Poster Abstracts

doi:10.1188/25.ONF.E13

. 2025 Mar 1;52(2):1–462. doi: 10.1188/25.ONF.E13

Poster Abstracts

PMCID: PMC12404698

Footnotes

Each abstract has been indexed according to first author. Abstracts appear as they were submitted and have not undergone editing or the Oncology Nursing Forum’s review process. Only abstracts that will be presented appear here. For ONS Congress^® scheduling information, visit https://www.ons.org/education-hub/events/ons-congress.

Data published in abstracts presented at the 50th Annual ONS Congress are embargoed until the conclusion of the presentation. Coverage and/or distribution of an abstract, poster, or any of its supplemental material to or by the news media, any commercial entity, or individuals, including the authors of said abstract, is strictly prohibited until the embargo is lifted. Promotion of general topics and speakers is encouraged within these guidelines.

Oncology Nursing Forum. 2025 Mar 1;52(2):7.

P1. New Graduate Transition to Practice: Effects of an Oncology Nurse Residency on Nurse Resilience

Kristi Adams ¹, Ashley Mitchum-Chapman ², Keri Fitzpatrick ³

Management

Significance & Background

As the demand for nurses increases, organizations must be prepared to recruit, train, and retain more new graduate nurses than ever before. The new graduate experience as young nurses transition from student to independent professionals can leave them feeling overwhelmed, fearful, and stressed. Nurse residencies are proven in the literature to have positive effects on new graduate transitions Oncology is ranked the most stressful of the specialty areas, and oncology new graduate nurses are expected to perform at even higher levels of clinical, professional, and emotional competence, while maintaining resiliency. As the complexity of oncology patients continues to increase, measures to protect new graduates in the oncology setting need to be acted upon.

Purpose

Implement an Oncology Nurse Residency to improve new graduate’s knowledge, confidence and resiliency.

Interventions

The proposal of a specialty-specific nurse residency was discussed with and approved by key stakeholders. Eleven new graduates participated in the accredited hospital system nurse residency and the Oncology Nurse Residency. Content planning for six months included didactic and simulation learning experiences. Pre- and post-knowledge tests were completed at each education session. The Brief Resiliency Scale was utilized to track new graduate levels of resilience.

Results

New graduates participating in the Oncology Nurse Residency completed Brief Resilience Scales every month. The Wilconox Signed-Rank test was utilized to determine improvement in resiliency throughout the residency. A positive increase in the level of resiliency in new graduates was identified.

Discussion

Oncology new graduate nurses are expected to care for complex and vulnerable patients with a high emotional burden. Implementation of an Oncology Nurse Residency had positive effects on the resiliency, knowledge, and emotional competence of new graduate oncology nurses. This project will improve new graduate’s transition to the professional setting and positively impact patient care.

Oncology Nursing Forum. 2025 Mar 1;52(2):7–8.

P2. Antineoplastic Medication Competency for the Experienced Nurse

Ashley Mitchum-Chapman ¹, Kristi Adams ²

Management

Significance & Background

Nursing education plans and competencies are crucial for onboarding new nurses, but standardized processes to ensure competency among experienced nurses are often neglected. The safe administration of antineoplastic medications is of the utmost importance to the organization. Although organizational policies serve as the standards for safe antineoplastic medication administration, a clinical observation component is lacking to ensure competency.

Purpose

This project aimed to utilize the yearly nursing competency period to complete an internal quality assessment on RN administration of antineoplastic medications.

Interventions

A pre-test on antineoplastic medication administration was completed by all antineoplastic-certified RNs. Questions included pre-administration safety indicators, weight-BSA calculations, administration of pre-medications, PPE procedures, closed-system transfer device utilization, and documentation practices. After the pre-test, RNs were observed administering antineoplastic medication in the clinical setting. An Antineoplastic Administration Competency Checklist that aligns with ONS Standards and organizational policy was used to verify that the nurse met appropriate administration practices. If the nurse demonstrated appropriate administration practices, they were deemed competent. Education and remediation were completed if necessary.

Results

All participants answered pre-test questions on pre-administration safety indicators and documentation practices correctly. Knowledge discrepancies in weight-BSA calculations, premedication administration, and PPE procedures were identified. The clinical observation time was used to individually re-educate nurses on proper standards and expectations in these areas.

Discussion

An internal quality assessment can serve programs with valuable information and identify educational needs. Individual clinical observations allow specific knowledge gaps to be identified and remediated. Experienced nurses require the same level of education and competency as new nurses. Standardized practices to ensure proper processes should be complemented on an interval basis to maintain high quality outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):8.

P3. Bringing Care to the Oncology Patient: Equipping Nurses to Provide Care Using a Novel Approach

Modupe Adenuga ¹, Alwine Acolaste ², Debrah Rigg ³, Rachel Hutchinson ⁴, Anne Saint-Louis ⁵, Leslie Landon ⁶

Treatment Modalities and Managing Administration

Significance & Background

The recent construction of a state of the art cancer center with a new model of care warranted the need for cross trained oncology nurses in the ambulatory setting. In the traditional model, patients traversed the medical facility to specialized departments such as surgical oncology, radiation oncology, medical oncology, infusion treatment center and core lab to meet their needs. In preparation for the new model, within the first 6 months several nurses were hired to fill specialized vacancies and address anticipated staffing shortages in this cancer center. Current nurses needed to be cross trained and new hires needed to learn all the specializations for maximal flexibility.

Purpose

The goal was to train nurses to provide all aspects of care in the cross-specialization concept.

Interventions

The leadership team collaborated with Director of Nursing Education to meet identified competencies and set a timeline. Simulations and return demonstrations were done with each nurse. This required weekly follow-ups and competency checkups with the nurse and their preceptor. New nurses were assigned to orient in clinic for 6–8 weeks then another 3–12 weeks with an infusion preceptor or until competent.

Results

After the new cancer center was built, 6 nurses were cross-trained in one disease specific unit, nurses were able to perform their roles in clinic, triage, infusion and procedures which facilitated meeting the holistic needs of the patient. Based on a survey, the number of nurses who were very confident about managing the patient receiving chemotherapy before cross training was 12.5% compared to 37.5% after cross training. Those extremely not confident before cross training was 25% versus post training 0 %. Nurses recommendations:

■ “Be patient with the process, learn to network within the clinic setting on behalf of the patient”
■ “Consistent, dedicated, focused training”
■ “Keep your spirts up as you go through ups and downs in training and realize you will not always be a novice in this area”

Discussion

After initial reluctance from some nurses, the new concept was adopted and everyone became aware of the importance of cross-training. The process is ongoing, with orientation expectations in place to guide and encourage nurses about becoming a cross-trained outpatient oncology nurse. Our highly skilled oncology nurses are better equipped to perform their duties on all aspects of patient care.

Oncology Nursing Forum. 2025 Mar 1;52(2):8–9.

P4. Centralized Cancer Surveillance for Patients and their Family Members with the BAP1 Tumor Predisposition Syndrome (TPDS)

Maria Gracia Agra ¹, Cathy Wagner ², Alexandra Lebensohn ³, Azam Ghafoor ⁴, Tenin Maglo ⁵, Raffit Hassan ⁶

Screening, Early Detection, Genomics

Significance & Background

BRCA1-Associated Protein-1 (BAP1) is a deubiquitinase associated with multiprotein complexes known to regulate critical cellular pathways and has several functions associated with tumorigenesis. Germline mutations in this tumor suppressor gene predispose families to develop multiple malignancies including mesothelioma, uveal melanoma, cutaneous melanomas, renal cell carcinoma, meningioma, and cholangiocarcinoma. Clinical research is still ongoing to understand BAP1 Tumor Predisposition Syndrome (TPDS) and limited centers are familiar with this. Patients and families with this condition face the challenge of following complicated and constantly changing guideline-driven care.

Purpose

To offer a centralized BAP1 germline mutation-positive surveillance program to address the burden of follow-up tests and treatment.

Interventions

Genetic testing is offered for first- and second-degree family members of individuals with a CLIA-confirmed positive BAP1 germline pathogenic mutation. Germline mutation-positive family members are encouraged to complete a series of cancer surveillance imaging, clinical assessments, and follow-up tests directed and reviewed by a team of physicians and genetic counselors. Oncology research nurses help patients navigate through various levels and types of multidisciplinary care.

Results

The program started in January 2019 and as of July 1, 2024, it has enrolled 208 patients belonging to 89 families, of whom 131 patients are enrolled in the surveillance program. Most patients have completed baseline screenings and one to three years of follow-up assessments. Patients diagnosed with new malignancies are under active surveillance or have received early intervention. Pre-genetic testing counseling helps address the psychological concerns associated with a potential diagnosis of a genetic predisposition for these heritable cancer risks. Nurse assessments of the patients’ and their family’s mental and emotional status while identifying socio-economic barriers assist in matching resources available to cope with a new diagnosis. Continuous education about BAP1 TPDS promotes patient compliance with scheduled surveillance assessments and facilitates the coordination of critical multidisciplinary care involving medical and surgical oncologists.

Discussion

Follow-up tests and treatment burden, if not addressed, may potentially delay early cancer detection and intervention for the BAP1 germline mutation-positive patients and their families. A centralized surveillance program managed by a team, including oncology nurses, with knowledge about this familial syndrome helps decrease the need for patients to self-manage this rare and complicated condition. Providing effective consolidation of care may continue to improve the education and support for this patient population.

Oncology Nursing Forum. 2025 Mar 1;52(2):9.

P5. Primary Nursing: Patient and Nurse Collaboration in Exceptional Care

Kerrin Albert ¹, Adonica Racicot ², Brianna Taglione ³, Carole DeAngelis ⁴, Georgina Torres-Calhoun ⁵, Jane Worrell ⁶

Quality and Safety

Significance & Background

The importance of advocacy, collaboration, and trust as hallmarks of primary nursing became even more critical to our infusion nurse team following the COVID-19 pandemic. The impact of Primary Nursing is found in the literature with positive outcomes noted to include increased patient and nurse satisfaction. Primary nursing is a tenet of nursing practice at our oncology institute as well as relationship-based care, a core part of our professional practice model.

Purpose

Improve implementation of the primary nurse model in our ambulatory oncology clinics.

Interventions

A Primary Nurse Taskforce was formed to address challenges and improve implementation of our primary nurse model. This includes ensuring each patient has a Primary and two Associate Nurses, and to analyze how each unit is meeting the target of 70% of patients being scheduled with their primary or associate nurses. Primary nurse champions from each unit are expected to review data, strategize ways to support primary nurse assignments, and identify challenges to implementation. In addition to unit-based work, the task force meets monthly to share learnings across all ambulatory oncology clinics. A core group of infusion nurses collaborated with our data analytics team to develop, design, and implement a dashboard for tracking primary nursing. The taskforce also developed an education program to highlight impacts of primary nursing for the institute.

Results

Over the last year, the percent of patients scheduled with their primary or associate nurse has been 55%, up from 47% last year. Following the continuing education program, 97% of attendees agree or strongly agree they gained further understanding of primary nursing and can identify the benefits for nurses and patients. 89% of attendees also reported greater confidence in their nursing practice. Patient satisfaction is another metric tracked by the taskforce. Our patient satisfaction survey currently measures “Your trust in the skill of the infusion therapy staff”. Pre taskforce, this item scored 96.81%, 76th percentile in our oncology peer group, C4QI. One year later, this same item scored 98%, 99th percentile.

Discussion

There are continued challenges faced by the taskforce, however interventions continue to show improvement in reaching our 70% target. Primary nurse champions describe that the relationship with patients adds to their sense of autonomy and satisfaction in caring for patients and spans the care continuum from survivorship to end of life.

Oncology Nursing Forum. 2025 Mar 1;52(2):9–10.

P6. Creating a Streamlined Workflow for Equitable Patient Distribution in an Outpatient Infusion Center

Yvonnie Alcasabas ¹, Greisi Avila ², Edwin Achimbi ³

Healthcare Delivery

Significance & Background

Our new Cancer Center officially opened its doors on May 16, 2023. The Infusion Center is a critical component of this facility, integrating two previously distinct infusion units: (1) one unit specializes in chemotherapy and immunotherapy, and the second infusion unit focuses on blood transfusions, non-oncologic infusions, and community-based infusion orders. As patient volume and treatment complexity have increased, the existing workflow has proven insufficient to meet the growing demands of the Infusion Center.

Purpose

This abstract aims to outline the development of a sustainable workflow that ensures a fair and efficient distribution of patients among nursing staff throughout the day.

Interventions

To tackle the identified challenges, we established distinct roles within the Infusion Center, including Charge Nurse, Triage Nurse, and Pod Leads. An Electronic Daily Patient Assignment template was created to assist the Charge Nurse in patient assignments, allowing real-time visibility for all staff. Additionally, we implemented an acuity tool to evaluate not only the complexity of treatments but also the level of care required and the specific needs of each patient. Recognizing the importance of communication, we established group chats (e.g., DLDCCC Charge Nurses) within the EPIC system to facilitate seamless communication among nurses and other departments, addressing messages sent to staff who are on leave or off the unit.

Results

After one (1) year of implementing the new workflow, a survey was conducted to assess its effectiveness. The results indicated that nurses reported improved efficiency and satisfaction with the new system.

Discussion

The introduction of the new workflow and clearly defined roles has resulted in a more organized and equitable distribution of patient care responsibilities. Positive feedback from the survey suggests that these changes have enhanced the overall functioning of the Infusion Center, enabling nurses to deliver high-quality care while effectively managing their workloads. Ongoing analysis and adjustments will be crucial to ensure continued success and adaptability as patient needs evolve.

Oncology Nursing Forum. 2025 Mar 1;52(2):10–11.

P7. Title: Developing a Comprehensive Head and Neck Radiation Oncology Service: Integrating Multidisciplinary Care and Advanced Technologies

Richie Alexander ¹

Healthcare Delivery

Significance & Background

Establishing a new head and neck radiation oncology service at a clinic where one previously did not exist posed significant challenges. The endeavor aimed to create a standard of care rooted in evidence-based practice, ensuring high-quality care for patients with complex needs. The intricate nature of head and neck cancers demands a multidisciplinary approach, integrating advanced technologies and clinical expertise to optimize patient outcomes.

Purpose

The primary objective was to develop a robust practice model tailored to handle the complexities of head and neck cancer patients, including setting up protocols for difficult airways, managing diverse patient populations, and ensuring seamless integration with existing clinic services. Drawing inspiration from established centers while maintaining our autonomy, we sought to build a service line that could adapt to evolving patient care standards.

Interventions

The development process was phased over nine months, from November 1, 2023, to July 31, 2024. Preliminary data was collected during this period to assess the effectiveness of the interventions and to identify areas for improvement. A multidisciplinary team was engaged in the development of the service, including radiation oncologists, nursing staff, and allied health professionals, all contributing to the creation of protocols and workflows designed to enhance patient safety and care.

Results

The phased approach allowed for gradual acclimatization of the staff to the increasing complexity of cases. Phase one involved low-risk patients, selected by our Radiation Oncologist, ensuring a controlled introduction of head and neck oncology into the clinic. Phase two escalated to moderate-risk patients, including those with established tracheostomies and more complex post-surgical needs. Phase three culminated in the inclusion of high-risk patients, such as those with new tracheostomies and laryngeal cancers, requiring advanced airway management. The success of each phase was measured through patient outcomes, staff feedback, and adherence to the established protocols.

Discussion

Developing a head and neck radiation oncology service from the ground up is both a daunting and exhilarating task. By introducing the service in controlled phases, we were able to align our goals and visions with the highest standards of care, grounded in evidence-based practices. The phased introduction allowed the team to build confidence and competency, ensuring that the service could provide optimal care for all patient acuities.

Oncology Nursing Forum. 2025 Mar 1;52(2):11.

P8. Development of a Workload Intensity Tool to Create Equitable and Safe Nursing Assignments on an Intermediate Care Hematology-Oncology Inpatient Unit

Mia Alexander Rollins ¹, Kristi Shrieve ², Stephanie Jackson ³

Quality and Safety

Significance & Background

A safe and equitable nursing assignment is important for better patient outcomes and nursing satisfaction. On a 26-bed inpatient, intermediate-care, hematology-oncology (hem-onc) unit within an academic medical center, bedside nurse dissatisfaction, including float pool nurses, regarding unbalanced assignments has led to patient care delays and negative feedback to charge nurses. There is a lack of a standardized process for charge nurses to create and demonstrate safe and equitable nursing assignments on this high acuity unit.

Purpose

The purpose of this project is to implement and evaluate the effectiveness of a novel nursing workload intensity tool (WIT) on an inpatient hem-onc unit to improve patient outcomes and nurse satisfaction.

Interventions

The WIT was developed to include hem-onc population-specific tasks to assess nursing demands that are not included as standard with the tool embedded within the hospital system’s electronic health record. Hem-onc criteria for the WIT includes frequent blood product administration, day-of cellular therapy infusions, and high-risk infusions that require increased monitoring or nursing tasks. This tool was created using an objective point system that evaluates the anticipated patient workload intensity score completed by the bedside nurse for the oncoming shift. This information is then utilized by the charge nurses to validate the complexity of each patient and develop an equitable and safe nursing assignment.

Results

Subjective outcome measurements includes pre- and post-evaluation of nurse-perceived assignment equity and transparency, intercollegiate collaboration, and job satisfaction. Objective outcome measurements include nursing-sensitive indicators such as number of patient falls, central line associated bloodstream infections, and pain reassessment after opioid administration.

Discussion

Nurse satisfaction and confidence is important in retaining nurses in high acuity environments. Implementing the Workload Intensity Tool empowers charge nurses to confidently create and demonstrate a transparent safe and equitable nursing assignment while also improving intercollegiate collaboration in highlighting which nurses may have a higher intensity assignment.

Oncology Nursing Forum. 2025 Mar 1;52(2):11–12.

P9. Establishing an Outpatient Adult and Pediatric Infusion Vascular Access Team

Emely Alfaro ¹, Lisa Coronado ², Robyn Johnson ³, Jeanne St John ⁴

Treatment Modalities and Managing Administration

Significance & Background

Most chemotherapy is given in the outpatient setting and the majority of patients will require vascular access to receive cancer treatment. The percentage of patients treated via peripheral IV is unknown, but estimates are around 40–60%. Obtaining access is a challenge for patients with difficult IV access (DIVA), a term coined in literature from studies in emergency rooms and pediatrics. These patients require multiple IV attempts, leading to use nursing resources, delays in care, and anxiety and pain to the patient. Inpatient settings often have support from vascular access teams. However, in alternate settings such as outpatient infusion these resources are not available. Line placement is dependent on axillary departments having capacity, such as interventional radiology.

Purpose

An outpatient IV team was developed to provide IV insertion support to five infusion centers. The goal to minimize IV sticks in patients with difficult access and avoid delays in treatment. A year later after initial team implementation, a combined team of 8 pediatric and adult infusion RNs expanded their training to ultrasound guided IV (USGIV) insertion.

Interventions

Infusion nurses were recruited based on existing expert skillset in IV placement. An algorithm was created to guide infusion nurses when to escalate to the IV team. After two failed attempts infusion RNs requested assistance from the IV team via a group text using the health system wide communication platform. An available IV team member would proceed to that unit to insert the IV. If the IV team RN failed after two attempts, they escalated to another IV team member.

Results

Pre IV team data demonstrates infusion places approximately 2000 IVs per month with a first attempt success rate of 80%. The adult IV team placed an average of 110 IVs per month. In July 2024 they began using USGIV and placed 11 successful USGIVs between July–August. The Pediatric team placed 30 USGIVs in June alone.

Discussion

Alternate settings such as infusion centers that do not have access to PICC nurses, teams or vascular access teams should consider finding self-sufficient solutions to address complex vascular access needs of cancer patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):12.

P11. At The Core of the Matter: Streamlining Ambulatory Oncology Continuity of Care

Cortney Alianiello ¹, Danielle Rother ²

Coordination of Care and Navigation

Significance & Background

Increasing patient safety event reports related to scheduling and treatment plan errors revealed the need for improved communication within patient care teams to ensure scheduling accuracy, correct appointment ordering, and overall management of treatment plans. Additionally, recurring errors in treatment orders and poor communication of treatment changes led to missed and unnecessary appointments, and increased potential for treatment errors including delays in patient care and unintended treatment decisions.

Purpose

Our purpose was to streamline oncologic outpatient care through the creation of a centralized team designated as the point of contact for all treatment changes, order date corrections, and scheduling modifications of treatment plans.

Interventions

All key players were identified, as well as their specific roles and responsibilities as they relate to treatment plan management and the scheduling process. All avenues of communication were identified as well as the person(s) responsible for the ownership of that communication. A CORE (Chemotherapy Order Review Expert) team was created to include a treatment plan content expert, scheduling team expert, advanced practice providers, clinical pharmacist, infusion center charge nurse, and nurse manager. A process was developed to relay the correct communication of all treatment to identified key players to ensure scheduling and order accuracy in real time. EPIC and paging system groups were created to streamline communication between patient care teams and the CORE team. One on one education was completed with infusion nurses, scheduling staff, pharmacists and providers. Education was reiterated at staff retreat, staff and faculty meetings, weekly email updates and real time feedback.

Results

We compared the number of treatment and scheduling related patient safety event reports entered pre and post implementation of the CORE team process and found a 40% reduction in related errors. Patient satisfaction scores also improved for calendar year 2023–2024.

Discussion

Multidisciplinary communication with patient care teams has pointedly improved patient safety through scheduling and order accuracy. This has resulted in increased efficiency, improved patient satisfaction scores, and overall patient care excellence. Upon implementation of CORE team process, initial messaging format was found to be excessive. Appropriate modifications were made to reduce unnecessary interruptions to patient care.

Oncology Nursing Forum. 2025 Mar 1;52(2):12–13.

P10. Building Bridges: a Staff Retreat for Teamwork, Oncologic Education, and Interprofessional Relationships

Cortney Alianiello ¹, Danielle Rother ²

Professional Development

Significance & Background

A hospital wide SCORE (Safety, Culture, Operational Risk, Resilience/burnout, and engagement survey) survey was conducted in 2022 with the goal of providing opportunities to proactively discuss work settings and to address issues such as teamwork, safety, learning and quality of leadership. In response to valuable feedback, we embarked on a proactive initiative by organizing an inaugural Staff Retreat through our internal professional development council. Our retreat was designed to address the identified opportunities, with a strong focus on: enhancing staff education, elevating customer service standards, fostering collaborative relationships, and nurturing team cohesion through teambuilding activities.

Purpose

Our purpose was to develop a robust staff retreat to improve local culture through staff education and teambuilding activities promoting interprofessional relationships on a more personal level.

Interventions

Our internal Professional Development Council convened regularly, ensuring a collaborative approach to identifying educational priorities for both non-clinical and clinical staff. We surveyed all staff, which gauged interest in potential subjects and solicited input for teambuilding activities, promoting a culture of inclusivity and engagement. We secured presenters whom delivered impactful sessions tailored to address educational needs, professional development, promotion of teamwork and positive work culture. We also role-played customer service strategies when handling difficult patient conversations building resiliency amongst staff. Educational binders were created offering supplementary material for attendees to reference post retreat.

Results

The developed resource binder included a post retreat survey, symbolizing our dedication to continuous improvement and the integration of feedback. The survey aimed to gather insights on the retreat experience and sought suggestions for potential topics for next year’s retreat. Presentations had an average score of 4.6 out of 5. Encouragingly, the feedback received was overwhelmingly positive, with staff expressing a strong desire to perpetuate this initiative in the future.

Discussion

Implementing annual staff retreats can have significant positive implications for practice within healthcare organizations. The enthusiastic response from staff following our inaugural retreat highlights investing in such initiatives regularly. The renewed sense of purpose and reinvigoration observed among staff directly translates into enhanced quality of care for patients. We have planned to continue this initiative in the coming years. Another SCORE survey for our hospital is being planned in the near future which will we will compare to our previous results.

Oncology Nursing Forum. 2025 Mar 1;52(2):13.

P12. Implementation of a System Wide Electronic Chemotherapy Consent

Cortney Alianiello ¹, Kim Peterson ², Peyton Neilson ³

Quality and Safety

Significance & Background

Organizational policy requires a consent prior to administration of chemotherapy to inform patients of the treatment regimen, side effects, benefits and goals. During evaluation of consents, it was found that unique consents were being used at each facility throughout the Medical System. With the implementation of a new electronic health record module, an opportunity existed to transition the paper consent process to a standardized all-electronic version in alignment with the standardization of the hospital patient consent process.

Purpose

The purpose of this quality improvement project was to ensure that all patients receiving antineoplastic medications for oncologic and non-oncologic diagnoses have the same uniformed information given and consented with a standardized chemotherapy consent across all hospital sites.

Interventions

A multidisciplinary approach with inclusion of operational stakeholders at each site was used to ensure buy-in for consent standardization. A comprehensive review of all current consents was conducted and consensus obtained for an implementation plan. A best practice for consenting patients was developed and added to the published systemwide Chemotherapy Processing Guidelines. Education was provided to providers and staff at each site. iPads were deployed for ease of completing the electronic consents. Hard stops were implemented for accurate drug and route documentation. A process was developed for utilization of the patient portal for signatures of consent. Chemotherapy Order Review Expert (CORE) nurses ensure consents are completed prior to patient arrival in infusion areas. An escalation process was developed for consistency and timeliness of chair time preventing treatment delays.

Results

Since implementation, a steady increase in the usage of electronic consents for chemotherapy was observed. Notably, patient safety events related to consents decreased across all areas post-implementation. The adoption of a standardized consent system has streamlined the process, eliminating the need for separate consents between inpatient and outpatient settings. The functionality of electronic consents opens additional opportunities for consents via the patient portal and facilitates cross-prescribing throughout the Medical System Cancer Center infusion sites.

Discussion

Use of standardized all electronic consents for chemotherapy has improved workflows. Review and categorization of patient safety event reports for consent accuracy including spelling and appropriate use of acronyms will continue. Identification and completion of modification requests will be ongoing to improve ease of use for providers and visual cues for nursing staff.

Oncology Nursing Forum. 2025 Mar 1;52(2):13–14.

P13. Navigating Hazardous Drug Safety: PPE Requirements and Best Practices for Nurses

Suzie Allen ¹, Raquel Luague ², Kate Burkhart ³, Christi Bell ⁴, Hallie Marino ⁵

Quality and Safety

Significance & Background

The safe handling of hazardous drugs (HD) is paramount in oncology nursing due to the inherent risks these medications pose to healthcare providers and patients alike. With the increasing use of chemotherapeutic agents and other HD, nurses must be equipped with the knowledge and skills to protect themselves and their patients from potential exposure and adverse effects. Key components of safe handling include proper use of PPE, adherence to guidelines for preparation and administration, and implementation of appropriate waste disposal methods.

Purpose

Upon reviewing the 2016 NIOSH list, nursing at an NCI-designated Comprehensive Cancer Center found that appropriate PPE was not utilized for Table 1–3 medications and received pushback when requesting pharmacy update their Safe Handling policy. This 6-month Oncology CNS-led project aimed to assess the system safe handling practices and provide guidance to update the outdated procedures.

Interventions

Using the ONS Safe Handling Toolkit, NIOSH list, USP-800 and ASHP, oncology nursing assessed current practices and found a list of medications not designated as hazardous within the EMR and an outdated HD PPE algorithm. The project expanded to system level with drugs found outside of oncology and pharmacy joined to form an interdisciplinary team. An action plan was created to address the deficiencies.

Results

The HD PPE Algorithm was updated to include Table 1–2 drugs requiring a CSTD, manipulated Tabel 3 drugs, and crushed HD drugs. The team standardized the HD drug identification in the MAR and Omnicell, using color coding and T1, 2, or 3 to coordinate with the algorithm. Lexicomp contains a link for the Algorithm and NIOSH Risk Assessment of every HD, pharmacokinetics, and required PPE. The Safe Handling module was updated and completed by all nurses and an HD segment added to the live Medical-Surgical system orientation class. A 2-sided Safe Handling education sheet was provided to each unit.

Discussion

Essential practices and training are needed to ensure the safe management of HD by all nurses. Additionally, ongoing education and assessments are crucial to keeping nurses informed about evolving standards and practices. By fostering a culture of safety through comprehensive training and strict adherence to established protocols, healthcare facilities can significantly reduce the risks associated with HD handling. This commitment not only enhances nurse safety but also contributes to improved patient care and outcomes in all settings.

Oncology Nursing Forum. 2025 Mar 1;52(2):14–15.

P14. Chemotherapy Fundamentals: A Comprehensive Training Course for New Oncology Nurses

Suzie Allen ¹, Christi Bell ², Hallie Marino ³, Kate Burkhart ⁴, Erica Scott ⁵, Edna Mae Smith ⁶

Professional Development

Significance & Background

The safe administration of chemotherapy is a critical competency for oncology nurses, given the complexity and potential hazards associated with these hazardous treatments. Administering antineoplastics is considered a high risk, low frequency event and oncology nurses are the last safety check to catch errors prior to medication administration. They require the knowledge and hands-on experience to provide safe care to oncology patients. ONS’s position statement defines specific content required to educate nurses who administer and care for these patients.

Purpose

A practice gap was identified at a NCI-designated Comprehensive Cancer Center with onboarding nurses to administer chemotherapy. With the increasing complexity of cancer treatments and the diverse array of chemotherapeutic agents, it is essential that nurses possess a thorough understanding of pharmacology, safe handling protocols, and the management of adverse effects. This initiative aims to equip new nurses with the necessary competencies and foster a culture of safety and excellence in oncology care.

Interventions

The 8-hour live course was designed to complement the ONS Oncology Orientation. Interactive learning methods, using didactic and simulation exercises, were employed to facilitate critical thinking and practical application of knowledge. The course is structured to cover eleven of the thirteen essential elements within the ONS position statement, including the pharmacology of chemotherapeutic agents, safe handling practices, and monitoring for adverse effects. Pre- and post-training assessments evaluate participants’ knowledge gains and confidence levels in administering chemotherapy.

Results

175 inpatient and outpatient oncology nurses completed the 8-hour live chemotherapy training class. The average score on the 25-question post-test of knowledge gained is 90. Prior experience ranged from “never seen chemotherapy administered” to “administering a few times with a preceptor.” Post-class, 100% of new nurses reported increased confidence levels.

Discussion

This abstract outlines a comprehensive training class designed for new oncology nurses, aimed at providing basic competencies in chemotherapy administration in accordance with ONS guidelines. By equipping nurses with the knowledge and skills necessary to administer chemotherapy safely, we can enhance patient outcomes, minimize the risk of errors, and reduce the incidence of treatment-related complications. Furthermore, effective training fosters nurse confidence and competence, ultimately contributing to a culture of safety and quality care within oncology settings.

Oncology Nursing Forum. 2025 Mar 1;52(2):15.

P15. Utilizing AM-PAC & JH-HLM Goals to Improve Outcomes on an Adult Inpatient Hematology/Oncology Unit

Amanda Alvarado ¹, Kathleen Arcidiacono ², Glynis Cox ³, Sadaf Hashimi ⁴, Esther Osoro ⁵

Quality and Safety

Significance & Background

Patients with cancer are more susceptible to disease and treatment-related decline during inpatient hospitalization. The consequences of immobility may include the inability to perform activities of daily living (ADLs), increased risk for hospital-acquired conditions, and increased healthcare utilization. Inpatient mobilization is essential to avoid negative outcomes and improve quality of life. The John Hopkins Activity and Mobility Promotion Program (JH-AMP) including the Activity Measure for Post-Acute Care (AM-PAC) and the Johns Hopkins Highest Level of Mobility (JH-HLM) goals were incorporated into our new Electronic Health Record (EHR). Despite the known benefits of this program, knowledge gaps persisted in its use.

Purpose

This project aimed to increase knowledge and reduce the discrepancy between AM-PAC scores and JH-HLM goals to ensure patients were mobilized and met mobility goals daily.

Interventions

A literature search was conducted in PubMed and ONS using search terms: “mobility”, “JH-AMP”, “AM-PAC”, “JH-HLM”, “immobility”, “cancer”, and “oncology”. Articles were reviewed to provide an overview of the incidence, risk, and effects of immobility in hospitalized oncology patients. From June to July 2024, a survey was disseminated to staff to determine attitudes and beliefs regarding mobility and potential barriers. Comprehensive education and mobility training was provided to nursing and ancillary staff on the accurate scoring of AM-PAC and JH-HLM goals, overcoming barriers, and prioritizing patient mobility.

Results

Providing re-education to nursing and ancillary staff about AM-PAC, JH-HLM, and the overall importance of mobility helped reduce discharge to rehabilitation rates by 15%. Electronic Health Record (EHR) documentation improved significantly, AM-PAC scores were more accurate and matched JH-HLM goals, and physical therapy consults were more appropriately utilized. During the implementation phase, there was an increase in patient falls, although we sustained 0 falls with injury per 1,000 patient days for at least 3 consecutive months. After implementation, there was a reduction in falls for at least 3 months. Patient satisfaction increased for at least 2 months.

Discussion

Mobilizing oncology patients requires a multidisciplinary approach and a culture that prioritizes mobilization. Implementing the JH-AMP program and providing staff education has significantly improved outcomes including reduced falls, no falls with injury, and patient satisfaction. Achieving JH-HLM goals daily preserves and enhances patient mobility, can be safely performed by ancillary and nursing staff, and improves the quality of life for patients hospitalized with cancer.

Oncology Nursing Forum. 2025 Mar 1;52(2):15–16.

P16. Enhancing Neutropenia Knowledge Among Spanish-Speaking Oncology Patients: A Pre- and Post-Education Survey Study

Ruth Alvarez Gaspar ¹, Faith Buziecki ², Pamela Minasian ³, Rebecca Choi ⁴

Patient Education

Significance & Background

In the oncology population, effective patient education is crucial, particularly for those undergoing intensive treatments such as chemotherapy and CAR-T (chimeric antigen receptor T cell) therapy, where neutropenia presents a significant risk. Los Angeles hosts a large Spanish-speaking Hispanic population, yet educational materials in their native language are not often readily available.

Purpose

This study aims to assess the impact of providing neutropenia education in Spanish and its effect on the patients understanding of their care.

Interventions

A pre- and post-education survey on neutropenia knowledge among Spanish-speaking patients was conducted on a 26 bed hematology oncology unit that provides both chemotherapy and CAR-T therapy. The survey included true/false statements and Likert-scale questions evaluating understanding of neutropenia, related precautions, and self-care practices. Initially, a pre-education survey assessed baseline knowledge. Following this, patients received a comprehensive educational session using a poster handout in Spanish and one on one teaching in Spanish, which covered neutropenia, infection risks, and preventive measures.

Results

Analysis of the pre- and post-education survey responses demonstrated a significant improvement in patient knowledge about neutropenia. Prior to the educational intervention, patients had an average knowledge score of 57%, indicating gaps in understanding key areas such as infection prevention and hygiene practices. Post-education, the average score increased to 88%, reflecting a marked enhancement in correct responses and overall knowledge. Patients also reported greater comfort in managing their condition and handling fever upon discharge.

Discussion

This project underscores the importance of culturally and linguistically tailored educational interventions in oncology care, particularly for patients receiving complex treatments like CAR-T therapy. The use of a Spanish-language poster handout proved effective in significantly improving patient knowledge and confidence regarding neutropenia, with a 29% increase in average survey scores. Enhanced knowledge not only has the potential to save patients’ lives by preventing serious complications such as sepsis but also to reduce hospital readmission rates. These findings advocate for the integration of Spanish-language resources to better serve the Hispanic population in oncology settings, ultimately improving patient outcomes and safety.

Oncology Nursing Forum. 2025 Mar 1;52(2):16–17.

P17. Managing Infusion Patient Expectations: The Impact of a Nurse-Developed Patient Education Resource

Beau Amaya ¹, Megan Hoffman ², Elizabeth Joy ³, Korkohjah (Dee) George ⁴, Lisa Tesoriero ⁵

Healthcare Delivery

Significance & Background

Cancer patients often face confusion and anxiety when preparing for treatment in infusion centers, leading to misunderstandings about the process and potential delays in care. At our cancer center, this gap in patient understanding was identified as a significant issue impacting the overall patient experience and treatment adherence. To address this, a team of oncology nursing leaders collaborated with the patient education department to create a comprehensive educational resource aimed at improving patient preparedness and enhancing communication. Nursing’s unique role in patient education is essential for fostering patient confidence and ensuring a smoother treatment journey.

Purpose

The purpose of this project was to develop and implement a patient education resource designed to help patients understand the step-by-step process of receiving treatment in the infusion unit. This resource aimed to reduce patient confusion, improve preparedness, and foster a better understanding of infusion treatment expectations, ultimately leading to improved patient satisfaction and outcomes.

Interventions

The intervention involved creating a patient education written resource and an animated video that will be distributed to all new patients scheduled for infusion treatment. These materials were developed in collaboration with nursing leadership, the patient education department, infusion nurses, and feedback from patients from our Patient Education Committee. Oncology nurses played a key role in delivering and explaining the educational materials during pre-treatment visits. This intervention was designed to improve patient comprehension and reduce the number of questions or uncertainties patients expressed during their infusion appointments.

Results

Initial feedback from patients and nursing staff showed a marked improvement in patient understanding of the infusion process. These resources have been approved in September 2024 patient satisfaction scores post implementation will be reviewed. Additionally, nurses reported fewer questions and less confusion from patients on infusion day, allowing for a more efficient workflow and improved communication.

Discussion

The creation of this patient education resource has important implications for oncology nursing practice. By providing clear, comprehensive educational materials before infusion treatments, nurses can help patients feel more informed and at ease. This intervention highlights the crucial role of oncology nurses in patient education and its potential to streamline care delivery. Future initiatives will focus on refining the resource based on continued patient and staff feedback and exploring the scalability of this approach across other oncology treatment areas.

Oncology Nursing Forum. 2025 Mar 1;52(2):17.

P18. Pacing Orientation for Optimized Learning in an Outpatient Clinical Trials Unit

Eileen An ¹, Kimberly Ito ²

Management

Significance & Background

Clinical trials at an ambulatory NCI-designated comprehensive cancer center are an essential part of treatment. Infusion nurses care for these acutely ill patients through implementing intricate research protocols. Orientation to the Clinical Trials Unit (CTU) requires knowledge of protocol compliance with the integration of critical thinking skills and a robust oncology knowledge base. Following the orientation of multiple nurses to the unit, CTU leadership recognized a gap in clinical expertise and the integration of critical thinking with research practice. A standardized orientation program was needed to ensure incoming nurses were prepared not only to perform required tasks and skills but also to understand the complexities of caring for patients on clinical trials.

Purpose

To develop a structured orientation program for experienced nurses transitioning to the outpatient oncology CTU.

Interventions

Nursing leadership, together with staff preceptors, convened to assess and develop a program to support oncology skill acquisition, research knowledge, and critical thinking during orientation. The Tiered Skills Acquisition Model (TSAM) guided the structure of the orientation. Originally designed to support newly licensed registered nurses transitioning into nursing practice, the TSAM was adapted for experienced nurses transitioning into oncology clinical trials. The model progresses so that nurses first attained foundational knowledge, then steadily incorporated the critical thinking required to care for this complex patient population. Weekly reviews of the orientation plan used iterative changes to align with the needs and learning pace of the individual nurse.

Results

A semi-structured interview process with nurses and preceptors supported the success of using the TSAM guided orientation. Orientees reported feeling ready to assume full patient assignments by the end of the program and believed they had acquired the critical thinking skills necessary to care for this patient population. Preceptors noted the successes in integrated didactic content and critical thinking.

Discussion

An essential element of the success of the TSAM model was the intentional pacing of knowledge and content delivery, paired with opportunities for critical thinking development. These findings suggest that the TSAM model may be adaptable and effective in other specialty settings as well.

Oncology Nursing Forum. 2025 Mar 1;52(2):17–18.

P22. Fostering Inclusive Oncology Care: A Nursing Council’s Role in LGBTQ+ Education and Engagement

Kevin Anderson ¹, Jillian Lawler ², Beau Amaya ³

Professional Development

Significance & Background

Oncology nurses play a pivotal role in addressing the unique needs of sexual and gender minority (SGM) patients. Given the evolving evidence-based practices, it is essential nurses stay informed about specialized care approaches. Continued and specific education is essential to provide comprehensive, equitable support during treatment and to collaborate effectively with experts and community resources. Despite their importance, a gap in LGBTQ+ specific care remains, emphasizing the need for targeted interventions.

Purpose

This led to the creation of a nursing-based council dedicated to enhancing oncology nurses’ competency in inpatient and peri-operative settings. The council employs a structured credentialing system to facilitate continuous education on LGBTQ+ health, ensuring nurses remain updated with the latest practices fostering an empathetic approach to care. By implementing this system, we sought to reduce barriers and elevate care quality for SGM patients.

Interventions

To achieve our objectives, we established a points-based system requiring members to earn 4 points per year through various educational activities. These include mandatory modules from the National LGBTQIA+ Health Education Center and other activities including programs such as gender-affirming care simulations. These opportunities not only update nurses on LGBTQ+ healthcare advancements but also challenge their thought processes and promotes deeper empathy and understanding. Additionally, it ensures engagement with emerging practices and continuous professional growth.

Results

Although specific measurement tools were not utilized, the council’s initiatives have maintained engagement and ensured nurses stay current with LGBTQ+ healthcare practices. Since the council’s initiation in 2023, more than 20 nurses have actively participated in the council annually. LGBT+ knowledge has spread hospital-wide through the dissemination efforts of these council members. As a result, this initiative supports the hospital’s continued designation as a Leader in LGBT Healthcare Equality, enhancing oncology nursing care by equipping nurses with the necessary skills to address the needs of SGM patients.

Discussion

This council’s initiatives are expected to foster an inclusive and well-informed nursing workforce, essential in oncology care. These efforts aim to reduce barriers faced by SGM patients by promoting empathy and awareness of diverse health needs. Engaging nurses in continuous education supports professional development, improving patient experiences and outcomes, especially in oncology settings where diverse identities play a vital role in care quality.

Oncology Nursing Forum. 2025 Mar 1;52(2):18.

P21. Regional Chemotherapy RN Task Force Optimizing the Staffing Needs Across All Campuses for Enhanced Patient Care & Efficiency

Shelita Anderson ¹, Renjitha Kolambel ²

Healthcare Delivery

Significance & Background

Quality and safety are vital in the administration of chemotherapy. The need for chemotherapy-credentialed nurses is crucial in a healthcare system comprising over ten acute care facilities. However, in community hospitals where chemotherapy may not be ordered daily, having skilled nurses readily available can be challenging due to low utilization. This creates gaps in care when chemotherapy is required, highlighting the need for a systemwide solution to ensure patient safety and staff efficiency.

Purpose

The regional chemotherapy nurse program, developed to optimize staffing needs while caring for patients in need of chemotherapy, is led by a select group of nurse leaders. With access to chemotherapy-skilled nurses, these leaders respond to campus leaders when chemotherapy is needed, ensuring efficient coordination of time, location, and chemotherapy regimen.

Interventions

Our healthcare system is committed to maintaining the highest standards of patient safety. When chemotherapy is ordered at any campus, a secure email is sent to the Regional Chemotherapy RN Task Force. Within 24 hours, the task force responds by identifyin0g an available chemotherapy-skilled nurse. Upon arrival, the nurse receives a detailed report from the patient’s assigned nurse and ensures that the patient has access to both pre-treatment educational resources and comprehensive verbal and written instructions about their chemotherapy regimen. The use of proper PPE and chemotherapy administration by a specially trained nurse further supports the program’s commitment to patient safety.

Results

Three of the ten campuses have utilized the regional chemotherapy nurse program, addressing the need for skilled chemotherapy nurses across all facilities.

Discussion

Utilizing skilled chemotherapy nurses across the system promotes staffing optimization, patient safety, and standardization of chemotherapy administration. A systemwide process is available and provides access to properly trained nurses.

Oncology Nursing Forum. 2025 Mar 1;52(2):18–19.

P19. Advancing Health Equity Community-Based Education on Cancer Prevention, Affordable Screening Resources and Needs Assessment for Underserved and Uninsured Populations

Shelita Anderson ¹, Shernette Sherrill ²

Screening, Early Detection, Genomics

Significance & Background

To promote health equity, addressing social determinants of health (SDOH) through community-based education and cancer prevention efforts is essential, particularly for underserved and uninsured populations. Barriers to cancer prevention and screening include social factors, financial limitations, and structural challenges within healthcare systems. Additionally, there are gaps in the translation of evidence-based practices (EBP) into addressing behavioral health issues such as obesity, alcohol consumption, poor nutrition, and physical inactivity, all of which influence cancer risk.

Purpose

We organized a health equity team of oncology nurse navigators to address education, cancer prevention, and SDOH. The goal is to remove barriers to care for underserved and uninsured patients.

Interventions

In line with the purpose of our health equity team, we have been working in collaboration with community partners and through community events. Our oncology nurse navigators provide health assessments, education, and cancer screening information to patients in local churches, community parks, and community events. This reassures our audience that our actions are aligned with our mission. Patients are also provided with education to address behavioral issues. Post-surveys are then provided to assess the impact of our education, cancer prevention, and screening efforts.

Results

Our efforts in cancer prevention and screening, SDOH, and education have been fruitful. We have provided education and screening for over patients in the community, resulting in a significant increase in their knowledge and participation in cancer screening post-education. This positive outcome gives us hope for the future of our health equity program.

Discussion

Providing underserved and uninsured patients with resources on cancer prevention and screening has led to improved education and participation in screening efforts. Our health equity program demonstrates the importance of addressing SDOH and behavioral health issues to promote cancer prevention, helping to bridge the gap in care for vulnerable populations

Oncology Nursing Forum. 2025 Mar 1;52(2):19.

P23. Exploring Opportunities for Improvement in an Oncology Nursing Unit Through Press Ganey Score Analysis

Marci Andrejko ¹, Laurn Arnold ²

Healthcare Delivery

Significance & Background

In oncology, patient experience is a critical measure of overall quality of care, where both clinical expertise and emotional support are essential. Press Ganey scores offer valuable insight into patient perceptions, helping to identify areas to improve patient-centered care. Understanding the factors influencing these scores is essential maintaining and improving care delivery.

Purpose

The aim of this project was to identify opportunities for improvement in an Outpatient Cellular Immunotherapy Oncology Unit by analyzing factors contributing to patient experiences.

Interventions

Outpatient oncology patient experience surveys (Press Ganey, LLC) were collected quarterly over a 12-month period from April 2023 to April 2024. Surveys were distributed to patients after their outpatient appointment, with responses scored on a Likert scale (1–5) and converted to a 0–100 scale. Higher scores indicated greater levels of satisfaction. Key areas of focus included access to care, interactions with care providers, personal issues, and overall assessment of care. Throughout the survey period, patient care practices remained consistent, emphasizing proactive communication regarding appointment delays, fostering transparency between staff and patients. Care providers maintained strong communication regarding conditions and treatment plans, and included patients in care decisions, establishing trust and demonstrating concern for patient well-being. Staff consistently addressed personal issues with sensitivity, respecting privacy and cultural, racial, and religious considerations.

Results

The quarterly survey results (N=51) showed consistently high satisfaction scores. Access to care averaged 93.91 (SD = 2.17), indicating efficient scheduling and responsiveness. Care providers scored 98.47 (SD = 1.00), reflecting strong patient-provider communication and trust. Personal issues scored 97.72 (SD = 1.60), demonstrating attentiveness to individual needs and preferences. Overall assessment averaged 97.52 (SD = 1.22), with patients expressing high confidence in the unit’s care and a strong likelihood of recommending the organization to others.

Discussion

This project underscores the oncology unit’s strengths in access, care provider communication, sensitivity to personal issues, and overall care delivery. Understanding the factors contributing to these scores reinforces effective practices and supports the continued deliver of high-quality, patient-centered oncology care. Even in high-performing areas, ongoing patient feedback is essential to uphold standards and drive continuous improvement. The key innovation is recognizing that successful units must continue to assess and refine their practices to ensure positive patient experiences.

Oncology Nursing Forum. 2025 Mar 1;52(2):19–20.

P24. Acknowledging Patient Deaths and Tools for Healthy Grieving in Oncology Infusion Centers

Jennifer Arfmann ¹

End of Life

Significance & Background

Oncology infusion nurses and staff form deep connections with patients and families throughout the longevity of their care. Routine exposure to patient suffering and subsequent deaths, combined with lack of opportunities to gain closure can lead to complicated grief for oncology infusion staff. Literature suggests that this repeated exposure to suffering and death can also lead to increased levels of burnout and compassion fatigue among staff members. Furthermore, literature also supports increased staff resiliency through formal opportunities to grieve patient deaths.

Purpose

The purpose is to share a formal process established at an outpatient oncology infusion center through which oncology infusion staff are notified of patient deaths and have an appropriate opportunity to express their grief in order to mitigate disenfranchisement and burnout. Prior to implementation of this process a survey of infusion staff was performed related to the death of patients. The survey revealed that 100% of respondents expressed a desire to be notified of a patient’s death and have an opportunity to honor a patient’s life in both formal and informal ways. This led to the key interventions for this process.

Interventions

A report was created within the electronic health record listing all infusion patients that are reported deceased to ensure accuracy. Based upon this list, sympathy cards for the loved ones of the deceased are voluntarily circulated amongst staff. Agendas at staff meetings include a formal time of remembrance to honor patients who have died and to aid in the process of grieving. Between staff meetings an informal debrief is coordinated with the same purpose.

Results

Three months following implementation a post survey was conducted. 100% of staff rated “memory sharing” and “sending sympathy cards” as “very helpful” in their grief and “closure” process.

Discussion

Complicated grief among oncology infusion staff can increase burnout and staff turnover. By promoting closure and healthy grieving, this process has improved staff satisfaction and resiliency. Due to its success, this process will be implemented at other infusion centers within our region. Further assessment of increased resiliency and decreased burnout and compassion fatigue as a result of this process will be evaluated moving forward.

Oncology Nursing Forum. 2025 Mar 1;52(2):20.

P25. Dying Lung Cancer Patients: Were their Stated Preferred Locations of Death Actualized?

Kathleen Armstrong ¹, John Taylor ², Verna Ferguson ³

End of Life

Significance & Background

A lung cancer diagnosis often comes with a poor prognosis, creating a trying time with a multitude of decisions to make for patients and families, including a preferred location of death. Little research has been conducted with terminal lung cancer patients with regard to place of death. One study that was found was conducted in Japan with advanced non-small lung cancer patients. This study concluded that these patients survived longer if end-of-life (EOL) care was facilitated at home or in a hospice facility rather than in a hospital. A study conducted by Swedish researchers concluded that 76% of palliative care cancer patients who stated they preferred to die at home actually did die at home. No studies were found that focused on terminal lung cancer patients and preferred locations of death versus actual death sites.

Purpose

The purpose of this study was to determine the incidence of deceased lung cancer (DLC) patients who died in their stated EOL preferred death location.

Interventions

We conducted a retrospective chart review of 125 DLC patients. Medical records were abstracted from patients who died during a 5-year period. Data collected for this study were diagnosis, age, gender, preferred death location, and actual death location.

Results

Death location preferences were recorded for 67 DLC patients. Forty-three patients (64.2%) died in their preferred death location, while 24 (35.8%) died in a non-preferred location. The comparison between those lung cancer patients who died in their preferred death location and those who did not was statistically significant according to a chi-square goodness-of-fit test: X²(1, n = 67) = 8.088, p = 0.004.

Discussion

End-of-life can be a stressful and emotional time. Having an EOL plan in place can be helpful, as it can help ease the burden of EOL decision-making for the dying patient and their family. Nurses, palliative care teams, and healthcare providers should assist dying lung cancer patients in considering their preferred death location and advocate for the patient to ensure their dying wishes are realized.

Oncology Nursing Forum. 2025 Mar 1;52(2):20–21.

P27. Take a Deep Breath: Aromatherapy Patches to Decrease Breast Cancer Patients Anxiety During Radiation Therapy

Erika Armstrong ¹, Brenda Wilbanks ²

Symptom Management and Palliative Care

Significance & Background

Breast cancer patients have reported feeling anxious during radiation treatment, from the initial simulation through each treatment session. Since many patients drive themselves to appointments, using anxiety medication can be difficult and may cause unwanted side effects. Patients have asked for alternative therapies to help reduce their anxiety. After reviewing the literature, aromatherapy was chosen to be trialed to decrease patient anxiety and improve satisfaction. A policy was created and approved by a multidisciplinary team to allow for aromatherapy.

Purpose

To provide a non-pharmaceutical approach for decreasing patient anxiety during radiation simulations and treatments by offering approved aromatherapy patches after conducting contraindication screening.

Interventions

During the nursing education visit, nurses offered the patient the option to use aromatherapy during simulation. If a patient was interested, the nurse conducted a 4-question survey to rule out contraindications to using aromatherapy (G6PD deficiency, COPD conditions, sensitivity to perfumes, and cardiac arrhythmias). If there were no contraindications, the patient could choose a lavender or orange peppermint aromatherapy patch to be placed on their gown in an area of their choice. Patients rated their anxiety before using the aromatherapy patches on a scale from 0–10 with 10 the highest level of anxiety and 0 meaning no anxiety. After receiving their simulation scan, if the patient tolerated the patch without unwanted effects, they were offered the option to continue using the patches throughout their radiation treatment. Patients were given a voluntary post-treatment survey to complete and were asked on a scale from 0–10 about their anxiety level post-aromatherapy.

Results

The use of aromatherapy patches reduced patients’ anxiety during treatment. Patients reported that their anxiety remained the same or improved with aromatherapy. The organization covered the cost of the patches, and nurses and therapists found the implementation of aromatherapy to be easy and helpful in reducing patient anxiety. Seventy percent of patients expressed interest in trying aromatherapy in the future.

Discussion

Aromatherapy can be a beneficial complementary and alternative medicine (CAM) approach for individuals undergoing radiation therapy. This can prevent patients from having restrictions, such as driving, seen with traditional anxiety medications. Screening patients before implementing aromatherapy is important to help decrease adverse effects, which could otherwise increase patients’ anxiety. Allowing patients to be an active participant in their care can also be supportive in reducing anxiety.

Oncology Nursing Forum. 2025 Mar 1;52(2):21–22.

P26. From Confusion to Clarity: Streamlining Workflow Education Initiatives for Radiation Oncology Nurses Across Multiple Sites

Erika Armstrong ¹, Walter Chin ²

Management

Significance & Background

In 2019, the physics group TG-203 published new guidelines outlining safe doses and management of radiation for patients with Cardiac Implantable Electronic Devices (CIED). Based on these guidelines, a multidisciplinary workgroup was formed reviewing the new guidelines at a multi-site academic radiation oncology practice. The workgroup designated nurses to be the primary coordinators for all CIED patients. The initial education initiative was led by nursing managers. Frequent adjustments to the workflow were made based on patient safety reports, leading to confusion and dissatisfaction among nurses and providers. Providing education for a multidisciplinary site without educators for training posed a challenge in ensuring that nursing staff received the necessary information clearly and efficiently. Consequently, a Nursing Professional Development Specialist (NPDS) role was created to address the need for implementing education across multiple sites.

Purpose

To streamline education using a NPDS across a multi-site radiation oncology academic center to improve nursing satisfaction in learning new workflows. Furthermore, to enhance patient outcomes and decreases delays in care for radiation CIED patients.

Interventions

After streamlining the workflow process and creating standard work, 3 webinars were scheduled with input from nursing managers to select the best time for delivering education to minimally impact clinic flow. A pre-education survey was required to assess initial familiarity with the workflow and comfortably discussing interventions when performing patient education. PowerPoint and screenshots of the workflow were presented with an open forum allowing for questions. A presentation was recorded for nurses to review materials. After attending either the online seminar or reviewing the recorded lecture, a post-survey was completed by nurses to assess the same metrics after receiving the education.

Results

42 nurses received the new streamlined education initiative. Pre education survey reported that 35% of nurses felt a level of discomfort with using the workflow. When nurses gave patients education on the workflow, 12% of nurses reported discomfort in doing so. Post survey, 5% of nurses reported still feeling uncomfortable in both using the workflow and educating patients, deeming the intervention successful.

