Evans Anna, Vingelen Mary Beth, Yu Candy, Baird Jennifer, Murray Paula, Bryant Pamela
Children's Hospital Los Angeles, Los Angeles, CA, USA.
University of Alabama at Birmingham, Birmingham, AL, USA.
J Pediatr Oncol Nurs. 2020 May/Jun;37(3):195-203. doi: 10.1177/1043454219900467. Epub 2020 Jan 29.
Chemotherapy-induced nausea and vomiting (CINV) is a distressing, underrecognized effect of treatment that can occur in up to 80% of patients. The purpose of this quality improvement project was to evaluate the impact of implementation of a standardized nausea assessment tool, the Baxter Animated Retching Faces (BARF) scale, on nursing compliance with nausea assessment and the frequency and severity of patient-reported CINV for children with cancer. The Plan-Do-Study-Act cycle was used to implement this practice change. With stakeholder support and hospital governance council approval, the BARF scale was introduced into the electronic medical record. Nurses were provided education about the assessment tool and were given badge buddy cards to prompt use of the tool, and workstation reminders were created. A root cause analysis was conducted to provide feedback for continuous quality improvement. Retrospective, aggregate electronic medical record data from May 2018 to April 2019 were analyzed for assessment compliance, total number of admissions with vomiting episodes, and average BARF score. Over the 12-month implementation period, run charts demonstrated a shift in nursing practice with increased compliance in documented nausea assessments during the second 6-month period. There was not a significant decrease in patient-reported CINV. The use of standardized nausea assessments based on patient self-reporting can provide useful and consistent feedback for nurses and health care providers. This quality improvement project demonstrated increased compliance with nausea assessment documentation. Further studies are needed to demonstrate that improvements in nausea assessment may reduce the frequency and severity of CINV.
化疗引起的恶心和呕吐（CINV）是一种令人痛苦但未得到充分认识的治疗副作用，高达80%的患者可能会出现这种情况。本质量改进项目的目的是评估实施标准化恶心评估工具——百特动画干呕面容（BARF）量表，对护理人员在恶心评估方面的依从性以及癌症患儿报告的CINV频率和严重程度的影响。采用计划-实施-研究-行动循环来实施这一实践变革。在利益相关者的支持和医院管理委员会的批准下，BARF量表被引入电子病历。为护士提供了关于评估工具的培训，并发放了胸卡提示卡以促使其使用该工具，同时设置了工作站提醒。进行了根本原因分析，以提供反馈促进持续质量改进。分析了2018年5月至2019年4月的回顾性汇总电子病历数据，以评估依从性、呕吐发作的入院总数和平均BARF评分。在为期12个月的实施期间，运行图显示护理实践发生了转变，在第二个6个月期间，记录的恶心评估依从性有所提高。患者报告的CINV没有显著下降。基于患者自我报告的标准化恶心评估可为护士和医疗保健提供者提供有用且一致的反馈。本质量改进项目表明恶心评估记录的依从性有所提高。需要进一步研究来证明恶心评估的改善可能会降低CINV的频率和严重程度。
