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Our institution performs chemotherapy/immunotherapy competency verification on an annual basis for nursing via in person simulation of chemotherapy specific skills. In previous years, live simulation was done with our team of nursing professional development specialists (NPDS). During the 2020 COVID-19 pandemic, we adjusted the competency to a paper format for social distancing compliance. Feedback around the paper format was mixed, yielding a change for 2021. Utilizing technology to its fullest, we opted to transition the activity to a digital Learning Management System (LMS) platform. The purpose of this project was to implement an electronic process for validating competency of nurses who handle chemotherapy/immunotherapy. The goal is to provide easy accessibility to ensure that nurses have completed the competency requirements within the deadline and provide instant continuing education (CE) credits. The NPDS team met and reviewed feedback from the 2020 competency program to determine the best way to proceed in 2021, providing a high quality experience while maintaining social distancing protocols. Consensus was obtained to proceed with an on demand LMS module. After a careful review of safety events reported along with trends identified by NPDS as a knowledge gap, topics were selected to be the focus of 2021's chemo/immunotherapy competency. Independent verification at the bed/chairside, hazardous drug spills, sexual and reproductive health during treatment, and order set verification were identified as priority topics. Each participant will receive a link to a survey upon completion of the LMS module. Results will be tabulated and reviewed by the NPDS team to compare to previous models of competency assessment. This project was designed using the data collected in during the 2020 assessment to meet the needs created by the changing landscape of the Covid 19 pandemic. The aim is to continue to share and evaluate how we have evolved the delivery of high quality content on an annual basis. The collation of data from this year's competency will be compared with previous years and used to help us grow and develop our annual competency verification program. Using technology to assess annual chemotherapy/immunotherapy competency by building a module within our existing LMS platform. This innovation will allow for easier use for nurses and easier compliance tracking / CE dissemination for NPDS. [ABSTRACT FROM AUTHOR]

The SARS COVID-19 pandemic poses a higher risk for individuals that are immunocompromised and with other pre-existing conditions, including cancer. Due to the risk of infection, survivors with cancer report high levels of emotional burden as well as employment and financial difficulties. Additionally, challenges in post-treatment follow-up care may be exacerbated. The purpose of this study was to explore the impact of the pandemic on lung and colorectal cancer survivor's perceptions of post-treatment follow-up care and quality of life. Between spring 2020 to summer 2021, survivors participating in a randomized trial of a self-management survivorship care intervention completed three questions on COVID's impact on healthcare delivery and quality of life domains following informed consent and as part of baseline assessment. The three questions explored the survivor patients' perception of the impact of COVID-19 on their care after cancer treatment, physical health, emotional well-being, and work/income/finances/housing. Written comments were consolidated into an Excel document and a content analysis approach was used to identify themes. Comments were coded by all investigators and discrepancies were reconciled through meetings. A total of 93 survivors participated in this study (68 colorectal and 25 lung). Their mean age was 62 and the majority (53%) were men. Care delivery was impacted in terms of the inability to have a significant other in attendance during appointments, delay of appointments, and the need to adapt to telehealth. Themes of isolation, decreased physical activity, fear of COVID-19 infection, and increased anxiety predominated. For the questions regarding care impact and work/income/finances/ housing, approximately half the respondents stated there was little to no impact on their lives. COVID-19 impacted patients in the areas of care delivery, mental health, physical activity, and employment. As we continue to move through the pandemic, this data will help providers and health care systems understand patients' on-going needs in these unprecedented times. Disclosure: Research reported in this paper is supported by the National Cancer Institute of the National Institutes of Health under award number R01CA249501-01. The statements presented in this article are solely the responsibility of the author(s) and do not necessarily represent the official views of the National Institutes of Health. [ABSTRACT FROM AUTHOR]