Discussion

Using a designated educator and collaborating with managers proved a successful intervention to providing education to nurses from multiple locations. Varieties in teaching methods and performing learning style assessments could be beneficial to ensure that 100% of nurses feel comfortable with new workflows.

Oncology Nursing Forum. 2025 Mar 1;52(2):22.

P28. Bridging the Divide: Bringing Research to Reality in Oncology Nursing Through Clinical Trials Liaison

Amy Attwood ¹, Cassidy Kotobalavu ², Jennifer Jones ³, Leanne Lujan ⁴, Catherine Cromar ⁵

Coordination of Care and Navigation

Significance & Background

As advancements in cancer research have accelerated, the demand for innovative treatment options through clinical trials has increased. However, many nurses and providers face challenges in understanding and adhering to these intricate protocols. Recognizing this, the Clinical Trials Office (CTO) and nursing department at an academic cancer institute identified the need for a dedicated position to facilitate clear communication between research and clinical operations. Consequently, the role of a Clinical Trials Liaison (CTL), who was also a trained oncology nurse, was established to bridge this divide.

Purpose

The primary purpose of the CTL is to bridge the gap between the CTO, providers, and nursing staff, ensuring protocol compliance and safety for trial subjects. Acting as a point of contact, the CTL helps streamline processes, address administrative concerns, and enhance the overall experience for all participants in clinical trials. This support ultimately contributes to the successful execution of trials and the advancement of patient care.

Interventions

The CTL role includes several strategic initiatives aimed at improving the integration of clinical trials within healthcare settings. The CTL works closely with the CTO and key clinical stakeholders to ensure the smooth integration of clinical trials into routine practices, and promoting collaboration. CTLs assess new research protocols for feasibility, ensuring that trials are practical and necessary resources are available. The CTL is highly involved in Site Initiation Visits (SIV) and logistics meetings, to ensure study teams receive the appropriate resources and training, while further clarifying expectations for clinical staff. Regular connection meetings are also held with leaders and the CTL to foster ongoing process improvement, problem solving, sharing of best practices, and identifying opportunities for role enhancement.

Results

Creation of the CTL role has enhanced clinical trial education and communication, resulting in fewer deviations and ensuring trial integrity, participant safety, and nursing comfort.

Discussion

The CTL contributes to a collaborative atmosphere that supports both clinical and research aspects of trials. Their role enhances access, education, and advocacy, fostering research awareness among nurses and improving patient outcomes while maintaining data integrity. In this increasingly research-driven landscape, the CTL has been a vital asset in advancing cancer care and enriching nursing practice.

Oncology Nursing Forum. 2025 Mar 1;52(2):22–23.

P29. Going for the Gold: A Collaborative Effort Between Recreational Therapy and Nursing to Improve Inpatient Quality of Life

Nancy Austin ¹, Tiffany Atkinson ²

Psychosocial Dimensions of Care

Significance & Background

Many oncology patients experience loneliness and a decrease in their physical conditioning while inpatient. Because of their immunosuppression and thrombocytopenia, the activities in which patients participate must be carefully considered for their safety.

Purpose

To encourage patients admitted to an inpatient oncology unit to engage in activities outside of their rooms to increase their quality of life while admitted by celebrating the Summer Olympics.

Interventions

Nursing and recreational therapy developed games to mimic Olympic activities. These activities included sports safe for patients of all mobility levels and would help with fine motor skills. Events included bowling, cup curling, sling shot-shot put, air hockey, foosball, darts, and yard games. Games were available to patients, their families, and staff. Participants were awarded for their participation with a medal ceremony and prizes donated to the unit.

Results

Each day, between 3 and 5 patients participated along with their caregivers. The ages of the participants ranged from the 11-year-old son of a patient to a 63-year-old patient. Many patients participated in multiple events while admitted, with one participating in all events. Of the 24 participants, 14 completed surveys about their experiences, stating that events helped them become more active on the unit and that bowling was rated the favorite.

Discussion

Patients enjoyed being out of their rooms and participating in the planned events. They enjoyed playing games against their family, friends, and staff. One patient, who participated in every event, told the staff that these events helped lift her spirits and gave her happiness. This particular patient has had issues with her mobility throughout her stay on the unit, and her caregiver mentioned that these activities gave her a fun reason to become more active again. With positive patient responses, new activities will be implemented twice a month. These activities will include improving fine motor skills and overall mobility while keeping patients safe.

Oncology Nursing Forum. 2025 Mar 1;52(2):23.

P30. Food Glorious Food! Initiating a Food Cart into an Infusion Center: A Nursing Perspective

Aprill Baker ¹

Symptom Management and Palliative Care

Significance & Background

The background of this poster is to share information on developing a food cart and discuss the pros and cons of this project from a nursing perspective. The significance and relevance to oncology nursing practice is related to the food insecurities and malnourished conditions that oncology patients are suffering from. Introduction of food items within the infusion center has been a topic of debate for several years. With the price of food items in today’s market, patients are coming into the infusion center hungry, malnourished and unable to buy food. The issue is how to implement this program in the infusion center without disturbing nursing care.

Purpose

The purpose of the food cart is to offer nutritional food items at no cost to oncology infusion patients while they are receiving their treatments.

Interventions

Oncology nutritionists and our integrative medicine coordinator developed food items that offer nutritional value to our patients while they are receiving their treatments. This food cart is managed by volunteers and is offered hourly until 2 pm Monday through Friday. The nutritionist researched foods that were high in protein. Patients are offered foods such as yogurt, pretzels, sun chips and high protein shakes and kombucha. Patients with nausea were offered “GIN GIN” candies, ginger ale and saltine crackers.

Results

The misperception by patients was that the food would always be available while they were receiving their treatments. When volunteers were unavailable for servicing the food cart, patients were disruptive and upset because they would rely on the food cart as part of their nutrition. Patients were not eating foods before appointments. Nursing was tasked with feeding patients instead of focusing on the treatments. Volunteers were entering rooms prior to nursing performing assessments causing delays in care. Volunteers would confront patients and family if they removed more than one item off the cart. Staff are now deescalating situations between patients and volunteers over food items. Patient and family members were also hoarding food items. Nurses were criticized by the volunteers when removing items off the cart without permission for patients.

Discussion

More research on implementation of foods into an infusion center is needed. From a nursing perspective, this project needs to have more structure and ground rules and a standard workflow during the week for improved patient care.

Oncology Nursing Forum. 2025 Mar 1;52(2):23–24.

P31. A Two-Step Approach to Improve Workflow Efficiency in Outpatient Hematologic Malignancy Fast Track Unit

Sherwin Balasia ¹, Victoria Aquino ², Surinder Kaur ³, Stephanie Farias ⁴, Melanie Pedreiro ⁵

Healthcare Delivery

Significance & Background

The dynamic complexity of cancer care and increasing volume of patients poses challenges in a fast-paced Outpatient Hematology-Oncology Department. A Fast Track (FT) pathway was created for patients requiring a lower level of care to help manage the department’s increasing workload. Patients eligible for FT include short infusions, injections, lab draws with possible transfusion, and central line care. However, the rise in patient acuity counteracts the purpose of FT, leading to an increase in overall wait times and slowing down individual RN workflow, affecting patient and RN satisfaction.

Purpose

A shift of patient acuity in FT from a lower level of care to a higher level can impact the department’s overall workflow efficiency. The FT team has sought to implement simple methods to improve the unit’s workflow and increase the overall team satisfaction.

Interventions

Initial data collected over 6 weeks from August – September 2024, showed that an average of 56.8% of patients were scheduled for labs with possible transfusion. 28.8 % of these patients eventually received transfusions translating to an average of 1.8 transfusion events per RN and an additional 3–4 hours of care per event. This extra workload was reported to negatively impact nursing satisfaction. In collaboration with Nursing leadership, the team developed a Two-step approach to improve the workflow. First, a Transfusionist nurse also referred to as a resource nurse is designated to oversee blood transfusion administration and collaborate with the infusion charge nurse. Second, the e-whiteboard will be used primarily as the team’s communication tool to jot down patients who will be assigned to the Transfusionist or handed over to the main infusion team for continuity of care.

Results

This project will measure the FT team’s overall satisfaction using a post-implementation survey. Data will be gathered over the coming months to identify other points of improvement in the workflow. Nursing leadership will meet monthly with the team to evaluate progress and address impediments to success.

Discussion

The team anticipates a successful implementation of the Two-step approach to help improve the workflow in FT and boost team satisfaction. We hope to leverage this implementation process and minimize the handoff of FT patients to the infusion area.

Oncology Nursing Forum. 2025 Mar 1;52(2):24.

P32. Liver Enzyme Results Prior to Immunotherapy Infusion Reviewing Our Process

Shannon Balog ¹

Healthcare Delivery

Significance & Background

Many patients with hepatotoxicity related to immunotherapy infusion are asymptomatic (Grover et al., 2022). Severe hepatic toxicity from immunotherapy is seen in 1% of patients receiving single agent and 4–9% of patients receiving combination therapy (Grover et al., 2022). Our cancer center is not able to run liver enzyme blood work on site.

Purpose

To evaluate our current process looking at staff perception, workflow, and reevaluation of the percentage of liver enzymes resulted prior to immunotherapy infusion.

Interventions

This quality improvement initiative involved 3 PDSA cycles. The cycle changes included utilizing treatment parameters, staff education, and immunotherapy labs drawn the day prior to infusion. This QI process has been reevaluated by rechecking lab result statistics and a follow up survey about workflow and improvement completed by the providers, nurses, pharmacy, and lab staff.

Results

The outcome was a decrease in the number of patients receiving immunotherapy without liver enzymes resulted. In 2021, 42% of patients did not have their CMP resulted prior to immunotherapy infusion. The percentage of patients after all 3 PDSA cycles not having the CMP resulted prior to infusion was 3.73% by October of 2022. Now, in 2024 ~100 percent of patients have CMP resulted prior to infusion. Twenty-five staff members completed the survey. All staff members note that liver enzymes result prior to immunotherapy infusion with our protocol. Twenty staff members strongly agree that the new protocol has made our practice more consistent for our patients and five staff members agree. Twenty-three staff members strongly agree that communication is more effective, and two staff members agree. Twenty-two staff members strongly agree that our current process is preferred, and three staff members agree. Twenty members of our staff strongly agree that the quality of care provided to our patient’s receiving immunotherapy has improved with our new process and five staff members agree. No staff members had additional recommendations. The survey responses were completed by one pharmacist, one member of the lab staff, thirteen infusion suite nurses, four nurse care coordinators, and six providers.

Discussion

The survey has shown that our staff finds this process to be effective and enables high quality of care. The current process may also benefit patients receiving other forms of IV treatment at our cancer center and alike centers.

Oncology Nursing Forum. 2025 Mar 1;52(2):24–25.

P33. Improving Access: Decentralization of Ultrasound Guided Peripheral IVS

Adrienne Banavage ¹, Katie Lassiter ²

Healthcare Delivery

Significance & Background

Approximately 13% of patients in our large academic medical infusion center require ultrasound-guided peripheral intravenous (PIV) catheter placement. The use of PIV can reduce central line days and minimize central line-associated bloodstream infections, however PIV placement using ultrasound requires additional competency. Nurses at our infusion center rely on the vascular access team (VAT) for ultrasound-guided PIV insertions, and share the VAT with the entire hospital. Long wait times for PIV placement leading to delays in treatment are significant daily challenges as well as staff frustration with this process.

Purpose

The purpose of this quality improvement project was to implement an internal infusion center VAT team in order to reduce the number of times the hospital VAT team have to place a PIV.

Interventions

Staff and leaders from the infusion center collaborated with hospital VAT leadership to identify durable and disposable equipment options needed for ultrasound guided PIV insertion, and to develop a training program for infusion nurses to become competent in ultrasound guided PIV insertion. Four nurses from the infusion center volunteered and completed 20 hours of simulated PIV placements alongside existing VAT members until competency was achieved. This team of 4 nurses comprised the internal infusion center VAT team and became the primary point of contact Monday through Friday from 8am to 5pm for ultrasound-guided PIV placements within the infusion center and the clinic-based pre-infusion departments. We measured total hospital VAT team calls for PIV insertion and the number of infusion center VAT team insertions. Additionally, we surveyed infusion center nurses about satisfaction of the new infusion center VAT team.

Results

One month after the establishment of an internal infusion center VAT, the number of hospital VAT team PIV insertions reduced from 13 to 0.The new infusion center VAT team placed 1–14 PIVs per day with a daily average of 8 PIVs. Surveys from infusion center nurses indicated they were satisfied with the new process of obtaining ultrasound guided PIVs for their patients.

Discussion

The creation of an internal infusion center VAT to place ultrasound-guided PIVs has reduced the need to wait for availability from the hospital VAT team. Infusion center nurses were satisfied with the change. Future plans include gathering additional metrics of time to treatment and early identification of patients who could benefit from an ultrasound-guided PIV.

Oncology Nursing Forum. 2025 Mar 1;52(2):25–26.

P34. Implementation of an Oncology Nurse Practitioner Role in a Regional Cancer Centre in Victoria Australia

Sue Bartlett ¹

Healthcare Delivery

Significance & Background

The Grampians Health (GH) cancer centre - Ballarat Regional Integrated Cancer Centre (BRICC) provides a cancer service in the Victorian Grampians Region covering a 48,646 square kilometre area, including three outreach cancer services to Stawell, Horsham, and Maryborough. With an increasing service growth, an Oncology/Haematology Nurse Practitioner (NP) was employed in April 2023, the first ever NP role for this service.

Purpose

The purpose of the NP role was to set up and implement a survivorship clinic, provide oral therapy education, and alternate patient treatment reviews with the medical oncologists and haematologists, including an outreach support to Maryborough. The NP role was also support the Symptom & Urgent Review Clinic (SURC), the inpatient ward and emergency department as well as to provide education and leadership to the nursing team within cancer services.

Interventions

The NP model was developed at BRICC by benchmarking and reviewing NP roles and models at other health services. There was regular meetings with internal and external stakeholders and a NP collaborative set up and developed at GH. We are also currently evaluating the current Oncology/Haematology NP role to benchmark for future NP roles in other specialities at the GH service.

Results

Since the implementation of the NP clinic in May 2023, a total of 726 oncology and haematology patients have been seen. This includes patients currently having systemic anti-cancer treatment (SACT), commencing oral therapy education and attending the survivorship clinic receiving a formalised survivorship care plan and appropriate interventions related to their care. Increased referrals to allied health professionals and other cancer programs including the Why Weight for Wellness program from the NP role saw a review of their services to ensure they were meeting the extra patient referrals. We are also currently evaluating completed questionnaires of patients who have been seen by the NP to review their experiences.

Discussion

NP roles are still very new in Australia. The NP role has improved quality of care and access for patients with specialist advanced practise and particularly with an alternate nursing/medical model. Patients now also have access to a formal survivorship clinic as well as an oral therapy education clinic to meet their physical, psychological and emotional wellbeing through the cancer trajectory. The NP role has also provided a single point of access for cancer nurses working within BRICC.

Oncology Nursing Forum. 2025 Mar 1;52(2):26.

P35. Improving Autologous Transplant Patient Education Through Multimodal Strategies

Drake Bastin ¹, Jessica Callanan ²

Patient Education

Significance & Background

A recent article in the Oncology Nursing Forum highlights the need for improved education for patients and caregivers undergoing autologous stem cell transplants. Due to the process being mostly outpatient, there is more emphasis on the patient and their caregiver needing to be aware of the process even more so today than in the past when it was mostly an inpatient stay at the hospital. The article notes that better-educated patients tend to have improved outcomes, but it lacks specific methods for delivering this education. The article concludes that there is a clear need for enhanced teaching strategies for both patients and caregivers.

Purpose

Autologous transplant patients are provided with a patient education binder before the start of their transplant journey. This patient education binder contains a significant amount of information and patients often become overwhelmed or have difficulty understanding the complexity of the binder’s contents. Frontline nurses identified the need to improve this process and incorporate another patient education platform to improve patient and caregiver understanding.

Interventions

The team concluded it was necessary to incorporate another education tool to cover the educational content in the patient binder. A video series was created, dividing the transplant process into six sections: BMT tips, mobilization, stem cell collection, transplant, post-transplant, and long-term follow-up care. After the videos were completed, they were uploaded publicly. QR codes in the patient education binder link the patient directly to the videos.

Results

A five-question survey assessing the patient’s confidence in preparedness for the phases of the autologous transplant process was provided to patients before sharing the videos with them. Pre-data showed that 40% of patients surveyed were not confident in post-transplant care. There was a significant increase in the confidence level of the patients in the post-survey following the educational videos.

Discussion

This project demonstrated that multimodal teaching strategies such as videos notably improve patient’s knowledge of the transplant process. This project also had significant benefits to the clinical coordinator, who is responsible for providing education to patients and their caregivers. A video introducing key BMT Team Members with their job titles and a picture help decrease patient anxiety and improve the overall experience.

Oncology Nursing Forum. 2025 Mar 1;52(2):26–27.

P36. Autologous Transplant Patient Education Transforms to Expanding Nursing Education

Drake Bastin ¹, Jessica Callanan ²

Management

Significance & Background

A recent article in the Oncology Nursing Forum highlights the need for improved education for patients and caregivers undergoing autologous stem cell transplants. Due to the process being mostly outpatient, there is more emphasis on the patient and their caregiver needing to be aware of the process even more so today than in the past when it was mostly an inpatient stay at the hospital. The article notes that better-educated patients tend to have improved outcomes. It is very important that our nursing team can reinforce the education provided to the patient. To reinforce the education provided, the nursing team must fully understand the autologous transplant process.

Purpose

Autologous transplant patients are provided with a patient education binder before the start of their transplant journey. This binder contains a significant amount of information and patients often become overwhelmed or have difficulty understanding the complexity of the binder’s contents. As we worked towards improving the patient’s understanding of the autologous transplant process, it quickly became apparent our BMT nurses wanted to review the information being shared with the patient to reinforce the education provided.

Interventions

The team concluded it was necessary to share the patient education video series with the nursing team based on the interest in the original patient education project. The videos were broken down into six sections: BMT tips, mobilization, stem cell collection, transplant, post-transplant, and long-term follow-up care. The QR codes created for patient education videos were shared with the transplant nursing team for review.

Results

A five-question survey assessing the nurse’s confidence in preparedness for the phases of the autologous transplant process was provided to patients before sharing the videos with them. Pre-data showed that 50% or greater of nurses surveyed were not confident in preparing patients for autologous transplant care. The post-survey following the educational videos showed that all nurses provided the survey were either confident or very confident after watching the videos.

Discussion

This project demonstrated that reinforcing autologous transplant topics in videos notably improves nurse’s knowledge of the transplant process. Increasing nursing knowledge on care pathways directly increases the nurses’ confidence in the care they provide to their patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):27.

P37. Encouraging Excellence: Launching a Comprehensive Exam Prep Course to Support Bmtcn Specialty Certification

Allison Baus ¹, Colleen McCracken ², Colleen McCracken ³, Sarah Davis ⁴

Professional Development

Significance & Background

Increasing nursing certifications is an organizational goal. More established exams (e.g., med-surg certifications or the Oncology Certified Nurse (OCN) certification) have ample resources to prepare nurses, including study guides, question banks, and exam prep courses. The Bone Marrow Transplant Certified Nurse (BMTCN) certification was more recently established and demand for this specialty certification is increasing, however, resources to prepare nurses for this challenging exam are limited. This is a barrier to increasing the number of nurses with this specialty certification.

Purpose

To meet the demand for this specialty certification, a BMTCN exam prep course was created to support test candidates.

Interventions

In collaboration with the local Oncology Nursing Society (ONS) chapter, a team of oncology educators created the course curriculum. The Oncology Nursing Certification Corporation (ONCC) test content outline guided content development. Subject matter experts (oncology educators and bone marrow transplant advanced practice providers) presented the material. An active learning approach through audience response software fully engaged learners in the course material. Course registration, with a virtual or in-person option, was limited to nurses from two BMT centers in the first year. In its second year the course was offered virtually only and advertised broadly on ONS and ONCC message boards.

Results

Attendees completed a post-course assessment regarding satisfaction, teaching strategies, knowledge obtained, and practice application. In year one (n=27), 96% of respondents reported an increase in knowledge and 72% reported being actively engaged in the course. In year two, 100% of participants (n=47) reported increased knowledge and active engagement in the course. In both years, open-ended comments suggested the course would positively influence participants’ nursing practice. No formal follow-up has been done regarding pass rates, however, to date, 10+ participants have independently contacted course instructors to share their achievement of the BMTCN certification.

Discussion

Our goal was to empower nurses to enhance their knowledge and obtain specialty certification in this expanding area of high-risk oncology care. The course continues to grow and, based on course feedback, new learning strategies will be employed to meet participants’ identified needs. Some improvements include modifying allotted time for each topic and increasing the number of practice test questions. To assess further opportunities, we will conduct additional formal follow-ups with participants to determine their success with the exam and improve the course based on exam experiences.

Oncology Nursing Forum. 2025 Mar 1;52(2):27–28.

P38. Administering Radiopharmaceuticals an Ambulatory Setting: a Testament to Collaboration

Christopher Bayne ¹, Aketia Seymour ², Anne Bledsoe ³, Lisa DeWolfe ⁴, Raed Al-Rajabi ⁵, Laure DuBois ⁶

Treatment Modalities and Managing Administration

Significance & Background

Lutathera is a radiopharmaceutical used to treat gastroenteropancreatic neuroendocrine tumors (GEP-NETs). It is administered intravenously and contains Lutetium Lu 177 dotatate, a chelated complex of lutetium with dotatate—a radiolabeled somatostatin analog. Lutathera targets cancer cells expressing somatostatin receptors making it effective for inoperable and metastatic well-differentiated neuroendocrine tumors. The treatment regimen consists of four infusions with an 8-week interval between administration. This topic is significant because of the intricate regime being administered in an outpatient infusion suite. Lutathera is just one of several theragnostic medications available that are paving the way for future radiopharmaceuticals.

Purpose

This will delve into the current state and our collaboration between nuclear medicine, nursing, physicians, pharmacy, radiation safety, and radiology. It will highlight the lessons learned in managing patient volumes, symptoms, and how a small-scale trial of changes contributed to the growth of the innovative treatment.

Interventions

Interventions included managing the side effects of the amino acids and developing a safe care plan for the patients. The financial process was crucial as many insurers initially were not providing coverage. The space constraints of the infusion department have been an ongoing challenge due to the growing demand for the medication. Implementing radiation safety principles of time, distance, and shielding has also been a challenge to ensure staff safety. Collaboration and innovative thinking enabled us to continue to grow and improve.

Results

The team’s success in launching and maintaining the program is evident from its growth over the past six years. We have treated over 157 patients, and the demand for treatments continues to rise. Initially, due to multiple constraints, we could only treat one patient per week. Over time, we increased to two, and now we can treat four patients weekly. This improvement is due to changes in our workflow and scheduling to meet the high demand. By increasing the Lutathera volume by 50% each month, we have been able to provide medication to those in need. This achievement highlights the collaborative efforts of the team and the positive impact on our patients.

Discussion

The need for collaboration across departments underscore the dynamic nature providing radiopharmaceutical based treatments. As we continue to explore novel therapies, multidisciplinary teamwork remains pivotal in achieving successful outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):28–29.

P39. The Importance of Follow up Telephone Calls Post Chemotherapy Treatments

Lisa Bazinet ¹, Alecia Haythe ², Emily Manuzzi ³, Mackenzie Docherty ⁴, Tara Monge ⁵, Dawn Noyes ⁶

Healthcare Delivery

Significance & Background

In December 2023 Clinical Journal of Oncology Nursing published an article highlighting the use of follow-up telephone calls to identify barriers to patients that may inhibit them from successful management of chemotherapy induced nausea and vomiting. Our office implemented a standard work developed around performing follow up telephone calls for patients on day one post treatment and then the following week.

Purpose

The purpose of the project was to increase communication with patients through telephone monitoring to proactively assess symptoms and side effects following their first cycle of chemotherapy or immunotherapy. Nurses initiated best practice interventions based on findings. They also provided reinforcement of education related to symptom management, home monitoring and medication adherence.

Interventions

Calls were conducted by RNs within 24 hours of initiation of treatment and again the week following. All patients were screened using the same series of questions. Questions were about the presence of common side effects, medication adherence and safety. Patients were given educational reminders about symptom management and infection prevention.

Results

Initiation of chemotherapy call backs began with the first patient on 1/17/2024 through 9/19/24. 39 patients were identified as receiving a new chemotherapy or immunotherapy regimen.

■ Symptoms not present: day 1 (14), day 8 (4)
■ Symptoms present: day 1 (13), day 8 (14)
■ MD/APRN/Infusion visit same day: day 1 (6), day 8 (12)
■ Voicemail: day 1 (5), day 8 (6)
■ Hospitalized: day 1 (0), day 8 (2)
■ Missed follow up: day 1 (1), day 8 (1)

Discussion

In addition to calling patients 24 hours after new treatment, the registered nurse conducted calls a week later to reinforce communication and education with patients. More patients had symptoms present in the week following treatment. Thirteen patients did not require follow up calls the following week due to planned toxicity visits with their providers or chemotherapy regimens with day eight treatments. Patients self-reported positive satisfaction with the outreach efforts and Press Ganey scores for patient experience has averaged 100% during the months we collected the data. Two patients were appropriately hospitalized for non-treatment related diagnoses during the week following treatment. This initiative continues to be utilized and additional data collected to monitor the effectiveness of these calls. Other locations within our organization will begin implementing this standard work this upcoming fall.

Oncology Nursing Forum. 2025 Mar 1;52(2):29.

P40. Streamlining Oncology Communication: Essential Contacts and Timing Guidelines for Patients and Caregivers

Ana Begley ¹, Maria Malloy ², Clara Hiltonq ³, Meghan Lucas ⁴, Megan Roy ⁵

Patient Education

Significance & Background

The challenges in patient communication within oncology care underscore a critical need for enhanced educational strategies. Addressing the inappropriate use of patient portals and voicemail systems is essential to ensure timely and effective care. A comprehensive approach to patient education can bridge this gap, providing clear guidelines on the appropriate channels for symptom management communication.

Purpose

By optimizing the timing and delivery of this education, patients can be better equipped to understand when and whom to contact, leading to improved triage times and more prompt interventions for symptomatic care. This initiative not only streamlines communication between patients and the oncology team but also reinforces the importance of using the right tools for healthcare communication.

Interventions

The proposed intervention strategy involves a multi-faceted approach to patient education and compliance monitoring. Initially, three providers will implement the pilot intervention, targeting new patients at the cancer center. These patients will receive educational materials through their online portal following their first chemotherapy session, ensuring immediate access to vital information. For patients who do not engage with the digital portal, printed materials will be supplied as an alternative.

Results

The evaluation process is equally thorough, focusing on verifying that patients have accessed and read the provided materials through their portal. Patients will be requested to send an affirmative response back to the nurse triage once they have read the message. Patient communication regarding symptom management will then be closely monitored, as per protocol. This dual approach aims to enhance patient understanding and engagement with their treatment process, potentially leading to improved health outcomes and a more streamlined care experience.

Discussion

The implementation of a structured educational strategy for patient communication within oncology care has the potential to significantly improve patient outcomes. By providing clear guidelines through the patient portal, patients are better equipped to manage their symptoms and communicate effectively with their oncology team. The dual approach of digital and printed materials, combined with thorough compliance monitoring, ensures that all patients receive the necessary information regardless of their preferred communication method. This initiative not only enhances patient understanding and engagement but also streamlines the overall care process, leading to more efficient triage and prompt interventions. Ultimately, this comprehensive approach to patient education and communication can bridge existing gaps, fostering a more responsive and effective oncology care environment.

Oncology Nursing Forum. 2025 Mar 1;52(2):29–30.

P41. Stay Interviews: Managing Retention as Human-Centered Leaders

Allegra Bell ¹, Maria Quirch ², Rayna McParlane ³

Management

Significance & Background

As the incidence of cancer continues to rise, with an estimated 20 million new diagnoses estimated in 2022, there is an unprecedented need for oncology nurses in the workforce (Challinor, 2023). The national turnover rate for Registered Nurses in 2024 was 18.4%, threatening healthcare organization’s abilities to adequately care for their patient population. Nurse leaders acknowledge retention as an expectation and responsibility of their role, and their actions have a known correlation to effect satisfaction and retention (Wang, 2023).

Purpose

To combat retention, as nurse leaders we seek to improve employee retention through the Human-Centered Leadership concept of “Stay Interviews”. Human-centered leadership (HCL) is a leadership style that prioritizes people, recognizing that organizations are human systems that function optimally when leaders care for and invest in the people at all levels. Stay interviews are structured discussions lead by leaders to learn directly from staff reasons why they stay and considerations for leaving (Synder, 2023). This dialogue not only builds trust but allows leaders the opportunities to address the unique concerns and priorities of the staff to ensure their needs are being met.

Interventions

Nurse leaders will conduct “Stay Interviews” with a goal target of 70% of staff members consisting of Registered Nurses and Certified Nursing Assistance from September 1, 2024–March 30, 2025. Nurse leaders will ask the same five interview questions to staff, upload notes to an online tracking system, and then extrapolate themes to address concerns.

Results

As of July 2024, the Solid Oncology nursing turnover rate for a rolling 12-month period was 15.3%. We hope to see improvement in that rate, analyzing data trends over continuous rolling 12-month periods.

Discussion

Nurse leaders can directly impact the nursing workforce, aiding in the goal to retain clinically experienced and competent oncology nurses within the organization. “Stay Interviews” act as a framework to support nurse leaders in developing interventions to promote engagement and retention on the unit, uncovering actionable items that left unanswered could lead to increased resignation. We hope to further analyze the data as it results, as well as uncover current themes that oncology nurses discuss as considerations for leaving their current position.

Oncology Nursing Forum. 2025 Mar 1;52(2):30–31.

P42. Biomarker Testing, the Future of Cancer Care: Bridging the Gap by Improving Access to Biomarker Knowledge, Creating Empowerment and Promoting Implementation of Key Data Among Oncology Nurses and Nurse Practitioners

Erica Bello-Rodriguez ¹, Kimberly Mueller ², Joanna Mohney ³, Joanna Mohney ⁴

Screening, Early Detection, Genomics

Significance & Background

Precision medicine is a tailored approach that leverages an individual’s genetic makeup, proteins, environmental factors, and lifestyle choices to prevent, diagnose, or treat diseases. In oncology, precision medicine specifically utilizes this detailed information to guide diagnosis, aid in development of treatment plans, serve to evaluate treatment effectiveness, and provide crucial prognostic insights. Biomarkers in oncology nursing are measurable indicators that offer valuable insights into a patient’s cancer status and response to current treatment, while also guiding decisions at time of disease progression. They can be further classified as predictive and prognostic biomarkers. Testing of biomarkers enables individualized treatment plans that reflect the unique characteristics of a patient’s cancer. This personalized approach enhances treatment effectiveness while reducing the risk of unnecessary side effects.

Purpose

To emphasize the essential role of biomarker testing in oncology and its significance in providing personalized, precision care. We aim to highlight how a thorough understanding of biomarker testing empowers nurses and advanced practice registered nurses (APRNs) to develop individualized treatment plans, improve patient education, and enhance overall outcomes. By recognizing the importance of biomarker testing, we advocate for its integration as a fundamental aspect of contemporary oncology practice. Comprehending precision medicine and biomarkers enables oncology nurses and APRNs to create personalized treatment plans that optimize therapeutic effectiveness while reducing side effects. This tailored approach enhances patient engagement and promotes informed decision-making, leading to improved overall outcomes.

Interventions

Improve nurses’ understanding of biomarker testing by organizing educational workshops on interpreting biomarker results, creating user-friendly reference materials, promoting collaboration across disciplines, and leveraging resources such as the ONS Biomarker Database and NCCN guidelines ensuring that providers stay informed about the latest research and advancements.

Results

Ongoing evaluation will include collecting feedback from participants regarding educational initiatives, measuring confidence interpreting biomarker tests, and monitoring patient outcomes linked to personalized treatment strategies.

Discussion

Integrating biomarker testing into oncology nursing is crucial for enhancing personalized patient care. By providing nurses and APN’S with essential knowledge and resources we can not only empower them to utilize these advancements, but we can also elevate patient outcomes, improve treatment tolerability, and work collaboratively to use precision medicine to tailor patient care throughout the cancer journey.

Oncology Nursing Forum. 2025 Mar 1;52(2):31.

P43. A Training Toolkit for Introducing Stem Cell Transplantation to the Inpatient Oncology Nurse

Susan Berg ¹, Jenna Ruggiero ², Jordan Mellinger Kish ³, Lisa Russo ⁴, Gavin Bauer ⁵, Tammy Selby ⁶

Management

Significance & Background

For patients with hematologic malignancies, stem cell transplantation may offer the best chance for achieving lasting remission. Lack of proximity to a transplant center can be a barrier to treatment. To improve access, one regional cancer institute set out to establish its own transplant program. The success of the program would be contingent in part on adequately preparing inexperienced nursing staff to care for this patient population.

Purpose

Implement a multifaceted approach to educating inpatient oncology nurses in all aspects of stem cell transplantation to achieve optimal patient outcomes.

Interventions

Staff education in stem cell transplantation was coordinated by an interdisciplinary team that included the director of the transplant program, the clinical nurse specialist for oncology, and the nurse educator for the transplant unit. A core group of registered nurses was selected for the initial phase of training, based on oncology experience and chemotherapy certification. These RNs were invited to attend a two-day in-person transplant course, along with a one-day on-site observation at an established transplant center. Weekly education sessions, each focusing on an aspect of the transplant process, were presented by the medical director of the transplant program and open to all unit staff. Nurses participated in simulations designed to provide hands-on experience in administering stem cells as well as specific drugs in the conditioning regimens. Validation of relevant skills was required prior to an RN assuming care of the transplant patient. In daily practice, the bedside nurse had on-demand access to resources including online practice guidelines, interdisciplinary team huddles, and transplant group texts.

Results

As of May 2024, six inpatient oncology nurses had completed the necessary stem cell education and validations. In a post-discharge debrief, these RNs described feeling well-prepared and confident in their ability to provide care for transplant patients. Feedback from patients and providers has been positive as well, as the nursing staff has demonstrated proficiency in implementing transplant protocols and modeling transplant nursing standards.

Discussion

Education tailored to the inpatient oncology nurse has been central to the successful launch of a stem cell transplant program. The core group of transplant RNs now serve as mentors to their nursing colleagues who are preparing to assume the transplant nurse role. Their insights have helped to troubleshoot processes and identify improvements that collectively advance transplant policy and optimize patient care.

Oncology Nursing Forum. 2025 Mar 1;52(2):31–32.

P44. Implementation of a Unit-Based Nurse Well-Being “Sunshine” Committee To Improve Nurse Recognition & Retention

Samantha Bergin ¹, Kelly Trautwein ², Katie Dove ³, Joanne Smith ⁴

Management

Significance & Background

In Spring 2023, the 2023 Jefferson Employee Survey revealed concerning results for our unit-specific nursing scores, with only 61% for “recognition” and 50% for “intent to stay,” both falling below healthcare benchmarks and hospital averages. Recognizing the critical importance of nurse retention and motivation, we sought to address these issues by implementing a designated nurse well-being committee.

Purpose

Our goal was to foster a culture of recognition, enhance team bonding, and improve overall job enjoyment.

Interventions

In April 2023, we established the “Sunshine Committee,” which focused on initiatives to promote recognition and teamwork. Key strategies included frequent staff recognition celebrations for both professional milestones—such as graduating with advanced degrees or passing certification exams—and personal achievements, like significant birthdays or family milestones. We also created bulletin boards to highlight nurses’ fun facts and accomplishments, allowing patients to connect with our team. Additionally, we organized team-bonding events, such as holiday gift exchanges and community fundraising activities, while ensuring that new nurses received a warm welcome to the unit.

Results

After 16 months of implementing these interventions, we conducted a follow-up survey in August 2024. The results were encouraging: the recognition score improved significantly to 83%, reflecting a 22% increase from 2023, while the intent to stay score rose to 61%, marking an 11% improvement. These findings suggest that our initiatives positively impacted nurses’ feelings of recognition and their intent to remain in the unit.

Discussion

In conclusion, the Sunshine Committee’s efforts have yielded measurable improvements in key indicators of nurse satisfaction. Moving forward, we aim to maintain this momentum by continuing to solicit dynamic feedback from our colleagues. This ongoing input will help us refine our initiatives and identify new strategies that can further enhance the work environment, ensuring that our nursing staff feels valued and supported

Oncology Nursing Forum. 2025 Mar 1;52(2):32.

P45. Oncology Service Line “Systemness.” What Does it Mean for Oncology Care Delivery and Nursing

Donna Berizzi ¹, MiKaela Olsen ², MiKaela Olsen ³, MiKaela Olsen ⁴

Healthcare Delivery

Significance & Background

“Systemness” refers to seamless integration and coordination across a health system to deliver cohesive, high-quality care. System integration involves creating a standardized, unified approach to cancer care for an oncology service line, ensuring patients receive the same expertise, protocols, and resources at all locations. Systemness enhances access to care and quality across the health system, promoting consistency and efficiency in oncology care delivery.

Purpose

Under the leadership of the executive director of nursing, a team of nursing experts, including clinical program directors in oncology nursing, cellular therapies, radiation therapy, informatics, and quality, collaborated with interprofessional colleagues to build a cancer service line. The goal was to strengthen systemness by empowering oncology nurses to manage care across the continuum, ensuring timely access to specialized interventions and interdisciplinary support, regardless of location.

Interventions

Developing the cancer service line involves strategic planning, clinical integration, and multidisciplinary collaboration. Teams from various oncology sites focused on policy harmonization, standard operating procedures, and quality initiatives. In the first three years, improvements occurred in nursing triage, staff communication, scheduling, and patient movement between sites. Successful system-wide programs included 5-FU home infusion, intravenous pump harmonization, staff education, and establishing a stem cell transplant program at a second site. An online policy manual centralized oncology protocols, reducing site-specific workload.

Results

Quality outcomes for each program were regularly measured, and teams met consistently to audit and report progress during cancer system steering committee meetings. These efforts improved care coordination and program implementation across the system.

Discussion

Oncology service line integration facilitates better coordination as patients move between settings, reducing care gaps and ensuring seamless transitions. Oncology nurses play a crucial role, contributing to direct patient care, quality improvement, and leadership in innovation. Their involvement ensures high-quality, patient-centered care across all settings within the system. Building a successful cancer service line requires careful integration of services, standardized protocols, multidisciplinary collaboration, and an emphasis on patient-centered care. Oncology nurses are pivotal in this process, from direct patient care to quality improvement and innovation leadership. Their expertise, compassion, and leadership are critical to the success of the service line, ensuring that patients receive the best possible care across all settings.

Oncology Nursing Forum. 2025 Mar 1;52(2):32–33.

P46. Leveraging The Capacity of the Senior Clinical Trial Project Training Specialist

Maria Berkeley ¹, Susan Brown ², Jeannine M Brant ³

Healthcare Delivery

Significance & Background

Oncology nurses play a vital role in clinical trial adherence and implementation. Oncology clinical trials determine whether an investigational drug is safe and effective and they are guided by a study protocol. Nurses strive to preserve the trial’s fidelity by drawing timely pharmacokinetics, collecting other biospecimens, and monitoring electrocardiograms at appropriate intervals. However, deviations can occur which jeopardize the viability of the study, potentially delaying the approval of life-saving drugs and therapies. One organization reported a number of protocol deviations in the hematology inpatient setting.

Purpose

The purpose of this presentation is to describe the implementation of a Senior Clinical Trial Project Training Specialist (SCTPTS) and recommend this role at institutions with a high volume of oncology clinical trials to improve clinical trial adherence and consistency, nurse knowledge, and nurse communication.

Interventions

The SCTPTS role was crafted to reduce deviations, enhance workflows, and promote bidirectional communication between clinical nursing and clinical trials. The SCTPTS, being knowledgeable of inpatient hematology workflows and clinical research nurse practices, develops and disseminates bite-sized clinical trial education and resources to new and seasoned nurses, conducts in person and remote anticipatory rounds, provides insight about individual studies, and empowers bedside nurses to deliver confident care to study participants. Most importantly, the specialist tracks and evaluates progress of key performance indicators. A baseline survey was completed by 50 inpatient hematology nurses to identify gaps and opportunities related to clinical trials. Top survey themes included knowledge deficits and communication rifts. In response to “I am comfortable navigating clinical trial treatment plans,” approximately 58% of nurses responded never, rarely, or sometimes. Similarly, for “Clinical trial treatment plans are clear and through” only 16% of respondents answered often or always. These metrics in combination with complaints of deviations became the focus of the SCTPTS role.

Results

The SCTPTS is a nurse-initiated role which has been a driving force in improving inpatient compliance for investigational product infusions. Infusion adherence, defined as infusion completion in the prescribed window and including appropriate start and stop documentation times, improved from 35% (April 2024) to 86% (August 2024).

Discussion

Too often, departments work in silos and lack insight into how interrelated and interdependent areas differ. The SCTPTS can facilitate diverse perspectives from stakeholders, maintain early and ongoing communication, and promote collaboration in promptly addressing challenges.

Oncology Nursing Forum. 2025 Mar 1;52(2):33–34.

P47. Integration of Innovative Interventional Radiology Modalities

Danielle Berry ¹

Healthcare Delivery

Significance & Background

A large NCI designated cancer center with a new procedural area allowing the expansion of an ambulatory interventional radiology department serving 7366 patients in FY 24. The incorporation of new technology and procedures mandated a process to assure competence in nursing skills and imaging technologist skills for provision of safe and efficient, best care.

Purpose

To initiate a standardized workflow based on evidence-based process for adaptation of new innovative technologies in interventional radiology oncology care.

Interventions

Capital investment in equipment and space allocation created opportunity for expansion of interventional radiology services. Goals were to implement state of the science knowledge, collaborating with educational partners, physicians and ambulatory clinics to meet increased demands across specialties. (i.e. image biopsies (US/CT) and radioembolization therapy both local and moderate sedation pathways). A team of subject matter experts and clinical staff convened to assess gaps in education and process adaptation of new technology. The team was comprised of physicians, nurse leadership, nurse educator leadership, staff, imaging leadership, and clinical support staff and they created a workflow map of new procedure from scheduling through patient discharge. Standard documents were developed for staff education: Multiple documents and processes were established to promote the education and implementation of the new technology. Scope of elements integrated into workflow adaptation included case cards, workflow process documentation in EMR, discharge Instructions, pre-procedural patient education, and policies. A shared model of implementation utilized simulation, established feedback protocols, and performance of post procedures debriefs in person and use of case studies for continued learning.

Results

The increased access for patients allowing for US/ CT biopsies facilitating early diagnosis with newest technology is a valuable addition to care across the cancer continuum. The change process was optimized utilizing comprehensive collaborative expertise to develop, education and ongoing evaluation for adaptation of this innovation in interventional radiology. Building clinical competence and knowledge improved the scope and accessibility for integration innovative interventional radiology modalities and thus the improved cancer outcomes across increased populations.

Discussion

This comprehensive, collaborative process of introduction of state of the science technology adaptation has creating a blueprint for future change management projects in the fast paced world innovations in interventional radiology and cancer care.

Oncology Nursing Forum. 2025 Mar 1;52(2):34.

P48. Flipping the Classroom: Revamping Chemotherapy Immunotherapy Patient Education Teaching

Sarah Bichler ¹, Caitlin Brecklin ², Denise Portz ³, Kristin Kingma ⁴, Marloe Esch ⁵, Tamiah Wright ⁶

Management

Significance & Background

Within our cancer network, inconsistencies related to the content and delivery of chemotherapy and immunotherapy patient education were identified. Patient and staff confusion and dissatisfaction inspired our team to improve and standardize the educational delivery process.

Purpose

The purpose of this project was to increase nurse knowledge and confidence in the delivery of patient education.

Interventions

Our team created a multimodal education plan using a flipped classroom approach to optimize active learning. Prior to in-person competency validation sessions, nurses were required to review a virtual presentation, newly developed evidence-based chemotherapy and immunotherapy education guidelines and nursing standards, and patient resources previously evaluated for understandability and actionability using a validated instrument. Presentation topics included adult learning principles, health literacy, locating appropriate resources, required elements of patient education, and documentation. After completing this pre-work, nurses participated in one in-person learning session consisting of an interactive unfolding group case study that lasted 1.5 hours. Facilitators ensured that all participants had the opportunity to demonstrate their understanding of the course content through real-world application.

Results

79 out of 87 total attendees completed a post-survey to evaluate the effectiveness of this educational intervention. Nursing knowledge and confidence were assessed before and after the educational intervention via Likert scale questions. After the educational session, knowledge increased by 28.4%, knowledge of educational resources increased by 42.7%, and confidence increased by 31.1%. Nurse comments suggest that the education was beneficial and applicable to their everyday work. Measuring patient impact is planned in future work. The impact on patients is planned in future work.

Discussion

The success of this intervention has ignited a passion for ongoing optimization of patient education and inspired future work to engage patients in this effort. This educational approach can serve as a model for other organizations that are also addressing healthcare education in the oncology population.

Oncology Nursing Forum. 2025 Mar 1;52(2):34–35.

P49. Empowering Excellence: Our Unit Council in Action

Danette Birkhimer ¹, Adrian Riley ², Grant Junge ³, Elizabeth Boyle ⁴

Professional Development

Significance & Background

The unit council provides a forum for staff to problem solve and make decisions in collaboration with unit management. It is also a forum to discuss staff satisfaction, patient satisfaction and nursing sensitive indicators and to then develop action plans based on those discussions. In addition to the action plans, an additional responsibility of unit council is to generate an annual report.

Purpose

The purpose of the unit council retreat was three-fold: to provide a time for team building, to provide a time to review and reflect on work from the past fiscal year, and to provide a time to develop goals and action plans for the upcoming fiscal year.

Interventions

Interventions for the retreat included securing a meeting room outside of the hospital. This was done to decrease the number of distractions for the staff. The next intervention was developing an agenda. This was done in collaboration with the unit managers, unit council chair and clinical nurse specialist. The agenda included time for an ice breaker/team building activity. Also on the agenda was time to reflect on patient and staff satisfaction surveys. Much of the agenda centered around a discussion of nursing sensitive indicators. We were able to celebrate success in decreasing hospital acquired pressure injuries over the past year and identified an opportunity to work on decreasing falls. The remainder of the agenda focused on developing goals for the new year.

Results

The staff established goals focused on the four pillars of Relationship-Based Care: care of patient, care of colleague, care of self, and care of community. For each pillar, we created specific goals and corresponding action plans. We incorporated evidence-based interventions where relevant, such as launching a mentorship program for new nurses to enhance retention, and implementing the Johns Hopkins Fall Risk Assessment Tool (JHFRAT) alongside fall predictive analytics to better identify patients at high risk for falls. By reviewing and highlighting the past year’s work, a second outcome was having the information to generate the annual report.

Discussion

The retreat is igniting interest among other staff members who want their voice heard. Staff have enjoyed the time off unit to discuss unit related issues, to have a voice in setting unit goals, having face to face time with unit management and spending time with each other.

Oncology Nursing Forum. 2025 Mar 1;52(2):35.

P50. Supporting the Professional Development of Oncology Nurses While Transitioning to Different Settings

Claudine Biscocho ¹, Tara Simon ², Sarah Middlekauff ³

Professional Development

Significance & Background

As oncology care continues to shift to the outpatient setting, there has been an influx of nurses with oncology experience transitioning into different roles. A change in role often comes with expectations and responsibilities that differ from current nursing experience, leaving experienced nurses feeling like they have gone from being an expert to being a novice, regardless of their knowledge. Nurse educators can encourage and foster professional development growth in nursing staff by helping them navigate these feelings.

Purpose

Nurses place pressure on themselves to perform at expert levels in oncology roles, even when their previous oncology experience does not translate to the new roles into which they are transitioning.

Interventions

Nurse educators met weekly with nurses and their managers to collaborate on ways to address the feelings and pressures nurses experienced during their orientation. The educators assisted these nurses in creating reference books in which to take and maintain notes on the key responsibilities, skills, and processes of their new roles, to which they could refer throughout orientation and after. Educators provided patient scenarios through role-playing in which nurses could demonstrate their skills and review gaps in knowledge or performance. Educators instructed nurses to complete assessments and courses that focused on skills and information needed for their specific roles while continuing to build on the knowledge and experiences they carried from previous roles. Nurse educators created a safe space during meetings and provided frequent reiteration of realistic expectations.

Results

Nurses implemented practices and met goals set by the nurse educators throughout their orientation. Nurses successfully completed their orientation and now work independently in their new roles. At the end of orientation, nurses verbalized increased levels of confidence and demonstrated improvements in their knowledge and skills compared to the start of their orientation.

Discussion

Providing education specific to role transitions and emotional support throughout orientation is integral to the success of nurses in their professional development.

Oncology Nursing Forum. 2025 Mar 1;52(2):35–36.

P51. The Creation of a Unit Based Council and its Effect on Innovative Patient Care Delivery in the Outpatient Oncology Infusion Setting

Benjamin Blackburn ¹, Katherine McLaughlin ², Kerri Dalton ³

Professional Development

Significance & Background

The oncology treatment center (OTC) at this tertiary, academic medical facility faced considerable instability and turbulence in its work environment, as reflected by the unit culture survey results and high burnout rates (87%) in 2022. Additionally, patient census declined, yet wait times held steady. Staff reported disorganization and disjointed workflows as factors leading to dissatisfaction. In response to this, a Unit Based Council (UBC) was created to empower individuals and foster collaborative workflow solutions that would be embraced and implemented by frontline staff.

Purpose

To describe the implementation of the UBC and its impact on workplace culture and workflow efficiency.

Interventions

The UBC was initiated in July 2023 with membership consisting of 8 frontline staff nurses and unit nursing leadership who met monthly. The UBC mission is to create a synergistic and collaborative relationship between leadership and employees that leverages the clinical knowledge and experience of the staff with leadership resources. Its purpose is to develop workflow standards for identified problems that improve either the patient experience, throughput efficiency, or nurse satisfaction. Agenda items are brought forward by staff and vetted by leadership to determine priority. Processes encompassing both workflow and clinical practice are additionally vetted by the unit’s pre-existing Clinical Practice Council.

Results

In the first year, the UBC implemented several workflow improvements, including: staffing a floating resource nurse to assist with complex care needs; assigning an IV resource nurse; training on point-of-care urine pregnancy testing; and pre-assignments for complex patient treatments and late scheduled patients in place of usual pull-method for assignments to increase accountability and decrease unnecessary treatment delays. Despite a 9% increase in patient volumes, wait times decreased by 14% since implementing UBC initiatives. Staff satisfaction survey results improved in every domain and reported burnout decreased by 55%, reflecting enhanced stability and employee satisfaction. The increase in patient volume and throughput efficiency, coupled with the 80% improvement in unit culture survey results shows that the UBC has positively impacted the OTC.

Discussion

Data collection is ongoing related to specific UBC interventions, but initial results suggest increased efficiencies in patient flow and increased staff satisfaction and engagement. The UBC and its members have significantly contributed to improving work culture and patient care. A UBC promotes unit shared-governance and can be expanded across unit-based practice settings.

Oncology Nursing Forum. 2025 Mar 1;52(2):36.

P52. Creative Way of Streamlining Antineoplastic Therapy Documentation

Jaimi Blackburn ¹, Anne Delengowski ²

Healthcare Delivery

Significance & Background

Need of accurate and concise documentation of antineoplastic therapy is imperative. Additionally, being able to readily obtain documentation of previously administered antineoplastic therapy is extremely important. Prior to this project the documentation was within a note in the EHR but not easily identifiable. Issues were identified when patients transitioned from initial inpatient setting to outpatient infusion center. Locating the documentation of the antineoplastic therapy administered during hospitalization was difficult, the administration was documented in a nursing note during the patient’s hospitalization but locating the note could be difficult and documentation was inconsistent.

Purpose

The purpose is to standardize documentation of antineoplastic therapy across inpatient and outpatient oncology units. To eliminate difficulty locating documentation of previous antineoplastic therapy administration. Promote successful transition of care with accurate and concise documentation.

Interventions

Collaborated with EHR Clinical application analysts to develop a new note type for the administration of antineoplastic therapy. The note that was created automatically pulls the antineoplastic medications administered in the last 12 hours. The medications appear at the top of the note in a table providing a quick view of all the antineoplastic medications administered with date, time, name and dosage. Standard text was added to the note below the table with the ability to add free text to individualize the note. The standardized note ensures documentation is consistent for each individual nurse and across sites.

Results

A standardized note was created to be used across the health system for any antineoplastic medication administered. The note is visible in the EHR with its own note title that was approved after presenting the value for patient care for patients receiving antineoplastic therapy. This new note is only used for antineoplastic therapy and allows providers and nurses to quickly view documentation in the EHR of all previous administrations. Creating a note that automatically generates the medications into the table and text to document the administration reduces time nursing staff are spending for documentation.

Discussion

The standardized antineoplastic note is used at all oncology locations in the health system. Several meetings were held with nurse managers and educators from all the locations during the implementation process to allow for feedback and recommendations. The new note creates concise documentation that is easily identified in the EHR allowing for successful transition of care between different setting.

Oncology Nursing Forum. 2025 Mar 1;52(2):36–37.

P53. Death.....Let’s Talk About It

Carol Blecher ¹, Elizabeth Dailey ², Rebecca Bowers ³, Susan Beaver ⁴, Michele Marquis ⁵, Anne Feaster ⁶

End of Life

Significance & Background

Multiple governing bodies have identified nursing’s responsibility for assuming a primary role in assisting patients and their families with Advanced Care Planning (ACP). Nurses are often willing to conduct these discussions but have not always been provided with the appropriate tools. Being that ACP is a focus of quality patient centered care we set out to equip nurses with the essential tools to enable them to conduct meaningful ACP conversations.

Purpose

This project was designed to enable nurses in our multi-site private outpatient practices to comfortably discuss ACPs with patients, providing them with the opportunity for informed decision making. It also allows the patients to share their wishes with their loved ones and the health care team while they can communicate their desires for care at the end of life.

Interventions

A committee comprised of RNs and APPs was established. A policy and procedure were established. ACP “talking points” were created and reviewed with all clinical staff. An Advanced Care Planning Nurses Note was created in the EMR. Patient Education Sheets were adapted for our practices. These are placed in new patient folders to be discussed and documented during the education session and are also distributed by the Medical Assistants to patients who state they do not have Advanced Directives. Infusion RNs have conversations with their patients at chairside during treatment and the outcome of the conversation is documented.

Results

Data collection over three months demonstrated an increase in ACP RN notes of approximately 33% in 4 of the six practices. Two of the practices had a large volume of notes in the first month and then leveled off, since the active patients had probably received information.

Discussion

This is an ongoing initiative which is designed to provide compassionate patient centered care and continuing open discussion. Death is a part of life and we, as nurses, can promote open and honest conversations with our patients allowing for self-determination and dignity at the end of life.

Oncology Nursing Forum. 2025 Mar 1;52(2):37.

P54. Empowering Nurses: A New Standard for Ordering Referrals and Enhancing Care Coordination

Alexandra Block ¹

Quality and Safety

Significance & Background

Verbal and Telephone Orders (VOTOs) are a high-risk method of order entry, allowable only in very limited emergent circumstances per organizational policy. Orders entered using this order mode are immediately active even without a provider’s co-signature, placing the nurse and patient at risk. As our Ambulatory Solid Tumor Cancer Services continues to expand, so has the volume of VOTOs entered by nursing; an average of 1,915/month as of February 2020. Over the years, nurses and providers have become increasingly dependent on nurses entering VOTOs even for non-emergent orders, leaving us with heightened compliance concerns. The goal for this initiative was to focus on a subset of non-emergent VOTOs orders frequently entered by nursing: referral and care coordination orders (RCCOs).

Purpose

To reduce the volume of RCCOs entered as VOTOs by 50% within 6 months. Monthly average (baseline) = 169, Target = 84.5.

