Mary Fournogerakis, BSN, RN, OCN Rebecca Martin, BSN, RN, OCN, BMTCN

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Presentation transcript:

Mary Fournogerakis, BSN, RN, OCN Rebecca Martin, BSN, RN, OCN, BMTCN Standardizing Cerebellar Assessment and Documentation in Patients Receiving High-Dose Cytarabine Mary Fournogerakis, BSN, RN, OCN Rebecca Martin, BSN, RN, OCN, BMTCN

Objectives Identify why a cerebellar assessment is important and necessary with high-dose cytarabine Describe how to implement a standardized cerebellar assessment tool into the electronic health record

Who We Are Froedtert & Medical College of Wisconsin Academic Medical Center 500 beds Clinical Cancer Center Ambulatory Clinics 240,000 visits annually Day Hospital 32,000 encounters

High-Dose Cytarabine Part of post-induction therapy for many patients with acute myeloid leukemia Irreversible neurotoxicity is a potential dose-limiting side effect in 8% to 26% of patients Important to complete a cerebellar assessment prior to each dose

Problem Inconsistency in documentation of cerebellar assessment Variability in: Frequency Type Number of tests performed Thoroughness of documentation

Pre-Intervention Documentation Documentation was simply “cerebellar exam intact” in a patient care note Vague statement Didn’t reflect what was done Unable to determine baseline Unable to compare assessments Hard to find Required extensive chart review of patient care notes

Purpose To develop an accessible, standardized workflow for the assessment and documentation of cerebellar function prior to administering high-dose cytarabine

Interventions Literature Review Collaborated with oncology physicians Educated staff Created electronic documentation tool and linked to eMAR Presented to nursing Shared Governance council Standardized cerebellar assessment tool created Collaborated with oncology physicians Literature Review eMAR = electronic medication administration record

Cerebellar Assessment Tool

Medication Administration Record

Flow sheet – Inpatient Synopsis – Outpatient

Project Outcomes Standardized method for assessment and documentation Improves efficiency by eliminating free text Compares historical assessments Promptly identifies adverse reactions

Future Directions Replicate with other medications with the potential of neurotoxicity Blinatumomab Develop and implement standardized tools to improve efficiency and thoroughness of documentation for other critical side effects Emphasize important role nursing has in assessment and mitigation of potential side effects

Mary Fournogerakis, BSN, RN, OCN Questions? Contact information: Mary Fournogerakis, BSN, RN, OCN 414-805-1259 mary.fournogerakis@froedtert.com

References Baker, W. J., Royer, G. L., Jr., & Weiss, R. B. (1991). Cytarabine and neurologic toxicity . Journal of Clinical Oncology,9(4), 679-693. Brown, C. (2010). Cerebellar assessment for patients receiving high-dose cytarabine: A standardized approach to nursing assessment and documentation. Clinical Journal of Oncology Nursing,14(3), 371-373. Szoch, S., & Kaiser, K. S. (2015). Implementation and evaluation of a high-dose cytarabine neurologic assessment tool. Clinical Journal of Oncology Nursing,19(3), 270-272.