Routine screening for financial hardship may identify patients at risk of financial crisis, such as bankruptcy or inability to afford food or medication and facilitate mitigation of financial toxicity. We describe our implementation of systematic financial hardship screening using the electronic health record (EHR) in an outpatient cancer center in New York City. Our process was developed previously with stakeholder input to screen all breast cancer patients for financial hardship risk using 2 items (Qi and Q3) from the Comprehensive Score for Financial Toxicity. Patients complete the 2 items either through: online patient portal during appointment check-in; or English or Spanish paper form distributed to patients by front desk staff during check-in and entered into the EHR during vital signs assessment. The EHR prompts survey completion again after 1 month. Using descriptive statistics, we evaluate implementation feasibility as the rate of completion; and we describe the financial hardship and worry experienced by respondents. From March to July 2021, 1,109 patients were seen in the breast oncology clinic, 23% were Hispanic/Latino and 14% were Black/African American; the mean age was 58 years (s=14). These patients represented 2,678 clinical encounters with an average of 2.6 visits per patient, and 864 (78%) patients completed at least one assessment using the online portal. There were 1,106 (41%) responses to Q1: "I know that I have enough money in savings, retirement, or assets to cover the costs of my treatment;" and 1,109 (41%) to Q2: "I worry about the financial problems I will have in the future as a result of my illness or treatment." For Qi, 517 (47%) responded "not at all" or "a little bit." For Q2, 455 (34%) responded "quite a bit" or "very much." Our study highlights two findings: first, implementing systematic financial screening in oncology clinics is complex; and second, financial hardship and worry are prevalent and require interventions to mitigate this devastating adverse effect of cancer care. Future research will focus on assessing patient perspectives to improve acceptability of current procedures, and developing interventions and referrals for patients most in need. [ABSTRACT FROM AUTHOR]

The primary nursing care model is utilized to improve patient outcomes while facilitating strong therapeutic relationships between nurses and their patients. Especially in this new era of severe acute respiratory syndrome-related coronavirus 2 or SARS-CoV-2 (COVID-19), the importance of preventing infection remains an utmost priority. This evidence-based project is an examination of the effectiveness of the primary nursing care model in improving patient outcomes, satisfaction, and decreasing infection rates. A primary nursing model was incorporated into the daily workflow for registered nurses and patient care technicians (PCT) on two stem cell transplant units over a three month pilot period. Charge nurses recorded on paper the patients and the members assigned to their primary nursing care team. Effectiveness of the model was measured through quality indicators including central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), falls, and pressure injury rates. The model was also implemented to prevent the exposure and transmission of COVID-19 amongst this immunocompromised patient population. Compared to pre-pilot data, the stem cell transplant units had a 100% decrease in CLABSI and CAUTI, 75% decrease in pressure injuries, and 92% decrease in falls. This continuity of care strategy also maintained patient and nursing satisfaction rates on both units. All patients surveyed at discharge agreed that the primary care nursing model benefited their quality of care and improved their outcomes. The results of the nursing satisfaction survey showed that the majority of the nurses found themselves more likely to catch medical errors and quickly address other patient safety concerns, such as identifying significant changes in the patient's condition. The majority of the nurses also agreed that being a part of a small, structured care team facilitated the development of therapeutic, trusting relationships between the patients, their nurses, and their PCTs. The implementation of a primary nursing care model allowed designated nurses to care for the same patients each time to develop stronger patient-staff rapport, address patient concerns, and improve patient outcomes. [ABSTRACT FROM AUTHOR]

The Infusion Centers at a large multi-site teaching hospital system use only two features of the BBraun Smart Pump due to lack of Oncology drugs in the pump library. The "set/time/volume" feature which allows the RN to input the volume to be administered and the length of time; the pump then calculates the rate of administration. The "titration" mode allows a program to be set to administer medications on a preset schedule. Patient safety reports are continuously mined by leadership for trends/repeating errors. In Spring of 2020 with the launch of Epic Beacon, there were multiple errors related to the programming of the pumps. In the 10-month period prior to the go- live of Beacon there were 5 noted pump programming errors. In the 6 months post Beacon implementation there were 14 documented pump programming errors, a significant increase and concern for patient safety. The implementation of Beacon was a move from paper orders to electronic orders and barcode scanning. The focus may have shifted away from the programming activity at the pump and contributed to the errors since the RN's focus was on performing Beacon-related skills. A Pump Programming Task Force was formed and concentrated on reducing external distractions and increasing RN focus. A scripted time out process was formulated, in addition to two RNs completing an independent double check on chemotherapy. Time out scripting was to be used everytime a medication was being programmed. The three keywords, time out, quiet, and safety, were required. For data collection, ten weekly audits for scripting were done and tabulated. A laminated 3x5 inch card was placed on each IV pole as a visable reminder to staff. Time out compliance of 100% was achieved and sustained across all campuses by the 6 week mark. This correlated with a significant decrease in pump programming errors. Medication event reports were monitored for errors related to pump programing. There were zero errors reported from the implementation for the first 4 months. At the 6-month mark, there were 2 reported. This demonstrated a 71% decrease in pump errors and an achievement of the stated AIM to reduce errors by 60%. Audit reports continued to demonstrate almost 100% compliance with the process. The 71% reduction of errors still proved true at one year. [ABSTRACT FROM AUTHOR]

