For the nursing community of Fox Chase Cancer Center, the drive for excellence goes beyond bedside care. This past April, 28 Fox Chase nurses attended the Oncology Nursing Society (ONS) Congress, 18 of whom presented new research and best practices.
“Continued improvement, research, and knowledge sharing are major parts of the Fox Chase culture, so it should come as no surprise that it extends to our nursing community,” said Anna Rodriguez, MSN, MHA, RN, OCN, NEA-BC, Fox Chase’s Chief Nursing Officer and Vice President, Nursing and Patient Care Services. “The Fox Chase Nursing story is one of continuous improvement and a desire to share what works best across healthcare.”
According to Rodriguez, Fox Chase nurses have authored 10 peer-reviewed papers over the last five years and made 63 professional presentations at ONS, the profession’s premier conference, as well as others including meetings of the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN).
Among the many poster presentations made at ONS this year, Rodriguez highlighted the particular excellence of the following four.
Best Practice: Virtual Whiteboard for Remote Employee Engagement
Lauren Cappelletti, MSN, RN, CCM
Innovation is not always about inventing the next great thing. Sometimes, it is about finding new uses for the tools at hand.
As Transitional Care Nurse Navigators, Cappelletti and her colleagues operate as a remote, distributed organization. Their need to stay connected and share ideas in real time led to Cappelletti’s poster at ONS, which demonstrates how the virtual whiteboard feature of Microsoft 365 – easily available for the TCNN team – enabled her group to brainstorm, share ideas, and make process improvements across the phone triage team.
“Good ideas often flash in at the moment but get lost in email,” said Cappelletti. “The virtual whiteboard allows us to share ideas on a virtual post-it note where everyone can see the idea with some efficiency and coordination.”
According to Cappelletti, there was some reluctance when she introduced the idea of integrating the virtual whiteboard into regular practice, but that withered away once her team started seeing it lead to regular progress. Now, teams across Fox Chase are exploring the virtual whiteboard feature and finding ways to use the tools it offers. “I think it also speaks to the ability of a team to trust each other, as well as trust the application to be useful, and now I see it moving quickly,” said Cappelletti.
Keeping on Pace: Coordination for Patients with Cardiac Implantable Electronic Devices Undergoing Radiation when Cardiology is Not Easily Accessible
Erin Longstreth Papsun, MSN, RN, OCN, NEA-BC
Nicole Seeley, BSN, RN, OCN
Sharon Charyszyn, BSN, RN
Janice Moore, BSN, RN, OCN
According to Moore, the best part of the ONS meeting has always been networking and finding new things to learn. This time around, Moore and her team in Radiation Oncology were the ones imparting important information and best practices.
At an ONS poster session, Moore presented her team’s work on developing procedures on how to proceed with radiation therapy patients who happen to have cardiovascular implantable electronic devices (CIEDs) – pacemakers – when you do not have an available cardiologist on staff. They demonstrate a multidisciplinary approach, where nurses, administrators, and physicians collaborate to determine potential risks for patients with CIEDs. While the odds of radiation damaging a CIED are rare, it is a possibility that healthcare providers need to monitor. The team’s findings report how the nursing team improved their device check compliance rates year over year.
“This is really exciting now that ONS has incorporated radiation oncology education for nursing,” said Moore. “Our team has been doing this for a while, so it is interesting – and satisfying – to see nurses learning about it for the first time.”
Palliative Care, Seriously, Why Are You Calling!? Am I Dying?
Matthew Farren, BSN, RN
As a palliative care nurse, Farren struggles daily to combat a fundamental misunderstanding of his chosen field of care. Each day, he finds that when following up on patient referrals to discuss pain management and quality of life issues, he is often told that there was some sort of mistake or he may even be rebuffed entirely.
“Many people, even very educated people, often believe that palliative care is only for terminal cases,” Farren said. “It is why you need to immediately establish a sense of trust between you and the patient at the first phone call in order to reassure them and have a meaningful conversation about their care.”
To further understand patient concerns, Farren has devised a four-question survey that he intends to call and offer to 80% of new patient referrals. The quiz is designed to better understand patient concerns and assess the level of trust they have in their palliative care nurse.
Stop or Go: How an Interprofessional Team Developed an Innovative Protocol to Reduce Catheter Associated Urinary Tract Infections (CAUTIs)
Sandi Wetherbee, MSN, RN, OCN
Pamela Jakubek, MSN, RN, CWOCN
The HOUDINI Protocol held no magic for Fox Chase Cancer Center’s catheter associated urinary tract infection (CAUTI) rate. HOUDINI requires a daily assessment of criteria for keeping a catheter in place. Of course, the longer a patient is catheterized, the greater their risk of developing an infection.
“HOUDINI can be complex and it just was not top of mind for physicians and staff, so our CAUTI rate was much higher than it should have been,” said Wetherbee. “We had a committee investigating a plan when our physician champion, Dr. Kutikov, a urologist, presented us with this brilliant idea that was as simple as green-for-go and red-for-stop.”
At their ONS poster session, Wetherbee and Jakubek presented the end results of the idea Alexander Kutikov, MD, FACS, shared with their committee. Each patient chart would be given a green or red sticker once they have received their catheter. Green means that the catheter should come out by eight in the morning the day after surgery, as long as certain basic urine output criteria were met and there was no sign of blood or clot in their urine. Meanwhile, a red sticker directs the nurse to talk to the physician to discuss the plan.
“We looked at a number of different protocols, and this was the simplest and most effective because it forced everyone to address the issue at least once a day,” said Jakubek. “As a result, we have seen a 57% decrease in the CAUTI rate in surgical patients across the hospital, which is huge.”