care, can take an active role in identifying older patients who may benefit from pegfilgrastim in all cycles of chemotherapy.

Using a computer-based risk assessment tool to identify risk for chemotherapy-induced febrile neutropenia

This article evaluates the feasibility of developing and implementing a computer-based risk assessment tool (CBRAT) for febrile neutropenia and determines whether it could improve documentation of risk assessment in patients starting myelosuppressive chemotherapy regimens. The CBRAT was designed using a template creator in a commercial electronic medical records system. The effectiveness of the CBRAT was evaluated by comparing medical records data of patients with one or more risk factor for febrile neutropenia who were given prophylactic granulocyte-colony-stimulating factor before and after implementation. CBRAT usage significantly increased the likelihood of documented febrile neutropenia risk assessment from 13% before implementation to 100% after implementation (p < 0.001). No significant changes occurred in febrile neutropenia incidence rates, dose reductions, or dose delays. In addition, healthcare providers quickly learned how to operate the CBRAT and used it routinely, significantly improving the number of patients with documented febrile neutropenia risk assessment. Implementation of a computer-based tool can help nurses follow evidence-based guidelines that recommend routine febrile neutropenia risk assessment for patients initiating myelosuppressive chemotherapy.