Chronic graft versus host disease (cGVHD) remains the leading cause of non-relapse mortality in patients post-allogeneic transplant. Novel agents are becoming available for patients with cGVHD, increasing the need for a personalized approach and evaluation of symptom control to guide treatment decisions. The National Institutes of Health (NIH) Consensus Development Project on Criteria for Clinical Trials in cGVHD has proposed use of the Lee Symptom Scale (LSS) in clinical trials to measure efficacy. Patient understanding of this questionnaire is essential to accurately capture data, minimize the impact of survey fatigue, and evaluate evidence of symptom improvement. Here we provide methods utilized to educate patients enrolled in SNDX-6352-0503 evaluating the use of axatilimab in patients with cGVHD. SNDX-6352-0503 is a Phase 1/2 study assessing the safety/efficacy of axatilimab in patients with active cGVHD despite ≥2 prior lines of systemic therapy. Key secondary objectives included improvement in LSS from baseline. LSS was assessed day one of each cycle and evaluates symptoms via 30-questions clustered by organ systems routinely affected by cGVHD. Total scores range from 0-120 and a 7-point improvement indicates clinical benefit. Study coordinators worked closely with participants to collect LSS data, used verbal instructions to educate on LSS value and addressed the sense of survey burden. Paper forms were provided with instructions to consider changes in their symptoms in the past 30-days. Ample time and a quiet space were provided with coordinators readily available to provide necessary clarifications. Areas typically requiring clarification included questions related to unintended weight loss and scoring of skin changes. Forms were then collected and scanned for completeness. The FDA and other regulatory bodies require an assessment of patient-reported symptoms when evaluating a new agent. Patients must receive appropriate education in the importance of the LSS questionnaire and completion to enable effective and reliable evaluation of novel agents in cGVHD. Applying these methods decreased questionnaire fatigue and led to the collection of a robust data set illustrating a 7-point improvement in 50% (n=19/38) of pts and contributing to axatilimab's continued development. AGAVE-201 and other studies in cGVHD will continue to utilize the original or modified LSS to assess symptom control, highlighting the importance of patient education in the utilization of these tools. [ABSTRACT FROM AUTHOR]

Assessing the right number and type of nursing staff to meet patient care needs is fundamental to inpatient care. Correctly identifying specific patient care needs per shift and equally balancing nursing workload increases nurse satisfaction and optimizes resources needed to provide appropriate levels of care. Subjective acuity grading results in perception of unbalanced assignments, increased nursing workload, frustration, and inaccurate representation of patient needs per shift on a stem cell transplant (SCT) inpatient unit. The goal of this project was to develop and implement an objective acuity tool to accurately define patient acuity based on specific needs and care required for SCT patients, appropriately balance nursing workload, and increase nurse satisfaction with patient acuity in their assignments. Observation and pre-survey feedback on the existing process and tool supported the need for a more defined grading approach. An objective acuity tool was designed to the needs of the SCT population. Educational materials were created for staff in-services and a bulletin board was displayed in the break room. Paper copies of the tool were completed by every nurse and collected each shift by the charge nurse. The total number for acuity was utilized by the charge nurse when creating assignments. Revisions were made based on staff feedback and a post survey was completed following initial roll out. 87% of staff perceived the objective acuity tool as accurately reflecting their patient care needs, compared to 26% with the subjective tool. 74% of staff felt there was an equal distribution and balanced nursing workload, compared to 26% with the subjective tool. 65% satisfaction with the patient acuity in assignments was also seen, an increase of 45%. The development and implementation of an objective patient needs-based acuity tool was successful on the SCT inpatient unit, with 97% of staff feeling the new acuity tool has been beneficial, and 94% rating they would like to continue using the tool. Literature supports the use of a tailored tool in specialized patient populations for it more accurately reflects necessary levels of care and leads to improved patient outcomes. Since the SCT population comes with its own specific set of needs that creates complexity in care, it is vital that they are accurately represented to provide the safest and highest quality nursing care. [ABSTRACT FROM AUTHOR]

