Huang Tzyy-Jen, Mu Pei-Fan, Chen Mei-Bih, Florczak Kristine
Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Nursing, School of Nursing, National Yang-Ming University, Taipei, Taiwan.
JBI Evid Implement. 2020 Dec;18(4):420-430. doi: 10.1097/XEB.0000000000000238.
Oral mucositis refers to mucosal damage and occurs in the oral, pharyngeal, and laryngeal cavities. When patients with cancer get oral mucositis, the painful condition can cause difficulties in eating, drinking, and swallowing and may compromise the patient's nutritional status. It also may be drastically associated with infections, resulting in longer hospitalizations.
The aim of this project was to promote best practices related to oral mucositis prevention and treatment for patients in the hematology-oncology setting.
This implementation project was conducted in the hematology-oncology setting at a medical center in Taiwan. The current project adopted the clinical audit methodology and integrated Lewin's Change Theory, using the JBI Practical Application of Clinical Evidence System software. Seven audit criteria that represented best practice recommendations for prevention and treatment of mucositis were used. A preimplementation audit was conducted with 30 nurses and 30 patients to measure compliance between current practice and best practice. From that audit we identified barriers and facilitators to practice change by undertaking a Getting Research into Practice analysis. A post implementation audit was conducted with 50 nurses and 50 patients at 4 months after implementing the best practice recommendations for mucositis to determine long-term compliance.
The seven criteria showed an improvement: nurses who received education about oral care protocols increased from 40 to 100%, patients who received education about oral care protocols increased from 23 to 98%, and patients who followed oral hygiene care protocols, including brushing of teeth, increased from 27 to 96%. There were small improvements in the following criteria: compliance with ongoing assessment of the oral cavity increased from 97 to 100%, nurses who conducted an oral pain assessment increased from 97 to 98%, and patients who followed the therapeutic oral care regimens increased from 88 to 100%. However, nurses who conducted initial assessment of the oral cavity remained at 96%.
The implementation of best practice for enhancing prevention and treatment of oral mucositis for cancer patients in four hematology-oncology settings is possible. Lewin's Change Theory underpinned the project, which integrated blended learning strategies and communication skills which contributed to the success of this implementation project.
口腔黏膜炎是指黏膜损伤，发生于口腔、咽腔和喉腔。癌症患者发生口腔黏膜炎时，疼痛状况会导致进食、饮水和吞咽困难，并可能影响患者的营养状况。它还可能与感染密切相关，导致住院时间延长。
本项目旨在推广血液肿瘤领域患者口腔黏膜炎预防和治疗的最佳实践。
本实施项目在台湾一家医疗中心的血液肿瘤科室开展。当前项目采用临床审计方法，并整合了勒温变革理论，使用循证系统软件JBI临床证据的实际应用。采用了七条代表黏膜炎预防和治疗最佳实践建议的审计标准。对30名护士和30名患者进行了实施前审计，以衡量当前实践与最佳实践之间的合规性。通过开展将研究应用于实践分析，我们从该审计中确定了实践变革的障碍和促进因素。在实施黏膜炎最佳实践建议4个月后，对50名护士和50名患者进行了实施后审计，以确定长期合规性。
七条标准均有改善：接受口腔护理方案教育的护士从40%增至100%，接受口腔护理方案教育的患者从23%增至98%，遵循包括刷牙在内的口腔卫生护理方案的患者从27%增至96%。以下标准有小幅改善：口腔持续评估的合规率从97%增至100%，进行口腔疼痛评估的护士从97%增至98%，遵循治疗性口腔护理方案的患者从88%增至100%。然而，进行口腔初始评估的护士仍为96%。
在四个血液肿瘤科室为癌症患者加强口腔黏膜炎预防和治疗的最佳实践是可行的。勒温变革理论为该项目提供了支撑，该项目整合了混合学习策略和沟通技巧，促成了本实施项目的成功。