Interventions

First, we created a VOTOs workgroup and identified that RCCOs made up 13% of overall nurse-entered orders. We researched best practices for implementing a Standard of Care by consulting with external organizations and conducting a literature review, then created our proposal based on this knowledge. Our Standard of Care document allows care coordination RNs to enter approved RCCOs using the “Within Role/Scope” order mode after consultation with the provider. Orders included in the Standard of Care were approved through the Ambulatory Associate CNO and Cancer Center Quality Committee. Associated inclusion/exclusion criteria were vetted by each department and converted into a SmartPhrase to both guide decision-making and standardize documentation. Additionally, an oversight, audit, and escalation process was built in.

Results

The 6-month pilot resulted in a 90% decrease in VOTOs for referral/care coordination orders, far exceeding our target goal of 50%. At 2 years post-implementation, we have noted sustained favorable outcomes with a 97% decrease.

Discussion

We have been very pleased with the success and sustainability of this project over the last two years. Our Quality & Safety Manager conducts audits every 6 months to ensure the order mode and Standard of Care is used appropriately. Individualized re-education is provided to nurses and leaders as needed based on audit results. Due to the success of this initiative, we are exploring other ambulatory settings that may benefit from the implementation of a similar workflow.

Oncology Nursing Forum. 2025 Mar 1;52(2):37–38.

P55. Improving Health Outcomes for the Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex+ (LGBTQI+) Patient

Linda Bloom ¹, Carmen Mendez ², Jillian Lawler ³, Kelly Haviland ⁴

Professional Development

Significance & Background

The World Health Organization (WHO) emphasizes that all individuals regardless of sex, gender, ethnicity, disability, or sexual orientation have a right to optimal health and healthcare. Historically, marginalized communities have faced intolerance, conscious or unconscious biases, overt discrimination, and stereotyping. Biases that may exist among nurses and other medical professionals can cause patients from underserved communities to be reluctant to present for essential health care.

Purpose

To improve health outcomes and ensure patient centered and sensitive care is available to LGBTQI+ populations at an NCI-designated cancer center in a large metropolitan area, nurses implemented an evidence-based education program on best practices for optimization of care for the Sexual Gender Minority (SGM) patient.

Interventions

The program components included staff education on the special considerations and unique needs of LGBTQI+ populations as well as methods of the effective delivery of culturally competent care for SGM patients. Access to professional support and educational resources were made available to patients during their treatment, and an LGBTQI+ specific consult service was established to request a meeting with a consultant. A system which allowed nurses to initiate an order in the electronic medical record for a member of the LGBTQI+ team to meet with a patient was launched.

Results

In 2023, 1,049 non-cisgender patients (sex-assigned-at-birth did not match their gender identification) and from January through August of 2024, 738 non-cisgender patients were treated at the institution. In 2023 hospital wide in-services regularly provided to nursing staff by the LGBTQI+ specialists resulted in 36 consult requests, and from January through August of 2024, in-services presented to nurses resulted in 26 consult requests.

Discussion

Providing clinical staff with education on the psychological issues, concerns, and physical needs of the LGBTQI+ populations can help address patient issues and improve their experience. The launch of the LGBTQI+ education and consultation program marked the first step to providing LGBTQI+ populations with a welcoming and compassionate care experience. Program evaluation will soon include staff and patient satisfaction surveys, however, positive feedback from both nurses and patients regarding the initiative resulted in increasing patient requests for consultation and demand for further training sessions on the units. Through this initiative, an institution wide LGBTQI+ Cancer Care Program consisting of an LGBTQI+ navigator and nurse educator has been established through institutional support and grant funding.

Oncology Nursing Forum. 2025 Mar 1;52(2):38–39.

P56. Optimizing Infusion Center Utilization: Increasing Capacity by Redirecting Low-Acuity Services to the Clinic Setting

Devon Bloxsom ¹, Holly Mellott ², Catherine Terrell ³, Adrienne Banavage ⁴, Katie Lassiter ⁵

Healthcare Delivery

Significance & Background

Following the shift of targeted and cellular therapies from inpatient care to our infusion center, we identified inefficient space utilization as a significant challenge. The increased patient volume necessitated diverting complex high-acuity services off-site. The infusion center nurses had limited availability to deliver complex high-acuity services due to existing appointments for routine services such as lab draws or dressing changes that could have been safely delivered in a clinic setting. This resulted in an inefficient use of space and clinician expertise as well as a significant loss in potential annual revenue.

Purpose

This quality improvement project aimed to optimize space utilization by redirecting routine low-acuity services from the infusion center, staffed by RNs with a higher scope of practice, to the clinic setting. This would allow the infusion center to accommodate a greater number of complex high-acuity services.

Interventions

We assessed services rendered to patients and the corresponding expertise required by staff to perform the needed service. We developed a list of routine low-acuity services that could be safely delivered in the clinic setting and a list of complex high-acuity services that required delivery by an infusion center RN. In April 2024, routine low-acuity services were redirected to the clinic, while complex high-acuity services were prioritized for the infusion center. The infusion and clinic leadership teams collaborated to maximize our collective space and resources. We measured space utilization by calculating the occupancy rate of each infusion chair. We calculated the revenue of infusion chairs using a rate of $3,100 per day per chair.

Results

After four months of redirecting routine low-acuity services to the clinic setting resulted in 4 infusion center chairs being repurposed for complex high-acuity services. This change will add $4,289,600 to our annual operating margin. Anecdotally, clinic staff reported increased job satisfaction due to increased utilization of skills within their scope of practice.

Discussion

This project successfully increased space and availability in the infusion center for complex high-acuity services by redirecting routine low-acuity services to the clinic setting. Not only did this project tremendously increase our projected annual revenue, but also, interestingly, clinic staff appreciated the increased use of skills within their scope of practice.

Oncology Nursing Forum. 2025 Mar 1;52(2):39.

P57. Improved Satisfaction and Retention of Nurse Care Coordinators in the Ambulatory Setting of a Comprehensive Cancer Center

Devon Bloxsom ¹, Catherine Terrell ²

Management

Significance & Background

Decreased satisfaction and retention of RN Care Coordinators (RNCC) is of great concern due to the complex and integral care that RNCC provide to patients with cancer in the ambulatory setting. Decreased RNCC satisfaction and moderate turnover exceed our organization’s target. Mounting evidence points to a poor onboarding process as negatively affecting RNCC satisfaction and retention.

Purpose

The purpose of this quality improvement project was to standardize the onboarding program for RNCC new to the cancer center to increase RNCC satisfaction and retention.

Interventions

We implemented the following strategies to improve RNCC job satisfaction and retention. We developed a standardized onboarding for new hires, including two weeks with a senior RNCC educator. We provided several months within onboarding for a gradual transition to independent practice and provided support to new hires from experienced RNCC staff. We also developed guidelines for a hybrid patient support model, which allowed the RNCC to work remotely when not providing in-person patient care. We measured Press Ganey staff engagement scores to measure RNCC satisfaction and RNCC vacancy rates to measure retention.

Results

Following the standardization of RNCC onboarding, over the course of two years, staff engagement scores from Press Ganey increased from the 70th percentile to the 90th percentile. RNCC staff vacancy rates decreased from 30% to 5% In surveys of RNCC, working remotely when there is no in-person patient care has greatly improved job satisfaction.

Discussion

RNCC satisfaction and retention increased following the implementation of a standardized RNCC onboarding program. The allowance of working remotely on days when there was no in-person patient care was highlighted by RNCC as integral to satisfaction. Key challenges included the impact of a longer onboarding on providers, and team staff becoming comfortable with RNCC shifting to a hybrid work model. Future steps involve training additional senior RNCCs to support the growing onboarding program.

Oncology Nursing Forum. 2025 Mar 1;52(2):39–40.

P58. Developing a Pathway for New Graduate Onboarding in an Ambulatory Oncology Infusion Center

Olivia Blumenschein ¹, Karen Anderson ²

Management

Significance & Background

According to the World Health Organization, there will be a shortage of 5.7 million nurses by 2030 contributing to increased demand for nurses. Ambulatory nurse leaders are increasingly exploring options to sustain and grow staffing, including employment of new graduate nurses. Undergraduate nursing students often have minimal exposure to ambulatory settings and additional resources and comprehensive education are beneficial to support their transition to practice.

Purpose

The purpose of this project was to develop a pathway to onboard new graduate nurses into ambulatory oncology infusion.

Interventions

In the fall of 2022, oncology nurse leaders at a National Cancer Institute (NCI) comprehensive cancer center developed a pathway to onboard new graduate nurses. The goal was to integrate a novice nurse into an ambulatory hematology oncology infusion clinic. The plan included an extended unit orientation over six months with a primary and secondary preceptor. Oncology specialty and general nursing orientation classes, a new nurse residency program, and shadow experiences across oncology departments were incorporated into the orientation pathway. Leadership check-ins were performed bi-weekly to support communication between new graduate, preceptor, unit manager, and the unit clinical nurse specialist. At the end of formal orientation, patient acuity and assignment volumes were gradually increased over eight weeks to allow the new nurse to develop time management skills and confidence.

Results

Thus far, one new graduate nurse has been successfully onboarded into ambulatory infusion and has been employed for 18 months. The new graduate has since transitioned into precepting new hires and orienting to the charge nurse role. Preceptor and leadership support and an extended orientation played a major role in the successful transition to practice. Of note, the new graduate nurse had exposure to outpatient oncology infusion through undergraduate nursing clinicals, which supported both commitment and interest in the oncology specialty.

Discussion

Comprehensive oncology orientation programs are important to support the successful transition of new graduate nurses to ambulatory infusion. Exposure to oncology during undergraduate nursing studies may serve as a valuable clinic rotation for recruitment and retention of ambulatory oncology staff. The pathway will be used as a foundational tool for the onboarding of additional new graduates into ambulatory infusion.

Oncology Nursing Forum. 2025 Mar 1;52(2):40.

P59. Development of an Enhanced Care Delivery Model for an Expanding Infusion Department

Kayla Boegly ¹, Rachael Coyle ², Lauren Cullen ³, David Ortwein ⁴, Francis Panebianco ⁵, Christine Usher ⁶

Healthcare Delivery

Significance & Background

Averaging over 75,000 infusion visits annually, the infusion department at a large academic medical center utilized 95% of available capacity, limiting opportunities for growth and ability to accommodate demand. With oncology and medicine patients competing for space, capacity constraints led to challenges with scheduling flexibility, increased wait times, strains on nursing and pharmacy resources, longer lead times for appointments, and difficulty accommodating urgent, same day appointments. Due to the increasing access needs for patients within the department, a new unit was opened using an enhanced care delivery model which decreased patient care delays and point of service needs.

Purpose

The expansion of the infusion department provided the opportunity to develop a new interdisciplinary workflow to prepare patient charts and medication orders in advance of the patient appointment. The advanced preparation model has several advantages, including advanced verification of medications and treatment plans by nursing, pharmacy and billing. This process further verifies that the medications have the correct dose, are administered on the correct day and have all the treatment needs in place prior to the patient checking in. Medications are prepared and delivered prior to the patient’s appointment, decreasing wait times for medication delivery and infusion start times.

Interventions

A standardized nursing chart check process was implemented to proactively review patient charts and directly message providers with outstanding issues seven days prior to the patient’s scheduled appointment. A second chart review is performed forty-eight hours before the patient’s appointment to confirm that any outstanding issues are resolved. The pharmacy team can then verify, prepare, and deliver medication orders in advance of the patient appointment.

Results

The advanced preparation model is utilized by the interdisciplinary teams for all patients scheduled within this unit. Quarterly, meetings are held with each department to review any workflow challenges to continue to make the model successful.

Discussion

The advanced preparation model has increased communication between nursing, provider, billing, and pharmacy teams, strengthening the multidisciplinary partnership. This model has also helped drastically decrease point of service needs across the department by identifying gaps in patient treatment plans prior to the patient arriving for their appointment.

Oncology Nursing Forum. 2025 Mar 1;52(2):40–41.

P60. Fostering Work-Life Harmony: Nurse Manager’s Innovative Approach to Streamlining Communication Technology and Utilizing a Four Day Work Week

Jenna Booth ¹

Management

Significance & Background

This abstract presents an innovative initiative led by a nurse manager aimed at enhancing work-life balance in healthcare management through two key strategies: implementing a four-day work week and optimizing communication technology. The initiative utilizes secure chat applications and email tools on dedicated work phones, alongside cloud technology for streamlined document sharing among the management team. These changes significantly minimize work-related phone calls during off days.

Purpose

Striking a balance between professional duties and personal well-being is crucial in healthcare, especially for nurse managers who face intense schedules and constant connectivity demands. This initiative exemplifies a strong commitment to tackling these challenges with innovative scheduling and technology use.

Interventions

As a nurse manager overseeing both the Intensive Care Unit and Surgical Stepdown Unit, and as a new mother, I began experiencing symptoms of burnout. With the support of the Chief Nursing Officer and Nurse Director, I implemented several changes to enhance my effectiveness and work-life balance. First, I transferred all work-related applications from my personal phone to a dedicated work phone, allowing for better control over work hours. I migrated essential documents to a shared cloud platform, ensuring my team could access files during my absence. Additionally, I educated staff on appropriate escalation protocols when I was out. The introduction of a four-day work week included a designated non-clinical work-from-home day.

Results

To evaluate the impact of these changes on my stress levels, I utilized the Ginger Application provided by our health system for regular anxiety check-ins. Following the implementation of these strategies, I observed a significant reduction in daily phone calls from staff and nursing supervisors. This allowed me to focus on my responsibilities at the hospital while dedicating quality time to my family at home.

Discussion

The primary goal of this initiative is to empower nurse managers to achieve a balanced integration of their professional responsibilities and personal well-being. Given their pivotal role in patient care and staff management, nurse managers face unique challenges that can lead to burnout and diminished job satisfaction. Addressing these issues fosters a healthier work environment that promotes both professional excellence and personal fulfillment.

Oncology Nursing Forum. 2025 Mar 1;52(2):41–42.

P61. Nursing Together: Forming our Teamwork Committee

Jenna Booth ¹, Alexa Livingston ², Rachel Schada ³

Management

Significance & Background

The Teamwork Committee is a nursing leadership initiative focused on improving relationships, communication, and collaboration among staff members in the Surgical Step-Down Unit (SSDU). Persistent concerns about inadequate teamwork and ineffective communication prompted leadership to adopt a proactive approach to address these issues, identified as contributing factors to negative patient outcomes. Notably, there was an increase in patient falls recorded toward the end of the previous fiscal year and into the current one, highlighting the urgent need for intervention.

Purpose

This initiative investigates the correlation between insufficient teamwork and poor communication and their impact on patient safety and overall outcomes. Staff members have highlighted key challenges affecting collaboration, including reluctance to respond to call bells for patients not assigned to them, a perceived lack of willingness among nurses to assist each other, negative attitudes toward assigned tasks, and heightened anxiety surrounding patient admissions and assignments.

Interventions

In collaboration with an HR specialist, leadership laid the groundwork for the Teamwork Committee. Initial discussions with the consultant led to the implementation of various team-building exercises tailored specifically for the unit. To assess the current state of team dynamics, a nine-question Likert scale survey was distributed among SSDU members, capturing their perceptions of teamwork effectiveness. Additionally, an email chain was established to solicit ideas for activities that could foster teamwork and enhance collaboration.

Results

Since the first meeting on July 16th, 2024, there has been a notable improvement in communication and teamwork among staff members. A pre-existing “shout-out” tool for recognizing exceptional peer performance has seen increased usage, with numerous acknowledgments emphasizing the collaborative efforts of nurses during their shifts. Management has also received commendations from multiple staff members regarding peers previously viewed as reluctant to help, indicating a significant positive shift in unit culture. Following the first meeting, two more sessions were conducted, with staff expressing excitement about their participation and a genuine desire to see change within the unit.

Discussion

This committee has effectively enhanced communication, increased patient safety through quicker response times, and fostered a more positive work environment. The initiatives undertaken by the Teamwork Committee have substantially impacted the nursing culture within SSDU, and we aspire for this positive momentum to extend throughout our institution, ultimately improving overall patient care and staff satisfaction.

Oncology Nursing Forum. 2025 Mar 1;52(2):42.

P62. Ready Set Check: Enhancing Code Cart Readiness in an Oncology Hospital Using Smart Check

Jenna Booth ¹, Elzbieta Kowalski ²

Quality and Safety

Significance & Background

This project aimed to enhance daily code cart checks through innovative technology. Transitioning from traditional pen-and-paper documentation to an electronic system not only safeguards patients but also ensures that clinicians have immediate access to necessary equipment during emergencies. This technological shift improves regulatory compliance, guarantees the completion of daily checks, and facilitates the prompt escalation of deficiencies for correction.

Purpose

An analysis by the ICU committee, which included code cart reviews, post-code huddles, and mock Joint Commission evaluations, revealed that code carts were sometimes incomplete and posed safety risks. By moving to an electronic system, all members of the multidisciplinary team can monitor real-time updates on code cart checks, track upcoming expiration dates, and ensure that carts remain locked until all required items are scanned in. A custom pharmacy and supply application was developed featuring a scanning function that enables staff to input lifesaving equipment and medications along with their expiration dates. The nursing application digitizes the daily check process, generating emails to alert managers about upcoming expirations and any issues with the cart.

Interventions

The team conducted a comprehensive review of all items in the code carts, removing unnecessary items to refocus them on essential equipment for achieving return of spontaneous circulation. Recognizing that our carts had shifted from being strictly for code situations to functioning as treatment carts, we collaborated with our IT department to create applications that ensure compliance and established a dashboard for monitoring readiness.

Results

Utilizing iPad technology has significantly improved code cart readiness and regulatory compliance. Daily email and text alerts to management confirm that checks are completed, with deficiencies addressed promptly at 9:15 AM. Recent data indicates a compliance rate of 99% for code cart checks over the past six months. We are now targeting procedural areas to ensure code carts are checked daily before 9 AM, currently achieving a 96% compliance rate at this time. Since the application went live in November 2021, with staff reporting increased satisfaction and no concerns regarding missing equipment in post-code huddles.

Discussion

Implementing iPad technology for code cart checks is beneficial in both inpatient and outpatient settings. This innovation enhances patient safety, boosts clinician confidence in having the necessary supplies, and improves overall code response readiness.

Oncology Nursing Forum. 2025 Mar 1;52(2):42–43.

P63. I’ll be there! Chapter Incentives to Promote Engagement

Jacqueline Boreland ¹

Professional Development

Significance & Background

There has been difficulty getting Gwinnett County ONS (GONS) members to attend chapter meetings. This challenge was further exacerbated by the recent pandemic and attendance was significantly lower than prior to the pandemic. Meeting attendance is imperative to the success and survival of local chapters. Many institutions no longer allow pharmaceutical representatives to enter their centers to provide education. Furthermore, many institutions have cut back on certification and education funds. Subsequently, opportunities for in-person oncology education have become increasingly scarce.

Purpose

The GONS chapter’s mission statement is, “Always striving to make a difference”. The mission statement is supported by monthly chapter meetings which provide education relevant to oncology healthcare professionals. With the rapid influx of newly approved medicines for treatment of oncology conditions, it is imperative to have the opportunity to learn about these treatments. The mission statement is in line with supporting educational meetings and making a difference in patient outcomes through increased knowledge and competence.

Interventions

Ensuring consistency is a key component in encouraging attendance at the monthly meetings. In past years, chapter meetings were held on different days, different weeks of the month, or some months were skipped entirely. Presently, the monthly meetings are scheduled every third Thursday. The guest fee for attendees who do not belong to ONS is set at a low cost of $15 and several meetings have no guest fee. Some meetings are posted as ‘for ONS member only’ with frequent inquiries from non-members. This opens the discussion about ONS and the benefits of membership. Another method to encourage attendance is through the use of incentives. Most meetings have raffle drawings for oncology textbooks or gift baskets. A favorite engagement activity is themed outfit contests. The past year’s contests have included the greenest outfit on St. Patrick’s Day, doppelganger day where two attendees dress alike, and the most festive outfit at the holiday party.

Results

Several members and guests have reported that they appreciate the lighthearted nature of the GONS chapter meetings, the educational programming, and the engagement activities. The average meeting attendance has slightly increased since the implementation of the engagement activities.

Discussion

Providing consistency and incentives can encourage increased engagement at ONS local chapter meetings. Collecting feedback from meeting attendees may provide suggestions for how to improve engagement and attendance at future meetings.

Oncology Nursing Forum. 2025 Mar 1;52(2):43.

P64. Partnering for Better Care: Integrating LPNs to Meet Rising Complexities in Acute Care Oncology

Emily Boucher ¹, Heidi Cutter ², Susanne Yeakel ³, Brandon Kulak ⁴

Management

Significance & Background

Over the past decade, Licensed Practical Nurses (LPNs) have primarily been confined to the ambulatory, subacute, and long-term care settings, as acute care has increasingly relied on Registered Nurses (RNs) rather than adopting a team-based nursing model. At a level-one trauma center in New England, leadership for the inpatient oncology unit faced rising patient acuity and workloads, compounded by a 50% increase in chemotherapy administration over the past two years. To address these challenges, the decision was made to implement LPNs on the inpatient oncology unit.

Purpose

The purpose of this project was to employ an innovative strategy to combat rising acuity on an inpatient oncology unit and help oncology nurses to better manage higher acuity assignments and their workload.

Interventions

Leaders from the inpatient oncology unit, central staffing, and professional development formed a workgroup. A local area hospital that had successfully integrated LPNs into their team was consulted. The state nursing practice act and hospital policies were reviewed and utilized to develop a clear scope of practice delineating LPN responsibilities. Unit staff were educated on this scope before the LPNs’ orientation. Two LPNs were hired in February 2024 and oriented using the RN onboarding schedule, omitting only arrhythmia interpretation classes. The professional development team created an interactive, hands-on transition-to-practice class for LPNs at the simulation center to further ease the shift to the acute care specialty space.

Results

This pilot has yielded positive outcomes. The LPNs work three 12-hour day shifts and are assigned to assist the two RNs who have the assignment with the highest patient workload and acuity. They work closely with the RN throughout the day to complete various tasks and to supplement overall patient care. Staff perceptions have been overwhelmingly positive, with most reporting that the addition of LPNs significantly enhances their ability to complete work efficiently and also allows them to provide higher quality care. One nurse remarked, “they’re the best thing that’s ever happened and a vital part of our team.”

Discussion

This pilot program indicates that incorporating a team-based approach in nursing care, specifically through the addition of LPNs on the inpatient oncology unit, can effectively improve RN workload management.

Oncology Nursing Forum. 2025 Mar 1;52(2):43–44.

P65. Leveraging Oncology Immediate Care Centers for Extended Monitoring and Management of Anti-Cancer Therapy Side Effects

John Bourgeois ¹, Daniela Casbourne ², Karly Goozee ³, Tara Ridgeway ⁴, Ashley Glenn ⁵, Tricia Mignott ⁶

Healthcare Delivery

Significance & Background

Oncology Immediate Care Centers (ICCs) provide specialized care for cancer patients experiencing urgent but non-life-threatening symptoms such as pain, fever, dehydration, and more. Staffed by medical assistants, nurses and advanced practice providers, these centers offer timely care, operating 24 hours on weekdays and 12 hours on weekends, ensuring continuous support for patients.

Purpose

With the introduction of new anti-cancer therapies that may cause side effects like cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS), many patients require observation periods of up to 24 hours. Once these anticancer therapies are administered in the infusion center, utilizing ICCs to monitor patients can reduce inpatient admissions, freeing beds for more acute cases. This approach also enables continued observation outside the infusion center, ensuring patients receive the appropriate level of care and timely interventions while optimizing the availability of infusion chairs.

Interventions

ICCs are well-suited to accommodate patients requiring extended monitoring due to new therapies. Ensuring capacity in the ICC is crucial to meet the growing needs of oncology patients and provide the appropriate level of care. Proper utilization of these centers ensures that organizations leverage appropriate care levels while maintaining patient throughput. Nurses and advanced practice providers are trained to recognize and address the side effects associated with these therapies.

Results

In our NCI and Magnet Designated organization treating more than 17,000 new patients a year, ICCs have significantly reduced the strain on infusion centers and inpatient oncology beds. After reviewing eight weeks of data for one medication for patients requiring 6-hour or 24-hour observation periods saved the infusion center up to 30 hours per week. With the average infusion chair occupancy being 4 hours, this saved time allowed us to treat up to four additional patients weekly. Furthermore, monitoring 24-hour observation patients in the ICC saved critical inpatient oncology floor beds, with a median of 3 and a maximum of 5 patient days per week. These interventions not only improve inpatient capacity but also generate additional revenue by optimizing infusion center utilization while taking advantage of 340B pricing.

Discussion

The use of ICCs to manage the side effects of new therapies demonstrates a valuable model for healthcare organizations. By optimizing resources, ICCs improve patient care, reduce inpatient bed usage, and enhance operational efficiency, ultimately benefiting both patients and the healthcare system.

Oncology Nursing Forum. 2025 Mar 1;52(2):44–45.

P66. Return on Investment (ROI) For Ultrasound-Guided Peripheral Intravenous (USGPIV) Cannulation in Ambulatory Oncology

John Bourgeois ¹, Suzie Allen ², Veronica Buckovich ³, Nikiya Howard ⁴, Jason Jean ⁵

Healthcare Delivery

Significance & Background

Patients with difficult intravenous access (DIVA) in ambulatory oncology settings increase costs due to wasted resources and staff time. While ultrasound-guided peripheral intravenous (USGPIV) cannulation by nurses has shown higher first-attempt success rates in DIVA patients in various settings, its use in ambulatory oncology remains limited. The validated Modified A-DIVA scale by van Loon et al. (α = 0.78) which denotes the likelihood of first intravenous attempt success could help identify patients who would benefit from USGPIV. Studies show USGPIV significantly reduces failed attempts, leading to cost savings, reduced need for invasive procedures like PICCs and Midlines, and preventing complications such as CLABSI. Despite limited research in ambulatory oncology, USGPIV offers clear financial and clinical benefits, and training nurses in its use is feasible and could enhance patient care across healthcare environments.

Purpose

The aim was to develop a business case demonstrating the cost-effectiveness and return on investment (ROI) of using USGPIV cannulation in an ambulatory oncology research unit which could be used in other areas. The focus is on reducing costs and improving clinical outcomes for patients with DIVA and removing the major barrier to implementation of USGPIV cannulation which is the cost of the machine which can greater than $35,000.

Interventions

Key interventions included developing data collection sheets, training nurses on the Modified A-DIVA scale, and conducting time studies. Costs associated with IV attempts, including nurse labor, equipment, and training, were calculated to project potential savings.

Results

Thirty patients were assessed using the Modified A-DIVA and for IV start times which is ten percent of the unit’s annual patient volume. ROI was calculated by comparing training and potential equipment costs to the projected savings from improved IV success rates and better utilization of infusion chairs. The assessment found that 600 patients annually could benefit from USGPIV which could translate to annual savings of $5,874.52, with ROI achieved in just 11 days due to a shared resource of the Ultrasound machine. Without this shared resource there would need to close to 3000 patients that could benefit from USGPIV canulation to break even.

Discussion

This methodology could be applied to various setting to calculate the ROI of USGPIV cannulation in oncology infusion centers to improve patient care and operational efficiency. Investing in ultrasound and nurse training improves outcomes and reduces oncology costs.

Oncology Nursing Forum. 2025 Mar 1;52(2):45.

P67. Enhancing Efficiency in Ambulatory Infusion Centers: Addressing Transfusion Support

John Bourgeois ¹, John Huban ², Dorice Nolan ³, Yolanda Camon ⁴, Tanya Frett ⁵, Karly Goozee ⁶

Healthcare Delivery

Significance & Background

Capacity limitations within ambulatory infusion centers (AICs) are frequently exacerbated by scheduling constraints, particularly for acute patients requiring transfusion support. As outpatient treatment options continue to expand without corresponding increases in AIC capacity, it becomes crucial to identify and utilize underutilized space creatively. Following an observation of high rates of no-show appointments and same-day cancellations (SDC), we conducted an in-depth analysis to understand the causes of missed appointments and the resulting wasted capacity.

Purpose

In 2023, our Magnet-recognized, National Cancer Institute-designated 72-chair AIC provided care to approximately 35,000 patients. Among these, the number of patients scheduled for transfusion support ranged from four to 12 daily, with each chair reserved for a four-hour period. However, we observed that only about half of these patients ultimately required transfusion services, and those who did often did not require the full four-hour allocation. This practice resulted in unnecessary reservation of chair time and delayed access for patients requiring chemotherapy, thereby contributing to inefficient resource utilization.

Interventions

To address this issue, we implemented a pilot program requiring specific resources—a dedicated staff member to perform laboratory draws, analyze results, and communicate findings to the charge nurses. Additionally, we needed to allocate a designated space for this staff member and establish standardized workflows. Through collaboration with operational and laboratory teams, we identified two licensed practical nurses (LPNs) who would assume these responsibilities.

Results

After personnel, space, and responsibilities were determined, the pilot was launched. Over a two-week period, 65 patients were scheduled for transfusion support; however, only 30 ultimately required the service, leading to an average utilization of 8.22 hours of chair time per day. These findings highlighted the need for more efficient scheduling and transfusion workflows.

Discussion

While the pilot showed success, several key components are needed for full implementation. A dedicated RN is required to coordinate lab draws, charge nurse communication, and patient engagement. EMR enhancements are also necessary for improved visibility of lab results. Additionally, space for dedicated lab draws, template updates, and scheduling education are critical. Leveraging the oncology immediate care center (ICC) could provide flexibility, allowing chairs to be used when transfusions are not needed. This approach would improve resource utilization and reduce delays in chemotherapy scheduling, optimizing patient care.

Oncology Nursing Forum. 2025 Mar 1;52(2):45–46.

P68. The Devil is in the Details: Understanding the Full Pi When Utilizing a New Drug Therapy

Rebecca Bowers ¹, Jennie Bea ²

Quality and Safety

Significance & Background

New therapies are consistently evolving in oncology care. Biosimilars and generics provide options that may not have been a consideration in the past. Alliance Cancer Specialists utilizes biosimilars and generics when appropriate. With the ever-changing landscape of treatments, constant research and education are required to capture the details needed for safe and effective administration. Due to the increase in utilization of the medications, we noted that a thorough review was not always completed. We experienced an instance where staff assumed a biosimilar was a single dose vial like the brand name biologic. The biosimilar was multi-dose and significant losses incurred before the error was identified. This error highlighted the need for extensive and documented education for all new therapies.

Purpose

The purpose of the project is to validate proper training and education to every team member that mixes or administers a new therapy.

Interventions

Alliance Cancer Specialists requires formal training for any new therapy initiated at any site of service. We created a new policy “New Medication Checklist” that requires thorough review of the package insert after formal training. Each staff member must complete a RED (Review, Educate, and Document) checklist before moving forward with mixing, teaching, or administering the medication. All completed RED sheets for the entire staff are maintained in a red binder that is kept in the Infusion Suite.

Results

Staff have willingly embraced the “New Medication Checklist” policy. Completed RED sheets are filed by team members names and they hold each other accountable in properly completing the form. No billing errors have been identified or event reports entered for an incident that evolved due to lack of staff education.

Discussion

The addition of new therapies has extended the length and improved the quality of life for the oncology patient. Safe and appropriate steps in calculating, mixing, and administering are critical to the success of safe and fiscally responsible administration.

Oncology Nursing Forum. 2025 Mar 1;52(2):46.

P69. Re-Examining the Visibility of Oncology Nursing on NCI-Designated Comprehensive Cancer Center Websites: A 15-Year Follow-Up

Deborah Boyle ¹

Healthcare Delivery

Significance & Background

Media representation is increasingly becoming a key source of information for the American public. While nursing is the largest cohort of healthcare professionals globally, they are often under-represented in the media specific to their organizational leadership, contributions to patient care, provision of education, and support of research initiatives. Initial survey results published in 2010 found this was the case in the 40 NCI-designated Comprehensive Cancer Centers (CCCs) where the names of Chief Nursing Officers were rarely, or difficult, to identify, links to the Division of Nursing sites were obscure, and professional achievements by nurses were generally not distinguished. Recognition of oncology nursing’s professional contributions is critical to inform both the public and interdisciplinary colleagues of the complexity and outcomes of oncology nursing capabilities.

Purpose

To survey the degree of oncology nursing’s presence in 57 current CCC websites.

Interventions

CCC websites were accessed directly from the online directory. Four major search categories included: 1.) Oncology nursing presence on the site homepage; 2.) Acknowledgement of nursing leadership; 3.) Presence of a nursing department link; and 4.) Citations of nursing contributions, awards, and recognitions. Results were clustered into Excellent (4 of 4 categories met), Good (3 of 4 categories met); Some (3 of 4 categories met), Marginal (1 of 4 categories met), and Poor (0 of 4 categories met) representations of oncology nursing.

Results

Nine CCCs met all four criteria for Excellent nursing website presence. In comparing results with initial findings, only one CCC remained in the Excellent category. Fifteen CCCs had either Excellent or Good portrayals. Approximately one half (n=29) had Poor or Marginal nursing representation. Only 19 websites identified nursing leadership at their CCC (i.e., Chief Nursing Officer, Nurse Executive).

Discussion

This survey demonstrated a comparable depiction of oncology nursing invisibility as compared to 2010. While most cancer care is rendered by oncology nurses, their contributions are often under-recognized in CCC websites. This limits the potential to educate the lay public and professional colleagues about the oncology nursing profession. There are numerous opportunities to change this paradigm which will be highlighted in this presentation. Exemplars will be used to depict CCCs where oncology nursing is prominently and effectively represented so that audience participants can enhance their websites following Congress.

Oncology Nursing Forum. 2025 Mar 1;52(2):46–47.

P70. Patient-Focused Teaching on the Infusion Experience

Victoria Bradford ¹, Sandy Jellen ², Jill Williams ³

Healthcare Delivery

Significance & Background

The oncology RN plays a critical role in patient and family education on cancer-related therapies. Until now, education has focused on the patient and family’s readiness, preferred learning style and potential barriers to learning about the clinical aspects of the therapy, focusing on purpose, symptom management and when/how to contact the clinical team. Patient and infusion team feedback, however, indicated that education on the infusion experience – what to expect and how to best prepare for time spent in an Infusion Center. Based on this feedback, leaders and staff drafted a New Patient Infusion folder (available in English and Spanish) containing information focused on the patient’s knowledge, comfort and wellbeing. The information in this folder is reviewed by the clinic RN before the patient’s first visit to the Infusion Center.

Purpose

Increase patient/family knowledge on how to prepare and what to expect during their Infusion Center stay.

Interventions

Based on feedback from patients, family members and team members, the following information was selected for inclusion in each folder:

Welcome to XXX Infusion Center overview letter:

■ Important information on parking (including valet and handicapped), available on-site food options, suggestions on what to wear for comfort and what to bring (electronic devices, headphones, chargers, books, comfort items)
■ Introduces the site leadership team in case the patient or family have any questions

Lab Locations Handout:

■ Information on days and hours of operation, walk-in or appointment only, available central line/port draws for all health system labs

The Chemotherapy Clock:

■ Explains the team and safety workflows for a patient’s cancer-related IV therapy to be developed, from lab results, preparation and checkpoints by Pharmacy and Infusion RNs
■ Explains options to have labs drawn the day before Infusion to decrease wait times and encourages patient to speak with primary oncologist about this option

Infusion Sites:

■ Rack card containing all Infusion Center addresses for patient convenience

Same-Day Cancer Care Clinic:

■ Rack card explaining same-day cancer care available Monday-Friday, 0800 to 2100, for symptom management
■ Patient able to contact directly and schedule appointment

NCI Chemotherapy and You:

■ https://www.cancer.gov/publications/patient-education/chemo-and-you

Results

■ Initial feedback from patients and families positive
■ Infusion teams report patients overall better prepared
■ Symptom Outreach Calls placed to all patients after their C1D1 visit – feedback requested on information packet

Discussion

■ Continued process improvement on contents
■ Translation into patient’s preferred language(s)

Oncology Nursing Forum. 2025 Mar 1;52(2):47–48.

P71. Fostering Engagement: Interactive Approaches to Oncology Education

Stephanie Bradshaw ¹, Kathleen Shuey ², Allison Steen ³, Eileen Dinnie ⁴

Management

Significance & Background

Quality cancer care from diagnoses through treatment, including symptom management, is emphasized by ONS in a position statement. Nurses new to oncology need an understanding of principals of oncology care. Multidisciplinary teamwork is needed to improve outcomes and reduce any negative impact on patient and family. Nurses new to oncology have limited exposure to oncology care. The program was initially updated two years ago. Participants continue to provide feedback that is incorporated into future programs.

Purpose

The original project goal was to provide basic information related to oncology and to provide the participant with more time on the unit with their preceptor. The goal od the recent update is to offer interactive activities leading to improved understanding of content and increased engagement of participants.

Interventions

All program content was reviewed. Based on participant and speaker feedback, several presentations were updated to include interactive activities. Examples of activities include a cancer basics bingo, a chemotherapy spill management relay, a simulated blood culture collection, and oncologic emergencies jeopardy game. Participants were also assigned a specific disease to review and present during the session, fostering deeper understanding and peer learning. The chemotherapy spill management relay allowed participants to assemble spill kits, arrange spill management procedures, and practice completing adverse event reports.

Results

A four-point Likert scale was utilized for participant feedback (1= not at all; 4=extremely helpful). There were 10 participants in the winter session and 4 participants in the summer session. Scores for interactive sessions were: Basics of Oncology winter 3.8 / summer 3.3; Introduction to Chemotherapy (which included the skill relay) winter 3.6 / summer 3 session; Oncologic Emergencies winter 3.7 / summer 3. Blood culture simulation was not evaluated.

Discussion

In the original update to the program, several sessions ran over the allotted time. In the recent update, timeframes were strictly adhered to. Program content is continuously evaluated. Suggestions from participants and speakers will be incorporated into future events with the goal of creating added interactive sessions. Additionally, simulation is being explored to incorporate into orientation.

Oncology Nursing Forum. 2025 Mar 1;52(2):48.

P72. A Scoping Review: Cancer Screening Among Eastern European Immigrants in the U.S

Vera Bratnichenko ¹, Karen Kane McDonnell ², Kesheng Wang ³, Polina Amburg ⁴, Jean E Davis ⁵

Screening, Early Detection, Genomics

Significance & Background

Cancer is a leading cause of death globally and in the U.S., with over 1.9 million new cases expected worldwide in 2024. More than half could be detected through screening, but access is limited, especially for immigrant populations. Eastern European immigrants face higher cancer mortality risks due to late diagnosis. Barriers include lack of health insurance and limited care access. Understanding facilitators and barriers is crucial for developing targeted interventions to improve cancer screening rates among Eastern European immigrants, reducing cancer-related morbidity and mortality. Current research on vulnerable immigrant populations is limited and fragmented.

Purpose

This scoping review aimed to identify and synthesize facilitators and barriers to cancer screening among Eastern European immigrants in the United States.

Interventions/Methods

Following PRISMA-ScR guidelines, PubMed, Embase, Web of Science, CINAHL Complete, PsychInfo, and Academic Search Complete were searched without date restrictions. Key terms included “Eastern European,” “immigrant,” “cancer screening,” and “early detection of cancer.” Inclusion criteria required peer-reviewed, U.S.-based studies on Eastern European immigrants aged 18+ years. Exclusion criteria omitted non-English studies and gray literature. Rayyan™, a program for managing literature reviews, was used in the process. Ten articles met the inclusion criteria. Data extraction retrieved author information, study details, screening facilitators, and barriers. Qualitative approaches, identifying patterns and themes, were used to interpret the data.

Results/Evaluation

Analysis revealed that females were studied more than males, with breast cancer as the most common cancer. Eastern European immigrants were often grouped with other immigrant populations. The three most cited barriers were lack of health insurance, difficulty navigating the U.S. healthcare system, and language barriers. Other barriers included limited knowledge about screening importance, insufficient provider recommendations, fear, and embarrassment. A patient navigator program was described as a successful facilitator in one study.

Discussion

Eastern European immigrants face numerous obstacles to cancer screening. Potential interventions include providing information on the cost of screening options, promoting the availability of nurse and lay navigators, educating healthcare providers, and utilizing ethnically matched providers and research teams. Community support significantly influences screening decisions. Maximizing facilitators and minimizing barriers may improve cancer screening rates in this population.

Oncology Nursing Forum. 2025 Mar 1;52(2):48–49.

P73. An Interdisciplinary, Cross Campus Approach to Create a Process for the Safe Administration of Bi-Specific T-Cell Engager Therapy

Kathryn Wigger ¹, Diana Pasqua ², Sarah Mendez ³, Susanne Braun ⁴

Treatment Modalities and Managing Administration

Significance & Background

Bispecific T-cell engagers (BiTEs) have revolutionized the treatment landscape of hematological malignancies and solid cancers. Despite their generally favorable safety profiles, particular toxicities raise valid safety concerns regarding management of these patients. These toxicities are cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Timely intervention and coordinated follow-up visits with the oncology care team are crucial for optimal outcomes. However, in the event of an acute illness, the medical attention sought may come from an Emergency Department (ED) where the practitioners may not be as knowledgeable in the management and/or recognition of these specific toxicities.

Purpose

To create a safe environment for patients receiving BiTE therapy.

Interventions

An interdisciplinary team consisting of: physicians, advanced practice providers, pharmacists, and nurses, reviewed the most recent literature regarding symptom management for BiTE therapies to determine the best management of CRS or ICANS. Maintaining optimal patient safety served as the impetus to design a workflow that ensured proper identification and management of symptoms by our healthcare providers. In addition, we identified that patient education regarding side effects was essential to this workflow. Patients are provided wallet cards detailing symptoms to be aware of and educated to present them to any healthcare provider beyond the oncology team. Together, these interventions facilitated patients to receive their therapy safely as an outpatient. The best methods for monitoring patients receiving BiTE therapy were identified, education regarding side effect management was developed and shared with our ED and inpatient colleagues. An alert gets triggered when a patient on BiTE therapy presents to the ED to ensure quicker assessment and intervention of symptoms related to CRS or ICANS. While there are various instruments available to assess an individuals’ neurological status, the instruments decided upon for patient assessment were unavailable in the electronic medical record; the team worked with our Information Technology team to ensure easy access to these neurological toxicity scales.

Results

BiTE therapies have been successfully administered to both inpatients and outpatients. The collaboration between disciplines and the education developed has been integral in ensuring high comfort levels with these newer BiTE therapies.

Discussion

Although not a new classification of medication, BiTE therapies are exploding on the marketplace where historically there has been only one. Education, communication, and workflows are crucial to safely and successfully treat these patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):49–50.

P74. Ensuring Medication Safety in Advance

Margaret Brodie ¹, Joanne Gonzalez ²

Coordination of Care and Navigation

Significance & Background

Complexities of cancer treatment infusions require exquisite attention to detail, and even small variation in practice and quality can negatively impact patient outcomes and nurse satisfaction. Previously workups were a responsibility rotated among 26 different staff, contributing to errors and inefficiencies. This project focused on ensuring consistency in review of appointments, labs, and orders for patients coming to our large cancer infusion center.

Purpose

The aim of this project was to standardize the role of the Medication Safety Nurse (MSRN) to ensure reliability in pre-workup processes. Key objectives included reducing medication errors and near-misses, improving the consistency and volume of completed workups, enhancing staff satisfaction with the quality of workups, and streamlining communication between nursing staff and providers.

Interventions

After identifying 6 core MSRNs to pilot the change, leadership met weekly with them to refine workflows and standards relating to medication-specific workups, communication with the care team, documentation in the chart, and formatting of the workups. All nurses on the infusion unit were surveyed before and after the pilot regarding their perceptions of workups. MSRNs tracked time spent in various categories of doing workups each day, and errors or missed opportunities were documented and reviewed daily. Results were shared with the whole infusion team during and after the pilot.

Results

Having 6 highly engaged MSRNs allowed for rapid improvement. Initially, MSRN errors centered around a few key themes, which were swiftly remedied after review, and the error rate dropped to near 0. Staff rated accurate workups as extremely important for patient safety and nurse workflow both before and after the pilot. Staff satisfaction with workups increased from pre-pilot 3.78 to post-pilot 4.51 on a 5-point Likert scale. Surprisingly, time spent per workup increased slightly from beginning to end of pilot.

Discussion

In conclusion, the project successfully demonstrated that standardizing the pre-workup process through dedicated MSRNs can elevate both the quality and consistency of workups, significantly improving staff satisfaction and reducing errors. The pilot highlighted the importance of clear communication and regular feedback in optimizing workflows. While the intervention improved overall workup accuracy and satisfaction, future efforts could focus on finding ways to reduce the time spent per workup. Expanding the role of MSRNs and exploring additional technological tools may further streamline processes, ensuring sustained improvements in patient care and staff efficiency.

Oncology Nursing Forum. 2025 Mar 1;52(2):50.

P75. Implementing AI-Generated Simulated Patients in Oncology Nursing Education: A How-To Guide for Nurse Educators

Lena Brokob ¹

Professional Development

Significance & Background

Simulation in oncology nursing education allows students to practice clinical skills and decision-making in a controlled environment. Traditional simulation methods, however, can be resource-intensive and may not fully replicate the complexity of patient interactions. With the introduction of advanced language models like ChatGPT, nurse educators have a new tool to create dynamic, interactive simulated patients. Utilizing AI can transform tomorrow’s simulations and provide students with diverse clinical scenarios without the associated high costs.

Purpose

This session aims to provide nurse educators with a practical guide on how to use ChatGPT’s GPT function to create AI-generated simulated patients for oncology nursing education. The goal is to empower educators to improve their teaching strategies, enhance student engagement, and prepare nursing students for real-world patient interactions.

Interventions

The session will briefly overview the AI language model and its capabilities in simulating patient interactions. It will provide step-by-step instructions on developing patient profiles with various cancer types, symptoms, and psychosocial factors, and provide guidance on scripting conversations that allow students to conduct assessments, provide education, and plan care interventions. The session will provide strategies for incorporating AI simulations into existing coursework or clinical practice sessions, ensuring student data privacy. Lastly, there will be tips on overseeing AI-student interactions and conducting debriefings to reinforce learning objectives.

Results

Participants attending this session will gain hands-on experience creating and implementing AI-simulated patients using ChatGPT and discover innovative approaches to improve student critical thinking, communication skills, and clinical reasoning. Participants will also learn to offer simulation experiences without the required extensive resources.

Discussion

The use of ChatGPT for creating simulated patients represents a significant advancement in nursing education technology. This session will explore the benefits and challenges of this approach, including ensuring patient privacy, maintaining ethical standards, and aligning simulations with learning outcomes. Participants will have the opportunity to discuss their experiences, ask questions, and collaborate on best practices for integrating AI into their teaching.

Oncology Nursing Forum. 2025 Mar 1;52(2):50–51.

P76. Reflection Rounds for Supporting Care Team Grief at an Oncology Infusion Center

Margaret Buff ¹, Daniel Sershen ², Olivia Seecof ³, Loren Spera ⁴, Danielle Delay ⁵

End of Life

Significance & Background

Outpatient oncology infusion nurses develop close relationships with patients and their loved ones over the course of a patient’s treatment. Unfortunately, when patients die, their infusion nurses are rarely notified, preventing closure or opportunity to grieve.

Purpose

A monthly “reflection rounds” program was developed by a palliative care physician and three nurses at an NCI-designated comprehensive cancer center to provide support and closure for infusion nurses after the death of their patients.

Interventions

Each month, the reflection rounds team compiled a list of patients who had died in the preceding month and shared it with the infusion nurses along with the date and time of reflection rounds. The reflection rounds began with a three-breath guided meditation honoring the patients, the patients’ loved ones, and their nurses. Nurses were then invited to share memories of the patients and sign sympathy cards addressed to the patients’ friends and family. Palliative care principles were shared to help with grief processing. The sympathy cards and a basket for written memories were made available at the nurses’ station throughout the week for nurses who could not make the reflection rounds in person. The sympathy cards were then mailed to the patients’ addresses on file.

Results

Reflection rounds received positive feedback from the nurses, who appreciated the opportunity to pause and reflect on patients they had lost and send condolences to the patients’ loved ones. A pre-intervention survey of nurses found that only 28% reported receiving either notification of a patient’s death or support processing the loss of patients. The 6 month follow-up survey after introducing reflection rounds showed marked improvement, with 94% of nurses reporting that they are both notified when patients die and receive support processing the loss of patients.

Discussion

Reflection rounds help notify outpatient oncology infusion nurses when patients die and provide a dedicated space to grieve collectively. In doing so, the rounds address an identified gap in both communication about patient deaths and support processing the loss of patients. Reflection rounds also give nurses an opportunity to gain closure by sending condolences to the patient’s friends and family, whom the nurses have often gotten to know during the patient’s care. Other endpoints that could be explored in the future include the impact of reflection rounds practice on oncology nurse burnout and staff cohesion.

Oncology Nursing Forum. 2025 Mar 1;52(2):51.

P77. Meet the Team: A Multidisciplinary Team Nursing Continuing Professional Development Series

Kate Burkhart ¹

Management

Significance & Background

With their intimate involvement in patient care, oncology nurses are poised to collaborate with multidisciplinary teammates (MDTs), elevating the care that patients receive. However, in a learning needs assessment (LNA), nurses expressed limited knowledge regarding the availability and roles of MDTs.

Purpose

To close knowledge gaps and promote collaboration between nurses and MDTs by providing a forum for them to connect.

Interventions

From the LNA, five disciplines were chosen to launch a nursing continuing professional development series titled “Meet the Team: Ask a...”: Social Worker, Oncology Rehab MD, Genetic Counselor, Dietician, and Nurse Navigator. One topic was scheduled per month, with two 30-minute sessions each. Before each session, staff questions were sent to the MDT, but the MDT was not asked to prepare a formal presentation. During each session, a moderator facilitated conversation utilizing the pre-submitted questions and fielded follow-up questions from participants.

Results

To date, three topics have been completed, with 38 attendees. Immediately following each session, all participants reported improved knowledge pertaining to the topic, with an average of 69% of participants reporting significant improvement. Following the third topic, a series midpoint evaluation was sent to nurses, receiving 15 responses. All reported feeling more equipped to care for the oncology patient and collaborate with MDTs. Notably, 80% felt “very” or “extremely” more equipped to collaborate. Two thirds reported having already provided or observed improved patient care due to relationships or knowledge gained. The main cited benefits were improved ability to utilize resources and answer patient questions. All wish to continue the series. A survey was also sent to each MDT. Two of three replied. They felt “very” and “extremely” more equipped to collaborate with nurses. Both reported having provided or observed improved patient care. Cited benefits included clarifying misconceptions, better understanding of nursing concerns, and increased referrals. Both would strongly recommend to a colleague to participate, and both would participate again.

Discussion

Nurses have requested meetings with 9 other MDTs, in addition to the two remaining scheduled sessions. Participating MDTs recommended that other locations adopt this model, and some requested a session where MDTs can ask questions to nursing. With its low barrier to start, positive reception, and reported positive impact, this model is recommended for consideration by other oncology teams as a method to promote multidisciplinary awareness and collaboration.

Oncology Nursing Forum. 2025 Mar 1;52(2):51–52.

P78. Enhancing Fall Prevention within the Oncology Service Line Through the Creation of a Falls Collaborative Interdisciplinary Rounding Tool

Malia Calciano ¹, Jaclyn Rieco ², Ellen LeGrand ³

Quality and Safety

Significance & Background

Falls in oncology patients present a significant safety challenge exacerbated by cancer treatments and inpatient hospital stays. The oncology patient population is vulnerable to an increased risk of falls due to compromised physical strength, altered cognitive function, and increased fatigue. Evidenced-based strategies are important factors in mitigating fall risks and improving patient safety. The Falls Collaborative Interdisciplinary Rounding (FCIR) tool addresses this gap between evidence-based practices and bedside rounding to enhance falls prevention interventions.

Purpose

The FCIR tool is designed to standardize and improve fall prevention during shift change between nurses. By utilizing a structured approach to purposeful bedside rounding, the tool aims to address, and document fall risk factors and interventions through a comprehensive checklist. This structured checklist facilitates proactive identification and management of fall risks, leading to reduction in the incidence of falls among oncology patients.

Interventions

The FCIR tool presents a multifaceted checklist focusing on universal fall precautions, cognition, environmental, and physiological aspects that can occur during an inpatient oncology hospital stay. The universal fall precautions include non-skid footwear, fall risk wristband, and icon on outside door display. Cognitive assessments and interventions involve evaluating patient awareness and confusion levels that may contribute to a patient’s fall and instilling interventions like a Neuro/ICE score or 1:1 supervision. Environmental interventions include assessing and addressing potential hazards in the patient’s immediate surroundings. Physiological interventions address factors such as mobility impairments and the impact of medications. Nurses use the checklist during shift changes to ensure all relevant aspects are reviewed, addressed, and managed. This checklist is placed in every patient room and ensures purposeful bedside rounding on patients to help reduce the number of falls that occur in the oncology service line.

Results

The falls rate across the oncology service line at baseline was 2.83/1000 patient days in FY24. The falls rate will be monitored throughout FY25 to assess the impact of the FCIR tool.

Discussion

The FCIR tool advances fall prevention strategies that oncology nurses can utilize in daily practice. It helps facilitate fall reduction among oncology patients by promoting interdisciplinary collaboration, standardizing evidence-based practices, and enhancing bedside care. Overall, the FCIR tool offers a promising checklist to help the improvement of fall prevention in oncology patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):52.

P79. Hematology/Oncology Specialized IV Team

Angela Caleca ¹

Treatment Modalities and Managing Administration

Significance & Background

Due to the nature of the disease and its treatments, as well as the age and comorbidities of the population, hematology and oncology patients are historically difficult to get peripheral IV (PIV) access on. While an algorithm for more specialized durable access exists, an experienced heme-onc RN has the unique expertise to both place difficult IVs and discern who needs central access based on their treatments, length of stay, and prognosis.

Purpose

Create a specialized IV team for the hematology/oncology population to add disease specific insight and expertise to the IV access algorithm, thereby decreasing delays in care and inappropriate escalation to central access.

Interventions

Nurses on the hematology/oncology units were interviewed to identify those who were skilled at IV insertion, knowledgeable about the IV access pathway, able to manage their time well, and agreeable to coach other RNs as they place the IVs. A team was established, goals were explained, units covered by the team were educated on the addition of the IV RN to the IV access algorithm, and a dynamic role was created so one member of the IV team could log in each shift. A tracking log was also created to ensure individual members of the team were effective, timely and compliant with the goals of the IV team.

Results

In the first 3 months, the IV access calls to those further along the IV access pathway (ICU RNs, resident/hospitalist procedure teams, PICC team, IR) from the hematology/oncology units decreased by 18%. The time from notification to placement of PIV was less than 1 hour 98% of the time, and less than 30 minutes 93% of the time. The success rate of the heme-onc IV RN was 92%, never having more than 3 attempts on a patient. In the 8% of the time the heme-onc IV RN was unsuccessful, 80% of the time ultrasound guided IV access was needed, while 20% of the time more durable access was indicated.

Discussion

Having a skilled hematology/oncology RN in an IV role decreased delays in care, increased appropriateness of access, and freed up other members of our difficult access team to prioritize care of critically ill patients. Furthermore, in a population with inherently difficult veins, the extra education and mentorship provided to the bedside nurses by the IV team was invaluable.

Oncology Nursing Forum. 2025 Mar 1;52(2):52–53.

P80. Reimagining Check-In at Multi Treatment Cancer Centers

Coleen Calero ¹, Marian Richardson ², Sherri Frothingham ³

Healthcare Delivery

Significance & Background

Complex Check-in Scenarios affect many patients, and negatively impact the experience for both patients and caregivers.

Purpose

Series Express is a human-centered one stop check-in solution that streamlines multi-appointment check-in workflows to reduce stress and drive operational efficiency. By piloting, series express, cancer centers can enhance patient satisfaction, reduce no-shows, and optimize staff productivity while setting a new standard of patient-centeredness for oncology care and building the case for integrating these enhancements into the Institution’s digital roadmap.