With a high volume, high acuity brachytherapy service, focusing primarily on patients undergoing therapy for gynecological cancers, the Brachytherapy RNs and physicians identified an opportunity to expand services, as well as increase patient safety and well-being with the integration of the Anesthesia team. The purpose of this project was to provide deep procedural and/or general anesthesia to new patient populations previously not eligible for brachytherapy services due to patient acuity and/or inability to provide specific brachytherapy service within OR setting. To ensure patient safety and regulatory compliance, a multi-disciplinary work group, composed of Radiation Oncology staff RNs and leaders, MDs, Physicists and Anesthesiology leadership worked closely together and identified the following critical steps and interventions: (1) Determination of resources (budget, time, people) and timeline; (2) Physical environment: Creation of dedicated post-anesthesia care space: (3) Create standard workflows for pre-anesthesia assessment and education by Anesthesiologist, Radiation Oncologist and RN, intra-procedure care and roles, and post-procedure care and roles; (4) Implement EMR documentation system: RNs had previously documented delivery of care, including moderate sedation, on paper flowsheets; Radiation Oncologists, Physicists and RNs generally use the EMR associated with the linear accelerators. This department uses ARIA (documentation and planning system of Varian) which then moves to EPIC via a one-way feed every 24 hours. Expanding services gave us the opportunity to move into our systemwide EMR - EPIC; Collaborative work with IS team to develop and implement EPIC OpTime (procedural module) in Radiation Oncology, aligned with other procedural areas throughout healthcare system; (5) Development of Competencies, Patient Education and Policies and Procedures in alignment with other perioperative and procedural areas: (6) Ensure regulatory compliance with all state and federally mandated requirements for anesthesia care (be sure to includes Regulatory Services from beginning of project and team planning for CDPH visit). Project management timelines and updates crucial to ongoing team engagement. Metrics: patient safety (airway management, reversal), staff engagement and satisfaction, and patient satisfaction - perception of comfort and wellbeing during brachytherapy. Look forward to reporting on launch by ONS Congress 2022! Radiation Oncology RNs are leading the way as part of an overall strategic department goal to clinical documentation within EPIC. Our department will be able to offer brachytherapy services to high acuity patients who previously could not safely have moderate sedation, positively impacting their outcomes [ABSTRACT FROM AUTHOR]

This study was conducted to assess the holistic needs of cancer patients in terms of physiological, psychological, social, and spiritual needs and to determine how they respond through coping strategies. The study utilized a quantitative descriptive approach as a research design and adapted the Sheffield Profile for Assessment and Referral to Care (SPARC) for holistic need assessment and adopted the Situational Version of the Brief COPE for coping strategies with 14 theoretically coping responses by measuring the 28-item self-report questionnaire. The study includes 20 diagnosed cancer patients from the early stage to stage 3 except for those who were not able to participate due to extensive progression of the disease and those who received palliative treatment. Purposive sampling was used in the selection of the subjects. It was found out that in terms of physiological needs, "Fatigue" is the most common symptom they experienced. In terms of psychological, social, and spiritual needs, most of the patients experienced a significant concern. Meanwhile, in coping, "Religion" dominates among the 14 strategies followed by "Use of Emotional Support" and "Positive Reframing", and, "Substance Use" obtained the lowest response. Most of the respondents were female and its significant relationship in terms of "Positive Reframing" agrees significantly. Moreover, in coping and civil status, "Positive Reframing" and "Humor" are significant among married respondents. In coping and stage of cancer, "Positive Re- framing" and "Humor" are significant with the stage of cancer. In coping and treatment modalities, "Active Coping", "Use of Emotional Support" and "Religion" are significantly related to patients' treatment modalities. There is also a significant relationship between "Active Coping and Physiological Needs"; "Religion and Psychological Needs", and, "Self-blaming and Psychological, Social and Spiritual Needs". Holistic needs and coping strategies are related to one another to achieve the goal of healing & coping. Spirituality & the presence of strong support system manifest a positive coping response in their journey to healing regardless of the stage and diagnosis. A formulated care intervention program "My Cancer Journey" would be beneficial among cancer patients. The paper is written based on scholarly work and all errors has been corrected and followed the appropriate format. The research follows and adopted the appropriate methods of research inquiry. [ABSTRACT FROM AUTHOR]

In 2008, the Oncology Nursing Society (ONS) and American Society of Clinical Oncology (ASCO) held a workshop that put forth the ASCO/ONS Chemotherapy Administration Safety Standards. Within these standards were recommendations to have both documented informed consent and written information available to the patient on their diagnosis, goals of therapy, planned duration and schedule, information on possible side effects, regimen risks or symptoms that require notification and emergency contact information, and a plan for monitoring and follow-up. In 2016, these standards were updated with adjustments in the language that stated that health care settings must have a policy in place that documents a standardized process for obtaining and documenting chemotherapy consent or assent and that informed consent (with assent optional) for chemotherapy treatment is documented before initiation of a chemotherapy regimen. In 2010, Dr. Hope Uronis began leading a team to bring chemotherapy consent to Duke University Health System. Through her work with multiple departments and disciplines throughout the system, an approved document was crafted for use. In 2020, Dr. Uronis formed an implementation team consisting of two oncology certified nurses and a Duke Health Technology Solutions analyst. This team was able to transition the chemotherapy consent from a paper-only option to an electronic format available within the electronic health record (EHR) and implement the new process into workflows across all three Duke Health hospitals. In addition, the team was able to coordinate use of the eConsent on iPads which were purchased for use in all oncology areas. Having an iPad available helps with accessibility of patients that are at high-falls risk, that need larger font, and have issues using a computer mouse for signing documents. Since implementation of this process, patient feedback has been positive. Patients are able to view the eConsent in their patient accessed EHR both prior to and after signing. This allows for patients to be able to properly review the eConsent language so that they are able to advocate for themselves or their family members appropriately. Implementing change happens in phases, with a period of opposition to be expected. However, because of the efforts of this implementation team, the new eConsent process was widely successful and met with little resistance from stakeholders. [ABSTRACT FROM AUTHOR]

