Eighth Na)onal Doctors of Nursing Prac)ce Conference How to be a Be*er DNP in 3 days

Transcription

1 Eighth Na)onal Doctors of Nursing Prac)ce Conference How to be a Be*er DNP in 3 days o Constantly problem- solving to move forward o It takes a team. o Responding to clinical data and outcomes o With LEAN methodology and o Microsystem Assessment o Timely Manner o OpFmizing PaFent Outcomes o Using DNP EssenFals Inten%onally

2 RESPONDING WITH MULTI- FACETED TEACHING PLAN AND INTERPROFESSIONAL TEAM TO TEACH IDENTIFICATION, RISKS AND RESPONSES FOR ADDRESSING FEBRILE NEUTROPENIA TO UNIT- BASED TEAM CARING FOR ACUTE HEMATOLOGY/ ONCOLOGY PATIENT POPULATION Regina M. DeGennaro, DNP, RN, CNS, AOCN, CNL Associate Professor, Oncology Clinical Nurse Specialist Tanya Thomas, MSN (c), BA, BSN, RN,OCN Tri Le, MD Michael Keng, MD University of Virginia School of Nursing University of Virginia Health System

3 Conference Learning ObjecFves o o o o o Learning outcome/purpose of this conference: to enable the learner to explore prac)ce techniques in order to enhance effec)veness and improve health care outcomes through doctoral prepared prac)ce. Describe techniques to sharpen prac)ce skills for the doctoral prepared nursing professional Iden)fy key doctoral prepared abili)es in academia, leadership, informa)cs, policy and prac)ce to improve health care outcomes Iden)fy methods of prac)ce in a variety of seungs to advance the services of the doctoral prepared nurse Discuss innova)ve roles and strategies of DNP prepared nurse to improve health care outcomes

4 The DNP EssenFals PrioriFzed: IniFal Work Organized SystemaFcally o o o o o I. ScienFfic Underpinnings for PracFce II. OrganizaFonal and Systems Leadership for Quality Improvement and Systems Thinking III. Clinical Scholarship and AnalyFcal Methods for Evidence- Based PracFce IV. InformaFon Systems/Technology and PaFent Care Technology for the Improvement and TransformaFon of Health Care V. Health Care Policy for Advocacy in Health Care

5 School of Nursing University of Virginia

6 University of Virginia Medical Center

7 Academic Center Acute Care Hematology Oncology o Febrile Neutropenia is a medical emergency and potenfally life threatening complicafon for pafents receiving systemic chemotherapy. o The need to be vigilant in the prompt recognifon and treatment of febrile neutropenia is key to survival.

8 Exp Ther Med Sep-Oct; 2(5):

9 The Perfect Storm Weather Channel image

10 Respond or React? o h[ps:// LZvhQ o Waterspout: Coming Right Towards Me o The Weather Channel, 2013

11 Microsystem Assessment Process to IdenFfy Quality/Safety Gap o An opportunity to improve quality and safety was idenffied in an acute hematology/ oncology populafon in an academic sedng when certain failure to recue cases were idenffied. These cases involved pafents who were febrile and neutropenic aeer receiving chemotherapy. o The RCA process and a microsystem assessment was uflized to address this quality and safety concern.

12 Evidence-Based Practice Inquiry n Review of 5P s was completed with audits: 1. Purpose 2. PaFent 3. Professionals 4. Care Processes 5. Pa[erns

13 n Assess the microsystem n Analyze the gap AIM: OpFmize PaFent Outcomes n Standardize process related to caring for febrile neutropenic pafents in the oncology sedng n Implement the evidence in the acute hematology/oncology pafent care sedng n Reduce failure to rescue cases related to febrile neutropenia

14 METHODS: Gap Analysis o A systems gap assessment was recommended, performed and analyzed. o A knowledge deficit regarding definifon of and treatment for febrile neutropenia. o Educa)onal sessions addressed this gap. o An educa)onal interven)on was proposed, implemented and evaluated.

15

16 IntervenFons Included: o o Nurses in the Adult Hematology/Oncology (AHO), a 29 bed unit, and Adult Stem Cell TransplantaFon (ASCT), an eight bed unit, implemented an intervenfon to improve the treatment for febrile neutropenic pafents. Assistant Nurse Manager and a hematology oncology fellow formed an interdisciplinary team to help develop and disseminate the informafon to the different disciplines.

