| Principal Investigator: | Shirley E. Harvey, RN, BSN, OCN |
| Co-Principal Investigators/Collaborators: | May Dean, Kathy Baker, Ashley Netting, Megan Ogle, Anne Fredrich-Cuntz, John Adams, Bill Brown, Dora Mendoza, Melissa Cole |
| Organization: | Texas Health Resource Arlington Memorial Hospital |
Abstract
Problem and Change Needed
Mucositis is a common toxicity associated with chemotherapy and radiation therapy. It is a complex process that begins with the initiation of chemotherapy or radiation and my last for weeks until healing is completed. At Texas Health Arlington Memorial Hospital, there was no structured protocol for preventing or treating mucosistits. This led to confusion and inconsistency for the staff and patients.
Evidence
The goal of this project was to develop a policy and protocol by an interdisciplinary team based on the Oncology Nursing Society’s (ONS) “Putting Evidence into Practice” (PEP) guidelines for mucositis. Team members were representative of nursing, research, education, nutrition, pharmacy, and medicine. We did a literature review to support and validate ONS’s information.
Strategy
Using the Iowa Model to Promote Quality Care, we developed a policy, protocol, and algorithm to prevent and treat mucositis. We educated both the patients and staff.
Practice Change
We now use bland salt and soda rinses and have eliminated products such as magic mouth wash from our hospital formulary. We have eliminated products which contain per ox-A-mint from our floor stock.
Evaluation
We monitored patient comfort and knowledge before and after implementation and found a decrease in discomfort post interventions.
Results
Due to the success of the policy on our oncology unit, our policy has been revised and combined with the existing oral care and dysphagia policies for the general hospital population.
Recommendations
The process that we followed using the Iowa model was successful. We hope to follow this model again as we develop policies for implementing additional ONS PEP guidelines.
Lessons Learned
Some of the nursing and medical staff were slow to change their practice and were content to use the old products which were ineffective. In the future I would continue to use an interdisciplinary team but include more staff members to ensure continued collaboration.
Bibliography
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- Eilers, J., & Million, R. (2007). Prevention and management of oral mucositis in patients with cancer. Seminars in Oncology Nursing, 23, 201–212.
- Harris, J. D, Eilers, J., Harriman, A., Cashavelly, B. J., Maxwell, C. (2007). Putting evidence into practice: Evidence based Interventions for the management of oral mucositis. Clinical Journal of Oncology Nursing, 12, 141–152.
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- Melnyk, B. M., Fineout-Overholt, E. (2005). Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia: Lippincott, Williams, & Wilkins.