EPIC, an electronic medical record (EMR), has the capability for patients to enter their own data through the patient portal, MyChart. However, this function was not utilized. Intake specialists e-mailed paper intake forms, which were returned by fax and scanned into EPIC. The nurse coordinator (NC) also called patients, gathered data by phone, and manually entered it into the EMR. The purpose was to provide patients with an electronic form via MyChart to complete before their visit engaging them to actively participate in their own care. The project workflow was designed to save nursing, administration, and transcription time. An Epic Optimization request was placed to initiate a disease specific fillable form to be added to MyChart for New Patient Intake in the Breast Clinic of Women's Oncology Services. The NC collaborated with the nurse analyst from the EPIC team to develop the form and create a new workflow. They trained the clinical staff on how to access the information and reconcile the medical record. After the electronic forms were developed, the intake staff was trained and a physician champion was identified to pilot the project. A total of 20 female patients participated in the pilot; 13/20 (65%) were diagnosed with breast cancer and 7/20 (35%) had benign breast issues. The age range was from 33-86 with the mean age of 61. A total of 15/20 (75%) completed the two questionnaires. Participants' feedback included ease, speed and simplicity of form completion, and reduction of redundant paperwork. Team member comments revealed major time savings, efficiency, and security of patient information. More nursing time remained to support the patient. After the pilot project was complete, it was presented at breast center leadership and staff meetings. The nurse analyst and NC provided individual and group training for staff. Smart phrases were developed and shared with staff for data input into the EMR. A full roll out was implemented with plans to expand to other disease teams. This workflow fully utilizes the EMR and allows patients to participate in their own care. It ensures that the medical record is accurate, secures patient data, and reduces redundancy. The information can be re-viewed prior to the visit and the process saves valuable nursing time. [ABSTRACT FROM AUTHOR]

Purposeful hourly rounding (PHR) is a well described nursing intervention that proactively addresses the needs of patients and improves patient safety outcomes and satisfaction scores. Tracking PHR can present a challenge. Methods of tracking include EHR documentation, flip charts, paper logs and staff locator data, however these audits only track the presence of staff in the patient room and not the quality of the interaction. RN's are overwhelmed with the amount of documentation and auditing required. The Clinical Nurse Specialist group at this NCI-designated comprehensive cancer center wanted to reinvigorate PHR and engage staff in this project. The goal was to improve and track the quality of PHR interactions through direct patient feedback. All units received refresher training on PHR. Direct patient feedback was obtained by the Clinical Customer Service Coordinators (CCSC) during their routine patient rounds. Patient were asked two questions. "Our goal is to check on you frequently, can you tell me how often your care team has checked on you?" and "when we check on you, do we consistently ask about your specific comfort and personal needs (pain control, toileting needs, positioning and possessions in reach)?" The CCSC's collected ten audits per month on each unit. The results were logged into a hospital audit system. Between February and August 2021, question 1 responses indicate patients perceive they are being checked on at least every 1-2 hours 90-100% of the time. Question 2 responses indicate patients perceive they are specifically being asked about their comfort and personal needs 98-100% of the time. Patient comments were also tracked, which were important in providing feedback to the staff on PHR and promoting staff engagement. PHR has a positive impact on patient safety outcomes. Nurses are asked to engage in many different initiatives simultaneously, and it is important to identify ways that both measures success and motivates staff to continue to value the work. Direct patient feedback is a means to measure success that does not add to nursing workload. Specific examples from patient/family comments reflect how PHR is valued and recognized by patients and contributes to patient satisfaction. To ensure sustainability audits will continue monthly to evaluate for compliance. If negative trends are identified, direct observation of PHR will be implemented. [ABSTRACT FROM AUTHOR]