Interventions

Identified a significant root cause of treatment complexity: the multi-appointment check-in experience. Reviewed complex check-in scenarios that affect many patients, and negatively impact the experience for both patients and caregivers. Identified systemic and cultural constraints making it challenging for Cancer Centers to improve registration and check-in. Organized for success and launch: Cross Functional Project Team and Sponsorship. Initiated a skateboard pilot approach, create value earlier, learn and scale.

Results

Patient and caregiver adoption - A total of 171 patients checked in with Series Express during the 10-week test period, exceeding the initial goal of 50. Eliminated No Shows - Unexpected No shows from pilot patients across participating floors were zero, compared to 15.2 unexpected no-shows per week before the pilot. Time Saved Breast Oncology patients on pilot floors reduced time spent checking in by an average of 80%. Potential to return 18 hours of labor efficiency for higher value tasks. Reduced questions at check-in Questions posed to pilot patients at check-in dropped from an average of 4–5 to 0–1 at the second and third check-in for the day. Safety protected - No patients safety risks or errors due to the pilot were reported. Patient Satisfaction improvement Pilot patients reported increases in overall ease and satisfaction, with a consistent upward trend as the pilot progressed. Adopted by Medical Oncology clinics in February 2024; second pilot currently under way; up to 400+ patients.

Discussion

The Institution are actively pursuing the “Sports Car “ for one-stop check in. Creating an Investment Model for a Skateboard Launch. Lessons for Launch: Start small and scale incrementally. Prioritize human interactions and support. Engage and empower caregivers. Plan for Integration and Alignment.

Oncology Nursing Forum. 2025 Mar 1;52(2):53.

P81. Nurse Coordinator Staffing Model in the Evolving Cellular Therapy Field

Emily Camastra (O’Connor) ¹

Coordination of Care and Navigation

Significance & Background

The Registered Nurse (RN) Coordinator role is crucial in Blood and Marrow Transplant (BMT) programs nationwide. This unique role works closely with the attending physician and requires experience in the BMT field and a vast nursing knowledge of the transplant process to safely transplant patients. With the rapidly growing field of cellular therapy and multiple new Chimeric Antigen Receptor T-cell (CAR-T) therapies that are now standard treatment, the RN Coordinator’s responsibilities have expanded. Cellular Therapy and Transplant Centers are faced with the challenge of developing sustainable nurse staffing models for RN Coordinators.

Purpose

To identify and compare RN Coordinator staffing models that support both CAR-T cell therapy and blood and marrow transplants at comparable size cancer centers with transplant programs.

Interventions

The following questions were asked to six Transplant Centers (TC):

■ What is the size of your program? How many transplants and CAR-T infusions are performed per year?
■ Do you have separate BMT RN Coordinators and CAR-T RN Coordinators?
■ How is the RN Coordinator assignment structured?
■ How many RN Coordinators are there? How many physicians do they each support?
■ How many patients are in the BMT and CAR-T RN Coordinator’s assignment? How are these patients assigned?
■ Do the RN Coordinators follow patients post BMT or CAR-T?

Results

It was discovered that most programs have RN coordinators that cover both BMT and CAR-T cell therapy, while a few programs have separate roles for BMT RN Coordinators and CAR-T RN Coordinators. Additionally, there is variability in the RN coordinator’s role for post BMT or CAR-T follow-up. It is evident that there is variation in nursing models but a willingness of nursing leaders to connect and learn more about sustainable staffing models. Figure 1 Attached.

Discussion

There is a need for RN leaders to update and collaborate on RN Coordinator models, particularly due to the rapid growth in CAR-T therapy. Creating a forum through the Oncology Nursing Society or American Society for Transplantation and Cellular Therapy ASTCT would be beneficial for nurse leaders to share best practices among this crucial, yet niche position of the RN coordinator.

Oncology Nursing Forum. 2025 Mar 1;52(2):53–54.

P82. Operation Cath-Care: A Quality Improvement Initiative to Decrease Catheter-Associated Urinary Tract Infections

Tania Canales ¹, Herson Portillo ², Neda Soleimani ³, Gabriela Giron ⁴, Emma Shump ⁵

Symptom Management and Palliative Care

Significance & Background

Catheter-Associated Urinary Tract Infections (CAUTIs) account for thousands of hospital deaths each year and billions of dollars added to the US Healthcare System, and they are preventable (Whitaker et al., 2023). Our Hematology/Oncology/Bone Marrow and Stem Cell population with compromised immune systems faces a significantly high risk of opportunistic infections. In the fiscal year 2023, we recorded six (6) cases of indwelling catheter infections, highlighting the urgent and critical need for our quality improvement project.

Purpose

To decrease Catheter-Associated Urinary Tract Infections (CAUTIs) from 6 to 4 CAUTIs by April 30, 2024, a 35 percent decrease.

Interventions

The methods listed below occurred in a 63-hospital-bed acute hematology/oncology/bone marrow and stem cell care setting. Designated nurses were assigned to be project champions and lead the project. 1) Utilize the Plan-Do-Study-Act cycle and John Kotter’s 8-step model for project success. 2) In-service key stakeholders, defined as Clinical Nurses level I–IV and Clinical Partners, were provided with three (3) selected tests of change interventions. 3) They implemented a nurse-created action-driven audit tool that fosters leadership by providing peer-to-peer feedback. Chart audits were conducted through the Redcap survey, and data was analyzed monthly for over eight months.

Results

By the end of June 2024, we had decreased CAUTIs by 83%. This significant reduction was achieved over eight (8) months, resulting in one (1) reported CAUTI in our unit.

Discussion

Nurse-driven quality improvement projects are instrumental in achieving infection stewardship and positive outcomes for our immunocompromised patient population. The methods implemented in this project help ensure a consistent and thorough approach to the problem. One limitation was reaching a 90% in-service rate at the beginning of the project, which led to in-services being done throughout the project’s longevity. This limitation helped offset nursing retention and introduce the project to new employees. This quality improvement project demonstrates how our commitment to quality patient care is at the core of our professional practice.

Oncology Nursing Forum. 2025 Mar 1;52(2):54.

P83. Patient Safety-Mandating Nurses Administering Chemotherapy and Rituximab to be Chemotherapy Certified

Kimberly McCoy ¹, Yana Cane ²

Quality and Safety

Significance & Background

Rituximab is a biologic that can be used to treat various non-cancerous conditions such as Chron’s disease, rheumatoid arthritis, and Lupus nephritis. Innate risks of administering biologic therapies include hypersensitivity reactions, while improper titrations can increase these risks. Nurses who are not chemotherapy certified may not be adequately prepared to manage such situations. The administration of Rituximab requires frequent vital signs, titrations, and knowledge of pre and post medications.

Purpose

There is no mandatory requirement that nurses must be chemotherapy certified to administer biologic therapies.

Interventions

Research was conducted with the assistance of the health care organization’s librarian to evaluate current best practices regarding Rituximab administration. The system oncology pharmacist confirmed there had been an increase in the volume of patients being ordered Rituximab. Key interventions included policy changes for the healthcare system, leading to all nurses administering Rituximab to be required to obtain chemotherapy certification.

Results

The Oncology Nursing Society recommends that nurses obtain chemotherapy certification to administer biologics including Rituximab to enhance patient safety and adhere to best practice, see figure 1. In 2022, pre-policy change, seven nurses were chemotherapy certified relative to thirty-six eligible on a medical-surgical oncology unit, a 197.61% increase. Normalizing our data to reflect observed growth in certification rates, we found the p value to be 0.000044, indicating a statistically significant increase.

Discussion

After receiving approval from both the Oncology Practice and Vascular Access Device councils as well as Nursing Administration, it was deemed appropriate that a chemotherapy certification is required for the administration of Rituximab. Moving forward, all nurses administering Rituximab are required to have obtained their chemotherapy certification to ensure safety and quality of patient care.

Oncology Nursing Forum. 2025 Mar 1;52(2):54–55.

P84. “Taking a Shot” At Influences and Interventions to Improve Immunization Rates in Patients with Cancer: Learnings from a Quality Improvement Project

Anna Canoy ¹, Nancy Thompson ², Andy Case ³

Quality and Safety

Significance & Background

Our community cancer center is one of 8 institutions in the United States chosen to participate in a 5-year cooperative grant from the Centers for Disease Control, focused on exploring, understanding, and improving our immunization processes and creating a positive impact in patient outcomes through interventions based on current, established national guidelines and recommendations. The value of immunization as a powerful tool to help patients with cancer improve outcomes is nationally recognized. However, management of immunization care gaps at our practice is generally deferred to primary care providers. This project focuses on the outpatient oncology practitioners and caregivers taking proactive steps in assessing and reconciling immunization care gaps, educating the patients and families, planning and recommending appropriate immunizations, administering vaccines or referring the patient to the primary care, and documenting interventions in the electronic medical record.

Purpose

To develop sustainable interventions aimed at making management of immunization care gaps as a standard of care for the outpatient oncology setting at our cancer institute.

Interventions

An immunization core team comprised of a Physician Leader, Quality Director, Project Manager, Nurse Practitioner, Clinical Nurse Specialist, and a Nursing Supervisor was organized to help lead the initiatives related to the project. PDSA model was used to guide discoveries and focus on project objectives. A strong collaborative, ongoing partnership between the immunization core team, physician leaders, caregivers, educators, nurses, pharmacists, and ancillary support worked together to address issues and develop interventions. A multi-disciplinary approach using variable methods of education and communication was utilized to address learning gaps and improve on the 3-month PDSA cycles. Surveys offered perspective on project questions and needs. Data was regularly reviewed and reported to the Council of Medical Specialty Societies platform as required by the grant, which guided ongoing and future work on the initiatives.

Results

Improvement in the assessment and reconciliation of immunization care gaps as well as administration of vaccines at the cancer institute was established. Variations in practices and revelations of persisting misconceptions and roadblocks to recommendations and administration of vaccines persisted as seen in data review.

Discussion

While immunization care gap assessment and reconciliation have improved, opportunities abound in further streamlining processes including onsite administration, patient referral for vaccine administration, immunization ordering, and documentation. Factors influencing vaccine hesitancy also need to be addressed in the system.

Oncology Nursing Forum. 2025 Mar 1;52(2):55–56.

P85. Development of Bispecific Education for Outpatient Administration and Patient Follow-Up in Community Oncology Private Practices

Lisa Caradonna ¹

Healthcare Delivery

Significance & Background

Bispecific Antibody drugs (BiTE) are becoming increasingly common for all disease types as they are the next generation of monoclonal antibodies able to target multiple mutations. As the number of BiTEs is increasing, so has our understanding of anticipated adverse events and their management. Subsequently, many clinical trials are seeking administration in outpatient settings as opposed inpatient hospitalizations. Side effects from BiTE drugs can include cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) which can be life-threatening if not treated appropriately and in a timely manner. The onset of these side effects differs from drug-to-drug which signifies the gross need to educate the patients, caregivers, infusion nurses, pharmacists, triage nurses, and any other personnel who may be part of the patients collaborative care team to ensure patient safety.

Purpose

Bispecific antibody drugs have a vast variety of administration, monitoring requirements, as well as specific dosing schedules that are significant for patients and staff to be aware of to ensure patients are safe both in the clinic and when they return home with caregivers.

Interventions

Creation of a bispecific fact sheet for all infusion units and development of an afterhours phone tree to facilitate timely and direct patient to physician contact to discuss symptoms for determination if emergency room is needed. Proper education and resources for our pharmacist and infusion nurses who are in direct contact with the patients while receiving medications, as well as proper education to pass along to patient and caregiver on signs/symptoms to look for once they leave in clinic. Education on how to use blood pressure cuff, thermometer, and pulse oximeter to document vitals at certain timepoints post-treatment. Creation of a care card for patients as a handy, prompt reference of who, when, why and what to call about timely.

Results/Evaluation

This tool started with the malignant hematology patients and the phone tree was specific to this group. With BiTE drugs now being used outpatient for solid tumors, such as Lung cancer, this education is now being implemented with all providers across the institution.

Discussion

This education is significantly important to ensure patients are seen in emergency room for potential CRS and ICANs related to treatment medications and given appropriate reversal drugs, which allows patients to continue their treatment with decreased tumor burden.

Oncology Nursing Forum. 2025 Mar 1;52(2):56.

P86. Enhancing Communication and Employee Engagement Through a Surgical Oncology Nursing Sharepoint Platform

Jennifer Carcel ¹, Shevon Smith ²

Professional Development

Significance & Background

Employee engagement is essential for improving job satisfaction, retention, and patient outcomes, especially in high acuity environments like surgical oncology. Feedback from our annual engagement survey and nursing team input revealed a need for better communication, streamlined resource access, and more professional development opportunities. To address these issues, we developed the Nursing Team Unit SharePoint, a centralized hub to improve access to educational materials, communication, and professional growth. This initiative is crucial in surgical oncology, where ongoing education and clear communication are key to managing complex patient cases, improving outcomes, and minimizing complications like infections.

Purpose

The Nursing Team Unit SharePoint was designed to enhance resource accessibility and foster continuous learning for surgical oncology nursing staff. By centralizing critical education, clinical guidelines, and institutional updates, it aims to strengthen communication and engagement within the unit. This is especially important in surgical oncology, where up-to-date protocols, oncology-specific care guidelines, and patient education materials are essential for providing high-quality patient care.

Interventions

The SharePoint site was structured to cater specifically to the needs of the surgical oncology nursing team:

■ Educational Resources: Up-to-date policies, procedures, oncology pharmacy guidelines, Lexicomp, Lippincott, and surgical oncology best practices.
■ Orientation and Training: Comprehensive materials for onboarding new nurses and assistants, tailored to the unique needs of a surgical oncology unit, with a focus on procedures, post-surgical care, and oncology-specific interventions.
■ Patient Care: Detailed patient care guidelines, with a strong focus on surgical oncology topics such as pre-operative preparations, post-operative care, chemotherapy protocols, wound care, and patient education for recovery.
■ Team Communication: Regular updates on surgical oncology events, staff recognition, patient satisfaction metrics, infection control protocols, surgical site infection (SSI) prevention, quality indicators, and weekly unit newsletters.
■ Interactive Features: Areas for staff feedback, live meeting links, and oncology-specific committee and project updates foster collaboration and drive improvement.

Results

Site effectiveness will be measured through user analytics, such as traffic, logins, and resource usage. A follow-up survey to assess the impact on team satisfaction and communication, comparing results to baseline engagement metrics from the prior fiscal year.

Discussion

The Nursing Team Unit SharePoint enhances staff engagement and communication, particularly within the surgical oncology unit. Early feedback has been positive, with staff citing easier access to oncology-specific resources. Ongoing evaluation will ensure continued alignment with team needs and patient care improvements.

Oncology Nursing Forum. 2025 Mar 1;52(2):56–57.

P87. Simulation Paired with Interdisciplinary Workflow to Prepare Oncology Nurses on Administration of Hazardous Drug Via Nephrostomy Tube

Courtney Carlisle ¹, Melissa Arangoa Miller ², Rebeccah Willard ³

Treatment Modalities and Managing Administration

Significance & Background

At an outpatient cancer center in Chicago, a team of nurses implemented a new workflow with hands-on staff training to safely administer a novel hazardous drug via nephrostomy tube. Jelmyto® is a chemotherapy treatment, which requires weekly instillation of mitomycin via nephrostomy tube for low-grade upper tract urothelial cancer. Instillation of Jelmyto® via nephrostomy tube is often done by the physician in the operating room or urology office but can be performed by registered nurses. Simulation is an established and effective method to train nurses on new procedures (Saragih et al., 2024; Sharkiya & Irit, 2024; Dale-Tam et al., 2024).

Purpose

The goal was for oncology infusion registered nurses to confidently administer Jelmyto® via nephrostomy tube utilizing simulation as a teaching method.

Interventions

After reviewing the State of Illinois Nurse Practice Act, Oncology Nursing Society guidelines, and literature on drug administration, it was decided instillation of Jelmyto® via nephrostomy tube was within the registered nurses’ scope of practice (Olsen et al., 2023; Draganski et al., 2017; Illinois General Assembly, 2024). The Clinical Nurse Leader (CNL) and Clinical Nurse Specialist (CNS) developed a nursing competency form and staff education. The infusion manager developed an interdisciplinary workflow with a series of meetings involving the urologist, pharmacy, urology nurses, leadership teams and UroGen® nurse to plan safe implementation of this new treatment. A nursing educator from UroGen® assisted with hands on training, provided simulation training kits and was present during the first instillation. Three nurses completed the initial simulation training. Additional staff completed competency via simulation followed by supervised administration on a patient.

Results

Pre and post surveys were completed by the staff that initially completed training. The post survey, completed after training but before drug administration, indicated that confidence in administration of hazardous drug via nephrostomy tube increased after training. Debrief sessions provided time to review case studies on how to improve workflow of future treatments.

Discussion

Novel treatments such as Jelmyto® via nephrostomy tube are rarely administered by oncology nurses. Simulation-based training with a multidisciplinary team approach is recommended to successfully implement education of hazardous drug administration via nephrostomy tube. Additional feedback will be obtained from nurses for follow-up to assess confidence long-term.

Oncology Nursing Forum. 2025 Mar 1;52(2):57–58.

P88. Experience of an Oncology Clinical Research Nursing Rotation in a Single Institution NCI-Designated Comprehensive Cancer Center: A Pilot Program

Colbi Carr ¹, Yuwei Yuan ², Lauren Farnon ³, Martin Edelman ⁴, Wencesley Paez ⁵, Anna Liza Rodriguez ⁶

Management

Significance & Background

Baccalaureate nursing programs include clinical rotations in various specialties to provide hands-on experience to future registered nurses (RNs). Despite this, programs do not include oncology clinical research rotations. New to practice RNs have minimal knowledge of oncology clinical research nursing and are unaware of the need and opportunity in this specialty.

Purpose

The purpose of this pilot program is to allow aspiring RNs the opportunity to shadow in oncology clinical research as part of their education to develop a knowledge and understanding of this specialty and seek out career opportunities post-graduation.

Interventions

Partnering with a local university, a fourth-year baccalaureate nursing student worked with an oncology clinical research nurse (CRN) for a 120-hour clinical rotation. The student interned in thoracic, women’s health, genitourinary, and gastrointestinal disease sites in the Office of Clinical Research, the clinical research unit, and ambulatory care clinic. The experience included review of treatment protocols, pre-screening and consenting patients, participant enrollment, involvement in site initiation visits, and multi-disciplinary tumor board observation. Additionally, discussion with the program director regarding career paths and potential job opportunities within the clinical research department was provided. The student obtained the CRN mentor’s contact information to grow her professional network.

Results

Initial barriers to providing nursing care in the oncology clinical research environment, as observed by the CRN mentor, included limited knowledge of general care of the cancer patient. This gap in understanding created challenges in patient education about treatment plans, conducting research-focused assessments, and effectively communicating with other research personnel. Observed improvements in the aforementioned barriers throughout the rotation led to the CRN mentor providing a professional reference for the student post-graduation. With this experience, the student nurse was equipped with foundational knowledge to successfully transition to oncology clinical research in the future. Subsequently, the student nurse secured a position in the ambulatory care department at a local cancer center.

Discussion

BSN programs can be strengthened by including clinical rotations in oncology and clinical research to foster knowledge of the specialties and provide additional career opportunities post-graduation. In the future, the program would aim to identify additional CRN mentors to provide the opportunity to more nursing students. Mentors would maintain communication with their mentees to track their career development.

Oncology Nursing Forum. 2025 Mar 1;52(2):58.

P89. Nurse Navigators as Crucial Members of the Virtual Prostate Cancer Care Team

Susanne Carsrier ¹, Rachael Rheaume ²

Healthcare Delivery

Significance & Background

Hartford HealthCare’s Tallwood Urology & Kidney Institute and the Cancer Institute collaborated to expedite the process for prostate cancer patients to be seen by multiple specialists. Typically, higher risk prostate cancer patients are seen by a surgical urologist, radiation and medical oncologist. With the institution of the Virtual Prostate Cancer Care Team (VPCCT) meetings all three specialists are brought together for a single, two-hour session that the patient can join from the privacy and convenience of their home. The Genitourinary Oncology Nurse Navigator (GU ONN) facilitates and supports the patient throughout the process from diagnosis through survivorship.

Purpose

The program aimed to achieve several key objectives: increase collaboration between healthcare providers, decrease communication gaps, provided consistent point of contact, and increase patient satisfaction.

Interventions

The GU ONN is given a referral to contact a patient to discuss and set up the virtual visit. The patient is scheduled to meet, via Zoom, with the surgical urologist, radiation oncologist and medical oncologist consisting of three 30 min sessions. At the end of the 1.5 hours of consults, the patient meets with all three specialists at the same time to explain their consensus recommendations for treatment based on their specific needs and answer any questions. The nurse navigator then provides the patient with a questionnaire evaluating time, visit flow and overall satisfaction with the program. After completing the questionnaire, the nurse navigator reviews and helps them with coordination of next steps of care. The GU ONN is available to provide education and support throughout their care and survivorship.

Results

The program’s multifaceted approach has improved patient satisfaction by enhancing knowledge of their diagnosis, improving communication, and adherence to treatment plans. Nurse navigators play a central role in achieving these objectives by facilitating seamless communication, coordinating care efforts, and advocating for patients’ needs within the healthcare team.

Discussion

Nurse navigators are pivotal to the success of the VPCCT program. Their role in multidisciplinary collaboration ensures a comprehensive approach to care delivery. They are a direct point of contact for the patient and their responsibilities extend beyond traditional roles to facilitate patient care through digital platforms. They are responsible for providing patient education, emotional support, coordination and continuity of care, advocacy, and technological facilitation.

Oncology Nursing Forum. 2025 Mar 1;52(2):58–59.

P90. Revising an Education Program at an Ambulatory Network: A New Approach in Clinical Care to Enhance Patient Education and Improve Outcomes

Vanessa Carrion ¹, Margaret O’Brien ², Elizabeth Mangold ³, Jennifer Hewitt ⁴, Marie Riehl ⁵

Patient Education

Significance & Background

Complex chemotherapy regimens combined with the broad spectrum of patient care needs, prompted a modification of the pre-infusion education process. Currently, pre-infusion education takes place in one session prior to the first infusion. The expansion of a newly opened network facility presented an opportunity to enhance patient education by implementing a series of education sessions.

Purpose

The complexity involved in teaching patients and caregivers about their treatment plan can be overwhelming for the patient. The role of the clinic nurse includes gathering educational materials, reviewing the treatment plan, coordination of care, and initiating the education. The clinic schedule does not allow an extended period to review this pertinent information. A phone call session after the clinic visit allows us to review education material in detail, focusing on the side effects, symptom management, and review of newly prescribed medications.

Interventions

Infusion nurses, clinic nurses, and leadership analyzed the current workflow and overall process of patient outreach. Gaps were identified on utilization of time and resources needed to manage the increasing volume of patients. Multiple outreach calls were being made by nursing staff to patients regarding their upcoming visits. The clinic and infusion staff proposed dividing the materials, while prioritizing the needs of the patient for each interaction. Revision of the checklists utilized for teaching was completed. Clear delineation of roles and responsibilities of the team members were discussed in the daily huddles.

Results

Attention to adherence of this process was imperative to the implementation’s success. The clinic team started the education during the initial visit highlighting the plan of care while coordinating all steps in the patient’s journey. The infusion nurses’ outreach emphasized the medications, side effects, and overall infusion. The medical assistants provided pre-infusion day tours to lessen the patient’s anxiety. The nursing team provided feedback during team huddles on patient educational topics requiring reinforcement. Leadership reviewed patient satisfaction by monitoring survey results and disseminating with the team.

Discussion

Positive patient outcomes are reflective of the interventions provided by the nursing staff. Continued evaluation of our current workflows and impact on the patient experience is the primary focus driving the success of our network site.

Oncology Nursing Forum. 2025 Mar 1;52(2):59.

P91. ESG and Nursing interventions – A Case of Disposable Head Caps in the Infusion Spaces in an Oncology Group in Brazil

Janyce Cassiolato Sguassabia ¹

Management

Significance & Background

Oncology treatments are essentially based on antineoplastic drugs bringing risks to health workers if they are not properly dressed. According to the Brazilian Regulatory Standard number 6 (NR-6), disposable head caps are not considered personal protective equipment (PPE). For the administration of antineoplastic drugs, the current international recommendation is to wear two pairs of gloves and a waterproof gown with long sleeves and tight cuffs with a back closure. When there is a splatter risk, the recommendation is to add a PFF22 mask. Historically, due to a lack of knowledge of the risks of handling these drugs, nurses use more “equipment” than necessary without evaluating the waste of materials and the financial and environmental impact.

Purpose

Provide evidence-based information about the PPE correct use. Reduce the waste amount produced by our Units and eliminate costs involved with unnecessary PPE.

Interventions

The first step was to review the scientific literature and find the best guidelines related to PPE wearing. As a second action, our workgroup selected the first six sets for the pilot project - 5 outpatient and 1 inpatient unit which received in-person visits for training and engaging the nurse staff and leadership. The third step was to find the root cause with the “5 Whys” tool and finally, we raised with our Supply Division the volumes and costs related to the disposable head caps.

Results

After the six units teams were guided and consumption was analyzed the achievements were: a montly saving of approximately US$200,00 and about 3.960 disposable head caps didn’t contaminate the environment in the pilot period. Expanding these numbers for a year including 145 units we’re expecting a saving of US$ 160.000,00 and the waste of more than a million disposable head caps was avoided with a direct impact on waste reduction. Furthermore, the nursing professionals were more confident about their own safety during the chemo administration.

Discussion

The ESG (Environment, Social, and Governance) concept applied to patient care must be considered by the leadership and professional staff. As we showed in this intervention, incorrect PPE wearing can cause financial and environmental impacts. Health sustainability is the responsibility of all professionals involved in that, and the Nursing staff can offer an important collaboration with this huge challenge!

Oncology Nursing Forum. 2025 Mar 1;52(2):59–60.

P92. Implementing a Hepatic Arterial Infusion Pump Educational Program for Oncology Infusion Nurses in the Ambulatory Setting

Kathrene Castelo ¹, Buerkley Opalecky ²

Treatment Modalities and Managing Administration

Significance & Background

Hepatic arterial infusion pump (HAIP) infusion, paired with systemic chemotherapy, is an innovative treatment option for colorectal and bile duct cancer metastasized to the liver. HAIP delivers chemotherapy directly to the liver, aiming to reduce tumor size and recurrence rates. There are few institutions in the United States that offer this treatment. Accessing and refilling the HAIP requires specialized training, and ambulatory oncology infusion therapy nurses at a National Cancer Institute designated institution have a key role in accessing HAIP, administering medications, and managing complications. An educational program was developed and implemented to assist the infusion nurses to effectively carry out this role.

Purpose

To implement an educational program in the intravenous therapy (IVTH) department to prepare nurses to effectively manage HAIP.

Interventions

Planning the educational program began in February of 2023, and training started April of 2023. Four nurses were selected for initial training. Nursing education involved presentations on HAIP indications, medications administered via HAIP, dosing calculations, toxicities, complications and troubleshooting. Hands-on and return demonstrations were used with a training HAIP and refill supplies. A “train-the-trainer” model was used with the rest of the IVTH nursing staff. The model of observation, performing the procedure with a trained nurse, and independently accessing and refilling a HAIP, was used.

Results

A survey was collected using RedCap. Nineteen nurses at the HAIP training completed the survey. Fourteen (73.7%) of the nurses indicated that they had moderate-to-extensive knowledge post-training. Thirteen (68.4%) nurses indicated that the education improved their comfort level with HAIP access and refill. Eighteen participants (94.7%) indicated the education helped them access and refill a HAIP. Seventeen (89.4%) participants indicated the quality of the education as good-to-excellent and that HAIP access and refill should be part of annual competencies. All participants indicated they would attend education on this skill at regular intervals.

Discussion

HAIP infusion is a skill that requires multimodal education and training. Nursing staff benefit from multifaceted learning to confidently, safely, and effectively access and refill a HAIP. Due to this survey, refresher in-services have been scheduled for continued learning. The training has also been integrated into annual competencies for nursing staff.

Oncology Nursing Forum. 2025 Mar 1;52(2):60.

P93. “Enhancing Infection Control: Impact of Daily Chlorhexidine Baths on CLABSI in Oncology Patients”

Maritess Castilan ¹, Rodilyn Lim ²

Quality and Safety

Significance & Background

A Process Improvement (PI) project was initiated in an Adult Oncology unit to address the rising incidence of Central Line-Associated Bloodstream Infections (CLABSI). These infections pose significant risks to immunocompromised oncology patients, impacting morbidity, mortality, and overall patient outcomes. In alignment with the organization’s safety standard, the project focused on implementing a consistent approach to daily Chlorhexidine gluconate (CHG) bathing for patients with central lines to promote patient safety and reduce CLABSI.

Purpose

The primary goal of this PI project was to evaluate and improve the process of conducting daily CHG baths for central line patients, aiming to reduce the incidence of CLABSI. This initiative sought to support the organization’s objective of providing a safer healthcare environment by maintaining a commitment to delivering high-quality patient care.

Interventions

The project followed the steps of the PLAN, DO, CHECK, ACT (PDCA) model. A multidisciplinary team reviewed existing practices and developed a standardized protocol for administering daily CHG baths to patients with central lines. Staff education sessions were held to ensure comprehension and compliance, and regular chart audits were conducted to assess adherence to the new protocol. Additionally, CLABSI incidence rates were monitored and compared pre-and post-implementation of the project to measure the impact of the intervention.

Results

The project’s findings, including compliance rates and CLABSI incidence, were presented as aggregate data internally and externally, with abstract submissions for poster or podium presentations. The initiative reduced CLABSI rates post-intervention, indicating a positive correlation between the daily CHG protocol and patient outcomes.

Discussion

The standardization of this infection prevention measure also enhanced staff knowledge and confidence in delivering high-quality care. This project highlights the potential for simple, targeted interventions to significantly improve patient safety and reduce healthcare-associated infections.

Oncology Nursing Forum. 2025 Mar 1;52(2):60–61.

P94. Use of Ultrasound Guided IV Insertion for Apheresis

Sarah Castro ¹, Elizabeth Tidei-Santamaria ², Maria Carmina Cariaga ³, Mackenzie Onan ⁴, Kate Sweeney ⁵

Healthcare Delivery

Significance & Background

Use of ultrasound guidance for placement of peripheral intravenous catheters (PIVs) can decrease the need for central lines for apheresis. Central line insertion is a safe procedure, but side effects can include bleeding, infection, thrombus, pain, longer recovery time and can lead to increased anxiety prior to collection. Central lines take more time to insert, need specialized MDs, and cost more than a PIV. Patients who are elderly, have a high BMI, or are chronically ill may not have easily visualized or palpated veins. Ultrasound can be used to find veins that are not visible or palpable on assessment and reduces the need for central lines. In the first half of 2024, 11.5% of apheresis for NMDP donors at non-partner collection sites was done via central line.

Purpose

Ultrasound guided PIV insertions have been successfully implemented in the inpatient and ED at our institution. As apheresis procedures increased in 2022 the decision was made to train apheresis nurses on ultrasound guided PIV insertion to decrease the number of central lines being placed.

Interventions

Nurses were trained, participated in an IV guided ultrasound class, and received tips from ultrasound experienced nurses. Exposure and practice increased nurse proficiency, which reduced the need for central lines. Networking with other apheresis centers provided additional recommendations to avoid central lines, such as using angiocaths instead of an apheresis needle.

Results

In 2023, 193 collections were performed at our location. Seventeen, or 9%, needed central lines. To date, in 2024, 166 collections have been completed. Only one, or 0.6%, needed a central line. Donor satisfaction for this time period remained high at 4.98/5. In the last 12 months there were 32 transfers of donors to our location because vein assessment identifying the likely need for a central line. There were seven urgent transfers from other locations that could not obtain access for apheresis. All of these patients were accessed peripherally using ultrasound guidance.

Discussion

Ultrasound guided PIV insertion is safe, cost effective and decreases the number of central lines needed for apheresis. Patient satisfaction remains high using this technology. Training apheresis nurses to use ultrasound guidance can lead to almost 100% of apheresis procedures being done peripherally.

Oncology Nursing Forum. 2025 Mar 1;52(2):61–62.

P95. Faith Over Fear: Colorectal Cancer Screening in the African Methodist Episcopal Church Community

Andria Caton ¹, Tamika Johnson ²

Screening, Early Detection, Genomics

Significance & Background

Colorectal cancer is the second leading cause of cancer-related death in African Americans. Research has identified faith-based settings as trusted places for the delivery of healthcare messages in the Black and African American community. Furthermore, most Black and African Americans identify themselves as being somewhat religious and that religious beliefs impact healthcare decisions. Conversely, only 1 in 5 Black and African Americans report receiving health information in a religious location.

Purpose

The project purpose was to increase colorectal cancer screening and promote awareness in an Atlanta district of the African Methodist Episcopal (AME) churches over three years. Additional goals included development of a community colorectal cancer screening resource, recruitment of colorectal cancer experts, survivors, and lay champions, and promotion of a district wide colorectal screening day.

Interventions

Barriers to colorectal cancer screening were identified in church focus group settings. Next, church members, the American Cancer Society (ACS), and community partners used the barriers to develop faith-based screening messages. Those messages were transformed into print and video materials. Additional community partners joined the AME and ACS members to help develop a Community Action Plan that included the implementation of “Colorectal Cancer Sunday”. Locally, oncology nurses collaborated with the AME pastor and members to deliver messages about colorectal cancer screening during and after the service, provide boxed lunches, supply participation stipends, and distribute fecal immunochemical tests (FIT) kits.

Results

For the larger project, the tailored messaged were distributed across 26 churches in the district. Ten AME churches participated in “Colorectal Cancer Sunday” and over 1,000 AME members were impacted. Locally, forty-eight people were in attendance. Twenty-two congregants received individual education, instructions on stool collection, and how to return the results. Nine results were returned. All results were read as normal. Participants were notified by mail of the results.

Discussion

Faith-based messages, resources, and programs targeting Black and African Americans in the AME community were well received by those participating. Furthermore, leveraging connections and improving relationships between churches, health systems, and community partners on a local level will help to increase colorectal cancer screening rates and reduce barriers to care for Black and African Americans. Future work includes the recruitment of additional lay champions in the churches to sustain the project work and disseminations of findings and lessons learned with decision-makers in the community.

Oncology Nursing Forum. 2025 Mar 1;52(2):62.

P96. Clinical Trials Nursing Orientation: A Reimagining of the Journey

Suzanne Chanel ¹, Viola Chitiyo ², Yelena Shames ³

Management

Significance & Background

Clinical Trials Nurses (CTNs) are critical to complex regulatory compliance, data integrity, and ethics guardrails of oncology clinical trials; essential to protect human subjects in research and foster public trust in seeking oncology clinical trials care. CTN learning needs and competency goal setting is comparatively more extensive in content and skills adaptation, versus standard oncology nursing orientation. In 2017, Clinical Trials Nursing Orientation (CTNO) was innovated to address these specialized learning needs. CTNs entering practice at our National Cancer Institute (NCI)-designated Comprehensive Cancer Center are required to complete this 2-day program upon successful completion of our institutional nursing orientation program.

Purpose

Learning barriers such as suboptimal learner engagement and concept retention, and distracted learning, were observed in this rigorous, information-rich, program. In 2023, it was posited that learners’ experiences would be positively impacted by a format reimagining, creating a more immersive, interactive, environment to advantageously balance didactic-intensive content with Case Study-based learning, “Gamification”, Flipped Classroom, and role play approaches.

Interventions

A contiguous 2-day case study framework was built mirroring our practice model, Protocol Life Cycle, selecting a live protocol, from pre-approval through closure; interwoven with the cancer journey of the inaugural patient, from pre-screening through treatment completion and bridging to a subsequent protocol. Interactive components such as concept-focused roundtable idea-sharing, role play, digital information scavenger hunts, and clinical trials Jeopardy games, invite the learner to apply CTN skills at each step of our patient’s journey. Learning objectives attainment are gauged by peer-to-peer and presenter feedback during protocol management and patient interaction simulations.

Results

The launch of the reimagined CTNO offers learners high-fidelity, realistic, true-to-life experiences, as it longitudinally mirrors the actual journey of CTNs, their clinical research teammates, and most importantly their patients. A Likert Scale course evaluation is provided at program conclusion. Observational measures include attentiveness, interactivity, refrain or decreased personal digital device use, and concept validation via teach-back.

Discussion

Case study-based adult education fosters meaningful learning outcomes by soliciting learner buy-in and personal relevance from empathy created with the depicted persons. The ideal results of which are learners’ independent motivation to problem-solve and use critical thinking for optimal outcomes. To support CTNO presenters’ understanding, confidence, and technique consistency of these teaching approaches, Clinical Trials Nursing Orientation Presenter Workshop was launched in 2023.

Oncology Nursing Forum. 2025 Mar 1;52(2):62–63.

P97. Standardizing Gender-Inclusive Pregnancy Testing Guidelines for Antineoplastic Therapy in Adults

Katherine Chang ¹, Marisa Quinn ²

Quality and Safety

Significance & Background

Since Laubach and Wilchins recommended pregnancy testing prior to chemotherapy in 1975, many cancer treatment facilities, including ours, lack standardized protocols, despite the serious risks associated with administering chemotherapy in the first trimester. A 2023 Agency for Healthcare Quality (AHRQ) literature review found no primary studies to inform practice standards for pregnancy testing during chemotherapy. Our evaluation of ordering practices at our NCCN-designated cancer center revealed significant variability in pregnancy testing requirements across oncology specialties, with language used in “reasons for not ordering” perpetuating barriers for transgender and nonbinary patients advocating for their health.

Purpose

In response, the cancer committee at a large academic center established an interdisciplinary workgroup to create the first standardized policy for pregnancy testing in accordance with ASCO-ONS Antineoplastic Therapy Administration Safety Standards for Adults and Pediatrics. The aim was to unify guidelines for: 1) pre-treatment testing, 2) assessment of pregnancy risk during treatment, and 3) addressing patients’ preferences for future fertility preservation before starting treatment and ensuring inclusive and affirming language throughout the process.

Interventions

We are revising our chemotherapy order writing policy to reflect ASCO ONS standards. In addition, we are standardizing our HCG ordering practices across solid tumor, hematology, bone marrow transplant, and cellular therapy clinics. We are incorporating documentation of patients’ fertility preservation preferences into the electronic health record (EHR) and revising the “reasons for not ordering HCG” based on recommendations from our Diversity, Equity, and Inclusion (DEI) committee and current evidence.

Results

The enhancements to the chemotherapy order sets will clarify to infusion nursing whether pregnancy tests are required before or during chemotherapy and at what intervals. The revised “reasons for not ordering HCG” will foster a more inclusive approach for our transgender and nonbinary patients. To assess the impact of these changes, we will track adherence to the updated pregnancy testing protocols, fertility preservation referrals, and measure patient satisfaction.

Discussion

The implementation of standardized, gender-inclusive pre-treatment and inter-treatment pregnancy testing guidelines will lead to increased appropriate testing and fertility preservation support, aligning with our commitment to diversity, equity, and inclusion in patient care.

Oncology Nursing Forum. 2025 Mar 1;52(2):63.

P98. Standardizing Admission Education for Stem Cell Transplant Patients

Jasmine Chapa ¹, LaTarvia Moore ²

Patient Education

Significance & Background

Stem cell transplant education equips patients with knowledge and understanding about expectations post transplant and strategies to help mitigate preventable events such as central line infections, falls, and pressure injuries. Providing nurses with the right resources and ensuring consistent patient education is vital to positive patient outcomes, especially for vulnerable populations. By implementing a standardized educational approach, including a preplanned education timeline, we can help nurses feel more confident in providing education for stem cell transplant patients, leading to decreased information overload in patients, improved patient compliance to treatment adherence, and reduced risk of secondary complications.

Purpose

The purpose of this quality improvement project is to standardize admission education for stem cell transplant patients to improve consistency in educational content, increase nurse confidence in providing transplant education, and increase patient satisfaction.

Interventions

The PDCA cycle was used to implement this quality improvement project. Feedback was collected from staff regarding perceived gaps in education and confidence in delivering education. Transplant goals were reviewed to align with daily goals and expectations during treatment, recovery, and discharge phases. A template for an admission education packet was created by the unit based nurse educator that included various education documents and a checklist that indicated what education should be taught on what specific day in the transplant process. Nursing staff was provided with admission education folders based on type of stem cell transplant (allogeneic or autologous). Education was given to nursing staff on how to appropriately use the admission folder, emphasizing key points and delivering specific education on specific days. A checklist was utilized for nurse and patient signatures and date to ensure accountability and verify compliance with educational initiatives.

Results

This project was implemented August 2024. Working through the PDCA cycle, adjustments to the implementation had to be made. Preliminary patient surveys show that the standardized education packets with preplanned education points, help to reduce information overload in patients and increase patient satisfaction. Nurse surveys will be given at 3 months.

Discussion

Implementing standardized and preplanned patient education for stem cell transplant patients not only enhances the quality of care but fosters a positive relationship between nurses and patients. This proactive approach leads to improved patient and nurse satisfaction, improved compliance to treatment and safety interventions, better health outcomes, and a more efficient healthcare environment.

Oncology Nursing Forum. 2025 Mar 1;52(2):63–64.

P99. How Prepared are Healthcare Professionals for Transitioning to the Digital ERA of Healthcare

Andreas Charalambous ¹, Nikolina Dodlek ², Dimitris Protogyros ³

Professional Development

Significance & Background

Technology has become an integral aspect of our daily life, such as wearable and information technology, virtual reality and the Internet of Things which have contributed to transforming healthcare business and operations. Healthcare professionals (HCPs) and health managers are at the centre of this transformation assuming a role in designing, developing, and utilising digital solutions as a means of high-quality services. This requires a specific set of digital skills of various levels of expertise.

Purpose

The EU funded TRANSiTION Project aims to foster up-skilling and reskilling in the context of digital health solutions for the oncology workforce. This presentation reports on the mapping of the existing training programmes on digital skills in Europe.

Interventions

An online survey that incorporated a mixed-methods approach was conducted during May–June and during November–December 2023. Experts purposively identified from 14 European states provided data about the existing training programmes. The Kirkpatrick model was utilized for analyzing and evaluating the results of the training and educational programs.

Results

57 training programmes were found, of which 47.9% addressed to HCPs, 29.2% to health managers, and only 4.2% were specifically targeted the oncology workforce. The availability of programmes revealed inequalities (Digital Skills Gap Index rankings) in this aspect, with certain countries reporting complete absence of such programmes. However, in the 95.8% of the cases, both HCPs and health managers were required to use digital solutions.

Discussion

The scarcity of digital training in oncology across Europe showed to be a barrier to the efficient digital transformation in healthcare. Commitments on the policy, clinical practice, research and education fields are needed to increase the preparedness of the workforce. This knowledge can serve as an example to explore and resolve the challenges of poor digital skills among the oncology workforce in other parts of the world.

Oncology Nursing Forum. 2025 Mar 1;52(2):64.

P100. Improving Patient Experience: Moving the Dial

Lisa Chartrand ¹, Kaitlyn Spejewski ²

Healthcare Delivery

Significance & Background

Patient experience is a national metric publicly reported by CMS. The goal of the survey is to obtain objective and meaningful information about the patients’ hospital experience. Patient experience can be as critical as treatment for cancer patients as they are going through a life changing experience where they have little control over events. The medical oncology unit was not meeting target goals for FY24. A deep dive into results indicated opportunities to improve scores in several areas. The unit determined key areas of focus included communication about medication and response to call lights. An unexpected increase in staff turnover may have impacted experience scores.

Purpose

The goal of this project was to improve patient experience scores to achieve a target goal of 74.6. In July of 2023, the unit was 14 points below goal.

Interventions

Working with the Service Excellence, unit leadership implemented a series of activities to meet the metric. Activities included training of new graduate nurses, implementing a nursing practice dashboard, charge nurse rounding focusing on patient experience and quality measures, completion of education modules on relationship centered communication, standard work for PCTs, and validation of purposeful rounding. The nursing practice dashboard included quality measures that charge nurses focused on during patient rounding. During huddles, leadership focused on the art of communication thereby enhancing information presented in the educational offering. To assist with side effects of medication, a list of common medications and side effects was laminated and placed in each room to facilitate medication education.

Results

June 2024 data revealed that communication about medication scores increased to 75.0 from 43.3 in July 2023 and 65.2 for FY. During the check off process for purposeful rounding, the highest score for response to call lights was 87.5. The score at the end of the fiscal year June 2024 was 75 and 57.5 FY from an initial score of 36.7. HCAHPS Composite score improved to 74.1 from 56.6. Although goal was not achieved (74.6), the unit underwent significant improvement.

Discussion

Interventions implemented facilitated the improvement of patient experience scores. When focus on a particular intervention shifted, the unit experienced some regression. This demonstrates that periodic validation is needed to maintain focus on patient experience. Additionally, processes implemented need be included in new hire orientation.

Oncology Nursing Forum. 2025 Mar 1;52(2):64–65.

P101. Clinical Care Expert: An Online Education Resource

Cynthia Chernecky ¹, Kandace Chariff ²

Professional Development

Significance & Background

Alphabetical, on-line nursing resource for clinicians, students, and educators and for those in reentry into nursing, changing practice areas, or needing updates for specialty care, and well as for those in need of assistance in didactic/clinical/simulation education and professional nursing organizational expertise. With vast amounts of experts in nursing by those working or retired, a platform now exists to share your knowledge so the profession does not have to self-learn experiential knowledge.

Purpose

To have a continual learning avenue developed by nursing experts to share their expertise in knowledge, skills and care. The initial resource has 57 areas of expert nursing Questions and Answers (with references) that you choose from an alphabetical list. Examples of areas includes systems (pulmonary, cardiac), specialties (bone marrow transplant, chemotherapy, genetics, palliative and hospice care, psychiatric mental health, plastic surgery), and areas of care (diabetes, transfusions, vascular access devices).

Interventions

This online resource is published by Cognella,Inc., academic publishers, and is updated by experts who wish to share their knowledge. Nurses who submit 20 Q&A’s with references will go through a review process and if selected for publication their submission will be added to the database.

Results

Number of platform users, number of additional expert care submissions to the platform, and feedback from users will be monitored once the platform goes live.

Discussion

Clinical Care Expert in Nursing is a place where experts, like oncology nurses, can share their knowledge so others can benefit from their years of expertise. With today’s fast paced environment, high acuity and leading-edge knowledge, a professional platform to disseminate expertise in nursing is a necessity. The website for submissions is www.clinicalcareexpert@gmail.com for all expert nurses.

Oncology Nursing Forum. 2025 Mar 1;52(2):65.

P102. Enhancing Text Readability in Education and Healthcare Using Bert and T5 NLP Models

Walter Chin ¹, Erika Armstrong ²

Radiation

Significance & Background

The need for easily understandable text is crucial, especially in education and healthcare. Natural Language Processing (NLP) tools such as BERT and T5 have advanced significantly in transforming complex texts into more readable formats. NLP focuses on the interaction between computers and humans through natural language, enabling computers to understand, interpret, and generate human language effectively.

Purpose

How effective is the T5 model in simplifying complex healthcare texts to improve patient comprehension at 4th to 6th-grade reading levels?

Interventions

This application leverages the T5 model to simplify text to a user-selected grade level, particularly targeting 4th to 6th grade reading levels. The Shiny app was built using R, incorporating several packages and APIs to enhance functionality: shiny: Framework for building interactive web applications in R. reticulate: Integrates Python within R, enabling T5 model use for text simplification. quanteda and quanteda.textstats: Used for text analysis and readability statistics. readtext: Facilitates reading various text file formats. pdftools: Enables reading and processing PDF files. officer: Allows reading and processing Word documents. plotly: Used for creating interactive plots and visualizations. stringr: Provides string manipulation functions for text processing. Users can upload text files in different formats (e.g., .txt, .pdf, .docx) and select the desired grade level for simplification. The application processes the text using the T5 model to generate a simplified version. Post-processing functions replace complex words with simpler synonyms and break down long sentences to enhance readability further.

Results

The application provides a user-friendly interface for uploading text files, selecting a target grade level, and analyzing the readability of both the original and simplified texts. It computes various readability scores, including SMOG, Flesch Reading Ease, Flesch-Kincaid Grade Level, and Gunning Fog Index. The simplified text is refined through post processing functions, ensuring the output text is accessible and easy to understand.

Discussion

By utilizing state-of-the-art NLP models and an intuitive interface, this application effectively transforms complex texts into more readable formats suitable for younger audiences or those with lower literacy levels. This tool is particularly beneficial in educational and healthcare settings, where clear communication is essential. Simplifying medical documents from a college reading level to a 5th-grade level, for example, can enhance patient comprehension, leading to better health outcomes and improved patient satisfaction.

Oncology Nursing Forum. 2025 Mar 1;52(2):65–66.

P103. Transfusion-Related Complications in Oncology: Strengthening Nursing Roles in Distinguishing TACO from TRALI

Pamela Minasian ¹, Ruth Alvarez Gaspar ², Rebecca Choi ³, Zenith Chua ⁴, Philip Tu ⁵

Quality and Safety

Significance & Background

Transfusion-related complications are critical concerns in the care of oncology patients, who often require multiple blood transfusions as part of their treatment. Among these complications, Transfusion-Associated Circulatory Overload (TACO) and Transfusion-Related Acute Lung Injury (TRALI) represent two potentially life-threatening conditions. Differentiating between TACO and TRALI is essential for timely and appropriate interventions, especially in vulnerable populations such as oncology patients. Nurses play a pivotal role in the early identification, prevention, and management of these conditions.

Purpose

This project aims to enhance the ability of oncology nursing staff to differentiate between TACO and TRALI in the clinical setting, improving patient outcomes through timely intervention and management strategies. The project also seeks to create an educational framework that increases nurses’ awareness and understanding of these transfusion-related complications. Interventions:

■ A comprehensive training program will be developed for oncology nurses, focusing on the pathophysiology, clinical presentation, risk factors, and management strategies of TACO and TRALI.
■ Pre- and post-educational assessments will be used to evaluate nursing knowledge and confidence in distinguishing between TACO and TRALI.
■ Case-based learning scenarios will be employed, where nurses will review patient case studies that exemplify both conditions.
■ Data will be collected on the incidence of TACO and TRALI before and after the educational intervention, along with the time to diagnosis and implementation of appropriate management strategies.

Results

The project anticipates that oncology nurses will demonstrate improved recognition and differentiation between TACO and TRALI, leading to quicker intervention and reduced morbidity. Additionally, it is expected that the incidence of misdiagnosis or delayed diagnosis of these conditions will decrease, contributing to overall improvements in patient care in the oncology setting.

Discussion

Educating oncology nursing staff on the differences between TACO and TRALI is crucial for the enhancement of patient safety and care quality. This nurse-driven initiative has the potential to serve as a model for other high-risk clinical areas where transfusions are common and prompt, accurate diagnosis of transfusion-related complications is critical.

Oncology Nursing Forum. 2025 Mar 1;52(2):66–67.

P104. Resilience and Low Anterior Resection Syndrome in Newly Diagnosed Rectal Cancer Patients: A Longitudinal Study

Yun-Jen Chou ¹, Hsuan-Ju Kuo ², Jeng-Fu You ³, Shiow-Ching Shun ⁴

Symptom Management and Palliative Care

Significance & Background

More than 70% of patients diagnosed with rectal cancer (RC) encounter the challenges of low anterior resection syndrome (LARS). Research has demonstrated that resilience plays a vital role in assisting these patients in dealing with RC and its associated difficulties. However, there were no studies to explore resilience issues in patients with RC.

Purpose

The aim of this study was to explore the relationship between resilience and LARS in patients newly diagnosed with rectal cancer.

Interventions

A longitudinal research investigation was carried out in a surgical clinic located within a medical center in the northern region of Taiwan. The study enrolled patients who had recently received a diagnosis of rectal cancer (RC) at stages I to IV and were scheduled for rectal-related treatments. A structured questionnaire was administered to evaluate the patients’ demographic and clinical characteristics, as well as their levels of depression, anxiety, resilience, and LARS at four time points: prior to treatment (T0), one month after treatment (T1), two months after treatment (T2), and three months after treatment (T3). The generalized estimating equations was used to investigate the relationship between resilience and the LARS.

Results

Among the 84 patients, the average age was 58.7 years (SD=10.8). Patients exhibited higher levels of anxiety, with a mean score of 3.8 (SD=5.8), as well as higher levels of depression, with a mean score of 10.4 (SD=11.5). In addition, patients reported elevated levels of LARS (M=24.2; SD=14.6) at two months after receiving rectal-related treatment. On average, patients displayed a high level of resilience before treatment and a moderate level of resilience after receiving rectal-related treatment. When examining the five dimensions of resilience, patients reported highest score in the purpose subdomain and lowest score at the authenticity subdomain at all four time points. The GEE results showed that self-reliance (β=−1.251; p=.016), purpose (β=−1.659; p=.005), and equanimity(β=−2.109; p=.013) were significantly associated with LARS.

Discussion

The results of this study highlight the significant important role of resilience, particularly in the subdomains of self-reliance, purpose, and equanimity, in relation to LARS in patients with newly diagnosed RC. Therefore, it is imperative for healthcare to implement resilience-related interventions aimed at enhancing the management of LARS in patients with newly diagnosed RC.

Oncology Nursing Forum. 2025 Mar 1;52(2):67.

P105. An Innovative Oncology Navigation Model Harnessing Technology, Science, and Human Touch to Expand Access to Biomarker Testing and Clinical Trials

Deborah Christensen ¹

Coordination of Care and Navigation

Significance & Background

Oncology nurse navigators (ONNs) work within institutions to help patients overcome health system barriers and improve timely access to care1. Significant barriers exist in patient awareness of and access to cancer biomarker testing and clinical trials2. Studies indicate less than 50% of eligible patients receive biomarker testing, and only 7.1% participate in a clinical trial.

Purpose

The lack of biomarker testing and clinical trial participation limits treatment options and worsens outcomes, inhibiting precision oncology care. A critical need exists to expand access to these services for patients nationwide, regardless of their location.

Interventions

The lack of biomarker testing and clinical trial participation limits treatment options and worsens outcomes, inhibiting precision oncology care4. A critical need exists to expand access to these services for patients nationwide, regardless of their location.

Results

Between July 2023 and August 2024, 82 individuals contacted CHD for treatment decision assistance. Only 23% had received biomarker testing, and over 55% requested CHD’s assistance in locating appropriate cancer treatment trials. CHD facilitated biomarker testing for 49% of patients and provided clinical trial options to 65%, significantly improving patient access to these vital services.

Discussion

Virtual navigation can significantly improve access to precision oncology by ensuring eligible patients undergo biomarker testing and are informed of clinical trial options. The continued development of CHD’s virtual navigation model will focus on educating community-based advocates on precision oncology care, creating seamless transitions to CHD services, and using digital solutions to enhance patient support.

Oncology Nursing Forum. 2025 Mar 1;52(2):67–68.

P106. Improving Rates of Social Work and Provider Referrals (Or Distress Screening): Implementation of the NCCN Distress Thermometer

Gina Chung ¹, Barbara Van de Castle ², Rebecca Stecher ³

Screening, Early Detection, Genomics

Significance & Background

When compared to the general population, cancer patients are at higher risk for experiencing distress; up to 60% of cancer patients report distress when assessed. Under-managed distress is associated with higher mortality rates, decreased treatment adherence and poorer quality of life. The NCCN Distress Thermometer tool aids clinicians in identifying potential stressors and improve care facilitation. Although most oncology units at this Comprehensive Cancer Center utilizes this tool, this is not a standard practice on the Transplant Cellular Therapy (TCT) clinic, where 0% of the patients are screened for distress.

Purpose

The purpose of this quality improvement project is to establish distress screening and management among oncology patients on the TCT clinic by implementing and measuring the NCCN Distress thermometer, an evidence-based, research-supported practice change. Approximately 150 adult oncology patients are expected to benefit from this project.

Interventions

Through the 15-week implementation period, nurses will screen patients using the Distress Thermometer tool within the current EHR; a score > 4 would indicate significance for distress. For patients that score significant, nurses will be advised to make a social work and or provider referral. Referrals will be documented in the EHR flowsheet and communicated through secure messaging systems. With weekly site visits, the project leader will conduct chart audits using a HIPAA protected collection tool to record data from the EHR: Medical record number, date of encounter, distress screening value and social work referral.

