Implementation of best practice for chemotherapy-induced nausea and vomiting in an acute care setting

Chung, Su Kyoung; Ahn, Mee Jung; Yoo, Ji Myong; Choi, Mona; Hyang, Na; Woo, So Rah; Kim, So Sun; Kim, Sun Ah; Oh, Eok Soo

doi:10.1111/j.1744-1609.2010.00198.x

Cited by 17 publications

(14 citation statements)

References 16 publications

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“…While available antiemetics can prevent 70-80% of CINV, 60-80% of patients continue to experience nausea and vomiting [4,8,3,9,10]. …”

Section: Background and Significancementioning

confidence: 99%

“…However, education alone does not improve guideline adherence [21,22]. Studies evaluating strategies for implementing antiemetic guidelines concluded that standardized order-sets and audit-feedback improve the transferability and sustainability of guidelines into oncology practices [21,23,9]. Mertens et al found that only when adherence feedback was coupled with patient outcomes did non-adherence decrease significantly, from 73% to a sustained 0%, yielding reduced overall CINV [21].…”

Section: Background and Significancementioning

confidence: 99%

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Adherence to antiemetic guidelines in patients with malignant glioma: a quality improvement project to translate evidence into practice

Affronti

Schneider

Herndon

et al. 2014

Support Care Cancer

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Purpose A quality improvement project was implemented to improve adherence to evidence-based antiemetic guidelines for malignant glioma patients treated with moderately-emetic chemotherapy (MEC). Poorly controlled chemotherapy-induced nausea and vomiting (CINV) reduce cancer treatment efficacy and significantly impair cancer patients’ quality of life (QOL). Review of Duke University Preston Robert Tisch Brain Tumor Center (PRTBTC)’s usual practice demonstrates a high incidence (45%) of CINV, despite premedication with short-acting 5-HT3-serotonin receptor antagonists (5-HT3-RAs). National Comprehensive Cancer Network (NCCN)’s evidence-based guidelines recommend the combination of the long-acting 5-HT3-RA palonosetron (PAL) and dexamethasone (DEX) for the prevention of acute and delayed CINV with MEC. Low adherence (58%) to antiemetic guidelines may have explained our high CINV incidence. Methods One-sample, quasi-experimental design evaluated a combination intervention that included a provider education session; implementation of risk-assessment tool with computerized, standardized antiemetic guideline order-sets; and a monthly audit-feedback strategy. Post-implementation adherence to evidence-based antiemetic order-sets and patient outcomes were measured and compared to baseline and historical data. Primary outcome was the guideline order-set adherence rate. Secondary outcomes included nausea/vomiting rates and QOL. Results Adherence to ordering MEC guideline antiemetics increased significantly, from 58% to a sustained 90%, with associated improvement in nausea/vomiting. In acute and delayed phases, 75% and 84% of patients, respectively, did not experience CINV. There was no significant change in QOL. Conclusion Combination intervention and audit-feedback strategy to translate evidence into oncology practice improved and sustained adherence to antiemetic guidelines. Adherence corresponded with effective nausea/vomiting control and preserved QOL in patients with malignant gliomas.

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“…While available antiemetics can prevent 70-80% of CINV, 60-80% of patients continue to experience nausea and vomiting [4,8,3,9,10]. …”

Section: Background and Significancementioning

confidence: 99%

Section: Background and Significancementioning

confidence: 99%

Adherence to antiemetic guidelines in patients with malignant glioma: a quality improvement project to translate evidence into practice

Affronti

Schneider

Herndon

et al. 2014

Support Care Cancer

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“…This will help identify the strengths and barriers of the organization and improve the nurses’ knowledge on, belief regarding, and capacity to adopt and implement EBP through education and training, environmental improvement, and organizational support while focusing on mentors who act as facilitators in the performance of EBP [24, 30]. Successful implementation of EBP can increase the job satisfaction of professional nurses and ultimately improve nursing-sensitive outcomes [6, 7, 31, 32]. The conceptual framework in this study was constructed based on the ARCC © model.…”

Section: Introductionmentioning

confidence: 99%

Clinical nurses’ beliefs, knowledge, organizational readiness and level of implementation of evidence-based practice: The first step to creating an evidence-based practice culture