17 INTERVENTIONS Steps included: 1) Educa)on regarding febrile neutropenia idenfficafon and treatment (including IPE simulafon) regarding the definifon of a fever, nofficafon process, febrile neutropenia treatment recommendafons, skills necessary associated to drawing blood cultures and administering anfbiofcs. 2) Standardized approach to treatment through the development of a Clinical PracFce Guideline (CPG) and a Licensed Independent PracFFoner (LIP) order set.

18 INTERVENTIONS 3) Performance Improvement Chart Reviews every 2 months on all pafents with febrile neutropenia. 4) Immediate peer feedback and coaching. 5)Standard work, Clinical Prac)ce Guideline and a Best Prac)ce Advisory were developed and implemented. 6) CreaFon of a Neutropenic Emergency Response Team (NERT).

19 SimulaFon Teaching Scenario Example v Pre- briefing emphasis on learning, teamwork v Scenario: 62 year old male admi[ed with fafgue, night sweats, and decreased appefte; AML diagnosed 2 months ago, s/p inducfon with 7&3 and 1 round of consolidafon, last HiDAC 7 days ago. IniFal assessment: c/o chills, assessment findings include increase HR, RR, T; decrease BP, and O2 sats.

20 Clinical SimulaFon IntervenFon v v v ParFcipant Roles: Shie manager, RN, PaFent Care Assistant, Health Unit Coordinator AcFons: MET team noffied, intern/resident to bedside, blood cultures, symptom management, VS, anfbiofc administered Debriefing Plus- Delta and Advocacy- Inquiry. Risk factors, s/sxs/labs, priority assessment, acfons, roles o

21 FOLLOW UP o o Nurses completed CVC educafon and collaborated with the medical team, pharmacy and Medical Emergency Team (MET) to address barriers to prompt treatment. Standardiza)on of process was put into place on units other than the inpafent hematology oncology unit.

22 RESULTS v v Decreased delay in the treatment for febrile neutropenia was demonstrated by implemenfng ISDA treatment recommendafons Clinical SimulaFon Learning Center (CSLC) and the use of simulafon were used to help apply the best pracfce recommendafons related to treatment of febrile neutropenia, administrafon to pracfce, enhance clinical reasoning and skills.

23 RESULTS v v v Increased confidence in caring for pafents with febrile neutropenia Plan: Incorporate MET nurse role, SBS approval for pre and post- survey, include members of the interdisciplinary care team and nursing staff from other acute care and crifcal care units in future simulafons. New Resource: Development of NERT (Neutropenic Emergency Resource Team)

24 OUTCOMES o Findings post- intervenfon included: 1) Reduced prac)ce confusion 2) Reduc)on in delays to ini)a)on of appropriate an)bio)cs 3) Increased knowledge 4) Increased interprofessional collabora)on 5) Op)mized Pa)ent Outcomes

25 OUTCOME DATA

26 IT TAKES A TEAM!

27 DNP EssenFals ReflecFons: Process, strategy, consistency o VI. Interprofessional CollaboraFon for Improving PaFent and PopulaFon Health Outcomes o VII. Clinical PrevenFon and PopulaFon Health for Improving the NaFon s Health o VIII. Advanced Nursing PracFce

28 CONCLUSIONS o Pre and post data indicate educa)on and process standardiza)on reduced incidence of failure to rescue pafent with febrile neutropenia and addressed a quality and safety gap for health systems.

29 REFERENCES o Neutropenic sepsis: prevenfon and management of neutropenic sepsis in cancer pafents (2012). NICE clinical guideline 151 h[p:// resources/guidance- neutropenic- sepsisprevenfon- and- management- of- neutropenic- sepsis- in- cancer- pafents- pdf o Freifeld, A.g., Bow, E.J., Sepkowitz, K.A., Boeckh, M.J., Ito, J.I., Mullen, C.A., Raad, I.I., Rolston, K.V., Young, J.H., Wingard, J.R. (2010). ISDA guidelines: Clinical PracFce Guideline for the Use of AnFmicrobial Agents in Neutropenic PaFents with Cancer: 2010 Update by the InfecFous Diseases Society of America.

30 THANK YOU!