Results

This project is currently in the data collection phase. Preliminary data shows that nurses are assessing for distress at the rate of three to five times a week. In four weeks, 58% of eligible patients were screened, and one patient screened significant for distress but no referral was made.

Discussion

It is hopeful that 100% of the eligible patients will receive distress screenings and that 100% of those patients that score significant for distress will receive appropriate referrals to social work or provider. Identified barriers to screening include nurse forgetfulness, increased workload and patient refusal. To mitigate these barriers, the project leader placed reminder fliers throughout the clinic and interviewed unit champions on methods to increase adherence. If regular screenings lead to more appropriate referrals, we can conclude that this tool is effective and should be maintained as a standard practice for TCT.

Oncology Nursing Forum. 2025 Mar 1;52(2):68.

P448. Tackling Multifocal Safety Failures

Savannah Ciacchi ¹, Anne Kolenic ², Amanda Musial ³, Kayla Cierniak ⁴

Treatment Modalities and Managing Administration

Significance & Background

Intravesical administration of hazardous drugs (HD) carry an exposure risk to nurses and an infection risk to patients if a standardized evidence based method is not followed. At our institution the administration of these agents has been under the urology institute and clinical space, which are not typically staffed by oncology nurses. Practice gaps were identified and included lack of: consent utilization, proper personal protective equipment (PPE) for HDs, and maintaining a closed system during administration. Nursing education was needed to align best practices utilized within the cancer center.

Purpose

To standardize nursing practice for the administration of intravesical chemotherapy and immunotherapy at a large multi-site cancer center.

Interventions

A team of urology nursing leaders, educators, clinical nurse specialist, and medication safety officer met several times to discuss current practice at both the academic center and satellites. Meetings occurred over a 6 month period to standardize education requirements, update policies, and develop a guideline for intravesical HD administration utilized at all locations, to help ensure safe patient care. Staff training, planning, and implementation occurred over 5 months. Training and education consisted of: intravesical treatment, safe medication administration, and proper sterile technique for urinary catheter insertion. Various methods were utilized to train: didactic, simulation, video and time for Q&A. Early on in the process unit leadership identified 3 champions to become knowledgeable about the process and be able to answer their colleague’s questions with additional support from our nursing educators.

Results

A total of 34 nurses were trained including six champions, three nurses, and three nursing educators. Two champion training sessions took place followed by four regular sessions, during regular sessions a champion would train a nurse with the support of a nursing educator. Utilizing the procedural guide, nurse leaders audited nurses performing the new skill and identified equipment discrepancies and opportunities for reinforcement of education. Barriers to education and implementation included nurse’s familiarity with preforming sterile catheter insertion and availability of proper equipment for insertion.

Discussion

By bringing the practice of intravesical HDs under the cancer center, a standardized process for education and administration was developed and implemented. This allows for safe, efficient, and consistent practice that aligns with current best evidence. It was imperative to have collaboration amongst interdisciplinary team members to make this transition successful.

Oncology Nursing Forum. 2025 Mar 1;52(2):68–69.

P107. Impact of a Designated Resource Nurse in an Outpatient Infusion Clinic

Ashley Clauson ¹, Zulma Rosado ², Sandra John ³

Management

Significance & Background

Ambulatory chemotherapy infusion centers treat complex high acuity patients. At a community site of an NCCN designated Cancer Center staff average seven patients per nurse, (14 infusion hours per nurse). Securing legally mandated rest breaks for nurses is a major challenge in all healthcare settings and is exceptionally challenging in the ambulatory infusion setting where there is no predictable pattern of medication administration and hypersensitivity reactions are common. Nurses often simply forgo their rest breaks which can lead to gaps in best clinical practice, decreased job satisfaction and ultimately staff burnout.

Purpose

To describe a staffing model incorporating the role of a resource nurse to address safe efficient care delivery while ensuring staff breaks in an ambulatory chemotherapy infusion center.

Interventions

An assessment of consistency of the occurrence of legally mandated breaks identified a need to make workflow changes. The clinical team worked with leadership to implement a new nurse staffing model that utilizes a resource nurse role. This resource nurse does not have a patient assignment enabling them to provide chemotherapy safety checks both at the chairside and on the computer, assist during adverse reactions, and ensuring rest breaks.

Results

Data collected post implementation confirmed that the availability of a dedicated Resource Nurse significantly ensured attaining rest breaks, and the ability provide best clinical practices. Organizational leadership is essential to assure ongoing commitment to allocation of funding for the resource nurse role.

Discussion

A dedicated resource nurse staffing model improves patient care delivery, staff efficiency while reducing the risk of staff burnout. Ongoing data collection will determine if the role of resource nurse affects patients’ wait times and patient satisfaction scores.

Oncology Nursing Forum. 2025 Mar 1;52(2):69.

P108. Using a Continuous Temperature Monitoring Device in Outpatient Stem Cell Transplant Program

Rebecca Clements ¹, Indumathy Varadarajan ², Judy Kauffman ³, Janvi Jani ⁴

Quality and Safety

Significance & Background

Neutropenic fever in patients undergoing autologous stem cell transplantation (auto-HSCT) or receiving Immune Effector Cell (IEC) therapy poses a significant life-threatening risk. Current guidelines recommend administering antibiotics within one hour of fever onset, as delays increase mortality risk. With the shift toward outpatient CAR-T and IEC therapies, early fever detection is critical for improving patient outcomes.

Purpose

The retrospective quality review project aimed to assess an effective method for early fever detection in the outpatient setting. Our institution seeks to manage auto-HSCT and CAR-T patients in the outpatient setting to improve quality of life, patient satisfaction, and reduce healthcare costs. We utilized TempTraq, a Remote Temperature Monitoring (RTM) device, to evaluate its effectiveness in alerting patients to early signs of fever and enabling timely interventions.

Interventions

Eligible patients undergoing outpatient auto-HSCT or CAR-T therapy, who owned a smartphone, and consented to RTM, were included. A designated nurse coordinator provided TempTraq training and the RTM kit to begin self-monitoring on Day 0. The FDA-cleared TempTraq Bluetooth patch, worn in the axilla, continuously recorded temperatures and transmitted data to the patient’s phone. Monitoring occurred from Day 0 to Day +12, or until fever developed. Institutional protocol for neutropenic workup, including inpatient admission, is initiated for a temperature of ≥100.4°F.

Results

The pilot with 10 patients showed TempTraq effectively alerted patients of fever onset, leading to timely evaluations and treatment. Consequently, the device was adopted as a standard practice. In a larger cohort of 25 patients, including the 10 pilot patients, 10 were alerted but delayed seeking care, while 12 were admitted on the same day as the fever alert. Only two of the 25 patients were not admitted following fever alert. Overall, all patients had fevers and were able to successfully utilize TempTraq to receive fever alerts, prompting early interventions.

Discussion

TempTraq significantly improved patient care and quality of life by enabling early fever detection, reducing treatment delays, and improving disease management. Its ease of use and reliable real-time monitoring contributed to better patient outcomes. Patient and caregiver adherence, along with adequate education from the clinician are key to successful implementation of an outpatient transplant program utilizing RTM. Future recommendations include expanding its use to treat neutropenic fevers in the outpatient setting and integrating it into telemedicine platforms to improve patient-provider communication.

Oncology Nursing Forum. 2025 Mar 1;52(2):69–70.

P109. Nurse-Led Implementation of Insurance Billed Scalp Cooling within an Electronic Medical Record System

Alicia Coffin ¹, Cassie Adams ², Katharine Sherwood ³, Mary Mulkerin ⁴

Healthcare Delivery

Significance & Background

Chemotherapy-induced alopecia (CIA) is a common and distressing side effect for patients receiving chemotherapy. The degree of hair loss or thinning is dependent on the type of chemotherapy, dose, frequency of treatment, and number of cycles. To address this side effect, the Wilmot Cancer Institute’s (WCI) Comprehensive Breast Care Center at Pluta implemented the Paxman scalp cooling system using a self-pay model in October 2022. The center transitioned to a buy and bill model in January 2024 to improve patient access and support expansion of Paxman scalp cooling systems to other WCI locations.

Purpose

A critical aspect of the transition from self-pay to insurance billing is adequately capturing charges. The process needed to be efficient and easily replicable across all WCI locations using the existing nurse and provider workflows.

Interventions

To bill insurance, cap fittings must occur during a provider office visit. Nursing collaborated with Epic builders to add the cap fitting CPT code to the nurse documentation flowsheet for the office visit. Selecting “yes” in the billing-eligible line on the flowsheet triggers the charge. The team then worked with the builders to add the scalp cooling monitoring CPT code to discharge documentation in an infusion visit encounter. Selection “yes” for scalp cooling monitoring triggers the billing charge for eligible infusion visits. This feature is limited to departments utilizing Paxman to avoid accidental billing in other departments.

Results

Clinic and infusion nurses were involved throughout workflow development. Billing is reviewed monthly to ensure charges are being processed as expected and to review insurance coverage for patients. Since January 2025, all patients who have utilized Paxman scalp cooling have been able to do so using their insurance coverage or through financial support from Paxman.

Discussion

Nursing staff are responsible for cap fitting so a nurse-led process was important to ensure comprehensive and accurate billing. Since nurses already complete these flowsheets at all WCI locations, adding an additional documentation row does not add significant burden. Accurately capturing charges and securing insurance coverage and/or financial support is crucial for expanding scalp cooling to all eligible patients at all WCI locations.

Oncology Nursing Forum. 2025 Mar 1;52(2):70–71.

P110. Cultivating Creativity in the Face of Adversity: A Book Club for Oncology Nurses

Lyndsey Conway ¹, Lisa LaBrie ², Lisa LaBrie ³, Laura Holford ⁴, Anu Gorukanti ⁵

Professional Development

Significance & Background

Professional organizations are working to increase member engagement and offer innovative opportunities to support oncology nurses both professionally and personally. It is well researched that oncology nurses experience burnout and moral distress in their roles, and that rates of burnout and attrition have exacerbated following the COVID-19 pandemic. A local oncology nursing chapter enrolled in a program offered by an external company to engage members in a 12-week book club and accountability group focused on reading “The Artist’s Way” by Julia Cameron.

Purpose

To provide chapter members with a unique and innovative opportunity to build community through peer-led facilitation discussions, and to investigate the impact of the book club on nurses’ creativity and well-being.

Interventions

Participants were recruited from the chapter’s email listserv and social media followings. A total of 11 members enrolled in the program: 9 were divided into two groups with virtual weekly meetings, and 2 participated in the book club asynchronously. The company provided weekly newsletters and facilitation guides that supported participants’ experience, and offered a private online community for a wider cohort of healthcare workers participating in the program. This community provided a space for participants to connect, share insights, and receive additional support.

A pre-survey collected baseline data on participant demographics, self-assessment around creativity, and measured moral distress. A post-survey will be administered to assess changes in creativity, moral distress, and the overall experience of the book club.

Results

In weekly meetings, participants engage in peer-led discussions around the assigned readings. Discussion questions encourage reflection, sharing of personal experiences, and the development of supportive relationships. Data analysis will be conducted upon completion of the program and will be available at the time of presentation.

Discussion

Participating in the company’s program provides members a structured and organized experience, allowing them to connect with a broader community of healthcare workers. Collaboration between the chapter and company to develop survey questions offered a unique opportunity to measure the program’s impact on participants. Post-survey results will provide valuable insights into the potential benefit of this strategy to improve the well-being of nurses. The program’s focus on peer-led facilitation and group accountability represents a novel approach to supporting oncology nurses. This approach fosters a sense of community, provides a safe space for sharing experiences, and encourages self-care.

Oncology Nursing Forum. 2025 Mar 1;52(2):71.

P111. Does One Size Truly Fit All? Implementing the Tiered Skills Acquisition Model in an Ambulatory Cancer Clinic

Latesha Cook-Webb ¹, Narah Latortue ², Shaniequa Green ³, Delores Llyod ⁴

Management

Significance & Background

Standardized orientation has positively affected retention and turnover rates in the ambulatory setting, while also ensuring a smooth transition from one specialty to another (Matousek, 2024). In 2023, three ambulatory oncology departments implemented a standardized orientation tool called the Orientation Progression Plan and Schedule (OPPS). The OPPS emphasizes focus weeks, promotes communication during orientation, tracks progression through orientation, and allows a collaborative awareness of the orientee’s weaknesses and strengths. Although implementation was successful, the OPPS lacked the ability to build and measure skills.

Purpose

The primary objective of this project is to evaluate the implementation of an orientation model specifically designed for newly hired inpatient registered nurses in an ambulatory cancer clinic. The Tiered Skills Acquisition Model (TSAM) model is intended to enhance nurse confidence and role satisfaction and reduce orientation length.

Interventions

According to Joswiak (2018), the Tiered Skills Acquisition Model (TSAM) is based on the idea that the orientee must master skills in one tier before progressing to the next. The nursing professional development specialist (NPDS) engaged key stakeholders before implementing the TSAM. After adjusting the model to fit the needs of the departments, the finalized structure included Tier 1 – Clinic Workflow, Tier 2 - Nursing Triage and Symptom Management, Tier 3 - Care Coordination, and Tier 4 Bringing it all together, where the orientee follows a regular clinic nurse schedule, encompassing all three tiers simultaneously.

Results

Ten nurses were surveyed between October 2023 and September 2024 after completing their orientation. All ten responded, and of those ten, four were oriented to their role using the TSAM. All four nurses were experienced but new to oncology. When asked if they found it easy to learn new skills after mastering the ones before them, three out of four responded, “Somewhat True.” One of the four nurses expressed that their orientation did not fully follow the model and that a structured, tiered orientation would have provided clarity on expectations before moving to the next tier.

Discussion

The post-survey results illustrate that having an orientation model to follow, regardless of its intended audience, can be beneficial in an ambulatory setting. The NPDS is committed to improving the use of the model and continuing to disseminate post-surveys until August 2025, ensuring robust evidence of need and a thorough understanding of the model’s impact.

Oncology Nursing Forum. 2025 Mar 1;52(2):71–72.

P112. The Implementation of a Cognitive Behavioral Therapy-Based Intervention for AYA Cancer Survivors to Reduce Depression and Anxiety

Liz Cooke ¹, Hannah Komai ², Estella Barrios ³, Megan Echevarria ⁴, Bernadette Melnyk ⁵

Psychosocial Dimensions of Care

Significance & Background

National trends over the last 10 years have indicated an increase in mental health conditions in adolescent and young adults (AYA) (Bommersbachet al., 2020). This trend has affected AYA cancer survivors (CAYA) with CAYA having poorer mental health outcomes when compared to non-cancer controls and barriers to effective treatment (Tanner et al., 2023). Cognitive behavioral therapy (CBT) is one of the most evidence-based psychological interventions for the treatment of depression and anxiety; online CBT is as effective as in-person CBT in alleviating anxiety and depressive symptoms among AYAs (Gautam et al., 2020; Howes et al., 2021).

Purpose

After a literature review, a CBT-focused intervention for young adults was discovered that had been utilized in schools, medical centers, and universities and was found to improve psychosocial outcomes in every population tested (Lusk & Melnyk, 2011, 2013, Melnyk, 2024). The purpose of this abstract is to describe the CBT-based intervention that was implemented for CAYA in one major cancer center’s survivorship program to assist with prevalent mental health issues.

Interventions

The Creating Opportunities for Personal Empowerment (COPE) program is a 7-session evidence-based, manualized intervention program used to address the high prevalence of child, adolescent, and young adult depression and anxiety. A nurse practitioner completed on-line training required to deliver the program. COPE was delivered online to a group of CAYA in 2024 over 7 sessions, each lasting 60 minutes. A book with skills building activities was sent to each CAYA to accompany the online sessions that covered various topics each week.

Results

There was a 50% decrease in participation after Session 1 (n = 9), but remaining patients were present for most of Sessions 2–7 (n = 4), and all found the intervention helpful. Although this was not a research project but an evidence-based practice implementation project with a CBT-based intervention, midway through the intervention, patient feedback mentioned the need for icebreakers at each session beginning, additional discussion time, more dialogue, and survivorship content inclusion. A formal evaluation also will be sent at intervention completion.

Discussion

AYA mental health disorders have become a public health epidemic. One cancer center’s survivorship program implemented an CAYA-focused CBT-based intervention with a plan to refine the program further, specifically for CAYA, and scale it wider to decrease depression and anxiety in this AYA high-risk group.

Oncology Nursing Forum. 2025 Mar 1;52(2):72.

P113. Implanted Vascular Access Port Erosion: Empowering Nurses Through Assessment and Education

Megan Corbett ¹, Susan Whiting ², Annika D’Auria ³, Michelle Flattes ⁴

Quality and Safety

Significance & Background

Before accessing ports, nurses must perform a comprehensive assessment to ensure patient safety, identify urgent concerns or risks, and prevent future complications. Evidence-based practice (EBP) standards guide care, yet clinical judgement and expertise are crucial in unique situations. To achieve high quality and safe patient care, nurses must leverage literature and established policies in consultation with practice experts. Erosions, while uncommon, are a serious complication. Despite the absence of recent literature related to erosions, nurses must recognize causes, symptoms, and the importance of early detection, escalation, and documentation.

Purpose

To share a quality improvement initiative within an adult ambulatory infusion clinic to enhance nurse education and standardize EBP related to port care.

Interventions

Three port erosions prompted an investigation of practices through observations and chart reviews. Electronic reports identified patients with ports. Nurses and nurse leaders evaluated each port before access. Daily coaching and feedback addressed aseptic no touch technique (ANTT), documentation, and EBP for all nurses. PDSA cycles identified and addressed inefficiencies in workflows. Applicable policies were reviewed. Mandatory attestation was tracked. Interdisciplinary team meetings fostered transparency, accountability, and quality improvement. Nurses received mandatory education, performed ANTT return demonstrations, and ongoing practice audits were instituted on the absence of recent EBP on port erosions led to the development of standardized best practices. This included an assess and pause or assess and stop triage model specifically designed for vascular access ports.

Results

Over four-weeks, 363 ports were evaluated. 26% required further intervention and escalation. An interdisciplinary case-controlled study revealed variations in insertion, device placed, port days, manufacturer details, and procedure technique among other data. Limitations included low sample size and missing or unclear documentation, making it difficult to identify a single factor for complications. A trend was observed between erosion and complications with site closure. Event summaries and action plans were presented to shared governance committees, policies were revised, annual education and competency assessments were developed, and an audit tool was adopted.

Discussion

Literature is lacking on erosions related to port care and maintenance. This highlights an opportunity to identify and escalate concerns to prevent complications. A clear, multi-step pathway to empower nurses to pause and assess, to determine safe access vs. escalation equips nurses with knowledge to improve patient outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):72–73.

P114. A Multidisciplinary Approach to Developing a Hands on Tandem and Ring Education Program for Nurses Caring for Cervical Cancer Patients

Terry Corbo ¹, Ashley Shelden ²

Radiation

Significance & Background

Early-stage cervical cancer is treated with concurrent chemoradiation consisting of 25 daily pelvic treatments. The external radiation is followed by a course of 4–5 high dose brachytherapy treatments, using a tandem and ring (T&R) applicator. The T&R applicator consists of a long mental tube that is placed in the uterus and a ring that is fitted against the cervix. The T&R applicator is inserted in the operating room under anesthesia. For optimal survival benefit the treatment interval between the first pelvic radiation treatment and the final brachytherapy treatment should not exceed 56 days. To improve the continuity of care, a T&R program was proposed for our treatment center.

Purpose

Early in the implementation process, radiation nursing leadership proposed a multidisciplinary approach to implementing a safe and effective T&R program bringing together radiation oncology nurses, radiation therapists, perioperative nurses, and the gynecology oncology nursing.

Interventions

A comprehensive educational program was developed that allowed for hands on instruction to all staff that would be interacting with the T&R patients. Letting staff see and touch the instruments in an education session helped to convey the importance of immobility after the instruments were placed in the vagina, since perforation of the uterus is a concern if the patient is allowed to sit up. Education around pain control, anxiety, nausea and expected side effects from external beam radiation was also offered to the peri operative nursing staff. A nurse to nurse bedside handoff was developed to ensure that the instrumentation was intact and there was no excessive vaginal bleeding prior to leaving the post anesthesia care unit.

Results

Three patients have successfully completed T&R procedures at our center, with all three completing treatments in the recommended 56 days. All perioperative nurses that received the training stated that they felt prepared to take care of the tandem and T&R.

Discussion

The post anesthesia nurses stated that including them in the education made them feel respected and valued, because they had a better understanding of the procedure and the hardware. These educational sessions have also produced a collegial relationship between the radiation nursing staff and the post anesthesia nurses. A formal survey is being developed to capture their retention of the instructions at the one-year mark.

Oncology Nursing Forum. 2025 Mar 1;52(2):73–74.

P115. Access to Registered Dietitian at Specialty Pharmacy Addresses Gaps in Oncology Nutrition Care

Kerry Coughlin ¹, Amanda Lewallen ², Douglas Mager ³, Timothy Dollear ⁴, Lesley D’Albini ⁵, Gail Bridges ⁶

Coordination of Care and Navigation

Significance & Background

Accreditation standards for community cancer programs require access to oncology nutrition care by a Registered Dietitian. Previous research suggests obstacles may limit utilization of this resource. Referrals from nurse to dietitian within a specialty pharmacy (SP) may narrow this gap.

Purpose

The objective is to measure access to nutrition care prior to engagement with SP dietitian. Improved understanding of gaps and barriers to care may inform potential mitigation strategies.

Interventions

Oncology nurses assess patients throughout therapy per drug-specific, evidence-based clinical protocols. Upon identification of unmet nutrition needs, nurses refer patients to an SP dietitian specializing in oncology for comprehensive consultation. During this consult, patients are asked if, since cancer diagnosis, they have ever received care from a dietitian in an alternate setting. When applicable, the primary reason for not receiving care is collected. Data was extracted retrospectively from the medical record, aggregated, and evaluated for correlation to an internal risk score estimating patient risk of health inequity based on demographic features associated with zip code. Risk was categorized as Very High, High, Medium, or Low, indicating relative risk of health inequity.

Results

Final sample included 263 patients who received care from an SP dietitian. One-hundred twenty-one (46%; 121/263) denied receiving care from a dietitian prior to SP nutrition intervention. Primary reasons were lack of provider referral (35.5%; 43/121) and lack of nutrition concerns (20.7%; 25/121). Patients with Very High or High scores were disproportionately impacted by lack of referral, with 76% (22/29) of responses reporting lack of access as the primary barrier. In patients with lowest risk of health inequity, the most common reason for not receiving prior dietitian services was lack of nutritional concerns. Less than 4.1% (5/121) of patients reported declining the referral, cost, or extended wait time as the reason for not receiving prior dietitian care. Of note, 9 (7.4%; 9/121) patients reported not knowing how to access a dietitian as their primary barrier to prior care.

Discussion

Conducting nutritional needs assessment and integrating a dietitian into SP care can help close oncology patients’ nutritional care gaps, particularly among those at highest risk of health inequity. An integrated SP model allows nurses to easily triage at-risk patients to high-quality dietitian care at no extra cost to the patient.

Oncology Nursing Forum. 2025 Mar 1;52(2):74.

P116. Development of a Nurse Driven HSR Algorithm

Rachael Coyle ¹, Christine Usher ², Francis Panebianco ³, Lauren Cullen ⁴, David Ortwein ⁵, Kayla Boegly ⁶

Treatment Modalities and Managing Administration

Significance & Background

In 2022, the infusion department identified deficiencies in the Hypersensitivity/Anaphylaxis management orders group. The primary concerns were the absence of clearly stated PRN reasons for use of rescue medications and the lack of a clinically supported sequence for administering these medications. These gaps posed potential risks in delivering timely and effective care during hypersensitivity or anaphylactic reactions.

Purpose

To address these concerns, an interdisciplinary workgroup was formed, comprised of oncology specialty pharmacists, experts in allergy and immunology, and nursing professionals. The group was tasked with revising the existing order set to standardize the administration of medications and include appropriate PRN indications, based on peer-reviewed evidence. The goal was to create a more standardized approach to handling hypersensitivity and anaphylaxis in the infusion setting, that was evidence based and could empower nurses to act in a timely manner.

Interventions

Over nearly two years of collaboration and review, the team developed the nurse-driven Hypersensitivity/Anaphylaxis Algorithm. This revised protocol was incorporated into all infusion-based care plans, ensuring that nursing staff could respond swiftly and consistently to hypersensitivity or anaphylactic events. In 2023, a comprehensive education program was rolled out to train the department staff on the new algorithm and its evidence-based rationale, and by early 2024, the process was fully implemented. A copy of the algorithm is displayed in every treatment room for real time reference.

Results

Initial compliance with the new protocol was low, as many providers and nursing staff adhered to previous practices or expressed personal preferences in treatment approaches. However, with ongoing audits and remediation with the infusion staff, compliance scores have steadily improved, and staff are becoming more proficient with the standardized protocol.

Discussion

The development and implementation of this nurse-driven protocol reflects the department’s commitment to evidence-based practice. The limited number of similar electronic health record (EHR) nurse-driven protocols in the infusion environment likely contributed to early challenges in adoption. This initiative serves as an important step towards optimizing patient safety and standardizing care in the management of hypersensitivity and anaphylaxis in infusion settings by allowing for a timely and evidence-based intervention to reaction management.

Oncology Nursing Forum. 2025 Mar 1;52(2):74–75.

P117. Multi-Disciplinary Case Study Sessions in the Ambulatory Cancer Care Setting

Rachael Coyle ¹, Francis Panebianco ², Christine Usher ³, Kayla Boegly ⁴, David Ortwein ⁵, Lauren Cullen ⁶

Healthcare Delivery

Significance & Background

At a cancer center, within a large academic medical center, effective care coordination across multiple cancer divisions, the infusion department, and several support services is crucial. Recent data from the National Database of Nursing Quality Indicators (NDNQI) revealed a decrease in nursing and physician interaction (RN-MD) scoring, and examination of HCAHPS data identified opportunities for improvement within the care provider domain. These findings underscored the need for a targeted intervention to build communication amongst healthcare providers to enhance patient care.

Purpose

Implementing interdisciplinary case studies provides a structured forum for the care team to come together. This intervention serves several purposes. First, it fosters stronger interdisciplinary relationships. By facilitating open discussions, team members can cultivate stronger collaborative relationships, which are essential in a multidisciplinary environment. Additionally, it created a space for event review. The case studies allow for a comprehensive review of significant events, which may require in-depth discussion—conversations that often go overlooked in the daily pressures of clinical practice. Lastly, the work aligns with High Reliability Principles. This approach is consistent with the principles of high reliability organizations (HROs), emphasizing the importance of communication, teamwork, and continuous learning to improve overall care quality.

Interventions

Each session gathers members from different interdisciplinary teams to review an event that occurred within the Cancer Center. The discussion is focused on four key points. First is what went well and review of successful elements; promoting effective practices. Second is areas of opportunity; focusing on identifying aspects that can be improved to address gaps in service or communication. Third is clarifying decisions made to ensure understanding of the rationale behind clinical decisions and foster transparency. Lastly, open discussion for best practice to encourage input on improved methodologies, which promotes continuous learning and enhances patient care.

Results

Preliminary survey data indicates positive outcomes, with themes of increased understanding of interdisciplinary roles among colleagues and a clearer grasp of the reasons behind clinical decisions. This enhanced comprehension is likely to contribute to more cohesive teamwork and improved patient care processes.

Discussion

The findings suggest that interdisciplinary case studies may effectively enhance communication and collaboration within cancer care teams across the ambulatory care continuum. By promoting open dialogue and shared learning, we can continue to improve clinical outcomes and patient satisfaction in our cancer center.

Oncology Nursing Forum. 2025 Mar 1;52(2):75–76.

P118. Expansion of Remote Nurse Triage

Bobbie Sue Crow ¹, Corinne MacDonald ²

Coordination of Care and Navigation

Significance & Background

Successful implementation of remote nurse triage in 29 clinics across the state of Florida, elicited an increased amount of interest in the remote triage platform. To further support timely patient care, Patient Contact Center (PCC), a centralized call team, was initiated to alleviate the burden of patient calls on clinic staff. Thus, allowing remote triage the opportunity to speak with patients and address their issues faster, requiring additional remote triage staffing and expansion. The in-clinic staff could then focus on face-to-face patients. To grow a successful program reevaluation of staffing needs, productivity, and clinic roll out time frame was necessary.

Purpose

Successful expansion of remote triage by educating providers, and clinic staff on the process and time to complete remote triage integration.

Interventions

PCC Implementation:

■ Create Teams Channels for communication.
■ Manage calls of clinics established with remote triage.

Pause for Optimization:

■ Evaluate current positions.
■ Evaluation clinic workloads, related to other community oncology practices.
■ Defined productivity of 40:1 ratio per nurse.

Approval of Positions:

■ New staffing positions approved by staffing committee.
■ As in-clinic triage positions are vacated that position is converted to remote triage position and back-filled by remote triage.

Training:

■ Training plan related to 1:1 trainer staff ratio.
■ Ensuring new staff are thoroughly trained on remote triage processes, EMR and communication with treatment team.

Go Live Process:

■ Preimplementation: Clinic identified as needing Remote Triage assistance based on current / future state staffing.
■ Meeting 1: Overview of Remote Triage/ PCC Process and creation of Clinic Contact Sheet
■ Meeting 2: Go Live Meeting / In-clinic and remote teams meet (virtually)
■ Meeting 3: Post Go Live
■ Ongoing Meetings: Quarterly Follow-ups

Results

Remote Triage expansion in clinics: Quarter 4 2024: 3, Quarter 1 2024: 3, Quarter 2 2024: 9.

Discussion

After pausing for optimization, fifteen additional clinics successfully integrated to remote triage platform. With the evaluation of staffing needs and productivity, to be in line with other community oncology practices a 40:1 ratio was adapted. Identifying a training plan which includes a 1:1 nurse/trainer ratio ensures patients receive efficient, quality care while working within the nurse’s scope of practice. The remote triage program continues to grow with the goal of remote triage in every clinic, company wide.

Oncology Nursing Forum. 2025 Mar 1;52(2):76.

P119. Decreasing Patient Wait Times Through “Treatment Readiness”

Lauren Cullen ¹, Kayla Boegly ², Rachael Coyle ³, David Ortwein ⁴, Francis Panebianco ⁵, Christine Usher ⁶

Healthcare Delivery

Significance & Background

An 81-chair infusion suite at a large academic medical center treats various cancer diagnoses. Due to complex patient needs, patients typically have multiple appointments in one day. The majority of treatment patients have labs drawn day of treatment, while approximately 70% of patients are seen by their oncology team prior to their infusion appointments with their infusion appointment being the last stop. On average, patients are waiting 24.3 minutes for MD signature, 20 minutes for orders, 22.3 minutes for consent, and 12 minutes for treatment clarification. Individually these delays do not cause much strain, but many patients are moved in multiple hold buckets leading to compounding delay and major patient dissatisfier.

Purpose

Our department has seen an increase in safety event reporting by infusion staff demonstrating that patients routinely are showing up for their infusion appointment without lab orders, signed treatment orders, conflicting treatment parameters, or missing consent. These patient safety concerns, coupled with the strain that is put on infusion staff to investigate a patient’s plan of care, increase in challenges at point of services, and delays in patient care were the driving force to address treatment readiness.

Interventions

A standard operating procedure (SOP) for “Treatment Readiness” was drafted in collaboration with our infusion leadership team and hematology oncology leadership. The “Treatment Readiness” SOP defines what treatment readiness is, outlines a chart check process for infusion patients, and how long infusion will wait for orders to be addressed before rescheduling a patient. Because the majority of patients are seen in clinic prior to infusion, infusion staff will proactively review patient charts of patient with decoupled infusion appointments and directly message providers with outstanding issues one day prior to the patient’s scheduled appointment. Infusion staff review treatment plan for treatment orders to be signed and dated correctly with clear treatment parameters, active consent, necessary labs ordered or resulted, and an appropriate appointment length.

Results

We do not have results at this time. Once implemented we will monitor for a reduction in patient wait times.

Discussion

The goal of treatment readiness is to decrease point of service needs and decrease delays in patient care by communication with care teams about the patient treatment plans prior to the patient arriving for their appointment.

Oncology Nursing Forum. 2025 Mar 1;52(2):76–77.

P120. Title: Navigating Grief in Oncology: Empowering Nurses with Healing Practices

Sarah Cunningham ¹, Stephanie LaRiviere-Miller ²

Professional Development

Significance & Background

Healthcare worker burnout is exacerbated by the inability to properly grieve losses, as documented in this study. However, there is minimal research exploring interventions that address grief-led burnout. Moreover, healthcare cultures often neglect teaching and supporting the grieving process.

Purpose

Cycles of burnout lead to frequent staff turnover which can degrade the quality of a unit over time. Through mentorship with experienced clinicians across disciplines, staff reflected on what would help stop the cycles of grief-led burnout so many nurses experienced regularly.

Interventions

■ Surveyed nurses at Oregon Health & Sciences University (OHSU) to identify needs for grief processing. The interventions explored included: creative outlets such as journaling, providing support systems that extend beyond the workplace, delivering educational sessions on grief management, and sharing information about available grief support resources.
■ Designed grief workshop based on survey responses to include: didactic session, followed by creative breakout sessions that incorporated meditation, writing, and collaging.
■ Applied for and was awarded grant funding of $2400 over two years.
■ OHSU Social Worker volunteered to facilitate and brought in contractors for creative breakout sessions.
■ Sought accreditation through OHSU’s Nursing Continuing Professional Development Program (NCPD) -- attendees were able to earn 2.83 NCPD contact hours.
■ Surveyed attendees at two intervals - immediately after workshop and again after 3 months.

Results

■ 44 people attended across two years; each RN attendee earned 2.83 NCPD contact hours.
■ All attendees reported they gained new tools to process grief.
■ Quotes from surveys include: “This should be a regular workshop”; “So completely wonderful and so needed. Thank you so very much. Please let’s find a way to continue this healing”; “Too often the death and grief are presented as an expected part of the job; [it is] nice to have some validation.”

Discussion

Processing grief through evidenced-based tools can decrease burnout. This workshop was designed, coordinated, and funded by a staff nurse through grant support. Limitations include: uncertain long-term funding; inability to provide the workshop during regular working hours, decreasing accessibility to many; and inability to capture 3-month feedback from the majority of attendees. In the future, we hope to provide more accessible programming through a variety of formats by gaining more institutional support (virtual and in-person, and offered during regular working hours).

Oncology Nursing Forum. 2025 Mar 1;52(2):77.

P121. An Evaluation of the Relevance of Palliative Care Education for the new Graduate Resident Nurse

Jenell Currence ¹

Symptom Management and Palliative Care

Significance & Background

Palliative Care is a new healthcare specialty, unfamiliar, and often mistaken for Hospice. Palliative Care education includes the roles and benefits of Palliative Care for patients and patient families living with serious illness, and healthcare professionals working in the acute care setting.

Purpose

To assess the relevance of the current Palliative Care education presented to the HonorHealth New Graduate Resident Nurse (HHNGRN) in the six months of practice following the Palliative Care Overview.

Interventions

A two-hour Palliative Care Overview utilizing End of Life Nurse Education Consortium (ELNEC) education materials, implementing multi-modal adult education (Instructional video, handouts, verbal education, case studies). A Consent Informational Letter is included with the surveys at the time of presentation. The principal investigator distributes a Six-Month Post Education online survey via HonorHealth email, providing QR code and survey link to HHNGRNs who received Palliative Care education beginning August 2023. Survey connected to HHNGRN through HealthStreams.

Results

133 surveys were completed. For, “number of times you explained Palliative Care to someone in your nursing practice”, 39% (52) replied 1–2 times. For, “number of times you transitioned a patient onto comfort care in your nursing practice” 44% (59) responded 1–2 times. For, “number of times you used symptom management information provided in Palliative Care overview in your nursing practice”, 35% (47) responded 1–2 times. For “number of times you discussed code status changes or Advanced Directives in your nursing practice”, 47% (63) responded 5 times or more. For “number of times you recommended a Palliative Care consult in your nursing practice”, 34% (48) responded 1–2 times. For “number of times you used statements in Palliative Care overview to begin or facilitate difficult conversations in your nursing practice”, 40% (58) responded 1–2 times. For “List one thing you learned that you used in your nursing practice”, responses included; know what questions to ask the patient and family (22), how to have tough conversations (16), able to better explain Palliative Care versus Hospice to patients and families (16), difference between Hospice Care and Palliative Care (19), advocate for my patients (13), and provide better education about Palliative Care (14).

Discussion

Adjustments to the Palliative Care Overview for the HonorHealth New Graduate Resident Nurse will be made based upon the evidence and feedback obtained from the Palliative Care Overview evaluation.

Oncology Nursing Forum. 2025 Mar 1;52(2):77–78.

P122. The Dynamic Duo: Fast Track Triage and Fast Track LPN Improving Infusion Efficiency

Alexa D’Alessandro-Fisher ¹, Briana Mulava ², Lisa Fidyk ³, Melanie Zisa ⁴, Erika Viggiano ⁵, Milena Polizzi ⁶

Healthcare Delivery

Significance & Background

The growth in suburban ambulatory care settings has opened the door to the development of innovative strategies to enhance operations and care. Budget constraints and the great resignation created an interesting opportunity to redefine infusion roles and entry of new-to-practice nurses within the infusion suite.

Purpose

In 2022, the implementation of a dedicated fast track triage RN allowed for timely order verification, lab review, communication with clinical team members and confirmation of appropriate scheduling. This effort optimized triage operations however with continued volume growth, infusion chair and/or nurse availability began to hinder fast track throughput. Evaluation of satisfaction scores, wait time and staffing uncovered the need to refocus on the fast-track population.

Interventions

With leadership endorsement, a new-to-practice LPN infusion role was developed to support the treatment of fast-track patients which include injections, port flushes, port lab draws and short infusions with the exception of chemotherapy, monoclonal antibodies, and titratable drugs. Two senior nurses created a nurse residency program built around the oncology population. This program focused on the development of the LPN to help enhance knowledge and hands-on experience needed to provide competent and high-quality care within scope. It also includes built-in mentors and access to support systems within the organization. The program is designed around ten competencies: Mastery of clinical skills, critical thinking, patient safety, leadership, communication, evidence-based practice, patient/ family centered care, professional development, understanding of operations, and education. Staff education on roles and responsibilities of the LPN was performed in addition to the development of treatment guidelines and orientation documents.

Results

The nurse residency program spans over one year with monitoring of a variety of goals that are to be reached as the year progresses. Surveys and wait time data collection is ongoing to measure success of the infusion LPN role and residency program. Progress has been demonstrated thus far with a 2-minute reduction in infusion wait time within 3 months of the LPN orientation.

Discussion

Introduction of an LPN role met the operational, clinical and budgetary needs for this center. In addition, the newly created nurse residency program helps prepare new-to-practice nurses to integrate new skills and competencies into caring for the growing and ever-changing oncology population.

Oncology Nursing Forum. 2025 Mar 1;52(2):78–79.

P123. Hematology Focused Education Series: An App to RN Investment

Amanda Dailey-Hansen ¹, LeAdelle Maez ²

Professional Development

Significance & Background

Hematology and Bone Marrow Transplant (BMT) nurses provide care to a complex population. However, specialty training for this population is often lacking in standardized nursing education programs. In one academic medical center, no additional specialty training, beyond basic unit orientation, is provided by the institution for nurses working with this population. This lack of specialty training from the institution could negatively affect patient outcomes and decrease RN confidence and morale.

Purpose

The purpose of this professional development initiative was to provide specialty focused training for hematology and BMT RNs on topics unique to the population. These included disease pathophysiology, treatment and oncologic emergencies among others. Education was delivered by APPs in the area to foster interdisciplinary collaboration between the RNs and provider teams.

Interventions

Pre-surveys were sent in November 2023 focusing on staff confidence in hematology specific diseases, treatments, patient education, and nurse confidence level in approaching APPs. A topic list was developed and then assigned to APPs within the department to provide NCPD approved education to the RNs for twelve occurrences. A mid-intervention survey was sent to the RNs in Sept 2024 to evaluate progress. Plans for a final evaluation have been set on series completion in March 2025.

Results

Pre-implementation data collected on a scale 1–5, 1 least and 5 most confident; showed RNs report caring for heme patients at 3.83, disease understanding at 2.83, patient education at 2.22, provider interaction at 3.67, and understanding disease treatment at 2.94. Mid-implementation data show improvement in all areas. Post-implementation data is to be collected in March 2025. Informal qualitative feedback from staff has been highly positive and nurses are grateful for APP investment around supporting specialized nurse training in these areas.

Discussion

In conclusion, we have seen a positive impact and response from RNs to an APP led educational series focused on hematology and BMT topics. Improvement in all measured areas has increased. Confidence in interacting with the unit APPs has remained stable but we hope to see further improvement here with post-implementation data. Future areas for study from this project could include evaluating patient outcomes and nurse retention rate on the unit.

Oncology Nursing Forum. 2025 Mar 1;52(2):79.

P124. Improving Ambulation Rates for Adult Oncology Patients Using an Evidence-Based Framework

Stephen Daily ¹, Taylor Melton ², Erica Alessandrini ³

Quality and Safety

Significance & Background

Hospitalized oncology patients at a large urban academic hospital spend most of their time in bed. Only about 50% of ambulatory patients have mobility activities and ambulation occurrences documented in their electronic health record (EHR). Prolonged immobilization leads to patient deconditioning and declines in functional status, as well as increases in hospital lengths of stay and an increased risk of readmission, all of which contribute to higher healthcare spending. Research shows that enacting nurse-driven mobility protocols or toolkits successfully improves patient outcomes.

Purpose

The purpose of this Quality improvement (QI) project is to increase documented mobility interventions and ambulation rates among adult patients on an oncology unit by instituting the Mobilizing adults Via a systems-based Intervention (MOVIN) framework.

Interventions

The QI initiative occurred on a 29-bed adult medical/surgical oncology unit. Patient eligibility was determined by nursing every shift, with the target population being patients who can ambulate with little to no assistance. The MOVIN framework contains five components to enhance mobility: ambulation environment, psychomotor skills training, communication tools, resource allocation, and a unit culture of mobility. The unit was measured in feet, and distance markers were established to objectively measure the distance walked and guide the creation of an ambulation pathway. A three-hour psychomotor training to educate staff on patient mobility and safe handling was offered by physical therapy throughout project implementation. Whiteboards in patients’ rooms were utilized to communicate patient’s mobility goals. Resource allocation included ambulation equipment and the use of a designated mobility aide. The unit culture was supported by encouraging staff and motivating patients to track the distance walked, with small prizes and staff recognition used as incentives.

Results

Preliminary findings to date suggest that 66% of eligible staff received psychomotor training, an average of 33% of staff utilized the in-room white boards for goal setting, and an average of 77% of patients had documented mobility interventions, with a median ambulation count of one walk per day. This QI project is expected to enhance the overall frequency of patient ambulation, increase the distance walked, and improve ambulation documentation.

Discussion

Enacting interdisciplinary, evidence-based nurse-drive mobility protocols or toolkits are successful in improving patient mobility and ambulation. Unit budgets and staffing must be considered when implementing new quality initiatives.

Oncology Nursing Forum. 2025 Mar 1;52(2):79–80.

P125. Optimizing Epic Communications in Transfusion Review

Erin Darby ¹, Sara Manley ², Tammy Arce ³, Ping Song ⁴, Angela Cotner ⁵, Anette Hjalmarsson ⁶

Coordination of Care and Navigation

Significance & Background

The integration of blood product workflows is essential to best care of cancer patients. A community cancer center, serving ~70 infusion patients daily and affiliated with an NCI designated comprehensive cancer center (CCC), identified gaps in communication and documentation across departments relative to transfusions. A review of patient transfusion data over 60 days demonstrated blood orders were being sent to the blood center too early or too late causing high percentages of blood products being returned to the blood center or long patient wait times resulting in delayed care on the infusion unit. Excellent communication is essential in providing timely, effective, and safe patient care to cancer patients in need of transfusions. Ineffective communication results in delayed care, poor blood product utilization, and decreased patient and staff satisfaction.

Purpose

To describe the development of a standard transfusion review workflow that comprehensively improves effective and efficient blood product administration for cancer patients.

Methods/Interventions

An Interdepartmental Communication Improvement Committee organized of clinic and infusion nurses, patient access staff, and leadership and administration convened with the intention of creating a standardized workflow. Assessment demonstrated absence in communication in EMRs (Epic), and utilization of Secure Chat limited visibility and accessibility across departments to any transfusion review work that was being done. A workflow was developed for clinic nurses to run a daily report of next day scheduled transfusions. Within the workflow options were structured to guide nurses to ensure various scenarios were assessed and appropriate clinical decisions implemented. A communication template (dotphrase) was established in Epic to assure essential documentation occurred for shared universal clinical visibility and patient care monitoring.

Results/Evaluation

The Clinic Nursing Supervisor and Clinic Charge Nurse piloted the new process for 30 days prior to team implementation. In the six months since implementation, infusion nurses report the new documentation process is integral to guide planning and administration of transfusions. The blood center reports a decrease in the percentage of returned blood products. Clinic nurses reported efficiency in determining monitoring and follow up care.

Discussion

Interestingly, implementation of the transfusion review workflow and documentation visibility resulted in more same day transfusion cancellations due to increased same day lab result assessments finding an increased number of unneeded transfusions. Clearly improving patient outcomes is best served by comprehensive documentation and communication.

Oncology Nursing Forum. 2025 Mar 1;52(2):80.

P126. Work Smarter not Harder: Optimization of an Oncology Signs & Symptoms Flowsheet for Infusion Nursing Documentation

Lindsay Darling ¹, Kristin Leonardi-Warren ², Jennifer Zaccone ³

Healthcare Delivery

Significance & Background

With increasing demands on registered nurse (RN) time, it is vital to identify efficiencies. The electronic health record (EHR) across an outpatient oncology infusion service line at a large academic medical center did not support clear and concise documentation of treatment toxicities.

Purpose

The purpose of this project was to optimize a signs and symptoms flowsheet with the EHR to utilize within defined limits (WDL) batch charting.

Interventions

A system-wide taskforce evaluated documentation requirements, removed redundancies, and enhanced a flowsheet to accurately capture toxicities specific to oncology patients receiving treatment. Body systems were created to consolidate pertinent oncological symptoms. Definitions for the WDL criteria of each body system were established and enhancements were made to clearly depict abnormal symptoms with the ability grade the symptom in alignment with the Common Terminology Criteria for Adverse Events (CTCAE). Lastly, options to document “not applicable (N/A)” or “unable to assess (UTA)” were added to remove assumptions for blank fields.

Results

The project condensed 52 rows requiring documentation to eight body systems. With the incorporation of WDL statements, N/A, and UTA, RN documentation requirements have decreased and been clarified. Previously, blank rows led to confusion because some RNs documented in every single row (even if a symptom was absent) whereas others documented only abnormalities. Following the optimization, it is easier to review trends in patient toxicities.

Discussion

Additional data will become available within the coming months as the new flowsheet is integrated. RNs have expressed excitement for clarity and efficiency in documentation. Patients are often treated at various locations across the health system, so consistency in documentation will facilitate communication between care teams. The hope is the optimized flowsheet will allow RNs to accurately capture pertinent findings in a timely manner, thus allowing them more time to focus on the vital and rewarding patient care.

Oncology Nursing Forum. 2025 Mar 1;52(2):80–81.

P127. Explore: An Initiative to Expand and Enhance Oncology CNA’s Professional Growth And Development

Sarah Davis ¹, Corey Schuller ²

Management

Significance & Background

Certified Nursing Assistants (CNAs) are an integral part of the oncology care team, yet there are limited opportunities to expand their knowledge and promote professional growth related to the care of oncology patients. Professional development for this group is critical as they contribute to positive patient experiences and outcomes.

Purpose

A team of inpatient clinical nurse educators developed a curriculum for CNAs to provide ongoing education about foundational oncology concepts and support their care of patients and their families.

Interventions

Topics for the curriculum were identified through needs assessments, audits, and event reports, as well as direct CNA feedback. The focus was on oncology basics, infection prevention, skin/pressure injury prevention, manual blood pressures, sensory loss, medical emergencies, symptom management, specimen collection, orthostatic blood pressures, and CHG bathing. Active learning techniques were utilized with short bursts of content (10 minutes) through online activities and learner immersion experiences (e.g., scavenger hunt, crossword puzzles, interactive activity rooms, games, and hands-on skill practice). Activities were designed to be completed independently during scheduled shifts. The importance of the CNA role as a member of the healthcare team was emphasized in this learning-centered training. New lessons were offered each quarter.

Results

CNA participants submitted their completed activity to their educator to promote additional discussion and support for the concepts learned. Participation was tracked through an online learning management system. Post-surveys were conducted after the lessons to validate the effectiveness of and engagement in the activities. Future learning needs we also assessed. Post-course surveys provide evidence that these self-guided learning activities were valued and effective. In fact, open-ended comments revealed some CNAs were inspired to go back to school to become a nurse or pursue a role in another healthcare profession.

Discussion

This novel CNA educational program contributes to the professional growth and development of an often invisible group of healthcare team members. CNAs spend considerable time at the bedside and are often the care provider with the most patient interactions. Importantly, CNAs can bridge the gap between patients and other members of the interdisciplinary team. This can have a positive impact on patient care. For example, earlier intervention because of CNA observations can lead to better patient outcomes. More formal evaluation is needed to understand the impact of CNA education and empowerment.

Oncology Nursing Forum. 2025 Mar 1;52(2):81.

P128. Beefing Up Awareness: Navigating Alpha-Gal Syndrome

Mary Elizabeth Davis ¹, Amelia Chan ², Katherine Vicinanza-Rickard ³, Rebecca Razel ⁴

Quality and Safety

Significance & Background

Alpha Gal syndrome (AGS) is an acquired allergy caused by an IgE-mediated reaction to alpha-gal, or galactose-α-1,3-galactose, a sugar molecule found in mammalian meat such as beef, lamb, rabbit, pork and venison. It is also found in animal-based products such as milk, milk products and gelatin. It is believed to occur after one is bitten by the lone star tick; however, current evidence is pointing towards other tick species as vectors. When exposed to alpha-gal, symptoms (which can be delayed) include hives, urticaria, angioedema, abdominal pain, nausea, vomiting and diarrhea. Anaphylaxis may also occur. Clinicians’ awareness of this syndrome is crucial as many medications contain animal products, for example, some heparin preparations can contain bovine or porcine sources. Specific to oncology, cetuximab, a chimeric monoclonal antibody targeting the epidermal growth factor receptor (EGFR) contains alpha-gal and can cause severe life-threatening infusion reactions.

Purpose

The purpose of this presentation is to bring awareness to this growing allergy and its impact on oncology treatments. Development of an algorithm for diagnosis, education, medication reconciliation and close collaboration with pharmacists is warranted.

Interventions

At this National Cancer Institute-Designated Cancer Center, a near-miss in administering heparin to a patient with suspected AGS prompted a workflow to effectively screen and manage medications for patients with AGS. Education for both staff and patients was developed.

Results

Oncology providers now have access to a pharmacy workflow, which includes a review of patients’ current and newly prescribed medications. If a desired medication is contraindicated, the pharmacist may suggest using an alternative medication, adding premedications, consulting an allergist, or proceeding with the requested medication with an escalation of monitoring.

Discussion

Alpha Gal syndrome is a growing concern for oncology providers. To effectively manage patients with AGS, education for patients and staff is crucial. Patients need to avoid mammalian meat and dairy products, avoid products and medications that contain alpha-gal or mammalian protein-derived additives, and report any allergy symptoms. Clinicians should treat the patient for allergic reactions as clinically appropriate.

Oncology Nursing Forum. 2025 Mar 1;52(2):81–82.

P129. LVAD Basics for Infusion Nurses

Kim Davis-Mitchell ¹

Management

Significance & Background

The increasing prevalence of advanced heart failure in oncology patients receiving outpatient treatment necessitates the infusion nursing staff’s ability to manage patients with left ventricular assist devices (LVADs). This includes comprehensive assessment, device management, complication anticipation, emergency intervention, and patient/caregiver education.

Purpose

To enhance infusion nurses’ confidence and competence in caring for patients with left ventricular assist devices (LVADs) through targeted in-service training and skills assessment, thereby reducing their anxiety levels and improving patient outcomes.

Interventions

Infusion nurses completed a pre- and post-survey to determine the knowledge gap. Survey responses were used to assess nurses’ perception of their competency level, taking into consideration prior LVAD training or experience and competency in using a doppler to obtain blood pressure/return to flow readings. LVAD in-service training and a skills competency assessment checklist were developed. Ongoing in-service training and skills competency are conducted by Unit Nurse Champions/Nurse Educators to ensure proper documentation in the EMAR, emergency response and interventions and the need for additional training.

Results

Nurses who received LVAD training expressed a reduction in anxiety when caring for this patient population.

Discussion

With the expanding use of LVADs, infusion nurses are increasingly encountering patients with medical or device-related complications in outpatient settings. Comprehensive knowledge and training are essential for nurses to provide patient-centered care and respond effectively to emergency situations. Ongoing in-service training and skills assessments are crucial to ensure that all nurses possess the necessary competencies to deliver safe and effective care to LVAD patients, particularly during emergencies.

Oncology Nursing Forum. 2025 Mar 1;52(2):82.

P130. Novel Trends in the Multi-Disciplinary Clinic Regarding the Treatment of Patients with Non-Metastatic Prostate Cancer

Sandy Decembre ¹, Anne Saint-Louis ², Alwine Acolaste ³, Erica Scott ⁴, Debrah Rigg ⁵, Shatreese Brown ⁶

Coordination of Care and Navigation

Significance & Background

The traditional sequential appointment process for newly diagnosed cancer patients often results in significant delays. Prostate cancer patients have different options for treatment ranging from surgery, radiation, chemotherapy, and observation at presentation or even bimodality treatment (surgery followed by radiation therapy). This necessitates a high level of care coordination and visits with multiple providers. A multi-disciplinary clinic (MDC) visit addresses these concerns by allowing providers from relevant specialties to meet with the patient during a single visit, offering a comprehensive, holistic care experience. By the end of the visit, the patient is presented with a complete initial treatment plan, significantly reducing both the time to treatment and the need for multiple appointments.

Purpose

This study describes an innovative multidisciplinary practice model treating non-metastatic prostate cancer in an academic tertiary medical care center. This project aimed to enhance patient care by incorporating a multidisciplinary approach to reduce the time to consultation for new patients to meet with cancer specialists, decrease wait times for a comprehensive treatment plan while also increasing collaboration among the multidisciplinary care team.

Interventions

Urology MDC Clinics across different institutions were shadowed to refine clinic workflows. A clinic template for appointments and standard work for clinic preparation and flow were created. Standard post clinic care coordination was created to track patient decision making, satisfaction and timing for scheduling. Also, designated patient care coordinators were assigned to gather records and schedule patients during visits as needed for continuity of care.

Results

The MDC has enhanced patient outcomes and satisfaction. Between November 2023 and July 2024, 73 patients were seen in the MDC clinic. Three nurses have been trained to run the MDC clinic. Patients chose a variety of treatment options: four chose high-intensity focused ultrasound, nine chose radical prostatectomy, thirty-three chose external beam radiation, one chose internal beam radiation, seven chose outside treatment, two were not candidates and thirteen remained undecided.

Discussion

Patients are now able to discuss multiple treatment options such as radiation, surgical, active surveillance, and or medical oncology, in a single visit with physician experts in each discipline. This allows for treatment decision-making to occur more rapidly and collaboratively.

Oncology Nursing Forum. 2025 Mar 1;52(2):82–83.

