Denver, CO—A recent project to implement a chemotherapy discharge class on a mixed medical oncology unit had encouraging results, according to Julianne Brogren, MS, RN, CNL, OCN, Clinical Nurse Leader, The University of Texas M.D. Anderson Cancer Center, Houston.
At the 42nd annual meeting of the Oncology Nursing Society, Ms Brogren described her work environment and the development of the project. She works at a National Cancer Institute–designated comprehensive care center in a 32-bed mixed medical oncology unit where most patients—primarily with genitourinary cancers—receive chemotherapy every 3 weeks for 4 to 6 cycles.
“Creating this class allowed the patient to be at the center. The class promoted active participation by patients. They were encouraged to ask questions during the open forum at the end of the class and during follow-up phone calls. The class prepared patients on what to expect, and had a positive impact on safety at home, with enhanced satisfaction,” Ms Brogren said.
“Preparing patients to manage their care at home reduces emergency center visits and unplanned readmissions,” she added.
The project was undertaken after a microsystem assessment showed that Ms Brogren’s unit was below the hospital average for Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores under the domain of Discharge Information. At that time, her unit had no standardized discharge education plan.
To rectify this, Ms Brogren and her colleagues developed a chemotherapy discharge teaching class with the goal of increasing the HCAHPS score by 10%.
Before implementation of the project, they surveyed 26 patients receiving chemotherapy for 2 consecutive weeks from November 2, 2013, to November 13, 2013, to determine patients’ perception of the current discharge plan with regard to preparedness before receiving chemotherapy, and knowledge about how to manage side effects upon discharge.
“The majority answered the questions unfavorably,” Ms Brogren told listeners.
- 56% said they were not well-informed about what to expect and where to get answers
- 68% said they were not well-informed about side effects and ways to manage them
- Only 1 patient reported being informed about all resources available
The most common resource used was the Chemotherapy Guide booklet, which 73% of patients said they received before initiation of chemotherapy.
Ms Brogren and the Associate Director undertook designing a standardized discharge education class for adults in December 2015. The hour-long class was given daily or as needed. All patients receiving chemotherapy for genitourinary cancer were invited. Topics covered potential side-effect management at home, review of medications, care for lines and drains, when to seek emergency care versus when to follow up with the physician, and how to access all available resources at M.D. Anderson Cancer Center. There was an open forum at the end of the class for questions and answers.
All attendees were given the Chemotherapy Guide booklet and a refrigerator magnet with emergency contact information for physicians and nurses.
Staff nurses were educated on the content of the class so that they could reinforce instructions at discharge. The staff made daily follow-up phone calls within 72 hours of discharge to high-risk patients most likely to be readmitted. Criteria for being high-risk included hospital admission during cycle 1, placement of new drains or lines, or having wounds at discharge, as well as being admitted with a primary diagnosis of pain. Patients were routed to their outpatient clinic for minor issues or referred to the emergency department if necessary.
“Because of the high volume in our unit, we can’t call every patient at discharge,” she explained.
The project was successful. HCAHPS discharge scores were 100% during the first 2 months, then took a slight dip when electronic records were instituted and the class was not consistently offered on weekends; this was followed by an upward trend for the rest of the year, with scores of 92% at the end.
“Not only were patients satisfied, but their caregivers were overwhelmingly positive. Many caregivers expressed appreciation at the extra time to prepare them, and they enjoyed talking with other patients. The nurses expressed greater appreciation and understanding for the discharge teaching, and how a standardized process can improve patient outcomes. This experience made the staff advocates for sending patients to the class,” Ms Brogren said.
She added that many patients who were already receiving their fifth or sixth cycle of chemotherapy did not feel the need for the class, and that patients with severe side effects and isolation precautions could not attend.
Ms Brogren and her colleagues plan to continue teaching the class and to educate new nurses about the class, as well as to continue tracking HCAHPS scores in the domain of discharge nursing.
“We also plan to track the readmission rate after the course,” she concluded.