Yoo

Kim

et al. 2019

PLoS ONE

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BackgroundThis study aimed to identify clinical nurses’ evidence-based practice (EBP) knowledge, beliefs, organizational readiness, and EBP implementation levels, and to determine the factors that affect EBP implementation in order to successfully establish EBP. This study was conducted at a university-affiliated tertiary hospital located in a provincial area in Korea. The research design was based on Melnyk and Fineout-Overholt’s Advancing Research & Clinical Practice through Close Collaboration model as the first step.MethodsA descriptive and cross-sectional design was conducted and a convenience sample of 521 full-time registered nurses from an 849-bed tertiary hospital were included. Structured questionnaires were used to assess EBP knowledge, EBP beliefs, organizational culture & readiness and EBP implementation. Data were analyzed using SPSS V 25.0 by using descriptive and inferential statistics and hierarchical multiple regression was performed to determine the factors affecting the implementation of EBP.ResultsOur findings showed that the clinical nurses had a positive level of EBP beliefs, but the level of EBP knowledge, organizational readiness and EBP implementation were insufficient. EBP knowledge, beliefs, and organizational readiness were significantly positively correlated with EBP implementation. In the final model, EBP knowledge and organizational readiness were significant predictors of EBP implementation; the model predicted 22.2% of the variance in implementation.ConclusionsBased on these results, the main focus of the study was the importance of individual nurses' efforts in carrying out EBP, but above all efforts to create an organizational culture to prepare and support EBP at the nursing organization level. In the initial process of introducing and establishing EBP, nurse administrators will need to minimize expected barriers, enhance facilitators, and strive to build an infrastructure based on vision, policy-making, budgeting, excellent personnel and facilities within the organization.

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“…16,17,[26][27][28][29] We identified several barriers to pain management, and then implemented strategies and provided feedback to nursing staff. 16,17,[26][27][28][29] We identified several barriers to pain management, and then implemented strategies and provided feedback to nursing staff.…”

Section: Discussionmentioning

confidence: 99%

“…Audits and feedback are widely used to change the clinical practice behaviours of health-care professionals, as well as to encourage guideline adherence. 16,17,[26][27][28][29] We identified several barriers to pain management, and then implemented strategies and provided feedback to nursing staff. The study adopted a top-down approach, as our EBP implementation study was formulated without input from staff nurses.…”

Section: Discussionmentioning

confidence: 99%

Evidence‐based practice for pain management for cancer patients in an acute care setting

Choi

Kim

Chung

et al. 2013

Int J of Nursing Practice

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The purpose of this study is to implement an evidence utilization project using an audit and feedback approach to improve cancer pain management. A three-phased audit and feedback approach was used. A 46-bed oncology nursing unit in the university's cancer centre was selected as a research site. Nursing records extracted from 137 patients (65 for the baseline assessment and 72 for the follow-up audit) were used to examine nurse compliance with four audit criteria derived from best practice guidelines related to the assessment and management of pain. We observed a significant improvement in compliance from baseline to follow-up for the following criteria: documenting the side effects of opioids (2-83%), use of a formalized pain assessment tool (22-75%), and providing education for pain assessment and management to patients and caregivers (0-47%). The audit and feedback method was applicable to the implementation of clinical practice guidelines for cancer pain management. Leadership from both administrative personnel and staff nurses working together contributes to the spread of an evidence-based practice culture in clinical settings. As it was conducted in a single oncology nursing unit and was implemented over a short period of time, the results should be carefully interpreted.

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Implementation of best practice for chemotherapy-induced nausea and vomiting in an acute care setting

Abstract: The results indicate that the pre- and post-implementation audits are an effective method in improvement of assessment, documentation and evidence-based nursing implementation for cancer symptom management.

Cited by 17 publications

References 16 publications

Adherence to antiemetic guidelines in patients with malignant glioma: a quality improvement project to translate evidence into practice

Adherence to antiemetic guidelines in patients with malignant glioma: a quality improvement project to translate evidence into practice

Clinical nurses’ beliefs, knowledge, organizational readiness and level of implementation of evidence-based practice: The first step to creating an evidence-based practice culture

Evidence‐based practice for pain management for cancer patients in an acute care setting

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