P131. Creating a Collaborative Learning Environment Through an Academic-Clinical Partnership on a Bmtu for Student and Clinical Nurses

Jamie Dees ¹, Bryce Catarelli ², Dannielle Obermeier ³, Karen Schofield ⁴

Management

Significance & Background

Specialty areas of nursing, including oncology, struggle with the engagement of student nurses who may not have extensive exposure to this patient population in the classroom setting. Open and collaborative partnerships between academic centers and specialty clinical units can create an encouraging learning environment and increase engagement for both students and clinical nurses. The positive impact of these academic-clinical partnerships (ACP) can extend well beyond the bedside and the classroom. Per AACN, ACPs are most successful when based on mutual goals, respect, and shared knowledge which fosters a commitment to lifelong learning and culture of trust.

Purpose

This project’s purpose was to enhance an ACP on a specialty oncology unit in the hospital setting through intentional collaborative efforts between nursing faculty and unit leadership. Through this partnership, the project team hoped to enhance student nurse clinical experiences, to increase awareness of the oncology specialty unit and patient population amongst student nurses, and to increase collaboration on unit-based quality improvement and research projects.

Interventions

Over the past 4 years, a partnership was created based on mutual investment, shared vision and expectations, and frequent and meaningful engagement. Students were actively included in weekly unit huddles, provided curated unit-based education to enhance preparation, and engaged with unit leadership on topics such as code management, professional development, and hiring processes within the hospital. Unit leadership provided guest lectureships in various courses and speaking engagements within student nursing organizations.

Results

Collaboration among faculty, the oncology unit leadership, and the clinical staff has created a favorable learning environment, increased engagement of students and clinical nurses, and produced highly desired student clinical experiences. This ACP has also led to increased recognition of clinical nurses in the academic setting: two clinical nurses were awarded preceptor of the year awards, increased applicant pool for clinical positions, and laid the foundations for the development and execution of a grant-funded published research project.

Discussion

Continued investment from both the academic and clinical setting is needed to sustain this type of partnership. Through development of more ACPs, clinical faculty and unit leadership hope to change attitudes towards clinical experiences and develop meaningful collaboration among both parties. Creating bonds between students and clinical nurses will aim to increase students’ confidence and engagement and possibly lead to improved retention and recruitment at the unit level.

Oncology Nursing Forum. 2025 Mar 1;52(2):83–84.

P132. Creative Opportunity to Support Caregivers

Anne Delengowski ¹, Caroline Glavin ²

Psychosocial Dimensions of Care

Significance & Background

The evolution of the caregiver for cancer care is ever changing. From the physical issues related to caregiving to the many psychosocial issues needing be addressed. Often the need is there for supporting this population but this comes with challenges. The challenges include the ability to access the group and support for patient when caregiver attends the group.

Purpose

The purpose of this project was to address the barriers to allow for support for the caregivers. The focus was emotional, psychosocial support and addressing educational needs of caregivers.

Interventions

A virtual caregiver session was established by the oncology clinical nurse specialist and the oncology social worker. In addition to the emotional, psychosocial support, the leaders would assess educational needs and needed support for other issues related to caregiving.

Results

In order to overcome the challenges related to caregivers accessing the group, the initial decision was to have a hybrid group, both in person and virtual. As very few attended in person, the decision was to do the sessions virtually. This has been successful with sessions at noon allowing time for those working to attend. Assessing educational needs, it was noted that participants had issues with physical issues related to caregiving, financial related issues, nutritional issues, and legal issues. The topics were driven by the caregivers’ verbalization of issues related to caregiving. To date, educational sessions have included physical therapist education on body mechanics related to best interventions for mobilizing patients, legal aid assistance and nutritional issues. Additionally a session was held introduce our supportive department which allowed the participants to gain knowledge into resources available. The session also allowed participants to verbalize the best way to receive information on hospice and palliative care.

Discussion

The monthly caregiver group has been meeting for over two years. A challenge with the group is supporting individuals who are a different points in the caregiver trajectory. The group has been together over enough time that progression of disease and EOL issues were addressed. The group supports each other with relatable issues and potential solutions. The leaders support the group between sessions with resources follow-up phone calls as needed.

Oncology Nursing Forum. 2025 Mar 1;52(2):84.

P133. Implementing an Oncology Nurse Residency Program to Improve Competence and Retention in New Graduate Nurses

Michelle Della Serra ¹

Professional Development

Significance & Background

Nurse Residency Programs are essential for improving retention and confidence in new graduate nurses. Overall new graduate nurse retention for our institution from June 2022–May 2023 was 89.5%, however, the inpatient oncology unit only had a 40% retention rate over the same period. To improve retention and graduate nurse confidence, an Oncology Focused Nurse Residency Program was designed and implemented.

Purpose

In 2023, an Oncology Nurse Residency Program was designed for our institution to help reduce new graduate nurse turnover and low confidence in an inpatient oncology unit. This program was to be used in conjunction with the existing hospital-based Nurse Residency Program. The purpose of this program was to focus on disease specific education combined with simulation to improve competence and confidence in graduate nurses hired to an Inpatient oncology unit. The long-term goal was to improve retention of newly hired graduate nurses in inpatient oncology.

Interventions

We created a 24-week program which incorporated disease by site education to be done weekly during their initial orientation period and the first two months off orientation. This program incorporated didactic content, post-tests, and simulations to ensure a well-rounded educational program. As the content was structured into the existing orientation period and done during a scheduled shift, this reduced the financial burden of the program.

Results

The Oncology Nurse Residency Program was evaluated based on Confidence surveys completed by the new nurse at hire and at 6 months. We also tracked retention rates post implementation and Jane Oncology Assessment scores pre and post implementation. The Oncology Nurse Residency Program helped to close the knowledge gap that our newly graduated nurses had in oncology. This program improved retention rates from 40% to 100% in one year and improved new nurses’ confidence in Oncology Care, allowing for earlier introduction to chemotherapy administration than was previously possible. Average scores in the Jane Oncology Assessment Pre-Residency program were 58% and post program scores increased to 70% at 6 months.

Discussion

The Oncology Nurse Residency program provides clear benefits in nurse retention and confidence, with new nurses showing improvement in Oncology Assessment scores at 6 months. After the conclusion of the Oncology Residency Program, when surveyed, all nurses expressed a strong commitment to the organization and planned to remain with the department for at least another year.

Oncology Nursing Forum. 2025 Mar 1;52(2):84–85.

P134. Bridging the Gap: Ambulatory Pediatric Populations Receiving Infusion Therapy

Caitlin Dematteo ¹, Erin McGarry ², Jaclyn Andronico ³

Healthcare Delivery

Significance & Background

Pediatric cancer is a growing population within the oncology health care system. Patients strive to receive treatment closer to home and prioritize quality of life. At one NCI designated cancer center, the pediatric population volume grew in the regional infusion site locations. This led to the demand for more nurses to treat the increasing number of pediatric patients in the infusion units. Due to their various geographic locations across 2 states, there were variations in practice and standards of care. Standardizing care involves addressing several key challenges to ensure effective and safe care.

Purpose

A committee of pediatric nurses at 7 regional sites was created to improve practice and standardize workflows in caring for pediatric patients in the outpatient setting. The group’s goal was to transform the culture into one of continuous improvement in this population.

Interventions

A committee of 38 nurses, inclusive of staff nurses, clinical nurse specialists, advanced practice providers, nursing professional development specialists and nursing leadership began meeting in January of 2024 to improve pediatric patient care, workflows and nursing practice in the regional sites. The meetings also included various interdisciplinary members, such as pharmacy and child life specialists.

Results

This group began the standardization process for patient visits at all sites, including streamlining the selection of supplies used for pediatric patients. It also identified knowledge and skills gaps in different areas. Pediatric education was developed to increase and maintain competencies. Discussion of pediatric patient assignments took place to improve the patient experience and balance workload distribution. The group identified gaps in the management of hypersensitivity reactions (HSR). The future state is looking to refine the HSR medication sheets. The group initiated additional taskforces to address practice issues and review relevant evidence, specifically around peripheral vesicant administration. The committee also reviewed case studies of patient emergencies to identify areas of opportunity to improve future responses.

Discussion

As the pediatric cancer population continues to grow, nursing staff are at the forefront of ensuring they have safe and effective care. Creating a committee using the shared governance model is a great way to address variations in practice across multiple outpatient sites. This committee can be instituted at any outpatient health care setting with multiple sites that treat pediatric patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):85.

P135. Impact of Social Drivers of Health on Cancer Treatment Decisions: A National Survey of Multidisciplinary Care Team Members

Kimberly Demirhan ¹, Elana Plotkin ², Editha Krueger ³, Molly Kisiel ⁴

Psychosocial Dimensions of Care

Significance & Background

Social drivers of health (SDOH) are individual factors that influence a person’s health outcomes. In cancer care, SDOH can affect a person’s ability to complete treatment or to participate fully in clinical trials, limiting access to high-quality care and optimal outcomes. Socioeconomic factors have been implicated in access to care, but the role of SDOH in treatment decisions remains unclear.

Purpose

This study aimed to assess the influence of SDOH factors, such as transportation challenges and financial burdens, on the selection of guideline-concordant treatment for patients with cancer.

Interventions

The Association of Cancer Care Centers (ACCC) conducted an online survey in January/February 2024 targeting healthcare professionals to assess their screening practices of SDOH and how that information affected their treatment choices for their patients. A total of 247 healthcare providers responded to the survey, including oncologists (n=138), nurses (n=47), social workers (n=24) and advanced practice providers (n=6). Respondents were from 42 states and practiced in urban (61%), suburban (31%) and rural (9%) settings.

Results

The survey revealed that SDOH screening typically occurs early in the patient’s care journey, with screening at diagnosis (75%) and at the beginning of treatment (60%) being the most common. However, follow-up screening is less common, with only 36% of practitioners screening when the treatment plan changes, and only 0.8% screening at the end of treatment. The survey also found that the health care team frequently consider financial factors (71%) in treatment decisions as well as caregiver availability (72%), transportation barriers (67%), and housing stability (62%). Cultural (54%), language (43%), and educational (43%) considerations were less common factors in treatment decisions. The most common screening tools include social worker evaluation (28%), NCCN Distress Thermometer (22%), and clinic designed survey/tool (20%). Social workers (77%), nurses (69%), and patient or nurse navigators (60%) were the most likely to participate in discussions about SDOH with patients.

Discussion

This survey highlights several opportunities to improve screening and integrate these factors into cancer treatment decisions. More frequent and comprehensive screening throughout the treatment process could ensure better alignment between patient needs and care delivery, helping to make high-quality cancer care more accessible to all. Addressing a broader array of SDOH factors, like cultural considerations and health literacy, could enhance outcomes, especially in underserved populations.

Oncology Nursing Forum. 2025 Mar 1;52(2):85–86.

P136. To PPE or not PPE? That is not the Question

Daija Dennis ¹

Management

Significance & Background

Nurses strive to provide competent and efficient care to their patients. To increase efficiency, some nurses forgo donning personal protective equipment (PPE) while administering antineoplastic drugs to save time. This decreased PPE use poses significant health risks, including mutagenic and teratogenic effects. It is imperative to preserve and promote the health of frontline healthcare workers by educating and implementing changes that promote increased PPE use.

Purpose

To assess current PPE compliance, understand barriers, and increase proper PPE adherence by nurses while administering hazardous drugs in the outpatient oncology infusion setting through re-education.

Interventions

For two months, nurses in the infusion center were randomly observed while preparing to administer antineoplastic drugs to assess PPE adherence. Proper PPE use was defined as donning two pairs of chemotherapy-resistant gloves that cover the wrist and a chemotherapy-resistant gown. Nurses were scored with either a ‘Y’ or ‘N’ to denote proper or improper PPE use. Following observations, nurses were re-educated during morning huddles, and an in-service was held for hands-on re-education of PPE donning and doffing techniques. Educational posters were displayed in PPE donning areas to reinforce compliance. Nurses were also surveyed to better understand the factors influencing their PPE adherence.

Results

Pre-intervention, 40% of nurses were observed properly donning PPE before administering hazardous drugs. Twelve nurses attended the PPE in-service. Post-intervention, adherence decreased to 30%. Survey responses revealed that time management, burnout, and potentially fixed mindsets contributed to PPE noncompliance. Despite the decrease, nurses expressed understanding and respect for the importance of proper PPE use.

Discussion

Increased nurse turnover during the observation period may have affected the results. Although the goal of the intervention was not met, PPE use remains crucial in the outpatient oncology infusion setting to protect nurse safety. The primary barriers to increasing compliance appear to be behavior change and addressing beliefs. Quarterly observations will continue to monitor PPE adherence, while leadership works to address the barriers, including time management and burnout. Future efforts will focus on addressing these challenges to create lasting improvements.

Oncology Nursing Forum. 2025 Mar 1;52(2):86.

P137. Multidisciplinary Communication and Monitoring with Cardiac Devices in Radiation Oncology

Cassondra Derck ¹

Radiation

Significance & Background

Cardiac Devices, such as ICDs or Pacemakers, have potential for interference with function of their device during radiation treatments. Vital communication and standard protocol are needed between Device Clinic staff and Cancer Radiation Center staff so that patients can be appropriately treated and monitored with the devices.

Purpose

The purpose of our work was to have a standardized communication form, protocol for monitoring, and need of magnet over devices when treating radiation patients.

Interventions

Every patient with a device will have message sent to device clinic asking for recommendations based off the fractionation and area of radiation treatment. Protocol established by radiation oncologist and cardiologist is followed for frequency of device checks, magnet use, and if device representative is needed during treatment. Those that would receive over 5Gy to device will be treated at a facility within a hospital that have extra monitoring available. Spreadsheet for all radiation oncology staff is shared with device patient information. Alert is placed in radiation charting system that device is present. On treatment visit notes indicate if there is presence of device and how often it should be checked. Nurses send device communication and checks during treatment to oncologist.

Results

In 2024, there were 15 patients that had devices that were treated with radiation. Protocol was followed for communication, monitoring, and treating with devices.

Discussion

Standard communication and protocol between radiation oncology and device clinic staff has ensured that patients are being treated and monitored appropriately during radiation. Staff at both facilities have clear guidance to which patients are higher risk that have potential to be treated elsewhere.

Innovation

In 2023, Radiation Oncologist collaborated with Cardiologist on a protocol for all staff to follow for magnet use, frequency of monitoring during radiation, and specifying high risk patients. The new protocol has made it clear for radiation staff if patients need to be referred out due to being high risk and if magnet should be utilized. Device spreadsheet has made it easy for radiation staff to have all device patients and their device information in one place. Fall out for monitoring by documentation of checks has been improved since adding device information into weekly on treatment visit notes.

Oncology Nursing Forum. 2025 Mar 1;52(2):86–87.

P138. New Anti-Cancer Treatments: Standardization of Drug Onboarding at A Large Ambulatory Oncology Center

Crystal Derosier ¹, Jacqueline Tuskan ², Megan Corbett ³, Jennifer Servant ⁴, Gayle Blouin ⁵, Bridget Scullion ⁶

Healthcare Delivery

Significance & Background

Oncology is a rapidly evolving field, introducing new life-saving therapies often monthly. This requires clinical teams to stay abreast of new knowledge required to advance safe clinical practice. At a large ambulatory oncology center, newly Food & Drug Administration (FDA) approved anti-cancer drugs are reviewed for formulary at interdisciplinary oncology meetings. Meetings are comprised of medical, pharmacy and nursing leadership. Once approved there is an immediate need to administer to improve survival or quality of life. This urgency has led to uncoordinated, rushed, and siloed work to onboard new anti-cancer drugs. Interdisciplinary efforts are needed to occur to safely “onboard” and administer newly approved anti-cancer drugs at adult ambulatory oncology clinics.

Purpose

To establish a standardized process to onboard newly approved anti-cancer drugs at a large ambulatory oncology clinic.

Interventions

A reoccurring, monthly nursing and pharmacy workgroup was initiated following interdisciplinary oncology meetings to discuss the onboarding of newly approved anti-cancer drugs. The group developed a standardized, comprehensive checklist to ensure crucial tasks were completed prior to the first administration of drug. The checklist established deadlines, standardization, and accountability for the workgroup.

Results

The workgroup prioritized optimization and standardization for new drug onboarding. Elements of onboarding new drugs were defined as infusion pump programming, treatment plan (orders), scheduling guidelines, patient education, and clinical team education. The team established a shared online space for storing critical documents. Evaluation of group membership was imperative to ensure inclusive and comprehensive representation from nursing and pharmacy leadership. This allowed for a broader range of perspectives and expertise, leading to more efficient decision-making. Practice implications included interdisciplinary communication pathways for provider, pharmacy, and nursing teams.

Discussion

Establishing an interdisciplinary workgroup and new drug onboarding checklist standardizes workflows to optimize patient safety. Ongoing checklist and workflow reviews are necessary to address emerging issues or changes based on evidence and clinical team input. The workgroup structure mitigates, known challenges with new drug onboarding, thus providing clarity and enhancing patient safety and team satisfaction.

Oncology Nursing Forum. 2025 Mar 1;52(2):87–88.

P139. Serenity in the Storm: Stress Transformation in A High-Stress Oncology Unit

Kimako Desvignes ¹, Herson Portillo ², Teresa Tandoc ³

Management

Significance & Background

This is a 63-bed unit specializing in oncology, BMT, cellular therapy, hospice, and PCU care. The unique patient population results in a significant psychosocial burden for staff due to the high acuity of clinical conditions and complex family dynamics. Staff face constant psychological and physiological pressures, leading to compassion fatigue—physical and mental exhaustion caused by prolonged caregiving (Ortega-Campos et al., 2020). Chronic exposure to stressful situations often causes oncology nurses to adopt passive coping strategies, such as emotional avoidance or turning to substances, which can have detrimental effects (Payson & Webb, 2022). Without proper intervention, this can also compromise patient safety.

Purpose

The goal was to create a dedicated space where staff could relax, unwind, and focus on self-care during their shifts to combat burnout and compassion fatigue.

Interventions

A proposal was made to convert a closed patient and family room into a serenity room where multiple staff members could meditate, stretch, and decompress without interruptions. To support this vision, massage chairs were ordered, a badge reader was installed, and the space was renovated with new paint and flooring. On September 12, 2022, staff were informed about the plan to create a peaceful, secure space. A survey was launched to involve staff in naming the room and designing its signage, with prizes for the top suggestions. The Serenity Suite officially opened on May 10, 2023, during Nurses Week. It features two massage chairs, aromatherapy, soothing music, wall art, a zen artist board, relaxation tools, and a QR code for staff to track usage.

Results

Between May 11, 2023, and September 10, 2024, 159 staff members used the Serenity Suite, with a satisfaction rating of 4.99 out of 5. Before using the space, staff reported feeling stressed (130), anxious (79), or exhausted (102). Afterward, most felt calm (114), relaxed (125), and less stressed (102). These results demonstrate the suite’s effectiveness in improving staff well-being by reducing stress.

Discussion

The Serenity Suite successfully addresses a critical need in supporting staff well-being. By offering a dedicated space for relaxation, it helps prevent burnout and compassion fatigue, which in turn enhances patient care. Future steps include expanding access to wellness resources and tracking long-term outcomes, such as retention and patient safety, to assess its sustained impact.

Oncology Nursing Forum. 2025 Mar 1;52(2):88.

P140. Implementation of Flex Shifts in an Ambulatory Infusion Center; Lessons Learned

Karen deVries ¹, Elizabeth Serrone ²

Management

Significance & Background

According to the ONS position statement: Staffing of Treatment Centers: “Appropriate nurse staffing levels contribute to the delivery of safe, quality care and optimal outcomes for patients receiving cancer treatment.” (ONS 2024) Many factors contribute to scheduling of Infusion treatments including length of combination therapies, patient comorbidities, language and cognitive barriers. “Balancing a flexible nursing schedule with this model in mind allows healthcare professionals to choose shifts that suit their personal needs, promoting a better work life balance.” (Fetto, 2022) Staff nurses in our ambulatory infusion center presented advantages to moving towards a flexible work schedule to senior leadership detailing their desire for 10 hours shifts and the benefits for staff and patients alike.

Purpose

To describe methods utilized to create 10-hour flexible shifts in an Ambulatory Infusion suite utilizing full time and per-diem nurses.

Interventions

Utilizing a shared decision-making model staff are given a calendar to choose their preferred day off with senior nurses choosing first. To supplement full time staffing six per-diem nurses were hired. Days off are rotated to allow each nurse the opportunity for a three-day weekend taking into consideration approved vacation and per-diem coverage. The majority of the time only two nurses are permitted to be off on any given day with exceptions made pending coverage. The calendar is created for a two-month schedule and vacation time is entered prior to distributing this so staff are aware of approved days avoiding overlapping of requests. Providing a two-month schedule affords the nurses the opportunity to plan for their personal needs.

Results

Since implementation of flex shifts on our unit staff have verbalized satisfaction with their new work schedule that affords a better time and work life balance. Retention and recruitment have improved with this change. Issues that have arisen includes understaffing when per-diem nurses are not available and lack of coverage when staff are out sick. Interventions in this situation includes assistance with patient care from nursing leadership.

Discussion

Allowing nurses the opportunity for different work schedules lets them individualize their time to meet their personal needs which in return improves employee engagement, satisfaction and retention.

Oncology Nursing Forum. 2025 Mar 1;52(2):88–89.

P141. The Application of A Dry Hot Pack to Restore Blood Flow to Occluded Venous Access Devices (VAD), Mediports (Ports) and Peripherally Inserted Central Catheters (PICC)

Jackie Dibernardo ¹

Treatment Modalities and Managing Administration

Significance & Background

For many patients with poor peripheral venous access, vascular access devices (VAD) such as Ports and PCC lines are essential components for treatment. One complication commonly experienced in the outpatient setting is an occluded VAD. Literature on the use of heat therapy restoring blood flow to an occluded VAD is scarce. Heat therapy is a common modality utilized to help promote successful peripheral intravenous insertion. The outpatient nursing team is proficient in the management of VAD occlusions however, it is time consuming, costly, invasive and anxiety provoking for both the patient and the nursing team. Per our hospitals protocol, the standard of care (SOC) for VAD utilization includes verifying a blood return to ensure catheter patency and placement. Prior to administering treatments, the nurse aspirates to verify a blood return. If a blood return cannot be verified, the SOC with thrombolytic treatment is initiated. Alteplase (Cathflo) is the thrombolytic agent utilized to restore patency. In this pilot study, the goal is to utilize heat therapy, a non-invasive intervention with a hot pack to attempt to restore blood flow prior to initiating the current hospital SOC.

Purpose

The purpose of this pilot project was to determine if the application of a dry hot pack on the skin at the site of a Vascular Access Device (VAD) for 10–15 minutes would improve blood flow to the device.

Interventions

If the RN is unable to aspirate blood from the device, which is necessary prior to administering treatments, a dry hot pack will be applied to the patient’s skin at the VAD site for 10–15 minutes. After that time frame, the RN will reassess for a blood return.

Results

The application of a dry hot pack to the patient’s skin at the VAD site for 10–15 minutes, restored blood flow to 95% of the patients (19/20) with a clogged VAD. The devices did not require Alteplase (cathflo) intervention. This was a time saving intervention utilizing a non-invasive, non-medicinal approach that prevented any potential harm and decreased the patient’s anxiety.

Discussion

Since this small pilot project with limited participants had a high success rate, we will continue to implement the heat therapy intervention to decrease the number of patient receiving thrombolytic therapy, while monitoring the outcomes and disseminating the information to change practice.

Oncology Nursing Forum. 2025 Mar 1;52(2):89.

P142. Breaking Barriers: Improving Communication on Comprehensive Biomarker Testing in Precision Oncology

Erin Dickman ¹, Theresia Pichler ², Merel Hennink ³, Celia Diez De Los Rios ⁴, Navdeep Dehar ⁵, Amy Moore ⁶

Patient Education

Significance & Background

Comprehensive biomarker testing (cBT), and the process associated with it, is essential in the era of precision oncology, yet it is inherently complex and requires a knowledgeable healthcare team. Throughout the continuum of care, there are critical points where discussions between patients and healthcare providers must occur.

Purpose

This presentation will summarize the outcomes of the publication “Understanding communication between patients and healthcare professionals regarding comprehensive biomarker testing in precision oncology: A scoping review,” emphasizing the communication gaps among pathologists, oncologists, nurses, and patients regarding cBT in precision oncology.

Interventions

The goal is to highlight key insights from the review and propose actionable recommendations for enhancing communication practices among these vital stakeholders.

Results

The scoping review identified 287 unique records, with data extracted from 42, including nine derived from expert input. Patients demonstrated a high motivation to undergo cBT and receive results across various cancer types and settings. However, their understanding of cBT-related concepts was notably limited. The session will address communication gaps among pathologists, oncologists, nurses, and patients, focusing on differences in understanding, information preferences, and knowledge levels. It will also emphasize the pivotal role of nurses as trusted communicators within the healthcare team.

Discussion

Oncology nurses play a crucial role in discussions surrounding biomarker testing. Effective shared decision-making requires patients to understand the rationale, process, timing, and implications of biomarker testing, along with the associated risks, benefits, and limitations. Furthermore, the session will explore the limited resources available to healthcare professionals, including nurses, seeking guidance on cBT-related communication. By identifying these gaps and proposing practical solutions, this session aims to enhance communication practices and support shared decision-making in precision oncology.

Oncology Nursing Forum. 2025 Mar 1;52(2):89–90.

P143. Enhancing Resilience in Oncology Nurses: Strategies for Sustaining Well-Being in High-Stress Environments

Kaitlin Didinger ¹, Cinthya Kiss ², Lauren Kehr ³, Kimberly Hissick ⁴, Casandra Marrero-Rodriguez ⁵

Professional Development

Significance & Background

Oncology nurses face unique emotional and psychological challenges due to the intensity of patient care and exposure to end-of-life situations, leading to high levels of stress, burnout, and compassion fatigue. Building resilience is critical for maintaining well-being and sustaining professional longevity. It is vital to explore evidence-based interventions aimed at increasing resilience among oncology nurses. Key strategies include mindfulness-based stress reduction, peer support systems, educational workshops on coping mechanisms, and institutional policies that promote a healthy work-life balance. Furthermore, organizational commitment to mental health support and fostering a positive workplace culture is essential. These approaches have been shown to enhance emotional regulation, improve job satisfaction, and reduce burnout rates.

Purpose

To create and implement a program to assess moral distress and improve nursing resilience in oncology nurses. Aim to reduce the burden of compassion fatigue among oncology nurses, increase employee engagement scores and improve moral distress inventory scores.

Interventions

The intervention targeted moral distress and resilience in oncology nurses through three main strategies. This unit created a peer support network to provide a space for nurses to discuss challenges and receive peer support through bi-monthly sessions, invested in a wellness space for rest and relaxation during shifts, and offered a 4-hour retreat focused on fostering a positive work-life balance, boosting morale, promoting self-care, and enhancing resilience. These combined efforts aimed to reduce moral distress and strengthen resilience within the nursing staff.

Results

The evaluation portion of this project has yet to be completed. Information on work-life balance was collected via an annual employee engagement survey, and prior to completion of the workshop a moral distress inventory was collected. In order to appropriately evaluate the effectiveness of program implementation, plan to have an initial re-survey of the moral distress inventory within six to eight weeks post-intervention, with follow-ups at three- and six-months post-intervention to determine long-term effects, along with utilizing the data from the next annual employee engagement survey.

Discussion

By integrating these strategies, healthcare systems can improve nurse retention and the quality of patient care. This research contributes to the growing body of literature on the importance of resilience in nursing, particularly within the oncology specialty, offering a framework for both individual and systemic interventions.

Oncology Nursing Forum. 2025 Mar 1;52(2):90.

P145. A Systematic Approach for Oncology Subject Matter Experts Utilizing an Evidence-Based Instrument to Improve Learner Engagement and Satisfaction

Stella Dike ¹, Joaquin Buitrago ², Nerissa Sawyer ³, Adrienne Ferrell ⁴, Anna Varghese ⁵

Professional Development

Significance & Background

Oncology nurses attend educational activities to develop their careers and adapt to healthcare changes. Developing and presenting high-quality educational materials is essential to enhance the knowledge and skills of an evolving workforce with diverse learning styles. An internal review noted inconsistencies in content development, revision processes, and presentation skills.

Purpose

To develop a comprehensive checklist that standardizes the development of educational materials and delivery methods to improve the overall quality of educational activities including presentation skills and participant satisfaction. The effectiveness of this checklist was also measured to identify the extent of improvement in practice standardization, evaluate the quality of course materials, and the delivery methods.

Interventions

The project lead formed a team in May 2022 called, “Presentation Skills Enhancement and Abstract Development (PSEAD), to focus on developing the checklist. Team members concentrated on style and content when they met bimonthly until the completion of the project in November 2022. The checklist was categorized into five major sections: general, content, style, accessibility, and presentation skills. The content was developed using evidence-based reference materials focused on accessibility principles, multimedia learning theories, and andragogy. The final checklist was presented to three departments for initial feedback and subsequently piloted in a two-day oncology course.

Results

Following the rollout, a survey was developed and administered to learners and speakers from two oncology courses. Eighteen participants completed the survey with the following themes emerging as essential to effective presentations: (1) Problem-solving using case scenarios to engage learners; (2) Nursing Practice focused on relevant interventions and rationales; (3) Body Function related to the cause and effect of disease and treatments; (4) Presentation Instrumentation that uses sensory enhancements to engage learners; (5) Effective Communication through skillful delivery of a clear message with active learner engagement including nonverbal communication.

Discussion

The project teams are pioneers in developing an innovative checklist that enhances the quality of educational materials, including design, content, style, and presentation skills. The post-implementation survey further identified the importance of delving into specific learner needs that the team will continue to address. Moving forward the team will continue evaluation of the project’s impact on the quality of educational materials, presentation skills, and learner satisfaction adapting to the evolving diverse learning styles.

Oncology Nursing Forum. 2025 Mar 1;52(2):90–91.

P146. Oncology Compliance Moves Online

Tracey Dilas ¹

Management

Significance & Background

Nurse educator and leader workloads are ever increasing, as are regulatory requirements for staff education and competency. High risk procedures and complex medications carry additional educational requirements to demonstrate staff competency. Our competency tracking process was traditionally slow, labor intensive, and difficult to maintain.

Purpose

Improving competency validation and our chemotherapy certification renewal process was necessary, as gaps in current documentation were found during a regulatory audit. Current paper-based competency checkoffs were routinely stored in individual employee files, and a list of staff due dates for chemotherapy renewal was not readily available. Educators were tasked with the manual review of paper documents and tracking lost or incomplete competencies. The goal was to increase employee accountability and promote time management. Leveraging new technology in the health system’s Learning Management System (LMS) allowed for centralized tracking of onboarding, chemotherapy and annual competencies, and ONS/ONCC Chemotherapy Immunotherapy Certificates.

Interventions

In partnership with staff development, competency standards for oncology staff onboarding, hazardous drug administration, and certification documents were updated to the LMS. The virtual system allows for standardized training, completion dates, and immediate reporting. Education was developed for preceptors to compare employee performance against predetermined guidelines and standards through integrating learning activities into the validation process. Preceptor and educator electronic signatures show the progression of the new nurse through their training process, which is beneficial during a regulatory audit.

Results

The health system currently has 68 oncology nurses, 25 nursing/medical assistants, and 4 clerical staff. After the launch of the LMS, all staff records are located within the online database. The LMS platform sends recertification reminders, reducing lapses in required staff qualifications. Nurse educators monitor the progression of new hires through the onboarding process via LMS and orientee meetings. Preceptor education on the use of the LMS and the validation process was straightforward. Feedback confirmed that the process is easier to manage than a paper-filled binder requiring multiple signatures. Additionally, there are no lost documents or need to complete rework since digitizing the process.

Discussion

The transition to online documentation was labor intensive initially, but the benefits were quickly appreciated due to improved organization, tracking efficiency, and ensuring compliance. Oncology played a pivotal role in our health system wide transition to digital competency tracking by initiating the process, hereby transforming the organizations regulatory compliance.

Oncology Nursing Forum. 2025 Mar 1;52(2):91–92.

P147. Efficacy of Virtual Reality-Based Interventions in Cancer-Related Symptom Management in Aya’s: A Systematic Review

Nikolina Dodlek ¹, Angelos Kassianos ², Josipa Flam ³, Marios Avraamides ⁴, Andreas Charalambous ⁵

Healthcare Delivery

Significance & Background

The research addresses the increasing need for innovative, patient-centered care strategies for adolescent and young adult cancer patients, a population often grappling with high levels of anxiety, depression, and fatigue during treatment. Virtual Reality (VR) has shown potential as a therapeutic tool to improve psychological well-being and enhance the overall treatment experience.

Purpose

This study explores the effectiveness of VR in comparison to traditional distraction techniques, particularly for cancer patients undergoing chemotherapy, and aims to highlight the diverse VR environments, from game-based settings to calming nature scenarios, that have been used to relieve symptoms. The findings also emphasize the underexplored potential of VR in remote or home-based cancer care, contributing to advancements in telemedicine and supportive care technologies. By reviewing current literature, the study offers practical insights for integrating affordable VR solutions into oncology care, fostering innovation in digital health interventions.

Interventions

The research examines a decade’s worth of studies (2012–2022), following PRISMA guidelines, and employs search terms related to digital health, VR, cancer, adolescent and young adult patients, and oncology treatment to identify relevant studies. These studies were indexed in databases such as MEDLINE, PubMed, PsycInfo, Scopus, EMBASE, and CINAHL. Specifically, the research focuses on cancer patients aged 18–25 years old, a demographic increasingly undergoing cancer-related treatments due to rising cancer diagnoses.

Results

The search yielded 823 initial records, including randomized controlled and case-controlled trials. The results confirmed that VR is more effective than traditional distraction methods in relieving anxiety, depression, and fatigue for cancer patients during chemotherapy. Additionally, there was significant variation in the types of VR environments described in the literature, ranging from interactive gaming to relaxing nature settings. Despite these findings, there is a lack of sufficient literature on the use of VR in home-based settings for patients receiving chemotherapy or other oncology treatments. On average, patients using the HADS-D (Hospital Anxiety and Depression Scale) reported a 15% decrease in depression, 13% decrease in anxiety, and an 18% reduction in pain perception following the VR intervention.

Discussion

Foundings highlights the growing interest in VR technology in healthcare, driven by the availability of affordable commercial VR hardware. This research has significant implications for improving remote cancer care and enhancing patient-centered treatment approaches.

Oncology Nursing Forum. 2025 Mar 1;52(2):92.

P148. Crafting Your Life’s Blueprint: Designing A Purpose-Driven Journey

Anthony Dodson ¹

Professional Development

Significance & Background

In the rapidly evolving field of oncology nursing, professionals face numerous challenges that require resilience, innovation, and a clear sense of purpose. Crafting a life blueprint that aligns personal values with professional goals is essential for driving meaningful impact and advancing the practice of oncology nursing.

Purpose

This session aims to equip oncology nurses with the tools and strategies needed to design a purpose-driven journey, fostering personal and professional growth. By aligning their values with their career aspirations, attendees will be better prepared to navigate challenges and contribute to the progress of the oncology nursing field.

Interventions

The session will include small group discussions, problem-solving scenarios, and case study analyses to help participants identify their core values, set strategic goals, and develop resilience techniques. Attendees will also create personalized action plans to implement the strategies learned during the session.

Results

Participants will gain a deeper understanding of how to align their personal and professional goals, leverage their unique strengths, and foster a mindset of continuous innovation. These skills will enable them to lead with purpose, inspire their teams, and make a significant impact in the field of oncology nursing.

Discussion

By crafting a purpose-driven life blueprint, oncology nurses can elevate their practice, drive sustainable change, and contribute to the advancement of the field. This session will provide practical, hands-on learning experiences that can be directly applied to their professional roles, empowering them to make a lasting difference in the lives of their patients and the broader healthcare community.

Oncology Nursing Forum. 2025 Mar 1;52(2):92–93.

P149. Effect of Remote Counseling on Screening Uptake in the First-Degree Relatives of Colorectal Cancer Patients: A Systematic Review and Meta-Analysis

Bei Dong ¹, Yongfeng Chen ², Dongting Zhang ³, Kai Chow Choi ⁴, Carmen WH Chan ⁵

Screening, Early Detection, Genomics

Significance & Background

Individuals with at least one affected first-degree relative (FDR) have an approximately two-fold higher risk of developing colorectal cancer (CRC) than those without a family history. Ensuring that the FDRs of CRC patients are properly screened is crucial to preventing the disease and controlling its development. Remote counseling has been used to facilitate the uptake of CRC screening in the FDRs, but a comprehensive evaluation of such an intervention remains lacking.

Purpose

To explore the characteristics of remote counseling and its effect on the FDRs of CRC patients.

Interventions

Eleven digital databases were searched from their inception to June 2024, including eight English databases (i.e., Cochrane Library, PubMed, Embase, CINAHL, Scopus, British Nursing Index, Global Health, and Web of Science) and three Chinese databases (i.e., China National Knowledge Infrastructure, WanFang, and China Biology Medicine). Grey literature and the reference lists of the included studies were also examined. Randomized controlled trials (RCTs) conforming to the inclusion and exclusion criteria were screened and extracted. Risk of bias was evaluated using the Cochrane risk-of-bias tool. The primary outcome was the uptake rate of CRC screening, and the secondary outcome included knowledge of and health beliefs about CRC and screening. All meta-analyses were performed with Review Manager 5.3.

Results

Five studies with 2,601 FDRs of CRC patients were included in this systematic review. Two studies had a low overall risk of bias, while the others had some concerns. Telephone, mail, and social media platform are channels for counseling delivery. All studies conducted only one counseling session, the average duration of which varied. Trained nurses were the most common counselors in this review. Meta-analysis showed that remote counseling could significantly increase the CRC screening rate (relative risk [RR], 1.65; 95% confidence interval [CI], 1.46–1.86; P < 0.01). Among interventions of this kind, mailing tailored printing also demonstrated a beneficial effect (RR, 1.57; 95% CI, 1.22–2.03; P < 0.01). However, evidence that remote counseling could improve knowledge of and health beliefs about CRC and screening was limited.

Discussion

Remote counseling is an effective intervention to improve the CRC screening uptake of the FDRs. However, the effects of the different intervention components require further exploration to determine an optimal intervention program. More rigorous theory-driven RCTs are necessary to assess the impact of remote counseling on knowledge and health beliefs.

Oncology Nursing Forum. 2025 Mar 1;52(2):93.

P150. Titratable Antineoplastic Medications

Bridget Dorkewitz ¹, Ashley Mitchum-Chapman ², Kristi Adams ³, Sundae Stelts ⁴

Treatment Modalities and Managing Administration

Significance & Background

The Oncology Nursing Society (ONS) guidelines emphasize the importance of proper procedures for administering antineoplastic medications to ensure safety and efficacy. Medications such as rituximab or carboplatin for desensitization, where titrating dose adjustments might be necessary, ONS recommends to prime the infusion tubing with the antineoplastic medication itself and attach a CSTD to the end of the tubing. Currently primary tubing is primed with compatible fluids and the antineoplastic medications are being infused as a secondary medication.

Purpose

Implementing the process change where pharmacy primes the tubing with the drug under a biological safety cabinet (BSC) before sending it to nursing, addresses a crucial aspect of medication administration safety. By priming the tubing with drug, you ensure that the drug is the first substance entering the patient’s system when the infusion begins, rather than a compatible fluid. This is critical during the titration process, where precise dosing and timing are essential.

Interventions

An interdisciplinary team consisting of expertise from pharmacy and nursing was established to implement the process change. Pharmacy would prime the antineoplastic medication under a BSC using the circle priming method and locking CSTD. The team researched best practices for tubing setup and prevention of drug loss during flushing. A new primary tubing set with a Y-port immediately below the pump and short set tubing with a locking CSTD was approved and purchased. This configuration helps in managing the infusion process more efficiently and safely. A small-site pilot was recommended prior to system-wide implementation. An education handout was developed for both pharmacy and nursing. In-person hands-on training would be provided to both nursing and pharmacy before and during the implementation.

Results

This process change represents a commitment to the patient, pharmacy, and nurse safety. Priming tubing with antineoplastic medication and the use of a short set for flushing ensures that antineoplastic medications are delivered accurately and efficiently. A smooth system-wide implementation process was ensured through clear education materials and interdisciplinary collaboration. The team will evaluate and adjust the process to ensure ongoing effectiveness and safety.

Discussion

Implementing a significant workflow change for both pharmacy and nursing staff requires a well-planned and interdisciplinary approach to minimize anxiety and resistance, and to address potential issues before they become problematic.

Oncology Nursing Forum. 2025 Mar 1;52(2):93–94.

P151. IVIG Administration Standardization

Bridget Dorkewitz ¹, Terri Price ², Cathryn Letton ³, Allison Heustess ⁴, Mya Bowen ⁵

Treatment Modalities and Managing Administration

Significance & Background

Inconsistencies in infusion practices for intravenous immunoglobulin (IVIG) can pose challenges in ensuring optimal patient outcomes and safety. Standardizing IVIG infusion practices across multiple sites is crucial for maintaining quality of care and minimizing risks.

Purpose

This interdisciplinary project seeks to standardize administration practices by educating staff and suppling tools that can be used at the chairside.

Interventions

An interdisciplinary workgroup consisting of oncology nurse and pharmacy leaders met to review best practices for IVIG administration. A literature review of administration recommendations, clinical guidelines, and expert recommendations were completed. The decision by the workgroup to titrate the first three infusions of IVIG and then run the fourth and subsequent infusions at the patient’s maximum tolerated dose reflects a thoughtful approach to managing both patient safety and treatment efficacy. Pharmacy staff developed an Excel-based rate titration calculator to assist nurses with determining appropriate infusion rates for various IVIG brands. The calculator was shared via OneDrive to ensure accessibility from any computer, facilitating ease of use across different locations. The ability to calculate ideal body weight (IBW) was added to the calculator. Nurses input either Actual Body Weight (ABW) or IBW to generate titration rates. Educated was given to use IBW except for when ABW is less than IBW. Basic functionality of the calculator and instructions on the new standard of titrating (titrate first three infusions then proceeding with the maximum tolerated dose for subsequent infusions) was shared with nursing. Education given on need to re-titrate when an IVIG brand is changed and blackbox warnings were reviewed. Demonstrations given on how to use the IVIG calculator to verify Alaris pump infusion programing.

Results

Standardizing protocols ensures that every patient receives IVIG treatment in a consistent manner, regardless of the infusion site. Standardization minimizes the risk of errors related to dosing, infusion rates, and monitoring, thereby enhancing patient safety. Consistent practices help in predicting and managing patient responses, making it easier to maintain high standards of care.

Discussion

Education regarding infusing IVIG at the patient’s maximum tolerated dose and not the maximum rate on the calculator had to be reinforced with nursing. The Excel-based IVIG calculator must be updated with any new brands of IVIG. Nurses demonstrated increased confidence with the standardization of IVIG administration.

Oncology Nursing Forum. 2025 Mar 1;52(2):94.

P152. Does Chlorhexidine Digluconate Use on Postoperative Oncology Patients Decrease the Incidence of Surgical Site Infections?

Alicia Dougherty ¹

Quality and Safety

Significance & Background

Hospital acquired infections remain a major problem in hospitals and health care institutions across the world. One method of reduction and prevention is chlorhexidine digluconate (CHG). This is a broad-spectrum antiseptic that is used in a variety of formulations for skin antisepsis, oral care, patient baths, and central line dressings.

Purpose

Ample evidence expresses a direct correlation between reduced infection rates in postoperative patients, as well as patients with foley catheters and central venous access, who routinely receive CHG baths during admission. While many studies have investigated CHG use over postoperative dressings and along tubing and catheters, very little research has been done focusing on the effect of CHG directly to the incision site. Given the nature of the surgeries performed and complexity of our patient’s disease processes, treatments, and stress caused to the body, our patients are already pre-disposed to increased risk for postoperative complications.

Interventions

Education has been provided in a variety of forms to our staff, including physical demonstration, PowerPoint presentation, and question and answer sessions. Nursing staff have been provided talking points for common questions that may be asked by patients about CHG use to the incision. Twice weekly audits are currently being performed to assess risks for hospital acquired infections. CHG education has already been implemented in this audit.

Results

In just over two months, we have seen a decrease in surgical site infections and drastic increase in the number of patients who demonstrate knowledge and use of CHG to the incision site. For patients who refuse the use of CHG wipes, we offer the available education and provide alternatives to SSI prevention, including but not limited to a Hibiclens wash.

Discussion

Though most staff members have been receptive to education, two members endorse that they firmly believe infections will develop after discharge, and inpatient education will not help prevention despite the research and data presented to them. If we set patients up for success while they are here, I anticipate a further reduction in SSI rates in our ongoing study and am hopeful that this data will encourage weary staff that infection prevention starts here, and our inpatient practices will transfer with these patients at discharge.

Oncology Nursing Forum. 2025 Mar 1;52(2):95.

P153. Nursing Residents in Outpatient Infusion

Jessica Dove ¹, Shavonda Neal ², Andrea Bales ³, Sarah Susi ⁴

Management

Significance & Background

Infusion is a highly specialized area with unique challenges and high-acuity patients. An academic cancer hospital was searching for an innovative way to attract staff to outpatient infusion without poaching from inpatient units. Continuing to provide the highest level of care to our patients has taken us past previous boundaries to embrace new opportunities in nurse staffing.

Purpose

To implement a new track in outpatient infusion for an established nurse residency program.

Interventions

A team was formed to adapt the resident onboarding program for outpatient infusion. We identified critical components in the 16–18-week orientation program, determining when nurse residents should learn to administer chemotherapy, take ECG classes, and other essential skills. Interviews commenced looking for exemplary candidates for two units engaging in this new initiative for outpatient infusion. Four nurse residents representing diverse backgrounds, entrusted the beginnings of their nursing journey to us. Each resident became members of a cohort from different nursing units in the hospital, meeting regularly throughout the first year. Weekly meetings took place with nursing education staff, nurse managers, and/or the director of the nurse residency program. During these meetings, education, support, and skills lab took place fostering a collaborative learning experience.

Results

One year later, all four nursing residents have successfully completed clinical orientation and are highly valued members on their units. During the completion program celebration, nurse residents made statements such as “ I know what to do when things aren’t going well for my patient now,” or “I was able to connect with a patient in a personal unique way.”

Discussion

Including nurse residents into the outpatient infusion areas is feasible. Adapting the nurse residency program to meet the needs of infusion areas helps to meet the increased needs of outpatient infusion. We look forward to welcoming additional nurses to this program as demand grows. Minor adjustments continue to be made for improvement, but nurses and their coworkers regard the program as a success!

Oncology Nursing Forum. 2025 Mar 1;52(2):95–96.

P154. Optimizing the Newly Diagnosed Breast Cancer Patient Experience

Anna Dowling ¹, Austin Weber ², Catherine Jansen ³, Lila Siu ⁴, Kimberly Beringer ⁵

Coordination of Care and Navigation

Significance & Background

Navigation has been shown to be beneficial to both patients and healthcare systems by facilitating transitions through diagnosis, treatment, and survivorship. Patients given a cancer diagnosis are often concerned, anxious and eager to hear their treatment plan. Scheduling appointments with their multidisciplinary provider team may be delayed while patients await further diagnostics, before the treatment plan can become fully established. A comprehensive evaluation of our Cancer Center’s practices identified an opportunity to enhance the experience of newly diagnosed breast cancer patients by providing earlier touchpoints.

Purpose

The objectives for this project were to 1) clarify and standardize the expectations for the care of newly diagnosed breast cancer patients; 2) develop a consistent workflow and touchpoints; and 3) improve timeliness of patient access into the department.

Interventions

We started with gathering input from all stakeholders (e.g., physicians, social workers, nurse navigators, our leadership team, advanced practice providers) to define our vision, identify potential challenges, and discern key elements (e.g. communication, workflow, education, resources). After reviewing the feedback, a more informed approach to patient has been achieved. The nurse navigator reviews all referrals, performs an initial intake to assess for any potential symptoms or needs, and informs the patient of any diagnostics required prior to the multidisciplinary clinic appointment. Pertinent concerns are shared with the social worker, who then initiates their own outreach to determine the individual’s distress level and psychosocial needs to provide early access to support and resources. The nurse and social worker share their patient assessment with the multidisciplinary team. Ongoing collaboration between the nurse navigator and social worker continues throughout the patient’s care journey throughout the patient’s survivorship process within the multidisciplinary team, ultimately allowing he patient to feel well-connected to support and resources.

Results

Implementing this structured approach has facilitated consistent and clear communication with patients and all team members, resulting in greater transparency and support. Patients have reported increased satisfaction due to the personal attention and timely updates. We have also observed a reduction in patient-initiated messaging and anxiety levels, indicating improved overall patient experience. This ongoing process improvement leads to greater efficiency and quality care for the patient.

Discussion

Early outreach to newly diagnosed breast cancer patients, through standardized touchpoints and structured workflows, effectively reduces anxiety and enhances patient satisfaction.

Oncology Nursing Forum. 2025 Mar 1;52(2):96.

P155. Nursing Considerations for Cell Therapy with Afamitresgene Autoleucel (Afami-Cel) in Patients with Solid Tumors

Terry Downey-Freiman ¹, Patricia McLaughlin ², Miriam Pudel ³, Susan Weigel Saintiche ⁴, Kathleen DeRose ⁵, Theresa Seiders ⁶

Treatment Modalities and Managing Administration

Significance & Background

The first engineered T-cell receptor (TCR) T-cell therapy was US Food and Drug Administration approved in August 2024. This therapy, afamitresgene autoleucel (afami-cel; Tecelra^®) comprises autologous T cells genetically engineered to target tumors presenting melanoma-associated antigen A4 (MAGE-A4) to the immune system via certain human leukocyte antigen (HLA) alleles. Afami-cel was assessed in the SPEARHEAD-1 Phase 2 trial (NCT04044768).

Purpose

To inform nurses of the data leading to afami-cel approval, and to share information on patient management and journey, and the importance of biomarker testing.

Interventions

Adults with unresectable or metastatic MAGE-A4–expressing synovial sarcoma who have received prior chemotherapy and are HLA-A*02:01P, -A*02:02P, -A*02:03P, or -A*02:06P positive are eligible for afami-cel. Patients must not express HLA-A*02:05P. Autologous T cells are obtained by leukapheresis and engineered to create afami-cel; patients may receive other anti-cancer therapies while this occurs. Patients then receive intravenous lymphodepleting chemotherapy (fludarabine 30 mg/m2/day on days −7 to −4 and cyclophosphamide 600 mg/m2/day on days −7 to −5) before afami-cel infusion. Granulocyte-colony stimulating factor (G-CSF) may be administered after lymphodepletion. Patients should be euvolemic and receive an H1-antihistamine and acetaminophen ~30–60 minutes before afami-cel intravenous infusion; prophylactic systemic corticosteroids should be avoided as they may interfere with afami-cel activity.

Results

The Figure shows adverse events of interest occurring in SPEARHEAD-1 and some clinical management recommendations. Nurses should be aware of the symptoms and management of cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS), which can occur in the ~week after infusion and may be serious. To assist with management, the immune effector cell–associated encephalopathy (ICE) score may be used to grade ICANS, and the Penn, CTCAE, and Lee scales for CRS. Nurses should also be aware of the potential for infusion reactions, and infections, fatigue, and bleeding due to prolonged cytopenias. Nurses can help educate patients and their caregivers on discharge and prophylactic medications, avoiding unwell contacts, and requirements to not drive/operate heavy machinery for 4 weeks following infusion and to stay close to the treatment center.

Discussion

Nurses play a key role at every stage in the patient journey, from diagnosis to treatment, including administration of T-cell therapy and monitoring after infusion. Nurses being aware of and understanding the profile of afami-cel will help patients who may benefit from this novel therapy.

Oncology Nursing Forum. 2025 Mar 1;52(2):96–97.

P156. Breaking the Delay Chain: Utilizing Outpatient Infusion to Reduce Delays in Scheduled Inpatient Chemotherapy Admissions

Kaitlyn Drew ¹, Megan Canterbury ²

Healthcare Delivery

Significance & Background

At a large academic NCCN-designated cancer center, scheduled chemotherapy admissions are often delayed (varying from two to twenty-four hours) due to an increasing inpatient census and lack of available beds. Even with best efforts to discharge patients earlier in the day to allow for room turnover, scheduled admissions are still not able to be admitted at their predetermined time. Delayed admissions have a ripple effect of delaying chemotherapy start time; thus, chemotherapy is not completed until late into the evening or night and can ultimately lengthen patients’ hospital stays. A partnership between a fourteen-bay outpatient infusion room and three inpatient acute care oncology units was developed to allow scheduled inpatient chemotherapy admissions to start an inpatient encounter in the infusion area while they wait for the inpatient bed to become available.

Purpose

To reduce the number of delayed scheduled chemotherapy admissions, thus decreasing hospital length of stays.

Interventions

A collaborative partnership between the outpatient infusion area and inpatient oncology units was led and supported by hospital administration. Multidisciplinary input from IT analysts, pharmacists, providers, nursing operational leaders, clinical nurse specialists, STAT RNs, and radiology was needed to establish workflows, identify inclusion criteria, and create handoff tools to ensure safe and seamless transfer between the outpatient and inpatient spaces. Three patients were selected in October and November 2023 to pilot the new workflow, which was named the Oncology Admission Hold (OAH). Starting in January 2024, inpatient and outpatient charge RNs began utilizing the OAH if there were no inpatient beds immediately available to prevent admission delays.

Results

Between October 2023 and September 2024, the OAH was utilized by 15 patients. The average time saved (time difference between outpatient admission and transfer to inpatient bed) was 2 hours and 51 minutes, with a range of 1 hour and 31 minutes to 4 hours and 29 minutes. The total time saved by all 15 patients was 42 hours and 42 minutes.

Discussion

Creatively looking at new ways to utilize oncology spaces and establish non-traditional workflows within a hospital system can help reduce scheduled admission delays. While the OAH has helped prevent some admission delays, it is still not being utilized to its full capacity. Continued education and encouragement to charge RNs is needed to increase utilization of the OAH.

Oncology Nursing Forum. 2025 Mar 1;52(2):97.

P157. Lessons Learned: A Staff Rn’s Perspective in Opening A New Hospital-Based Community Infusion Center

Stephanie Duffy ¹

Healthcare Delivery

Significance & Background

Opening a new infusion center can be overwhelming for both new and experienced oncology RNs. Integrating performance excellence principles allowed our nursing team to instill best practices, evaluate safety concerns and create a culture of collaboration based on a proactive approach to patient care.

Purpose

To share how developing performance excellence principles influenced our ability to provide proactive risk mitigation and fortified our use of evidence-based practices and collaborative patient care. Performance excellence principles are strategies that ensure patients are cared for effectively, efficiently, and compassionately from admission to discharge.

Interventions

The infusion center employs 2 full-time RNs who engaged in several areas of focus to prepare for opening. Scenario based learning provided an opportunity for front-line staff to work through clinical processes and patient safety issues in real time, in the infusion center space. This facilitated collaborative dialogue between leadership and frontline staff and established a foundation for performance excellence. The scenarios allowed the nursing team to set practice standards, assess patient safety concerns, identify potential barriers to patient care, and resulted in innovative process improvement strategies. Furthermore, the nursing team implemented daily huddles, which created an opportunity for multidisciplinary clinical teams to communicate together, review patient care plans, identify challenges, develop creative solutions, and implement changes together. Lastly, leadership influenced, and the nursing staff embraced a collaborative and supportive team culture with an emphasis on daily check-ins and communication. These practices helped our team come together, collaborate, and recognize when there is potential patient risk.

Results

Since opening, our nursing team has had zero incidences of patient harm or nursing error.

Discussion

Developing performance excellence strategies are paramount in opening a new infusion center. As a front-line RN who has not been previously exposed to performance excellence principles, I have learned the value of a streamlined, systematic approach to patient care. These strategies and interventions have created engagement, a sense of empowerment, and a feeling of belonging amongst the nursing staff. This has directly translated into high quality patient care and has influenced nursing staff satisfaction and retention. By focusing on learning, collaboration, and mitigating patient risk, our nursing team has been given the opportunity to provide excellent, unparalleled patient care.

Oncology Nursing Forum. 2025 Mar 1;52(2):97–98.

