Dawn Stacey1,2, Claire Ludwig3, Lynne Jolicoeur4, Meg Carley5, Katelyn Balchin6, Lindsay Jibb7, Freya Kelly8, Craig Kuziemsky9, Suzanne Madore10,11, Lisa Rambout12, Michael M Vickers13, Lorraine Martelli14. 1. School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada. dstacey@uottawa.ca. 2. Ottawa Hospital Research Institute, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada. dstacey@uottawa.ca. 3. School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada. 4. Regional Cancer Program, The Ottawa Hospital, Ottawa, Ontario, Canada. 5. Ottawa Hospital Research Institute, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada. 6. Blood and Marrow Transplant Program, Regional Cancer Program, The Ottawa Hospital, Ottawa, Ontario, Canada. 7. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada. 8. University of Ottawa Heart Institute (Cardiac Virtual Care), Ottawa, Ontario, Canada. 9. MacEwan University, Edmonton, Alberta, Canada. 10. Eye Care Program, The Ottawa Hospital, Ottawa, Ontario, Canada. 11. Acute and Chronic Pain, Substance Use Program and Medical Device Reprocessing, The Ottawa Hospital, Ottawa, Ontario, Canada. 12. Pharmacy, The Ottawa Hospital, Ottawa, Ontario, Canada. 13. Medical Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada. 14. Cancer Care Ontario, Toronto, Ontario, Canada.
Abstract
PURPOSE: To determine the quality of cancer symptom management when evidence from clinical practice guidelines are used in telephone-based oncology nursing services. METHODS: Guided by the Knowledge to Action Framework, we conducted a quality improvement (QI) project focused on "monitoring knowledge use" (e.g., use of practice guides) and "measuring outcomes." In 2016, 15 Pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) practice guides that synthesize evidence from guidelines were implemented with training for all oncology nurses at a regional ambulatory oncology program. Eighteen months post-implementation, Symptom Management Analysis Tool (SMAT) was used to analyze audio-recorded calls and related documentation of cancer symptom management. RESULTS: Of 113 audio-recorded calls, 66 were COSTaRS symptoms (58%), 43 other symptoms (38%), and 4 medically complex situations (4%). Of 66 recorded calls, 63 (95%) were documented. Average SMAT quality score was 71% (range 21-100%) for audio-recordings and 63% (range 19-100%) for documentation of calls. COSTaRS practice guide use was documented in 33% calls. For these calls, average SMAT quality scores were 74% with COSTaRS versus 69% without COSTaRS for audio-recording and 73% (range 33-100%) with COSTaRS versus 58% without COSTaRS for documentation. Patient outcomes indicated symptom was resolved (38%), worse (25%), unchanged (3%), or unknown (33%). Eight patients (13%) had an ED visit within 14 days post that was related to the symptom discussed. CONCLUSIONS: Only a third of nurses indicated use of COSTaRS practice guides. There were higher quality symptom management scores when COSTaRS use was reported. Nurses documented less than what they discussed.
PURPOSE: To determine the quality of cancer symptom management when evidence from clinical practice guidelines are used in telephone-based oncology nursing services. METHODS: Guided by the Knowledge to Action Framework, we conducted a quality improvement (QI) project focused on "monitoring knowledge use" (e.g., use of practice guides) and "measuring outcomes." In 2016, 15 Pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) practice guides that synthesize evidence from guidelines were implemented with training for all oncology nurses at a regional ambulatory oncology program. Eighteen months post-implementation, Symptom Management Analysis Tool (SMAT) was used to analyze audio-recorded calls and related documentation of cancer symptom management. RESULTS: Of 113 audio-recorded calls, 66 were COSTaRS symptoms (58%), 43 other symptoms (38%), and 4 medically complex situations (4%). Of 66 recorded calls, 63 (95%) were documented. Average SMAT quality score was 71% (range 21-100%) for audio-recordings and 63% (range 19-100%) for documentation of calls. COSTaRS practice guide use was documented in 33% calls. For these calls, average SMAT quality scores were 74% with COSTaRS versus 69% without COSTaRS for audio-recording and 73% (range 33-100%) with COSTaRS versus 58% without COSTaRS for documentation. Patient outcomes indicated symptom was resolved (38%), worse (25%), unchanged (3%), or unknown (33%). Eight patients (13%) had an ED visit within 14 days post that was related to the symptom discussed. CONCLUSIONS: Only a third of nurses indicated use of COSTaRS practice guides. There were higher quality symptom management scores when COSTaRS use was reported. Nurses documented less than what they discussed.
Authors: Alison C Wiesenthal; Sandip P Patel; Thomas W LeBlanc; Eric J Roeland; Arif H Kamal Journal: J Palliat Med Date: 2018-04-16 Impact factor: 2.947
Authors: C Ludwig; J Renaud; L Barbera; M Carley; C Henry; L Jolicoeur; C Kuziemsky; A Patry; D Stacey Journal: Curr Oncol Date: 2019-02-01 Impact factor: 3.677
Authors: Charles Friedman; Joshua Rubin; Jeffrey Brown; Melinda Buntin; Milton Corn; Lynn Etheredge; Carl Gunter; Mark Musen; Richard Platt; William Stead; Kevin Sullivan; Douglas Van Houweling Journal: J Am Med Inform Assoc Date: 2014-10-23 Impact factor: 4.497