P158. Success Strategies to Engage Your ONS Chapter

April Dumond ¹, April Dumond ², Marie King ³

Professional Development

Significance & Background

Our chapter had a core of seasoned members. Our officers were mostly from one cancer center. We “recycled” officers due to lack of interest. We wanted more! We visited other ONS chapters for ideas. We started our path to growth, resiliency, and strong engagement.

Purpose

We hope to inspire other chapters to try new strategies to improve engagement.

Interventions

We reviewed our board composition. We diversified our board to include members from different cancer centers. We added “Board Member at Large” positions to include other members whose main role was to engage other nurses in ONS and consider being an officer or committee chair in the future. We added a senior nurse student in an advisory position to the board to encourage nursing students to consider oncology and to join ONS. We developed a scholarship program to award Congress travel scholarships and other for student book assistance. We started an annual vendor night to learn about new oncology products and services and to establish good working relationships with vendors who support our chapter. We also now have two “Hot Topics” conferences each year. We scout for speakers and topics at Congress. We also plan fun “self-care” activities for our chapter. We previously had monthly chapter meetings with a program. During COVID, we held virtual programs. Our attendance waned. As soon as we were able to meet in person, we began meeting weekly for either drug-company sponsored dinner meetings or programs with contact hours. These were so well received that we have continued weekly programs, with average attendance of 30–40. We allow non-members to attend, and we gain a lot of members from our guests. There is no charge to attend any of our programs. We raise money from vendor night to cover our expenses.

Results

These strategies created a thriving, growing, and engaging chapter. We are known as a strong educational resource in our area. We have more student nurses choose oncology, since they know that they will have support to grow and learn.

Discussion

It is our hope that other chapters will use our ideas to promote growth and engagement like we have experienced.

Oncology Nursing Forum. 2025 Mar 1;52(2):98–99.

P159. Optimizing Education and Workflow for Managing Electronic Medical Record Messages to Enhance the Timeliness, Efficiency and Safety of Patient Care

Iuliana Dutu ¹, Ermina Cavcic ², Kayla Kafka-Peterson ³

Healthcare Delivery

Significance & Background

Radiation Oncology departments provide high levels of nursing care to patients with many medical conditions, often including patients of high medical acuity. Electronic medical record (EMR) messaging has become a primary way for Radiation Oncology departments to communicate with patients and internally with other staff within the department. As Radiation Oncology departments treat a high number of patients, and with the increasing use of smartphones and apps supporting EMR messaging, the number of electronic messages is substantial. Increased messaging has often outpaced staff education and adjusted workflows, leading to messages not being answered on time, messages being incorrectly routed, and staff, physician, and patient dissatisfaction. It can also lead to delayed patient care, which poses a significant safety concern.

Purpose

The purpose of this quality improvement project was to standardize the workflow and staff education for handing messages within our Radiation Oncology department’s EMR, to improve efficiency, communication, satisfaction and safety.

Interventions

A root cause analysis was performed during this quality improvement project, which revealed the need for standardization of workflow and education. Initial subjective data was gathered by surveying the staff on their comfort and familiarity with the EMR messaging system. Through this needs assessment, objectives were created. A targeted didactic lecture was created, addressing handling EMR messages. Nurses also gained a better understanding of triaging messages based on acuity level and developed many templated responses for frequently asked questions to use when appropriate.

Results

Subjective data gathered from a survey of staff (n=15 ) revealed significant improvement in all metrics after the educational intervention and updated workflow were implemented.

Discussion

The goals of this project were that the nurses would find the process of handing EMR messages to be simple and efficient, providers would have increased satisfaction with the messages that require their assistance, and patients would be pleased with the timeliness of their questions or concerns being answered. This quality improvement project is a great example of how surveying staff before and after intervention, creating targeted didactic lectures based on needs assessment, and developing subsequent standardization of workflows can quickly improve and support optimal and safe patient care.

Oncology Nursing Forum. 2025 Mar 1;52(2):99.

P160. Cardiovascular Care Throughout the Cancer Journey: Developing an Outpatient Cardio-Oncology Screening Tool for Optimal Cancer Care in The Infusion Center

Eileen Dwyer ¹, Heidi Fischer ², Rose Francucci ³, Danielle Kyrillidis ⁴

Healthcare Delivery

Significance & Background

Each year there are nearly 2 million new cancer cases in the United States, and many of these patients will receive life-prolonging cancer therapy that may impact the heart. And, owing to advances in oncology, there are now 18 million adult cancer survivors in the United States. Cancer treatment-induced cardiotoxicities are on ongoing concern throughout the cancer care continuum from treatment initiation to survivorship. Also, many cancer survivors are at risk of developing cardiovascular disease. This occurs due to the increasing age of patients, risk factors common to both cancer and heart disease, and damage to the heart from several cancer treatments, including chemotherapy, immunotherapy, transplantation and radiation. A referral to a cardio-oncology service can help active cancer patients live full, vibrant lives by protecting your quality of life and long-term heart health. Therefore, at our cancer center, we acknowledged the importance of an easily accessible cardio-oncology risk assessment and screening program upon initiation of cancer treatment.

Purpose

The purpose of this collaborative project was to start an “Oncology Outpatient Cardio-Oncology Screening Program.”

Interventions

The project was launched in June 2024 and is ongoing. The infusion nurses met regularly with the oncology inter-professional team to develop a cardio-oncology screening tool. Nurse participation facilitated the structure and logistics of patient screening. Infusion nurses provided newly diagnosed cancer patients with cardio-oncology education and distributed the cardio-oncology screening form to complete during their first infusion appointment. A weekly tracking system quantified the number of patients referred to our cardio-oncologist in collaboration with the oncology team, ensuring follow-up screening evaluation compliance.

Results

■ Early identification and education for at-risk patients
■ Increase the number of cardio-oncology referrals
■ Manage existing cancer patients’ cardiovascular disease
■ Enhance professional collaboration and communication
■ Patients’ cardiotoxicities will be managed so they can complete the prescribed cancer therapy

Discussion

This collaborative project supports the understanding of the importance of the cardio-oncology service tailored for active cancer patients and survivors that starts from preventive efforts to diagnostics and therapeutic interventions to promote heart health. The infusion nurses advocate for the patients to participate in the cardio-oncology program to ensure patients with cancer can receive the most appropriate cancer therapy while minimizing their risk of heart complications and in turn leading an enhanced quality of life.

Oncology Nursing Forum. 2025 Mar 1;52(2):99–100.

P161. Implementation of A Formal Geriatric Oncology Assessment Program at A Community Cancer Center System

Mary Eanniello ¹, Holly DeFeo ², Sabra Dunn ³, Brianna Lynes ⁴, Shannon Pindar ⁵, Alicia Ignatowicz ⁶

Healthcare Delivery

Significance & Background

Formal geriatric oncology assessment for older adults has been endorsed as a best practice by national and international professional oncology societies for many years. This assessment can help reduce treatment toxicities and poor clinical outcomes enhancing the opportunity for shared decision making. Despite the strong recommendation for this assessment, many community cancer centers are unable to implement and operationalize this best practice.

Purpose

The purpose of this project was to create a formal geriatric oncology assessment program in a community-based cancer care system to serve our older adult population.

Interventions

This large community-based health care system consisting of seven hospitals and thirteen medical oncology/infusion centers was designated as an IHI Age Friendly Cancer Institute in 2020. A formal geriatric oncology assessment was built into Epic and a standard work process was created for all patients over the age of seventy. The assessment can be performed by a registered nurse or an advanced practice practitioner, making it adaptable to the community medical oncology setting. The assessment includes all the geriatric domains including a chemotherapy toxicity predictor to help the medical oncologist guide the plan of care. Best Practice Alerts were built into the assessment to suggest supportive care interventions and referrals to inform the care team during consultations. The geriatric oncology program includes on-boarding education for all care team members (licensed and un-licensed). This education focuses on unique needs of the older adult experiencing cancer and the team member’s role in ensuring the quality, safety and experience of our older adults and their family care partners.

Results

At present, the program is live at seven sites. Since July 2020, the majority (72%) of those assessed have indicated quality of life as what matters most to them, 50% screened positive for depression and psycho-social distress and 80% scored vulnerable or frail, demonstrating the vulnerability of these patients prior to starting treatment. Over 50% had multiple co-morbidities, polypharmacy as well as impaired physical function.

Discussion

The IHI Age Friendly Framework and implementing a formal evidence-based geriatric assessment program has helped our team identify vulnerable at-risk older adults. Next steps will be to expand this program to all sites and to continue to identify opportunities to improve the care of our older adult patients with cancer.

Oncology Nursing Forum. 2025 Mar 1;52(2):100.

P162. Optimizing Blood Culture Collection Practice with A Nurse-Driven Algorithm to Reduce CLABSI on an Inpatient Adult Bone Marrow Transplant Unit

Megan Edgerton ¹, Megan Edgerton ², Christina Paik ³, Caprice Vanderkolk ⁴

Quality and Safety

Significance & Background

Central line-associated bloodstream infections (CLABSI) are serious healthcare-acquired infections that prolong hospital stays, increase patient mortality, and are costly to healthcare organizations. At an urban academic medical center in the Midwest, the adult bone marrow transplant (BMT) unit reported the highest number of CLABSI cases across the health system in 2022 and 2023, with the second-highest volume of blood cultures collected next to the emergency department. In 2023, 13 of 15 CLABSI cases were associated with blood cultures collected from central lines. Statistical analysis showed that the BMT unit’s practice reflected a lower proportion of venipunctures (p-value 0.000) and a sevenfold higher potentially contaminated specimen count (p-value 0.002) compared to a non-CLABSI sample. BMT patients had a median of 17 blood cultures per admission, compared to 7 in the sample group (p-value 0.000). Evidence suggests poor blood culture practices increase the risk of unnecessary antibiotics, line removal, and care delays. CLABSI cases must be reported if they meet National Healthcare Safety Network definitions, regardless of clinical context.

Purpose

This project aims to improve blood culture collection practices on the adult BMT unit by optimizing the source and frequency of cultures. Shifting from exclusive central line collection to include peripheral venipuncture and refining blood culture criteria is expected to increase the days between reportable CLABSI events by 20% among BMT patients by Q4 2024.

Interventions

A nurse-driven blood culture algorithm was developed to guide conditional release of blood culture orders. Features of the algorithm include an initial culture collection from all central line lumens and one peripheral site, an updated fever threshold to align with evidence-based guidelines, and an outline of conditions upon which additional cultures should be collected within 72 hours. Refer to attached algorithm.

Results

The intervention was implemented in July 2024, with results still being collected and analyzed. Balancing measures include ICU transfers, rapid response calls, and code blues related to delayed sepsis detection. Early data suggest a 54% reduction in mean blood culture volume and a 52% reduction in standard deviation. Days between CLABSI events anticipated to be calculated by December 2024.

Discussion

By aligning blood culture practices with current guidelines, clinicians can reduce unnecessary interventions, improve diagnostic accuracy, enhance patient outcomes, and reduce healthcare costs. The utilization of an algorithm supports nursing clinical decision-making and promotes interprofessional collaboration.

Oncology Nursing Forum. 2025 Mar 1;52(2):100–101.

P163. EMR Transition From Aria to EPIC for the Outpatient Radiation Oncology Department at an Academic Health Care System

Nicole Edwards ¹, Monette Santos-Moss ², Lisa Briner ³

Healthcare Delivery

Significance & Background

Currently the radiation oncology department primarily uses a separate EMR system for documentation than the rest of the organization. This has been the practice for the department because the treatment plans created for patients in Aria are connected to the linear accelerator machines that are used to deliver radiation treatment. EPIC does not have the ability to interface with our treatment machines. While the documentation is thorough enough to provide information for staff in our department, it has been challenging for other departments within the organization to get updates about mutual patients in real time.

Purpose

We aim to provide accurate and detailed information through documentation about patient care that meets current guidelines for the healthcare system and is easily obtainable by all departments within the organization. Our goal is to move from documentation in the current EMR system (Aria) to the primary EMR system hospital-wide (EPIC).

Interventions

A task force has been created to determine the timeline to implement the “go live” date for EPIC use. We will need to determine template needs for all specialties, determine different types of documentation formats such as consult notes, follow up notes, point of care testing notes, nursing notes, on treatment visit notes and other miscellaneous notes currently recorded in a “nursing note” in Aria. We hold weekly zoom meetings with the task force to discuss the logistics of this project. People involved in the task force include IT specialists, managers, clinical operations, MDs, resident MDs, Registered Nurses and supportive staff who are familiar with and currently documenting in EPIC.

Future needs will include individual training of nurses, doctors, radiation therapists, front desk staff, schedulers, administrative assistants, dosimetrists, physicists and other ancillary staff to introduce all members of the team to our new way of documenting and communicating through EPIC.

Results

We continue to make progress weekly to develop templates, review workflows, validate integrated tests and work with various divisions in EPIC (Beacon team, ambulatory clinic team, etc) to help guide a smooth transition to EPIC EMR.

Discussion

■ We continue to work side by side with the EPIC team to help the department transition to the new EMR system.
■ Collaborate with radiation oncology stakeholders regarding the implementation plan.
■ Hold training sessions for all staff to learn the new EMR system.

Oncology Nursing Forum. 2025 Mar 1;52(2):101.

P164. Innovative Education to Support A Practice Change-Removal of Heparin

Heather Edwards ¹, Angie Morris ²

Management

Significance & Background

Packing intravascular access devices (IVAD) with heparin to prevent clotting is a longstanding practice, but current evidence supports vigorous saline flushing as adequate to maintain line patency. This practice change impacted patient safety, reducing unnecessary exposure to heparin. Successful implementation depended on staff flushing lines with normal saline using the push-pause, or pulsatile method, which was a change to current practice.

Purpose

The purpose of this education plan was to teach the new physical skill of using vigorous pulsatile flushing to clear the line of blood, reducing the risk of clotting. A hands-on visual aid was used to demonstrate the necessity of pulsatile flushing on a vascular access device.

Interventions

A clear plastic water bottle with a central line placed through the lid was used to demonstrate the fluid dynamics of pulsatile flushing. Nurses participated by flushing the line and visualizing the turbulence in the water. Proper technique resulted in swirling flow, illustrating the reduced risk of stasis and clotting.

Results

To measure the success of this practice change, administered doses of alteplase for IVAD de-clotting were tracked for 3 months before and 3 months after heparin was removed from IVAD discontinuation order sets. System-wide there was an 18.9% decrease (852 to 691) in alteplase administration. In oncology specific areas during the same period, there was a 76.36% decrease (55 to 13). Feedback from staff on the education was positive, with many reporting they didn’t grasp the concept of pulsatile flushing until they were able to visually see this demonstrated within the bottle.

Discussion

Removal of heparin from IVAD packing did not increase risk of clotting, as evidenced by decrease in alteplase administration. Visual and hands-on learning tools have shown to be effective in educating this practice change.

Oncology Nursing Forum. 2025 Mar 1;52(2):101–102.

P165. Beyond Patient Ratios: Nursing Perceptions of Key Influencers in Staffing Appropriateness in Oncology Infusion

Alden Egan ¹, Debra Shapert ², Corilynn Hughes ³, Bo He ⁴, Ping Ye ⁵

Management

Significance & Background

Appropriate staffing in oncology infusion rooms is paramount for ensuring safe and effective care, and is a key driver of patient outcomes, as well as nurse engagement and retention. Ensuring the right staffing levels goes beyond merely maintaining patient-to-nurse ratios; it involves understanding the complexity of patient needs, the acuity of care required, and the dynamics of the care environment.

Purpose

The purpose of this study was to assess the baseline characteristics, readiness, and anticipated impact of an acuity-based staffing model on nurses in a community oncology site. Additionally, the study aimed to understand nurse perceptions of the key drivers influencing staffing appropriateness.

Interventions

A survey was conducted among infusion room nurses and leaders in a multisite community oncology practice to gather their perceptions and insights. The survey consisted of 40 questions, with 30 being multiple-choice and 10 open-ended, exploring their roles, experiences, and views on staffing assignments, as well as the factors they considered most critical to appropriate staffing.

Results

The survey results revealed a diverse range of perceptions among the nurses. Key findings include: Sample: A total of 37 nurses participated in the survey, including infusion nurses, nurse supervisors, and nurse managers, with varying levels of experience and responsibilities. Challenges to acuity-based staffing models: Common challenges mentioned were the subjectivity in assessing patient acuity, the time required to assign acuity and stratify nursing assignments, and the difficulty in predicting patient needs and changes in condition. Key Influencers of Staffing Appropriateness: The top factors identified by nurses included patient assignment volume, patient acuity, adequate support staff, clear orders and communication from providers, and teamwork and communication among colleagues.

Discussion

The implications for oncology nursing practices are substantial. The findings suggest that moving beyond simple patient-to-nurse ratios to a more nuanced acuity-based model could improve staffing appropriateness and, consequently, patient care and nurse satisfaction. However, successful implementation will require addressing the identified challenges, particularly in terms of providing clear methods for acuity assessment and ensuring robust communication and support systems. These insights highlight the importance of considering a holistic approach to staffing that considers the complex and dynamic nature of oncology care. Potential solutions are explored further in companion abstracts “Development of a Predictive Acuity Model for Oncology Infusion Staffing: Integrating Data Science” and “Development of a Comprehensive Oncology Infusion Staffing Dashboard.”

Oncology Nursing Forum. 2025 Mar 1;52(2):102.

P166. Impact of Transition from Heparin to Saline-Only Flush Protocols on Central Venous Access Device Complication Rates: A Large, Multisite before-and-after Study

Alden Egan ¹, Jennifer Fernandez ², Jody Garey ³, Bo He ⁴

Treatment Modalities and Managing Administration

Significance & Background

Managing central venous access devices (CVADs) is vital in oncology, with flush protocols crucial for catheter patency and complication prevention. Traditionally, heparin-based protocols have been standard practice. Recent evidence suggests saline-only protocols may be a safe, cost-effective alternative with lower overall risk. However, most evidence is from small hospital-based studies, leading to hesitancy in adopting saline-only protocols across oncology practice. A large multisite study conducted in adult community oncology would fill gaps in evidence and help determine appropriate CVAD flush protocols across oncology populations.

Purpose

This study aims to compare the rates of line complications before and after transition from heparin based to saline-only CVAD flush protocols in a large, multisite adult community oncology sample.

Interventions

The primary intervention was transition from a heparin-based to a saline-only CVAD flush protocol. A multisite before-and-after study was conducted in eight independent, community oncology practices that switched CVAD flush protocols between 2019 and 2023. Using data from the electronic health record (EHR), heparin and tissue plasminogen activator (TPA) administration rates for patients with CVADs were identified for 6 months before and after each practice’s flush protocol change. Using TPA as a proxy for line occlusion, the goal was to determine if there was a difference in the rate of line occlusion complications before and after flush protocol change.

Results

Over 240,000 patient days with instances of line care were available for analysis, 123,324 before transitions (PRE) and 120,078 after transitions (POST) to saline-only protocols. There was a statistically significant reduction in heparin use per line care day instance in the six-month POST period compared to the six-month PRE period (mean (std) PRE 0.71 (0.09), POST 0.06 (0.09), p < 0.001). There was no statistically significant change in TPA utilization rates between PRE and POST periods (PRE mean (std) 0.008 (0.006), POST 0.010 (0.008), p = 0.065).

Discussion

The findings indicate saline-only flushing protocols do not increase the risk of CVAD line occlusion in the adult community oncology population, suggesting they are a safe and effective alternative to heparin-based protocols in this setting. These findings support larger nursing practice and guideline adoption of saline-only protocols for CVAD maintenance. Drivers of successful implementation of saline-only protocols are discussed in companion abstract. Future areas of research include differences in protocol effectiveness by CVAD type and flush frequencies.

Oncology Nursing Forum. 2025 Mar 1;52(2):103.

P167. Key Drivers of Successful Transition from Heparin-Based to Saline-Only Protocols in CVAD Management: A Multisite Study

Alden Egan ¹, Elizabeth Ashworth ², Regena Price ³, Lee Ann Ladics ⁴, Amy Sheldrick ⁵, Tiffany Hopper ⁶

Treatment Modalities and Managing Administration

Significance & Background

Effective management of central venous access devices (CVADs) is essential in oncology nursing. While heparin-based protocols have long been the standard, emerging evidence suggests saline-only protocols offer a safer, cost-effective alternative. Despite this, there is resistance to changing CVAD care protocols amongst oncology nurses due to traditional practice standards and beliefs that heparin reduces line occlusions. Studying sites who have undergone successful transition from heparin-based to saline-only CVAD flush protocols without increase in line occlusions can offer insights to key drivers of effective saline-only flush protocol implementation and help guide larger adoption of evidence-based practices.

Purpose

This study aims to identify key drivers of successful transition from heparin based to saline only CVAD flush protocols.

Interventions

Transition from heparin-based to saline-only CVAD flush protocols at eight adult community oncology sites from 2019 to 2023. Statistical analysis comparing the rates of heparin use and line complications six months before and after saline-only CVAD flush protocol adoption. Surveys and interviews of nurse leaders from the eight sites, gathering perspectives on key drivers of successful transition from heparin-based to saline-only protocol.

Results

Pooled analysis of the eight sites demonstrated successful transition to saline-only protocols, marked by a significant reduction in heparin use per line care instance (mean (std) pre-intervention 0.71 (0.09), post-intervention 0.06 (0.09), p < 0.001), with no significant change in TPA utilization rates (pre-intervention mean (std) 0.008 (0.006), post-intervention 0.010 (0.008), p = 0.065), indicating stable line occlusion rates. Interviews and surveys of nurse leaders revealed themes of emphasis on proper flushing and locking techniques, securing buy-in of direct care staff for change, having an effective patient communication plan, the presence of change management champions, and proactive communication with extended healthcare team (e.g., home health, hospital systems, imaging centers) regarding change as key drivers of successful saline-only protocol implementation.

Discussion

The findings demonstrate saline-only flush protocols can be safely adopted without increasing CVAD line occlusion risks. Critical elements for successful implementation focus on proper technique, engaging stakeholders, and strong change management. These findings offer critical insights for promoting saline-only protocols and understanding the broader adoption of evidence-based practices (EBP) in nursing.

Oncology Nursing Forum. 2025 Mar 1;52(2):103–104.

P168. Strategic Approaches to Addressing the Oncology Nursing Shortage: Customizing Clinical Ladder Programs for Community Care

Alden Egan ¹, Cheryl Scalese ², Bryn Thompson ³, Amie Bieckert ⁴, Michael Van Epps ⁵, Amber Sorelle ⁶

Management

Significance & Background

Oncology nursing faces a projected shortage of up to 450,000 nurses by 2025, emphasizing the need for strategies to develop and retain skilled oncology nurses. With 85% of cancer care now in community settings, strategies must be tailored for community oncology practice. Clinical ladder programs (CLPs) incentivize professional engagement and reduce turnover, yet most are designed for acute care settings and do not meet community oncology needs. Tailoring CLPs for community oncology can significantly enhance oncology nurse development and retention, benefiting national cancer care.

Purpose

■ Develop an evidence-based CLP for community oncology nurses.
■ Assess the financial implications of CLPs in community oncology.
■ Implement strategies to encourage CLP adoption in community oncology.

Interventions

■ Design a structured CLP tailored for community oncology based on available evidence and expert consultation.
■ Conduct financial impact analysis of CLP for community oncology sites.
■ Create targeted resources and communication encouraging CLP adoption.

Results

Ladder Elements

The Community Oncology Nurse CLP uses a Level I-IV scale to represent progressive professional engagement and expertise. Key categories include Experience, Education, Professional Certification, Evidence-Based Practice Leadership, Professional Development and Peer Teaching, Preceptorship, and Community Engagement. Objective criteria ensure clear pathways for professional growth and enable objective assessments of CLP levels. This CLP uses an annual bonus model with bonuses ranging from 2% of base pay for Level I to 5% for Level IV.

Financial Implications

Financial analysis of 32 community oncology practices showed full adoption and the highest level of CLP achievement would yield a payout of $8,570,097.01 in bonuses. In comparison, the cost of voluntary RN turnover (excluding retirement and relocation) to these practices was estimated at $15,764,000 in 2023, suggesting potential savings with a CLP.

Promoting Adoption

A comprehensive toolkit was developed to convey best practices and provide key resources for successful CLP implementation. These materials and financial projections were presented to practice leadership across clinical, Human Resources, and executive roles, offering meaningful insights into resources needed to implement change.

Discussion

The adoption of CLPs in community oncology can serve as a cost-effective strategy for nurse retention while enhancing professional engagement. This CLP design and rollout is promising, with the program under review for adoption in several community oncology practices. Future studies will assess CLP adoption, impact on nurse professional engagement, retention, and financial outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):104–105.

P169. Fostering A Culture of Support for Novice Nurses: The Empower & Excel Mentorship Program

Meagan Enneking ¹, Karissa Cox ²

Management

Significance & Background

In 2023, our bone marrow transplant unit hired 14 new graduate registered nurses. The nurses underwent a robust 12-week education plan to provide them with the knowledge needed to care for this complex population. Based off final orientation check ins, it was apparent to leadership that the nurses were struggling with feelings of work-related anxiety and stress. Unit leadership discussed different ways to support these nurses during this transition phase.

Purpose

The Empower and Excel Mentorship Program was created to support the new nurses and provide them with the space to talk about difficult situations and offer tips to help make the transition to practice seamless.

Interventions

An initial survey was conducted to gauge the new graduate nurses’ perspectives on a variety of issues oncology nurses endure. Over a six-month period, the unit manager and educator led monthly, guided discussions with the new nurses. These meetings were mandatory and were held in the evenings to accommodate night shift staff. A Zoom option was available for those unable to participate in person. Guided discussion topics included self-care for nurses, difficult patient/family interactions, coping with death and dying, setting career goals, and oncology nurse burnout. At the last meeting, the nurses were surveyed again to discuss what topics they felt were most helpful and if they had any suggestions to improve the program.

Results

Overall, the nurses found the program helpful and informative. Several commented that they felt the program was an extension of their education classes during orientation. One nurse commented that the program “helped me feel closer to my peers.” Another stated that they enjoyed the topics that were discussed and that it “made me feel less alone and feel more supported.” When asked if they had any suggestions to improve the program for future cohorts, several nurses would have preferred a later time to accommodate night shift better. Others remarked that the meetings were too frequent and recommended having the meetings every other month.

Discussion

The results of this program reflect that new to practice oncology nurses need additional support and mentoring past the orientation period. The Empower and Excel Mentorship Program will continue to be required for all new graduate nurses on our unit to provide them with the support and guidance they need to be successful in this specialty.

Oncology Nursing Forum. 2025 Mar 1;52(2):105.

P170. Transforming Leadership in Nursing: Evaluating A Multidisciplinary Initiative to Improve Leadership and Management Competencies in Nurse Leaders

Jennifer Erickson ¹, Katelyn Cavanaugh ², Courtney Holladay ³

Management

Significance & Background

The landscape of nursing in the United States is evolving, with nurses facing increasingly complex care delivery, high workloads, and job stress. Quality leadership is crucial for protecting nurses’ wellbeing, motivation, and productivity. Equipping today’s nursing leaders with effective skills is therefore essential for delivering high-quality patient care and enhancing nurses’ work experience. At a large academic cancer hospital system in the southern United States, a multidisciplinary team of experts in leadership development and nursing practices developed a program aimed at improving leadership competencies (LCs) of nursing leaders.

Purpose

To demonstrate the effectiveness of a custom-developed leadership initiative designed to enhance specific LCs of nursing leaders (e.g., Nurse Managers, Clinical Outcomes Specialists, Assistant Directors of Nursing).

Interventions

A multidisciplinary effort between the organization’s Leadership Institute and Nursing Education departments led to the creation of the five-week Nursing Transformation Leadership Development Program, which included modules addressing transformational (“lead-the-business”) and transactional (“run-the-business”) content for cohorts of 20–30 participants. Specifically, modules covered business metric and management skills as well as chosen competencies from the organization’s leadership competency model (See table). Facilitators also led participants in interactive activities integrating discussion of practical nursing scenarios and issues.

Results

Three months post-program, nurse manager participants reported a 16% increase in self-rated leadership competencies. Their supervisors observed a 7% increase in their subordinate’s leadership competencies. By contrast, the control group displayed minimal to negative changes, with an average decrease of −0.58%. Initial turnover results suggest that participants in the leadership development program maintained a relatively stable and low turnover rate amongst their direct reports, despite an increase in the total number of direct reports. The control group had a small increase in direct report turnover rate during the same time period, in a much smaller number of direct reports.

Discussion

An improvement in participant’s leadership competencies was observed by both participants and supervisors three months after participation. The disparity in competency improvement between participants and control demonstrates the effectiveness of the program and supports the teachability of the targeted leadership competencies. The program’s modular structure with both lead- and run-the-business components allows for consistent delivery across years. The program could be easily replicated by other healthcare institutions focused on supporting the talent of nurses for the future.

Oncology Nursing Forum. 2025 Mar 1;52(2):105–106.

P171. Connections: Advancing DEIB in Oncology Nursing Leadership

Nick Escobedo ¹

Management

Significance & Background

In the field of oncology nursing, the integration of Diversity, Equity, Inclusion, and Belonging (DEIB) principles has been recognized as vital for enhancing patient care and enhancing organizational culture. Despite progress, disparities in cancer care persist, and oncology teams often face challenges related to bias and exclusion. Addressing these issues is essential for creating a more equitable and effective healthcare environment, and meeting the needs on oncology patients across the continuum.

Purpose

This presentation aims to highlight the significance of DEIB in oncology nursing leadership and to provide actionable strategies for incorporating DEIB principles into practice. The goal is to equip leaders with the tools needed to foster an inclusive culture, enhance work unit retention and engagement ultimately improving care outcomes and team culture.

Interventions

The session will explore various interventions for promoting DEIB in oncology nursing, including:

■ Implementing DEIB training and education programs.
■ Developing inclusive policies and practices.
■ Addressing and mitigating systemic biases within healthcare teams.
■ Creating support networks and mentoring programs to enhance belonging and retention.

Evaluation and Results

Effectiveness will be assessed through interactive dialogue, feedback from participants, and real-world examples of successful DEIB initiatives in oncology settings. Metrics for evaluation include improvements in team engagement, patient satisfaction, and reductions in observed disparities in care.

Discussion

The discussion will focus on the impact of DEIB on both leadership effectiveness and patient outcomes. Participants will reflect on the challenges and successes of implementing DEIB strategies and explore ways to sustain these efforts in their own organizations. By sharing insights and experiences, the session aims to foster a collaborative approach to advancing DEIB in oncology nursing.

Oncology Nursing Forum. 2025 Mar 1;52(2):106.

P172. Guardians of the Specimen: Enhancing Integrity and Management of Oncologic Specimens

Amy Estrada ¹, Christina Passio ²

Healthcare Delivery

Significance & Background

Safeguarding patient specimens is critical to ensure the integrity, security, and traceability of biological samples throughout their collection, handling, transport, and storage within healthcare facilities. Proper specimen management, accurate diagnostics, timely treatment decisions, and research reliability are essential. Gaps in communication and processes resulted in a negative impact to the overall quality of patient care in terms of appropriate treatment plans based on a given specimen sample. This initiative focused on implementing standardized protocols, advanced tracking technologies, and comprehensive staff training to prevent specimen loss, mislabeling, or degradation.

Purpose

The oncology patient’s journey begins once at the time of diagnosis. Delays in treatment negatively impact patient satisfaction and overall outcomes. Innovative solutions to streamline processes are essential for the patient’s care trajectory. Key factors include the adoption of a barcode scanning system for real-time specimen monitoring, and accurate labeling of specimens to trace path from collection to final analysis. Enhanced handling and secure transport procedures promote specimen integrity during various processing phases. The initiative emphasized interdepartmental communication and collaboration, ensured alignment between clinical, laboratory, and logistical teams.

Interventions

To support these efforts, health care staff received specialized training on best practices for specimen collection, labeling, and transport, as well as reduction of human error and promotion of a culture of accountability. Additionally, the initiative encouraged the use of digital management systems for documentation and compliance reporting, thus improving the transparency of specimen scanning processes.

Results

Avoiding misidentification of specimens and patient verification, preventing sample mishandling errors, and improving traceability was our target goal. Analysis of scanned specimens revealed post-initial implementation of 67% compliance in operating room (OR) setting. To date, the compliance in the OR has increased to approximately 95%. The subsequent roll-out occurred in the gastrointestinal (GI) setting with initial data yielding a 57% compliance rate and increasing to 63% from a recent analysis.

Discussion

This safeguarding initiative aims to optimize the oncology patient’s care journey by ensuring the accuracy and reliability of laboratory results, fostering trust in the diagnostic process, and enhancing the overall efficiency of healthcare operations. As patient safety and data integrity remain increasingly prioritized in healthcare, this initiative supplies a robust framework for protecting vital patient specimens.

Oncology Nursing Forum. 2025 Mar 1;52(2):106–107.

P173. Staying Proactive: Anal Cancer Screening and High-Resolution Anoscopy Clinic for Preventive Health

Jennifer Euton ¹, Kim Gafford ², Kristi Schimberg ³

Screening, Early Detection, Genomics

Significance & Background

High-Resolution Anoscopy (HRA) is crucial for early anal cancer detection in high-risk groups, such as the LGBTQIA community, and women with history of Human Papillomavirus (HPV). Limited geographical locations, shortage of trained providers, and lack of awareness among providers and patients also play an important part in the lack of care. Specialized care is often only available in major cities or academic centers.

Purpose

To improve access, outcomes, and reach underserved communities at increased risk of anal cancer. This will include educating these groups on the importance of anal cancer prevention through screening, and HRA within our outpatient setting.

Interventions

The HRA clinic improves healthcare access by addressing the lack of resources available in rural areas and the community. With shorter wait times, it provides faster care and prioritizes early diagnosis and prevention. The clinic treats HPV and anal dysplasia before potentially developing into cancer, thus enhancing general health outcomes. It combines services into one location for better patient outcomes and continuity of nursing care. Additionally, our community-based approach creates a familiar and less intimidating environment compared to traditional hospital settings. We are committed to offering emotional support through our nursing staff, who are trained to provide compassionate care, mitigate biases, and address patients’ emotional needs. This allows us to foster a healthier community by delivering high-quality, patient-centered care that is accessible and supportive.

Results

The HRA clinic has significantly improved patient access and care through nursing support and outreach. Advanced risk assessment tools have enabled precise and personalized care plans. Coordinated and effective follow-up procedures have provided continuity of care. Increased nurse education has improved compliance with health maintenance and follow-up appointments. Nurse education has increased competency, leading to higher-quality care, streamlined processes, and improved operational efficiency.

Discussion

As a preventative measure, high-resolution anoscopy enables nurse advocacy, outreach, and education. In addition to organizing community outreach activities and implementing nurse-led educational programs, nurses may promote HRA as a required component of preventative screenings for high-risk groups. Nurses work with interdisciplinary teams, provide emotional support, and help with increased access to care. This will allow patients the freedom to manage their healthcare with acceptance, respect, and greater insight, leading to improved patient compliance and outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):107–108.

P174. Oncology Infusion Center Hyperglycemia Protocol

Ashley Miles ¹, Helen Evers-Hunt ², Roseanne Dimarco ³, Franklin Thelmo ⁴, Eric Shiffrin ⁵, Claudia Thomas-Nembhard ⁶

Treatment Modalities and Managing Administration

Significance & Background

Patients undergoing chemotherapy often experience significant emotional and physical stress, which can lead to overlooked medical issues. The onset of hyperglycemia or diabetes during treatment complicates care and may diminish the effectiveness of chemotherapy, as early studies suggest a negative impact of hyperglycemia on treatment outcomes.

Purpose

This initiative aimed to establish a protocol at the Oncology Infusion Center (OIC) to ensure that patients maintain adequate blood glucose levels. The protocol sought to eliminate uncertainties in insulin management, facilitate timely consultations with endocrinology specialists, and minimize disruptions to chemotherapy schedules.

Interventions

A hyperglycemia protocol was developed through collaboration among endocrinology, oncology, pharmacy, and nursing teams. It included steps for confirming blood glucose levels, treatment options, patient education, and referrals to endocrinology based on an established algorithm. The protocol was activated for any patient with a random glucose level exceeding 300 mg/dL, with treatment decisions made by the onsite Oncology Nurse Practitioner. Chemotherapy would be paused if necessary, and patients could be referred to the emergency department for further evaluation. This protocol was informed by a review of hyperglycemia cases among OIC patients over the past year.

Results

The protocol was applied to 33 patients; 7 needed insulin and IVF, while 21 were managed with IVF alone, with no emergency department visits and coordinated follow-up care provided. Results indicate that most patients could be effectively managed with IVF alone, highlighting the effectiveness of less invasive measures. The lack of emergency department referrals underscores the protocol’s success in maintaining stable glucose levels. Additionally, providing education empowers patients to better manage their condition, promoting adherence to treatment and improving health outcomes.

Discussion

The implementation of the hyperglycemia protocol at the OIC reflects a proactive approach to managing blood glucose levels in chemotherapy patients. Promptly addressing hyperglycemia enhances patient care and may improve treatment outcomes. The clear guidelines established by the protocol reduce uncertainty for healthcare providers and patients, fostering a collaborative care model that prioritizes safety and timely interventions. In summary, the hyperglycemia protocol not only addresses immediate medical concerns but also supports patients throughout their cancer treatment journey. Future research could further evaluate long-term outcomes and refine the protocol for broader applicability.

Oncology Nursing Forum. 2025 Mar 1;52(2):108.

P175. Navigating TILs: Forging A New Roadmap

Andrea Fadel ¹, Asta Siugzdinis ²

Coordination of Care and Navigation

Significance & Background

Tumor infiltrating lymphocytes (TIL), a type of immune effector cell therapy, was FDA approved February 16, 2024 for metastatic melanoma. Cell therapy nurse coordinators had to develop navigation plan and coordinate with multiple teams to streamline patient care.

Purpose

With a new cell therapy product now involving solid tumor teams and surgery, cell therapy nurse coordinators needed to forge new relationships to successfully treat patients. Cell therapy nurse coordinators worked with surgery nurse associates and surgeons to successfully schedule and collect patients.

Interventions

Nurse coordinators, solid tumor cell therapy physicians, surgeons, and nurse associates in general surgery all meet every other week to discuss upcoming patients, potential dates, and insurance approval status. Every month the group comes together to discuss upcoming, current, and past patients. Patients whose products were found to be out of specification (OOS) are also discussed at these meetings. Nurse coordinators and nurse associates discuss patients and potential dates following the oncologist’s appointment and prior to the appointment with the surgeon. Cell therapy nurses and physicians did have to initially explain the process for scheduling patients for surgical resections related to insurance approval.

Results

To date, 26 patients have been surgically resected for TILs, and 14 of the possible 15 who were eligible to move forward with TIL have successfully received their cells. Eight patients have had cells found to be out of specification, which has led to five second resections.

Discussion

Developing contact with appropriate team members and educating them on the TIL procurement process (insurance approval, slot allocation) is crucial to a successful TIL program. Determining who needs to be involved prior to starting, but allowing for additional education following implementation is crucial. Frequent meetings to discuss patients, as well as additional meetings to discuss the process are critical to ensuring everyone is on the same page. Ensuring that the surgeons and general surgery nurse associates are also involved with the manufacturer can help ease tension by making the process more transparent.

Oncology Nursing Forum. 2025 Mar 1;52(2):108–109.

P176. The Role of the Radiation Oncology Nurse in Sexual Health Assessment

Lisa Falsetto ¹

Radiation

Significance & Background

The radiation oncology RN can play a crucial role in initiating communication surrounding sexual health and guiding patients to appropriate interventions and resources. Side effects from treatment can directly affect relationships. Sexual health is part of quality of life, however difficult to discuss and often overlooked. There is inconsistency in the approach, timing, and implementation of care regarding sexual health.

Purpose

To identify barriers that hinder the RN from discussing sexual health and provide interventions to address them.

Interventions

A literature review was performed to identify common barriers. A survey was given to measure attitudes toward sexual health among radiation RNs. Barriers identified; lack of training, difficulty discussing topic, attitudes towards sexuality, lack of knowledge about resources, lack of time, and lack of privacy. A journal club, educational PowerPoint, and provider support were developed about side effects of treatment to address lack of training. The BETTER model with handouts were used to educate on initiating discussions about sexual health. To explore attitudes towards sexuality the Sexual Attitudes and Beliefs (SAB) survey was given to the nurses along with examples of scripting. A resource list including online resources, handouts, and PT and SW contacts were provided. Education time with the patient was extended to 45 minutes to give the nurse adequate time for discussion. Options are being explored to address the feeling of lack of privacy. An electronic flowsheet was created in our EHR for charting that can be utilized at education, follow up, and survivorship visits.

Results

Post-data was collected 3 months after initiation of group discussions, education, and utilizing of the BETTER Model tool. The survey results demonstrated improved understanding of how treatment may affect sexuality and confidence in bringing up issue. RNs strongly agree about the importance of making time to discuss sexual health and that it is a nursing responsibility to give permission to talk about sexual concerns.

Discussion

The radiation RN is more confident in the ability to discuss sexual health. The EHR flowsheet provides a framework that can be utilized to track interventions and evaluation. Comparing data findings suggest that further education and support will improve outcomes surrounding the discussion of sexual health with patients. Findings from this project can be shared with other departments, to raise awareness and encourage open discussions.

Oncology Nursing Forum. 2025 Mar 1;52(2):109.

P177. How Clean is your Clave? A Campaign to Reduce CLABSI’s

Caitlin Fanning ¹, Alicia Dougherty ²

Quality and Safety

Significance & Background

Central line associated blood stream infection (CLABSI), one of the most common hospital acquired infections, is a major contributor to in-hospital morbidity and mortality and is associated with increased expenditure and length of stay. At our facility we saw an increase of CLABSI’s from five in fiscal year 2023 to nine in fiscal year 2024.

Purpose

The purpose of this project was to determine if CLABSI nursing education and demonstration-based competency could improve nurses’ knowledge and reduce the incidence of infection.

Interventions

We worked to implement evidence-based policy and practice changes for the insertion, maintenance, and patency of central lines. New products were presented and approved through our system’s value analysis process. An educational program was then created to emphasize the importance of proper central line care and maintenance with review of proper technique to improve adherence to policy and practice changes. A combination of didactic education and demonstration-based competency was created to address both knowledge and skill. Staff participated in our “Back to Basics” roving in-services conducted by our Clinical Practice Leads, where staff were challenged in real time scrubbing the hub techniques and how clean their claves were using glow germ. Education focused on motivating team members, providing feedback, and creating positive social change while advancing nurse knowledge and improving patient outcomes.

Results

There were nine reported CLABSI’s in fiscal year 2024. Since the education initiatives have taken place, we have reached over two hundred days with no reported CLABSI’s.

Discussion

This initiative emphasized the need for multifaceted strategies to present to staff and increase their engagement. These strategies should address knowledge gaps, support positive attitudes, and address practical barriers faced by nurses to ensure successful implementation of CLABSI prevention.

Oncology Nursing Forum. 2025 Mar 1;52(2):109–110.

P178. Peer Presentations: Bridging the Professional Development Gap for Ambulatory Nurses

Jocelyn Faro ¹

Professional Development

Significance & Background

In December 2023, a multi-site outpatient cancer center consisting of seven infusion centers, eight clinics, and one radiation oncology unit conducted a Continuing Education Assessment (CEA) to establish staff education goals for 2024. Fifty-nine percent of registered nurse survey respondents identified Professional Development as a top priority for improving performance as a nurse. Almost 200 outpatient oncology nurses in the cancer institute meet eligibility criteria for the healthcare system’s clinical ladder program, but nurses expressed difficulty identifying advancement opportunities in the ambulatory care environment to apply for and maintain desired clinical ladder status. After evaluating the CEA and nurse feedback, the Clinical Nurse Educator created “Peer-to-Peer Presentations”.

Purpose

The purpose of “Peer-to-Peer Presentations” was to offer outpatient oncology nurses an innovative Professional Development opportunity to gain presentation experience, disseminate Oncology education or evidence-based practice projects, and meet clinical ladder advancement criteria through presentations to peers.

Interventions

Presentation opportunities occurred monthly via a virtual collaboration platform, accessible to nurses from work or home. Nursing presentations were limited to 15 minutes and presenters were required to utilize a slide deck for the presentation. Nurse presenters earned 10 points in one category toward clinical ladder advancement, which requires 15 to 60 points depending on the clinical ladder level.

Results

Since program initiation in March 2024, nine oncology nurses have provided presentations across three virtual presentation events. When surveyed, 80% of presenters stated they participated for advancement points, with 75% identifying as first-time clinical ladder applicants. After presenting, 100% indicated they felt more confident in their ability to present to peers and would present again. Fifty Oncology nurses attended the events, with 67% attending more than one session. All nurses who attended indicated they learned something new about Oncology nursing and 83% expressed interest in presenting at future events.

Discussion

“Peer-to-Peer Presentations” not only offered a valuable professional development and clinical advancement opportunity, but also fostered collaboration and created community at a multi-site cancer center. All presenters interested in advancement applied for or advanced on the clinical ladder. While the initial intent was to offer presentations monthly, verbal feedback from the nurses indicated this was too frequent. The 2025 goal includes quarterly presentations to allow enough time for nurses to develop presentations and gain feedback from the Clinical Nurse Educator.

Oncology Nursing Forum. 2025 Mar 1;52(2):110.

P179. Operationalizing A Breakthrough Bladder Cancer Medication with A Multidisciplinary Approach: Insights from the Nursing Team

Rebecca Farrell ¹, Christine Amoroso ², Brianna Miller ³, Deborah Donahue ⁴, Erin Longstreth-Papsun ⁵

Healthcare Delivery

Significance & Background

Non-muscle-invasive bladder cancer (NMIBC) is one of the most common forms of bladder cancer in the United States. Given the high recurrence rate of NMIBC many patients require ongoing treatment and monitoring. Treatment is rapidly evolving, focused on immunotherapy, gene therapy, and precision medicine, offering hope for better outcomes. These treatments are particularly critical, as they offer bladder-preserving alternatives to radical cystectomy.

Purpose

Adstiladrin is a gene therapy, unique compared to traditional chemotherapy or immunotherapy. This drug has shown high efficacy in this difficult-to-treat group with intravesicular administration. In clinical trials, a significant portion of patients treated with Adstiladrin experienced complete remission. Healthcare facilities with the highest number of appropriate patients with NMIBC were invited to apply for an Early Experience Program through the drug manufacturer. For successful implementation of the new drug, due to supply, stability, and cost, a multidisciplinary team was developed to assure efficient and safe use, and best outcomes for patients.

Interventions

Key stakeholders were recruited which included genitourinary service line leaders, pharmacy, nurse leaders, nurses, financial counselors, and urologic oncologists. This multidisciplinary team identified the following steps needed prior to Adstiladrin implementation: Hospital formulary review and approval, pharmacy preparation and support, logistics and supply chain, insurance and reimbursement, patient education and consent, monitoring and reporting, and most importantly, multidisciplinary collaboration. Nurse leaders facilitated communication and problem-solving across disciplines to optimize patient outcomes, ensuring that the new therapy was administered in a way that maintains high safety and quality standards.

Results

Regular team meetings were held to review the process and provide updates. Changes were made based on patient experiences and process flaws. To date, 6 patients have completed a first dose, and 2 have had their 2nd dose of therapy. Maintaining contact with the manufacturer is beneficial for awareness of changes to recommendations. Continuous review of objectives helped to determine when milestones were being achieved, and when achieved, they were celebrated.

Discussion

By utilizing a multidisciplinary team led by a nurse leader, the implementation process was streamlined, ensuring all aspects—from pharmacy procurement to medication administration—were coordinated efficiently. This collaborative approach set a replicable model for other institutions. Sharing these best practices can empower more facilities to successfully adopt this new therapy, ultimately providing greater access to essential care for patients in need.

Oncology Nursing Forum. 2025 Mar 1;52(2):110–111.

P180. A Statewide Oncology Education Program for New Hire Nurses and Medical Assistants Aimed to Impact Employee Retention

Jeana Faske ¹, Marianna Tryggestad ², Sabrina Q Mikan ³

Management

Significance & Background

The Education Team (ET) for an ambulatory oncology organization created a process to meet the educational demands of new hire nurses (RNs/LVNs) and MAs, who a majority were oncology naïve, after the high voluntary turnover due to the challenging COVID-19 pandemic. The ET’s challenge was how to implement this process for over 300 sites of service across the state and increase retention.

Purpose

Effective education and onboarding help new employees feel supported, confident, and secure in their new roles. This benefits organizational performance and significantly impacts employee retention. The ET’s plan of action was to focus on a structured onboarding process to meet the demand of educating new staff and remove the burden from site managers and preceptors.

Interventions

A standardized clinical orientation (CO) was created and tailored for nurses and MAs. In addition, twelve clinical development (CD) courses were made aimed to educate staff on important oncology topics and workflows related to the organization. All courses are auto assigned with a cascading 2-week due date through a learning management system. CO is assigned first then CD courses follow thereafter with all being completed in the first 6 months of employment. CO includes teaching of cancer basics, overview of prevalent cancers and their diagnosis, treatments, and side effects. Our organization’s mission statement, core values are reviewed as well as clinical and HR policies pertinent to their roles. A handbook is provided to the new staff with orientation information included for the employees to reference throughout onboarding. CD courses include an overview of immunotherapy, chemotherapy, radiation, side-effects and their treatments and various supportive care processes. Oncologic emergencies, cancer rehabilitation, survivorship, and other topics pertinent to patient care delivery are covered as well.

Results

Over the past nine months, 385 employees completed CO and CD. Employee reports were evaluated to determine the impact CO and CD courses have had regarding improved retention rates as compared to the rates prior to launch. Findings showed the termed employee rate dropped by 50% post program implementation.

Discussion

The goal of CO and CD was to create valuable education for oncology naïve new hires, remove the burden from clinic staff and improve retention. In conclusion, essential education empowered staff, provided them with confidence to perform well, improved productivity, and reduced turnover ensuring long term success for all.

Oncology Nursing Forum. 2025 Mar 1;52(2):111–112.

P181. Why Advanced Practice Nurses Stay in Oncology Nursing: A Qualitative Analysis

Laura Fennimore ¹, Vanessa Battista ², Ashley Leak Bryant ³, Judith Paice ⁴, Betty Ferrell ⁵

End of Life

Significance & Background

Advanced practice nursing in oncology involves profoundly challenging work yet affords deep meaning and satisfaction. Despite this essential role, little is known about what is important to oncology advanced practice registered nurses (APRNs), and what keeps them in the profession, especially in the current challenging health care environment. Retention of these highly skilled practitioners is critical to the delivery of quality cancer care and to minimizing turnover costs associated with extended orientation periods. The ‘intent to stay’ experience of oncology APRNs has not been described in current literature.

Purpose

The purpose of this qualitative study was to understand what drives oncology APRNs to stay in the field despite considerable challenges in today’s healthcare settings.

Interventions

The End-of-Life Nursing Education Consortium (ELNEC) Oncology APRN (EOA) course is a 3-day, in-person training to prepare oncology APRNs to integrate palliative care within their current role to improve the quality of patient care. Sixty-three APRNs and three physician assistants attended this National Cancer Institute (NCI)-funded training and responded to the simple, open-ended question “Why do you stay?” on the final course evaluation.

Results

A qualitative, phenomenological approach was used to sort responses. Participant responses were entered in a Microsoft Excel document and reviewed multiple times by course investigators and faculty who coded key phrases. The COnsolidated criteria for REporting Qualitative research (COREQ) guidelines were used to support this process. Five faculty members met multiple times to discuss coding of this qualitative data and achieve consensus regarding key themes. The faculty team collapsed these themes further into the five categories describing APRN commitment to oncology nursing including: 1) passion/calling; 2) personal or family history; 3) people with cancer; 4) the opportunity to do challenging work or make a difference; and 5) relationships with members of the oncology healthcare team. Individual quotes supported each category.

Discussion

More than 30 years ago, ONS commissioned the Life Cycle Task Force to better characterize the career trajectory of oncology nurses and the meaning of oncology nursing. The results of that initial project are consistent with this study and align with reports of APRNs’ intent to leave and job satisfaction. Stakeholders concerned about the delivery of quality cancer care must recognize the values and meaning that APRNs and oncology nurses ascribe to their roles to support and retain this essential workforce.

Oncology Nursing Forum. 2025 Mar 1;52(2):112.

P182. Nursing Considerations in Coordination of TIL Therapy

Kristin Ferguson ¹, Farele Telfort ²

Coordination of Care and Navigation

Significance & Background

In February 2024, the U.S. Food and Drug Administration approved the first cellular therapy, lifileucel (Amtagvi), for solid tumor malignancy (Melanoma). Our center was designated as an Authorized Treatment Center (ATC) by Iovance (manufacturing company) in late February. The significance of this FDA approval cannot be understated, as it shows that soon a wave of approvals for cellular therapy products in solid tumor malignancies will increase the shift of therapeutics in cancer to personalized, patient-specific products necessitating oncology nurses to be educated and trained in cellular therapy coordination.

Purpose

To adequately build TIL service line and educate oncology nurses in coordinating patients referred for TIL/Amtagvi therapy for melanoma.

Interventions

Our cancer center created workflows (between interdisciplinary departments, for example referring providers, medical oncologists, surgeons, internal cell lab, pharmacy, outpatient infusion center, inpatient cell therapy nursing floor), SOPs, patient education materials, standard EHR documentation, caregiver teaching, and discharge teaching guidelines for patients referred for Amtagvi (lifileucel) for metastatic or unresectable melanoma.

Results

Our cancer center has been accepting both internal and external patient referrals as well as patient self-referrals for Amtagvi therapy. We are able to quickly assess patient records, navigate them to new patient appointments, work with the medical oncologist treating with Amtagvi, coordinate clearance testing (cardiac, pulmonary, labs), work with insurance coordinators, educate patients, refer patients for surgical consults, and adequately have patients prepare to receive Amtagvi therapy.

Discussion

As cellular therapies begin to be more available for solid tumor malignancies (clinical trials are underway in many cancer types) more oncology nurses will need to be trained and confident in navigating patients through the process of cell collection and/or tumor resection, communicating with commercial manufacturing companies, managing patient expectations on timing of therapy and patient/caregiver education.

Oncology Nursing Forum. 2025 Mar 1;52(2):112–113.

P183. Oncology Department Skills Day: An Educational Intervention to Promote Harmonized Practice

Jamie Ferrell ¹, Karen Anderson ², Ella-Mae Shupe ³, Julia Prokic ⁴, Dena Hofmeister ⁵

Professional Development

Significance & Background

Historically, oncology staff education at our academic center relied on unit-based approaches, resulting in variability in topics covered and instruction techniques. Departmental nursing practice and professional development specialists (NPPDS) and clinical nurse specialists (CNSs) noted gaps in foundational skills for nurses and unlicensed assisted personnel (UAP). Recognizing that both staff and patients can cross care settings, a harmonized approach to reviewing and refreshing fundamental skills for inpatient and outpatient oncology was needed. Skills fairs are an educational intervention to reinforce clinical practice, skills, and guidelines in a structured and efficient format.

Purpose

The purpose of the project was to promote harmonized clinical practice by developing department-wide skills fairs for nurses and UAPs.

Interventions

NPPDS and CNSs created curricula for nurses and UAPs focusing on practice gaps, policy updates, and safety event trends. Lesson plans reinforced evidence-based practices, policies, and procedures using gamification, simulation, case scenarios, and question and answer instructional techniques. Standardized teaching plans were developed to support consistency among rotating instructors. Twelve nursing and six UAP training sessions were offered over seven weeks. Staff rotated between rooms for 20-to-25-minute instructional stations during four-hour sessions. Nursing topics included chemotherapy administration, hazardous drug and excreta handling, vascular access device management and specimen collection, blood product transportation, hypersensitivity/anaphylaxis, and emergency response. UAP sessions focused on safe patient handling, hazardous excreta handling, emergency response, patient and environmental hygiene, vascular access, and specimen collection. The knowledge and satisfaction of attendees was measured quantitatively and qualitatively using pre- and post-test surveys.

Results / Evaluation

Ninety-four percent (269) of nurses and 85% (74) of UAPs attended the sessions. Nurses demonstrated the greatest improvement in pre-and-post test questions on blood product transportation (62%) and hypersensitivity/anaphylaxis management (30%). UAPs showed the greatest improvement in lab draw technique questions (56%). Qualitative data showed an appreciation for the gamification, teamwork, and hands-on instructional approaches in small group formats with information relevant to routine practices.

Discussion

Nursing and UAP oncology skills days promoted increased staff knowledge about common oncology related skills and topics. Staff reported feeling empowered and confident in their ability to provide quality care. Working together as an oncology department allowed for a unified approach to planning, teaching, and evaluating the skills days to promote harmonized practice across care locations.

Oncology Nursing Forum. 2025 Mar 1;52(2):113.

P184. Optimizing Oncology Care: Successful Implementation of Outpatient Desensitization Protocols for Hypersensitivity to Chemotherapy and Biotherapy

Arlene Ferrer ¹, Sunny Stirling ², Shankar Sundaram ³, Ann Marie Moeller ⁴, James Connor ⁵

Healthcare Delivery

Significance & Background

Hypersensitivity reactions to chemotherapy and biotherapy can be life-threatening and may prevent patients from receiving optimal cancer treatment. Desensitization protocols, traditionally performed in inpatient settings, are now supported by literature for their feasibility in outpatient settings (Barmettler et al., 2019). Transitioning desensitization practice to outpatient enables patients with hypersensitivity reactions to safely receive full, first-line therapy doses, while reducing healthcare costs and improving patient experience. This initiative was implemented in a hospital-based outpatient infusion center accredited by the American College of Surgeons, Commission on Cancer, an Integrated Network Cancer Program. Oncology nurses play a crucial role in leading the desensitization process, monitoring hypersensitivity reactions, and ensuring safe and effective therapy administration within a multidisciplinary team.

Purpose

The goal is to implement outpatient chemotherapy and biotherapy desensitization practice, which has proven to be effective and safe in oncology outpatient settings.

Interventions

The target population includes patients who have experienced a grade 3 or 4 Infusion-Related Reaction by the Common Terminology Criteria for Adverse Events (CTCAE v5.0). These patients were offered tailored outpatient desensitization protocols developed through collaboration among oncology infusion nursing leadership, oncology pharmacists, and oncologists. The treatment begins with highly diluted medication administered at slow rates, incrementally increasing as tolerated. Chemotherapy and immunotherapy certified oncology infusion nurses provide dedicated one-on-one care, patient education about desensitization, emergency preparedness, and coordination of comprehensive cancer care.

Results

Since March 2023, the outpatient infusion center has successfully completed desensitization procedures for eight patients, involving therapeutics such as oxaliplatin, rituximab, paclitaxel, and carboplatin. Six patients received their full intended doses, one discontinued due to disease progression, and one was unable to complete due to a recurring reaction. There were no fatalities, highlighting the safety and success of the outpatient desensitization process.

Discussion

The implementation of outpatient desensitization is an innovative approach in oncology nursing, offering a safe alternative for administering treatments. It results in cost savings and an enhanced patient experience. The success of this program has led to its adoption in other outpatient centers, expanding access to essential therapies. The shift from inpatient to outpatient care is a transformative step that aligns with healthcare trends emphasizing patient-centered, cost-effective treatment. Further recommendations include establishing systemic patient selection criteria and a formal training program to facilitate expansion to other sites.

Oncology Nursing Forum. 2025 Mar 1;52(2):113–114.

P185. Delineation of the Nurse Navigator and Clinical Practice Nurse Roles. There is a Difference

Kelly Filer ¹

Coordination of Care and Navigation

Significance & Background

The necessity to outline the nurse navigator (NN) role and clinical practice nurse in a newly expanded cancer center. Initially in this setting, the nurse’s role was one nurse doing both. With the expansion and hire of clinic nurses, the staff, providers, and patients needed clarity of the role differences.

Purpose

The objective is to clearly define the nurse navigator role and the clinical practice nurse role to maximize care team interactions thus optimizing patient care.

Interventions

The NN developed a plan with the expansion of a new cancer center to offer definition of navigation and importance of NN as a specialized nurse role. The NN educated the team on what to expect from a navigation nurse versus a clinical practice nurse. The references used for this qualitative research project are based on material derived from multiple resources. The job descriptions for both the nurse navigator and the clinical practice nurse were obtained. The navigation director’s analysis of nurse role delineation was assessed for relatable data pertaining to role differences. Also, Oncology Navigation Standards of Professional Practice along with the previously mentioned materials were disbursed to the cancer center team and providers for references. Additionally, new patients receive a copy of the Academy of Oncology Nurse navigator, “What is a Navigator and Why Every Patient Needs One” is offered with the NN contact information.

Results

The implementation of outlining the NN role has completed 4 months (cancer center opened May 2024). This research study will conclude after 6 months. Plan to assess qualitative feedback from the medical oncology team and selected patients using a Likert style survey at 6 months and 8 months. The survey will include questions based on previous lack of understanding the nursing role differences and the current understanding.

Discussion

The nurse navigator and clinic nurse roles were previously undefined in the medical oncology setting. The nurse navigator capitalized on the opportunity with the expansion of the cancer center to delineate the roles. Education based on valid resources was provided to the medical oncology team and providers for which nurse is the appropriate resource for the patient. Also, patients were given a clear description of navigator provided services. In conclusion, the ideal nurse is utilized for the prioritized needs of the patient thus improving continuity of patient care.

Oncology Nursing Forum. 2025 Mar 1;52(2):114–115.

P186. Development of A Simple Language -Patient Education Tool to Support Safe Outpatient Bispecific Antibody Therapy

Nellee Fine ¹, Margie Guillory ², Clare Sullivan ³, Jeanne Cerulle ⁴

Patient Education

Significance & Background

Bispecific antibody (BsAb) therapy for relapsed refractory multiple myeloma and lymphoma presents unique safety challenges in the outpatient setting. Safe and successful treatment depends on an informed, engaged patient and a responsible caregiver to monitor for treatment-related toxicities at home. We recognized the need for a patient education tool to bridge the gap between hospital and home monitoring. To achieve this goal, our interdisciplinary team developed an instructional booklet using simple language to describe treatment rationale and responsibilities of the caregiver and patient for extensive home monitoring and assessment. This resource empowers patients and caregivers to identify early signs of toxicity, such as cytokine release (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) and seek timely interventions.

Purpose

The purpose of this project was to develop a patient-centered education booklet to support the safe administration of BsAb therapy in the clinic setting. The tool was designed to meet the needs of both patients and caregivers with varying literacy levels, to help them monitor and manage potential side effects at home with guidance from their healthcare team.

Interventions

The interdisciplinary team used the principles of health literacy and the Health Belief Model (cues to action) to create the tool. The team simplified complex medical information, developed visual aids, and created daily tracking worksheets for vital signs and neurotoxicity symptoms. The focus was on clear, actionable instructions for when and how to escalate care based on specific symptoms. Paper and electronic formats were designed to maximize accessibility.

Results

The team evaluated the content for readability, clarity, and clinical relevance. Iterative feedback from stakeholders, including nursing staff, assessed the success of the pilot tool in promoting patient and caregiver engagement and safety. The Patient and Family Education Committee will review the tool to ensure that both patients and their caregivers needs are met prior to the next publication.

Discussion

The creation of this educational tool underscores the importance of interdisciplinary collaboration in addressing the complexities of patient education for BsAb therapy. The team developed a resource that enhances patient autonomy and caregiver engagement in home monitoring of an innovative cancer therapy that had been exclusive to hospitals. This project highlights how a tailored education tool can boost patient and caregiver confidence in managing complex cancer therapies in a clinic setting.

Oncology Nursing Forum. 2025 Mar 1;52(2):115.

P187. Inspiring Oncology Professional Development Through Nurse Participation in Oncology Power Rounds

Heidi Fischer ¹, Anna Leah Apil ², Emily Lewis ³, Caitlyn Nolan ⁴, Catherine Lambert ⁵, Stephanie Rodriguez ⁶

Professional Development

Significance & Background

Care of oncology patients extends beyond their treatment therapy. Professional development toward achieving chemotherapy administration competence represents 38% of our oncology inpatient nursing team; however, all nurses on the unit care for some aspect of the patient’s cancer experience, either in symptom management, psychosocial support, spirituality, and quality of life issues. Developing all nurses’ professional development in oncology care is crucial in the provision of quality care for our patient population (Tucci et. al, 2022). Developing Oncology Power Rounds by oncology nurses, for all nurses and the inter-professional care team fosters greater understanding of the patients’ experience through the cancer journey. Oncology Power Rounds offers a rich oncology professional development opportunity for both chemotherapy immunotherapy competent nurses and nurses pursing competency validation.

Purpose

The purpose of this collaborative project is to develop and implement Oncology Power Rounds to increase oncology professional development opportunities.

Interventions

The oncology professional development project launched in June 2024 and is ongoing. The unit-based council recognized a need to structure a forum designed to share monthly case studies related to a current oncology inpatient. Oncology Power Rounds are driven by the chemotherapy and immunotherapy competent nurses collaborating with the clinical nurses. The case study details the primary cancer, pathophysiology, incidence, risk and prognosis, how is the cancer diagnosed, patient characteristics and presenting symptoms, past medical and surgical history, treatment, disease specific NCCN guidelines, side effects, lab monitoring, supportive care, potential oncological emergency, patient education, survivorship, support and quality of life issues. Open discussion forum fosters nurse critical thinking and facilitates the nurse’s ability to identify priority goals for patients.

Results

■ Increase nurses’ oncology professional development through improving critical thinking
■ Increase chemotherapy immunotherapy competent oncology nurses’ leadership and mentorship skills
■ Increase recognition of oncology nurses
■ Maintain oncology nurse retention
■ Increase oncology knowledge among nursing team

Discussion

Case studies, as a part of the oncology professional development series, are an effective way to develop nurses’ oncology skills and competence though engagement and application of knowledge (Fixen, 2024). Power Rounds offers a rich experience for both chemotherapy and immunotherapy competent nurses, as well as nurses preparing for competency validation. Chemotherapy competent nurses develop leadership and mentorship skills by preparing and implementing Oncology Power Rounds. Nurses preparing for competency are developing their critical thinking and knowledge application skills.

Oncology Nursing Forum. 2025 Mar 1;52(2):115–116.

P189. Improving Intake and Output Accuracy for Hospitalized Bone Marrow Transplant Patients

Allison Fisher ¹, Kaitlyn Dhooge ², Laura Larsen ³, Michel Benz ⁴

Quality and Safety

Significance & Background

Accurate fluid balance monitoring is an essential component of the clinical care of hospitalized bone marrow transplant (BMT) patients. Maintaining fluid balance is accomplished by correctly documenting intake and output of fluids and patient weights. The precise monitoring of fluid balance guides medical decision making and nursing interventions to achieve physiological stability. Studies have indicated fluid deficits can lead to fatigue, impaired cognition, and deterioration in health. In addition, excess fluid can result in medical emergencies such as acute dyspnea and pulmonary edema especially in patients with cardiac and renal comorbidities.

Purpose

The inpatient BMT team at a large medical center identified a lack of consistency and accuracy in the documentation of intake and output. A workgroup of inpatient BMT staff nurses and providers convened to initiate a quality improvement project to increase accuracy of intake and output.

Interventions

An 8-question electronic survey was used to assess knowledge, confidence, and barriers of intake and output documentation within the EHR to identify knowledge gaps. The survey results from 44 BMT inpatient RNs, and 4 patient care assistants guided the project’s three interventions: the standardization of intake and output documentation for continuous fluids and intermittent IV medication volumes; the installation of dedicated whiteboards in each patient room to facilitate real time capture of intake and output by both patient/family members and staff; and creation of “badge buddies” for quick reference of common fluid volumes of beverages/foods.

Results

Post intervention, the accuracy of IV medication fluid documentation improved from 27% to 70% accuracy. Additional measures collected included urine and stool documentation accuracy which improved from the baseline of 85% to 100% for urine and from 88% to 92% for stool post intervention.

Discussion

The interventions implemented enhanced awareness and improved accuracy of intake and output documentation for hospitalized BMT patients. The marked improvement in documentation accuracy, particularly for IV medication fluids, underscores the effectiveness of standardized protocols and real-time data capture tools. The use of dedicated whiteboards and “badge buddies” enhanced communication and engagement among staff and patients, contributing to the overall success of the project. These findings highlight the importance of continuous education and practical tools in improving clinical practices. Future efforts should focus on sustaining these improvements and exploring additional strategies to further enhance patient care.

Oncology Nursing Forum. 2025 Mar 1;52(2):116.

P188. The Heartbeat of it All: Supporting Families at the End of Life Through an Innovative Initiative

Lexi Fisher ¹

End of Life

Significance & Background

Patient and family centered rituals as well as memory making activities are critical to facilitate coping at end of life for patients and families. This allows for the grief process to be a more healing experience as well. This was brought to light was when a wife whose husband was at the end of life was struggling with the realization that her husband was not going to get better. She told us that she often put her head on his chest and loved hearing his heartbeat. She said this was one of the things she would miss the most after he was gone.

Purpose

To develop a means by which the sound and picture of a patient’s heartbeat could be captured, recorded, and transmitted to family members to keep as a memento of their loved one.

Interventions

A special Bluetooth stethoscope was used to amplify the sound of a patient’s heartbeat. I was able to determine a means of transmitting this sound along with a visual of the heart rhythm (EKG strip video) to my phone. I screen recorded this and was able to send it to the family as a memory of their loved one.

Results

The patient’s family was very thankful and appreciative. They would now have a piece of their loved one to keep forever. Because of the success of this one event, our unit has now purchased additional Bluetooth stethoscopes to be able to offer this to other patients/families. A presentation on the process was given to leadership including nursing and other disciplines to facilitate the purchase of even more stethoscopes to be used throughout the organization.

Discussion

Nurses have a pivotal role in caring for patients at end of life including supporting their families and loved ones through the experience. The nurse can make a difference in this being a more positive life altering experience rather than a devastating one. Finding ways to ritualize a patient’s death can honor a patient’s life and allow their memory to comfort the family in their time of grief and beyond.

Oncology Nursing Forum. 2025 Mar 1;52(2):116–117.

P190. Cutting Down on Emails and Implementing an Epic Ambulatory Referral Order to Oncology Clinical Trials

Lisa Fitzgerald ¹

Management

Significance & Background

At Mount Sinai Tisch Cancer Institute Clinical Research Support Unit (CRSU), patients for clinical trial are referred for evaluation via email from referring provider to clinical research team. The CRSU had 435 clinical research patient accruals in 2023. As of July 2024, it has 247 accruals. However, there has been no mechanism for evaluating total referral volume rendering it impossible to evaluate the percentage of referrals converted to accruals. An accrual defined as a patient who has signed informed consent for treatment on clinical trial.

Purpose

Understanding the true volume of referrals screened across CRSU teams is essential to properly allocating staffing. The lack of insight into total referral volume is a barrier against delving into possible patterns of failed patient referrals. A failed referral defined as one that does not translate to an accrual within 90 days of referral.

Interventions

In October 2024, an Epic Ambulatory Referral Order to Oncology Clinical Trials was launched at Mount Sinai to replace the current email referral system. With this order, it is possible to track the volume of referrals to each disease focus group (DFG) and track the percentage of referrals that transform to accruals. Given the structure of the order itself, it is now possible to track the percentage of referrals who speak English, have a secondary malignancy, need treatment now, and are currently on active treatment. This will be done via radio button selections imbedded in the referral order.

Results

With this launch yields the ability to see the volume of referrals for each disease group. It allows for tracking volume of referrals who get scheduled for a research visit versus those referred but never scheduled for visit. It allows for stratification of further details regarding referred patients collected via the radio button selections.

Discussion

Understanding statistics of patients referred to the CRSU is essential to improving practice. For example, the advantage inherent in advanced notice of a patient who will required a translated informed consent form. Or facilitating prioritization of referrals to screen with immediate knowledge whether or not treatment is needed now. This order minimizes email back and forth by having essential questions automatically imbedded in this first communication creating a more streamlined approach for both referring provider and receiving clinical research team.

Oncology Nursing Forum. 2025 Mar 1;52(2):117.

P191. Please Call Don’t Fall: Preventing Falls in the Ambulatory Care Setting

Michael Fitzpatrick ¹, Sarah Porzig ²

Quality and Safety

Significance & Background

Preventing falls, particularly among older adults, is a critical public health concern due to the high risk of injury and the associated healthcare costs. Education and awareness programs can empower individuals to take proactive steps in minimizing risks. Implementing these strategies within the healthcare setting can significantly reduce the incidence of falls improving safety and quality of life for vulnerable populations.

Purpose

To roll out a quality improvement project to reduce falls in the Ambulatory Care Setting. Leadership along with the quality improvement team identified that most of our falls were assisted falls to the ground when patients were being weighed. Patients also reported that they had fasted prior to coming to their appointments even though fasting was not required or recommended. For these reasons we focused our interventions on patient nutrition information as well as signage around our scales and in our bathrooms.

Interventions

We created a patient education handout to be given out with initial chemotherapy teaching and any time a patient presents to clinic. The education focuses on proper nutrition prior to coming to appointments and what to report to their care team ie: dizziness, lightheadedness, fatigue. We also implemented new signage that will cue staff and patients to discuss any signs of dizziness or lightheadedness at the scales and in the bathrooms. Furthermore, we installed a patient refrigerator and facilitated a contract with our nutrition department to keep patient refreshments on the unit.

Results

We are still evaluating the results of these interventions, but the expectation is that the number of falls will decrease.

Discussion

In the past fiscal year we have had 9 falls in our Ambulatory Care area, with the majority of them occurring at the scale. We anticipate that implementing the interventions we laid out will help decrease our patient falls.

Oncology Nursing Forum. 2025 Mar 1;52(2):117–118.

P192. Managing Blood Transfusion Reactions: A Guide for Ambulatory Oncology Nurses

Leighanne Fitzpatrick ¹, Rosmary Ramos ²

Treatment Modalities and Managing Administration

Significance & Background

In the outpatient infusion setting, many patients who are undergoing chemotherapy will need to have one or more blood transfusions throughout the course of their treatment. As chemotherapy targets cells that grow and divide quickly, healthy cells can be damaged along with cancer cells. As the bone marrow is damaged, low hemoglobin is a common side effect that is closely monitored by the nursing staff. Oncology infusion nurses must be confident in handling blood products and understand the policies and procedures to take in the event a blood transfusion reaction occurs.

Purpose

To increase nurses’ confidence, with a tip sheet, in handling blood products correctly leading to increased patient safety.

Interventions

A survey was completed by the nursing staff to evaluate the need for and effectiveness of a blood transfusion reaction tip sheet on the infusion floor. The survey was used to evaluate how often nurses were handling blood products and how confident they felt in handling a potential blood transfusion reaction. After the need for a blood transfusion reaction tip sheet was established, a tip sheet was formed using our organization’s policies and procedures. A survey was obtained after implementation of the tip sheet determining its usefulness.

Results

The pre-survey showed 60% of infusion nurses selected “somewhat confident” in handling blood transfusion reactions according to our hospitals policies and procedures. As blood transfusion reactions can occur quickly and spontaneously, it is important nurses have easy access to the proper policies and procedures to follow. Following the creation of the tip sheet, 100% of the survey participants selected that the blood transfusion reaction tip sheet helps them feel more confident in handling potential reactions.

Discussion

Blood transfusion reactions may cause anxiety for nurses handling blood products. The implementation of the blood transfusion reaction tip sheet on the infusion floor not only increased nurses’ confidence in handling blood products, but also helped address patient safety. As nurses feel more prepared to handle potential reactions, adverse symptom resolution can occur quickly and safely. As policies and procedures are revised and implemented, the tip sheet will be updated to reflect the most up-to-date practice.

Oncology Nursing Forum. 2025 Mar 1;52(2):118.

P193. Central Line Blood Culturing in Immunocompromised Patients

Brianna Flanagan ¹, Nichola Gotheil-Weinstock ², Thea Malile ³, Jennifer Sather ⁴

Quality and Safety

Significance & Background

In a large academic teaching hospital, there are standardized evidence-based practice algorithms that are intended to guide clinical decision making. In the oncology population, there was specific guidance for blood culturing in patients with a hematology diagnosis or patients who had stem cell transplants. The most recent version of this guidance had not been reviewed since 2017 and incidence of CLABSIs on the inpatient hematology and medical oncology units revealed an opportunity to improve diagnostic stewardship.

Purpose

To reduce the number of blood cultures being drawn, specifically from central venous access devices.

Interventions

Based on best practice and with multidisciplinary input from hematologists, infection prevention, safety & quality, and nursing, a new blood culturing pathway was created for febrile adult patients (temperature ≥ 100.4 F) with neutropenia (ANC < 500), impending neutropenia or active treatment for Graft Versus Host Disease. The guidance now captures patients with solid tumor diagnoses with febrile neutropenia but notably minimizes repeat culturing in patients who are persistently febrile without further clinical deterioration to 72 hours. Additionally, surveillance culturing guidance was more clearly defined and was changed from one set of central cultures to one set of peripheral cultures. Finally, the recommendation to culture from every lumen of all central lines was adjusted to just one set of peripheral cultures and one set of central cultures.

Results

In Q1 through Q3 of FY2024, the inpatient hematology and medical oncology units had an average CLABSI rate/ 1000 device days of 1.23. In Q4 of FY2024, after go-live of the new culturing pathway, the average CLABSI rate/ 1000 device days decreased to 0.64.

Discussion

While decreased culturing does not prevent CLABSIs, it does minimize the risk of contaminated specimens, especially from central venous access devices. Inappropriate culturing of central lines can lead to unnecessary removal of lines and antibiotic treatment in the absence of true infection. Additionally, the new culturing guidance provides more standardized recommendations amongst neutropenic patients regardless of primary malignancy.

Oncology Nursing Forum. 2025 Mar 1;52(2):118–119.

P194. Old Dogs Can Learn New Tricks: A Look at Expert Infusion Nurses Embracing Change in Practice by Partnering with Physicians and Patients

Patricia Foley ¹, Jean McGonigal ², Elizabeth Dailey ³, Carol Blecher ⁴

Treatment Modalities and Managing Administration

Significance & Background

Chemotherapy induced peripheral neuropathy (CIPN) is a known side effect of treatment with oxaliplatin and taxane therapies. A patient at a private infusion center presented for treatment requesting the use of cryotherapy during her treatment with oxaliplatin. The seasoned, expert nurses were quick to tell this patient that they were not comfortable with this. They cited examples of untoward reactions witnessed when patients undergoing oxaliplatin treatment touched or drank cold things. The patient’s oncologist provided the nurses with multiple studies citing the efficacy of cryotherapy in preventing CIPN. The nurses, though hesitant, complied. Due to the incidence of CIPN with taxanes, the nurses sought and discovered evidence which prompted them to offer cryotherapy to these patients as well.

Purpose

The purpose of this project is to empower and encourage expert oncology nurses to embrace new evidence-based practices and to share these practices with their peers and their patients.

Interventions

Patients receiving oxaliplatin and/or taxane therapy were presented with the evidence and were given the opportunity to use cryotherapy during treatment. To date, 13 patients have opted to participate. Nurses created patient guidelines for using cryotherapy. Patients brought their own cryotherapy mittens and socks to each treatment which they donned 15 minutes prior to treatment and wore throughout the infusion. Additionally, patients receiving oxaliplatin chewed on ice chips during their infusion.

Results

Patients were assessed for CIPN, cold sensitivity, and other side effects at the start of each treatment and during risk stratification phone calls between cycles. Data was collected and evaluated. Seventy percent of patients participating in the project experienced no CIPN or cold sensitivity, 15% experienced mild, transient CIPN or cold sensitivity, and one patient left to pursue CAR-T therapy. This project is ongoing and has been adopted by other practices in the organization.

Discussion

Patient centered care has been proven to increase patient satisfaction scores and ultimately patient outcomes. This collaborative project between physicians, nurses, and patients has taught us the importance of listening to patients’ desires, searching the literature for evidence, and being open to different approaches to care.

Oncology Nursing Forum. 2025 Mar 1;52(2):119.

P195. Establishing A Standard Procedure to Flush Hazardous Drugs: A Nurse Driven-Initiative

Jenna Forsythe ¹, Summer Perez ², Yuly Endo ³, Roseanna Chan ⁴, Stefanie Rebholz ⁵, Jo Ann Kelly ⁶

Quality and Safety

Significance & Background

21–35% of intravenous medication administered via intermittent infusion can remain in infusion tubing as residual volume (RV) (Harding et al., 2020). Underdosing is a medication error that can lead to reduced efficacy, suboptimal outcomes, and increased risk of morbidity and mortality (Bolla et al., 2020). At the John Theurer Cancer Center, a variety of tubing, filters and IV attachments are used to administer hazardous drugs (HDs), however, flushing practices are not tailored to account for the priming volumes of these products, and there is variability in flushing practices amongst nursing staff.

Purpose

To establish a standardized nursing procedure for flushing hazardous drugs with a dual focus on reducing residual medication volume by ensuring the complete delivery of intravenous medications, and prioritizing the safety of patients and team members by preventing exposure to hazardous drugs.

Interventions

A taskforce of infusion room nurses was established to evaluate current flushing practices and the priming volumes of products used to administer HDs. A literature review was conducted identifying best practice, and a standardized, evidence-based flushing procedure was developed. The procedure was aimed to ensure the complete delivery of HDs while maintaining patient and staff safety from inadvertent drug exposure. Nursing staff was educated on the new procedure through multiple channels including staff meetings, unit huddles with demonstrations, designated unit champions on every floor, and written guidelines with visual aids.

Results

The majority of nurses (74.7%) reported the standardized flushing procedure was easy to integrate into their clinical practice, with the most significant change being the procedure for flushing small volume drugs prepared on “short set” infusion tubing. Additionally, 66.8& of nurses believed the procedure reduced their risk of inadvertent exposure to HDs. Nurses also felt the new flush procedure reduced the residual volume of HDs remaining in IV tubing following administration.

Discussion

Nurses’ involvement in decisions that impact clinical practice is essential to ensure practicality and effectiveness. The implementation of a standardized flushing procedure helps to ensure consistency in patient care and experience across the board. Recommendations for flushing practices and volumes have not been defined in literature. The practices and volumes established for the purposes of this project were determined based on the priming volumes of the supplies utilized at the institution.

Oncology Nursing Forum. 2025 Mar 1;52(2):119–120.

P196. Code Lavender: Implementing A Staff-Led EBP Intervention to Decrease Perceptions of Nurse Burnout on A Medical Oncology Step-Down Unit

Shannon Forty ¹, Nadeen Robinson ², Christina Osorio ³, Archana Shenoy ⁴, Nicole Turkoglu ⁵

Management

Significance & Background

Burnout among healthcare providers, particularly nurses, is a well-documented issue that adversely affects the quality of care and patient experiences. On a medical oncology step-down unit at an urban academic medical center, nursing staff reported significant burnout levels. In response, we implemented Code Lavender, an evidence-based staff support intervention designed to address the emotional toll of stressful events in the workplace.

Purpose

This project aims to reduce perceptions of burnout among oncology nurses on the step-down unit through the introduction of a staff-led Code Lavender program.

Interventions

The Code Lavender program empowers all staff to initiate support during distressing events, fostering a culture of care and collaboration. Implemented on both day and night shifts, the initiative includes a curated “code lavender basket” with stress-relief items such as candy, tea, aromatherapy, skincare products, and a designated safe space for staff to share their feelings. Additionally, the nursing team collaborated with spiritual care and the well-being team to offer meditation, reflection, and spiritual support.

Results

The Oldenburg Burnout Inventory measured burnout levels pre- and post-intervention, assessing disengagement and exhaustion across 16 questions (scores range from 16–64). The average burnout score decreased from 41.75 (n=16) (moderate burnout) in Jan 2024 to 40.8 (n=15) (moderate burnout) in April 2024, indicating a 2.3% improvement. Pre intervention 8 number of nurses reported a high level of burnout and post intervention 4 number of nurses reported a high level of burnout, indicating a 50% improvement.

Discussion

Post-implementation, fewer nurses reported high burnout levels, and many expressed feeling more supported and less stressed. Notably, engagement in shared governance increased, with 10 new nurses joining hospital committees and 3 joining the Unit Council. Between January and March 2024, patient experience scores improved, culminating in a 5-star rating for the unit. Continued interest in the Code Lavender program suggests its positive impact, with ongoing evaluations planned to assess long-term efficacy.

Oncology Nursing Forum. 2025 Mar 1;52(2):120–121.

P197. Get Engaged: Improving Workplace Relationships in the Ambulatory Oncology Setting

Kirsten Foster ¹, Ashley Shelden ²

Professional Development

Significance & Background

Achieving compassion satisfaction and reducing burnout is essential to providing high-quality and compassionate nursing care. Nurse burnout is especially common in the oncology field due to the high levels of emotional and physical stress involved in caring for patients with terminal illnesses. Workplace engagement has led to increased patient safety, improved quality of care, and patient satisfaction.

Purpose

To improve workplace engagement, compassion satisfaction scores, and burnout scores of surveyed employees.

Interventions

An Engagement Committee was established at the ambulatory oncology center. Co-chairs have implemented activities to encourage staff engagement, boost morale, strengthen relationships amongst staff, and reduce burnout. The staff was surveyed on preferred activities and timing to encourage participation. In-clinic activities included staff donation and distribution of Valentine’s Day treat bags to patients and encouraging patients to vote for a Halloween costume theme. Activities outside of the workplace included the implementation of a quarterly book club, happy hours, and a holiday party. Clinic staff were surveyed using the standardized ProQOL tool and perceived strength of relationships pre and post interventions.

Results

A total of 25 employees participated in the pre-intervention survey and 26 employees participated in the post-intervention survey. 100% of participating employees had pre- and post-intervention ProQOL scores in the “average” or “high” category for compassion satisfaction. Burnout scores did not show improvement, from 61% in pre-intervention to 57% in post-intervention. The perceived strength of relationships amongst employees improved with 70.37% of participating employees rating their relationships “strong” or “very strong” on the post-intervention survey as opposed to 52.50% on the pre-intervention survey. 77.77% of participating employees expressed the engagement activities strengthened their relationships with other staff members.

Discussion

Compassion fatigue and nurse burnout are two common occurrences leading to decreased workplace satisfaction. The interventions aimed at developing awareness of compassion satisfaction and strengthening teamwork to mitigate the negative effects of burnout. Despite unchanged burnout scores, the implementation of staff engagement activities has shown an improvement in employees’ perceived strength of relationships amongst staff. Committee co-chairs will continue to survey staff twice a year and plan a variety of activities in and out of the clinic. The in-person book club will continue to be hosted quarterly as it was well received by staff with high attendance and positive feedback.

Oncology Nursing Forum. 2025 Mar 1;52(2):121.

P198. Reducing Oral Mucositis Severity in the Transplant Population

Yvonne Francis ¹, Leslie Smith ¹

Symptom Management and Palliative Care

Significance & Background

Individuals receiving chemotherapy and radiation have an increased risk of developing oral mucositis. In 2020, the Mucositis Study Group of the Multinational Association of Supportive Care Cancer/International Society for Oral Oncology (MASCC/ISOCC) updated the oral care guidelines to include frequent basic oral care (BOC) to decrease oral mucositis (OM) severity. Frequent and consistent BOC practice decreases the load of oral microbes and reduces the ulcerations and pain associated with OM. Additionally, the need for intravenous pain medications (patient analgesic control or PCA), total parenteral nutrition (TPN), and risk for systemic infection declines. Based on the MASCC/ISOCC guidelines, a BOC initiative was conducted on a group of inpatient stem cell transplant (SCT) participants in our institution.

Purpose

At our institution, the SCT unit did not have a BOC bundle. Oral agents such as sodium bicarbonate, commercial mouthwashes, medical grade honey, toothbrush, and toothpaste were available, but they were not routinely offered to patients. To proceed with the BOC bundle, the Clinical Research Nurse (CRN) and Clinical Nurse Specialist (CNS) organized an oral care bundle (OCB), created a daily oral care check-off calendar, formulated an education brochure, and developed an implementation plan.

Interventions

The BOC bundle initiative consisted of three phases. In the first phase, pre-pilot data was obtained, a random sample of patients were questioned as to their current BOC practices, and a nurse’s readiness survey was conducted. After this phase was completed, the second phase consisted of implementing the OCB. The patients were given the OCB, calendar to mark when they performed the OCB, and an education brochure in English or Spanish. During implementation, the CRN and CNS performed weekly face-to-face education with patients and monitored compliance mucositis grade as documented by the provider, and nursing documentation.

Results

The OCB initiative was met with success. Improvement in daily oral hygiene revealed a decrease in OM on the unit from an average of Grade 2 mucositis in 2022 to an average of Grade 1 by May 2024. Nurses also experienced a reduction in their workload.

Discussion

Improvement in oral hygiene has led to a decrease in the severity of oral mucositis. The OCB is currently integrated into the unit culture, and patients are receiving ongoing oral care education to decrease oral mucositis severity.

Oncology Nursing Forum. 2025 Mar 1;52(2):121–122.

P199. What to Expect: Creating Patient Education Videos for Radiation Oncology Patients

Olivia Franek ¹, Kerri Dalton ², Deborah H Allen ³, Jackie Burger ⁴, Sarah Brady ⁵

Patient Education

Significance & Background

Noticing an increase in questions about what to expect prior to starting radiation led our team to consider new methods of educating patients on expectations for the radiation planning scan (RPS). Many patients requested to see the scanner, who would be caring for them and which immobilization devices might be used. While RPS was explained by the provider at consultation, it was often forgotten due to the overwhelming amount of information presented and many patients presented to this scan unprepared.

Purpose

To increase patient’s knowledge of what to expect for their RPS.

Interventions

After researching the use of patient education videos through a literature review, a nurse-led interprofessional team was formed to improve patient education on the radiation oncology experience and care expectations; the team started with the RPS. This team, consisting of a nurse, radiation therapist, and communication strategist, developed the video concept and script. Once approved, filming utilized staff in their typical roles with voice-over narration. To distribute this video, a QR code was created and placed in clinic rooms; providers would direct patients to view it. An automated distribution of the video went to the patient’s MyChartTM when the RPS was scheduled. Viewing was also available while waiting for their RPS. Patients were asked to complete a nine-item survey after their RPS to better understand how the video impacted their experience.

Results

Forty-nine patient responses were collected. An overwhelming majority (87.75%) of patients felt the video increased understanding what to expect for their RPS, and over half (65.30%) stated the video helped them feel more prepared for their RPS. Most patients (48.97%) watched the video in the nurse triage area prior to their scan, with 24.48% watching via QR code and 24.48% on MyChartTM. Additional comments included:

■ “Everyone needs to see it”
■ “Thank you for presenting this to me”
■ “This video is a good well-made project”

Discussion

This innovative, multifaceted, approach to patient education demonstrated feasibility while increasing patient preparedness and understanding of the RPS. The team continues to incorporate feedback into these educational strategies. Next steps include broadening dissemination of existing content and creating more patient education videos using this concept. Other units have begun using this format and commented that this project “set the precedent” for new content.

Oncology Nursing Forum. 2025 Mar 1;52(2):122.

P200. The Optimization of the Clinic Nurse Role in A Community Cancer Center

Lauren Frazier ¹, Latoya Griffiths ²

Healthcare Delivery

Significance & Background

In 2020, a large NCI-designated comprehensive cancer center created an alliance with a community cancer center (CCC). As care delivery was transitioned with this new entity, it was recognized a fundamental restructuring of the model of care was necessary. The composition of the oncology care team and complexity of care mandated an in-depth analysis and new strategic plan formation was essential to efficiency and best cancer outcomes.

Purpose

To provide an overview of a new oncology nurse model of care within a community cancer center.

Interventions

A new nurse leader conducted the analysis and created a proposal utilizing the McKinsey’s 7-S change management model for a CCC. Subject matter experts were hired, including a Nurse Manager and Supervisor, with expertise in Comprehensive Oncology care. The Executive committee approved proposed plan for staff composition and allocation of FTEs in alignment with projected year over year growth. A system was established to reduce unscheduled/overbooked patient clinical time at the infusion center. A pivotal element was the utilization of the clinical nurse coordinator (CNC) role for the management of unanticipated patient care. The CNC oversees patient triage, treatment, and appropriate schedule templates, thus decreasing unanticipated time spent in nursing and medical care. Extensive Standard of practice didactic education and establishment of a multidisciplinary transitions meeting enhanced holistic patient care and optimized efficiency.

Results

Post implementation and evaluation reported Improved satisfaction for both nursing and providers, increasing staff retention. A decrease was noted in same-day cancellations after patient arrival at the infusion center, reduction for next available chemotherapy appointment by up to five business days. There was an average of 4% increase in infusion revenue over organizational targets by year two. A sustained reduction infusion nurse overtime was also observed whilst maintaining highest quality patient care.

Discussion

The CNC role proved integral to meeting high Quality standards in complex oncology care while demonstrating positive fiscal and revenue implications. This model shows promise for enhancing operational success and scalability in other community oncology setting during initial growth phase.

Oncology Nursing Forum. 2025 Mar 1;52(2):122–123.

P201. The Role of Oncology Nurses in Cancer Prevention and Public Education

Mitra Freer ¹

Screening, Early Detection, Genomics

Significance & Background

American communities are facing a healthcare crisis, and disparate rates exist in cancer prevention, diagnosis, treatment, and survival across populations. More than two million Americans will be diagnosed with cancer and 30–50% of cases are preventable. Cancer incidence is higher in the non-Hispanic white population, yet cancer death rates are higher in non-Hispanic black, and non-Hispanic American Indian/Alaska Natives. A gap exists for the public in obtaining and evaluating information and accessing services for cancer prevention and screening to improve outcomes and reduce the burden of disease and financial toxicity. Another significant crisis is nicotine addiction, a known carcinogen, flavored to compound the habits-forming behavior among youth. A need exists for oncology nurses’ organizations and policymakers to promote cancer prevention knowledge and improve access to screening.

Purpose

Provide a model for cultivating oncology nurse engagement in cancer prevention, promotion of healthy life choices, public education, and advocacy in policy formation.

Interventions

Oncology nurses are knowledgeable about social determinants of health, vulnerable populations, and care policy positions that mandate access to cancer screening for uninsured and underserved communities. Specifically, oncology nurses are proponents of the need for unbiased care provision for BIPOC and LGBTQIA+ populations. Collaboration with the Oncology Nursing Society (ONS) creates opportunities for a dynamic dialogue between the public and healthcare professionals, with policymakers to establish actionable outcomes. Utilization of the American Cancer Society/Cancer Action Network (ACS CAN) and Cancer Information Services provides relevant and current content for education and outreach.

Results

Within professional practice, nurses need to integrate prevention and screening best practices education for their patients. Also, nurses can participate as informed ambassadors with agencies such as ACS/CAN as well as community-level cancer prevention and awareness events. Enhanced alignment between nurses with ONS membership and legislators promotes prevention and best practices policies. Increased access to oncology experts facilitates the required future changes. Evaluation of public education about screening methods and ensuring accessibility to underserved and rural populations are vital.

Discussion

Nurses are essential across the cancer continuum collaborating with agencies, organizations, NCI-designated centers, community health educators, social media, and high school curriculums to increase the scope of influence and power brought to bear for cancer prevention and decreases in morbidity and mortality for all populations.

Oncology Nursing Forum. 2025 Mar 1;52(2):123.

P202. Implementation of A Nursing Skills Day in Community Oncology Practices

Taylor Fulka ¹, Shannon Nottingham ², Elizabeth Ashworth ³

Professional Development

Significance & Background

Validation of nursing knowledge and skills is an essential element of professional nursing development. Standardization of nursing skill validation is challenging in the community oncology practice environment, particularly with numerous practice sites that span hundreds of miles. A centrally located nursing skills day was designed and offered monthly to facilitate annual education and skills validation for community oncology nursing staff.

Purpose

In 2023–2024, a monthly nursing skills day was implemented based on stakeholder feedback regarding essential competencies for community oncology nurses. Exercises were developed to foster critical thinking, validate competencies, and standardize nursing care to facilitate safe practice across all clinical sites. Organizational policies were reviewed in interactive and engaging ways to increase confidence and clinical competence.

Interventions

Oncology nurse clinical educators developed content based on knowledge deficits, errors, and near-misses identified by supervisors and preceptors within the clinical sites. A lecture of evidence-based oncology symptom management was designed based on feedback from staff nurses, particularly nurses new to oncology. An escape room was designed around a vesicant chemotherapy extravasation scenario, with participants solving puzzles to “escape” the room. A trivia game was created to test knowledge areas such as oncologic emergencies and symptom management. Skill stations were developed offering hands-on practice in programming pumps, sterile central line dressing changes, and chemotherapy admixture calculations. Finally, a radiation oncologist provided an engaging case study surrounding standards of care for patients with lung cancer.

Results

Attendees answered a pre-and post-survey using a Likert scale to measure their confidence regarding skills day content. A diverging bar chart displays significant growth across all topics, most notable in radiation. Nearly 88% of respondents agreed with the statement, “skills day provided education that will improve my daily patient care.” In ranking which topic was “most helpful,” 44% of respondents reported the symptom management lecture, while 38% answered the radiation oncology case study.

Discussion

A dedicated nursing skills day offered in a central location is an effective way for multi-site practices to provide clinical education for community oncology nurses. Stakeholder feedback should inform curriculum design, taking into consideration a variety of nursing experience levels. Inclusion of unfamiliar topics, such as radiation oncology, proved crucial in building nurses’ confidence. Centralized education allows for the identification of knowledge gaps, providing clinical insights, while fostering a spirit of learning and community.

Oncology Nursing Forum. 2025 Mar 1;52(2):123–124.

P203. Medication Reaction Management: A Nurse-Initiated Approach

Kathleen Gander ¹, Jennifer Larsen ²

Treatment Modalities and Managing Administration

Significance & Background

There are risks of reactions with the various medications patients receive in the infusion therapy center (ITC). If medication reactions are not managed effectively, there can be interruptions in patient treatment and inability to continue a specific regimen safely. Nurses administering these medications can frequently encounter patient reactions in practice and are often the initial healthcare providers to assess patient symptoms and manage treatment response. Fifty-two nurses in the ITC at a large academic medical center were surveyed, and 96% reported observing a medication reaction while working in the setting.

Purpose

The purpose of this project was to implement a nurse-initiated approach to quickly respond to medication reactions and enhance nursing support and confidence for effectively managing treatments in the ITC.

Interventions

In collaboration with nursing, pharmacy, and providers, a nurse-initiated protocol was established with evidence-based treatment orders for medication reaction management. Nurses participated in an educational session and completed a virtual learning module to promote understanding of the protocol and included treatments. In January 2024, the protocol was implemented for use in the ITC.

Results

After implementation of the protocol, 100% the ITC nurses surveyed reported increased support for managing infusion reactions and improved response time for patient treatments. From pre-intervention to nine months post-intervention, nurses reported increased confidence for managing reactions and identified that treatment orders were more readily available when needed (see attached figures). Since implementation, there has been a reduced number of patients transferred to the emergency department or needing a higher level of inpatient care. Emergency medical rapid response team (RRT) calls to the ITC have not increased, and of the RRT calls to the ITC, there have been less patients requiring additional therapy after RRT arrival.

Discussion

These results demonstrate the effectiveness of instituting a nurse-initiated protocol to manage medication reactions. Since implementation, there has been increased nurse empowerment and a positive impact to patient outcomes and timeliness of treatments provided. This protocol has been utilized across all ITC locations within the large multi-site healthcare system. Implementation of a standardized nurse-initiated protocol for medication reaction management is feasible for various healthcare settings.

Oncology Nursing Forum. 2025 Mar 1;52(2):124–125.

P204. Development of A Standardized Data Collection Tool for Additional Full-Time Employee Justification Across A Large Community Oncology Practice

Ashley Gandy ¹, Deja Ross-Jenkins ²

Management

Significance & Background

This community oncology practice consists of 93 offices where Clinical Nurse Managers and Office Managers from each location are responsible for collecting data to justify the need for additional employees. Justification is then presented to the hiring committee for final approval of additional positions.

Purpose

Staffing data is being collected and presented in multiple ways, not always capturing the true picture of the operational needs. The current process frequently results in insufficient justification for additional positions. Insufficient justification causes an increase in time spent revising, analyzing, and resubmitting data, resulting in delayed approvals for additional staff. The purpose of this project is to improve the current method of FTE justification with the development of standardized data collection tool.

Interventions

A tool was developed with specific guidelines and automation features to help guide Clinical Nurse Managers in justifying the need for additional full-time employees (FTEs). This tool is used for requesting new FTEs and replacement FTEs. Automation features were created to calculate ratios over a 12-week period using current staffing numbers and projecting ratios with an additional or replacement FTE. The calculated ratios will change colors automatically, based on organizational limitations, to quickly identify out of range ratios. This template was distributed to all Clinical Nurse Managers.

Results

Providing a resource that requires specific data points to better rationalize the necessity for additional or replacement positions resulted in a lean process improvement by reducing the time it takes to compile information and improving the quality of data presented to the hiring committee. A summary section has since been added to this template. This section will automatically display the number of days a clinic would be outside of the appropriate ratios without the addition or replacement of a full-time employee.

Discussion

This tool was originally launched within Clinical Operations to facilitate staffing justifications for nursing roles. It has now been expanded to Practice Operations to assist in justifying non-clinical positions. The introduction and growth of this tool has streamlined the justification process and ensured uniformity across the organization.

Oncology Nursing Forum. 2025 Mar 1;52(2):125.

P205. Optimizing Workflow: Mitigating Distractions and Interruptions for Radiation Oncology Nurses as Patient Volumes Increase

Gabby Gannon ¹

Quality and Safety

Significance & Background

As our Radiation Oncology clinics are growing, clinical staff are becoming increasingly busy, and their attention is frequently being pulled in many directions. With this growth, the volume of phone calls to the nurses’ station has also increased. The frequent calls range from informational, scheduling, medical records questions, patient concerns, radiation therapist concerns, and urgent messages.

Purpose

Published studies show that distraction and interruption can have detrimental effects on nursing care and job satisfaction. This initiative was created to improve safety, communication, and nurse satisfaction. Interruptions directly affect job performance and may compromise decision-making processes and efficiency. The quality and safety of care delivered to patients is affected, potentially resulting in numerous errors. Additionally, interruptions unnecessary for direct care can generate frustration, stress, and demotivate professionals, contributing to job dissatisfaction.

Interventions

A new role using a designated nurse to assist with clinic flow was implemented after results of a nursing staff questionnaire indicated the need for change. The questionnaire detailed nurses’ perceptions of frequency of interruptions, and their impact on job satisfaction. The “Radiation Oncology Triage Nurse” position was approved by nursing leadership. One RN is assigned daily who assists with triaging phone calls from administrative or therapy staff regarding urgent or non-urgent clinical matters. A detailed algorithm was created to help our office staff understand how to route calls, including examples of calls that should still come directly to the nurses’ station, calls directed to the triage nurse, and which should be communicated through the electronic medical record, email, or other written communication methods. On daily morning huddles, the triage nurse’s name is identified to our multidisciplinary staff, and a reminder is given to call that person for clinical needs.

Results

A questionnaire was administered to the nursing staff pre-initiation of the nursing triage nurse role and repeated 1-month post-initiation. The pre- and post-initiation questions assessed the perceived volume of calls and their impact on job satisfaction and interruption to nursing care.

Discussion

Upon reviewing the results of the 1-month post-initiation questionnaire, our nurses felt there was a decrease in call volumes and an increase in appropriate usage of written communications with the initiation of the triage nurse role. Additionally, nurses felt the quality of care they provide has improved with less distraction, and increased their perception of job satisfaction.

Oncology Nursing Forum. 2025 Mar 1;52(2):125–126.

P206. Role Innovation Staffing Model: Utilizing Admission, Discharge, and Transfer (ADT) Nurses in Oncology Units

Julio Garcia ¹, Anely Campo ², Gina Martinez ³, Deinier Salmon ⁴, Elizabeth Smith ⁵, Jonelle Mattis ⁶

Healthcare Delivery

Significance & Background

The ADT staffing model was launched as a pilot in 2019 at University of Miami Hospital to tackle several critical issues, including low patient satisfaction, and elevated readmission rates, particularly in oncology. The initiative focused on improving patient care and optimizing discharge processes.

Purpose

The ADT model aimed to enhance patient outcomes and create a more supportive environment for nursing staff. The emphasis on efficient discharge processes was designed to ensure that patients received comprehensive follow-up instructions, minimizing the risk of complications post-discharge.

Interventions

To enhance the effectiveness of the ADT model, several key initiatives were implemented. Regular committee meetings and leadership communications were established to increase executive engagement and share relevant data. Staff education focused on quality initiatives through Lean and Plan-Do-Check-Act (PDCA) methodologies, ensuring that team members were well-informed. Additional full-time equivalents (FTEs) for ADT nurses were approved to bolster staffing levels. A standardized discharge planning process was implemented alongside the promotion of conditional discharge orders to expedite patient discharges. The development of an ADT dashboard enabled the tracking of discharge issues and facilitated timely interventions. Finally, follow-up calls were conducted at different intervals post-discharge to ensure continuity of care and address any emerging concerns.

Results

The implementation of the ADT model led to significant improvements in key performance metrics. For oncology units, readmission rates dropped markedly from 23.23% to 15.6% (See Figure1), indicating more effective patient management and support. Additionally, patient satisfaction scores, as measured by Press Ganey, reflected notable enhancements across several domains, including the Likelihood to Recommend the facility and the quality of discharge information provided (See Figure2). These positive outcomes underscore the model’s success in improving both patient care and experiences within the healthcare system.

Discussion

The ADT model effectively improved discharge processes and patient satisfaction in oncology units, thanks to strong leadership engagement, continuous staff education, and collaborative initiatives. The use of an ADT dashboard and follow-up calls ensured timely attention to patient needs post-discharge. Ongoing evaluation is crucial for sustaining these outcomes. Overall, the model’s success led to its expansion across all inpatient units, representing a holistic approach to patient care. Given its impressive results, the program was successfully expanded to include all inpatient units.

Oncology Nursing Forum. 2025 Mar 1;52(2):126.

P207. Promoting Participation and Engagement Through Peer Mentoring

Jana Garde ¹

Management

Significance & Background

Literature indicates that mentorships provide new graduate nurses (NGN) the opportunity for guidance, encouragement and reassurance as they pivot into their new role. Peer mentor programs have shown success in increasing NGN job satisfaction, retention, empowerment and professional identity development. Since the pandemic, it has been challenging to find experienced nurses to serve as mentors. Mentor to NGN ratios have been critically low, with some mentors taking several NGNs for 1:1 mentoring.

Purpose

In 2023 the Peer Mentor Program was evaluated and found to lack involvement. In an effort to improve participation, a restructure of the program was developed to begin in 2024. Evidence was collected from literature to revamp the program by adding a group mentoring option.

Interventions

The Peer Mentor Program was revised to offer more options for NGNs to participate. By offering group mentoring sessions as well as 1:1 mentoring, we hope to appeal to different personality types as well as offer several opportunities of engagement. By using Duchscher’s Transition Shock Model, discussion questions have been developed to add structure and guide meaningful conversations as well as developing relationships to help NGNs feel supported, receive guidance, and increase confidence. Overall, the program restructure was developed to encourage participation and engagement with both the mentors and mentees.

Results

This project will include outcomes that show participation and engagement by compiling attendance from group sessions and 1:1 meeting logs. We will compare this data to previous cohorts to explore any changes in participation and engagement. The January 2023 cohort had 71 NGNs and 55 mentors with a 33% participation rate. We will also use interview data to make adjustments in future mentorships. This data will assist to guide efforts to support NGNs in role transition and development of mentorship skills resulting in an increase of experienced nurses as mentors. The revitalization of the Peer Mentor Program will benefit our NGNs, nurse mangers, educators, and theoretically patient outcomes.

Discussion

This project aims to increase NGN and Peer mentor participation and engagement in a peer mentor program. Outcomes will be used to guide future endeavors in peer mentor programs. Future initiatives should explore further development of mentors to influence the persons, the team, and the organization.

Oncology Nursing Forum. 2025 Mar 1;52(2):126–127.

P208. Hazardous Drug Spill Management Process

Jana Garde ¹

Quality and Safety

Significance & Background

USP <800> standards and best practice recommendations for the handling of hazardous drugs. Any individual that has exposure to hazardous drugs require education on handling and managing Hazardous Spill Managment.

Purpose

A knowledge gap was identified in spill management procedures for licensed and unlicensed staff. All personnel who handle HDs must be trained based on their specific job functions. Personnel competency must be reassessed at least every 12 months.

Interventions

Developed a spill management procedure and doffing procedure document that will be with every spill kit in all units of the facility. Since this is an uncommon event, staff need a resource to use to refer to sequence of steps for both spill management and doffing procedures.

Results

All licensed staff and unlicensed staff are educated yearly on spill management procedures. Staff participate in live spill management education.

Discussion

We have found that staff feel more knowledgeable and comfortable when faced with a hazardous drug spill. We have seen decreased exposure and fear of handling hazardous drugs.

Oncology Nursing Forum. 2025 Mar 1;52(2):127.

P209. Reviving A Residency Resulting in Ready And Retained RNS

Jana Garde ¹

Management

Significance & Background

Baseline data indicated nurses did not feel the residency program prepared them to enter the workforce. Previous residency practices were outdated when compared to literary implications. Literature has indicated residency programs can have positive impacts on NGNs transition to practice. Theoretically, a strong GNR program should improve nurse retention and readiness to practice.

Purpose

Starting in September of 2022, a critical assessment of the current Graduate Nurse Residency (GNR) program was conducted, and results indicated areas of improvement. Evidence was collected from the literature and previous New Graduate Nurses (NGN) to guide a revitalization of the GNR program.

Interventions

Data was collected from NGNs, human resources (HR), and nurse leaders. Data informed a quality improvement initiative to revamp onboarding to form evidenced-based and learner centered education. Course objectives were aligned with program competencies to increase clinical competence. The curriculum was revised to focus on practical application and critical thinking. Teaching strategies now include the most up to date adult learning strategies and principles. Overall, the program moved away from knowledge-based content to patient-centered care, clinical decision-making, and quality outcomes. NGN satisfaction and readiness to practice along with retention data was also obtained.

Results

NGN satisfaction data indicates nurses felt more prepared, supported, and felt the GNR program was conducive to learning. Nurse Managers echoed that they felt their NGNs were more prepared and were better able to apply their nursing school knowledge as compared to NGNs in the past. Comparatively, after this GNR program change, voluntary turnover decreased from 17% (2021) to 8% (2023), showing a 9% reduction. Casey-Fink Readiness data will be reported once analyzed. 2024 data is still being analyzed and collected. Overall, the revitalization of the GNR program benefited our NGNs, nurse mangers, educators, and theoretically patient outcomes.

Discussion

This project aimed to align the former GNR program with current literature and principles. The result is a learner-centered approach utilizing practice application to encourage critical thinking and impacting NGN readiness and retention. Future projects should explore maintenance and application.

Oncology Nursing Forum. 2025 Mar 1;52(2):127–128.

P210. A Retrospective Review to Identify Prostate Patients with Chronic Radiation Proctitis and their Management and Outcomes: No Butts About It

Jaylon Garrett ¹

Radiation

Significance & Background

Radiation proctitis can occur due to rectum injury caused by pelvic radiation therapy. Prostate cancer patients have an increased risk of developing chronic radiation proctitis after completing radiotherapy. Side effects can include rectal bleeding, tenesmus, rectal urgency, and rectal pain. Untreated radiation proctitis can lead to fistulas, anemia, and secondary cancers. Prior to starting radiation, patients are provided with bowel preparation instructions, which include taking a laxative each day to clear the rectum of stool. This preparation moves the rectum further out from the radiation field to help reduce the potential side effects of radiation proctitis.

Purpose

A retrospective review was performed to identify patients who developed chronic radiation proctitis after completing radiotherapy and the management and outcome of these cases.

Interventions

A retrospective review was performed from 2020–2024 for one Advanced Practice Provider’s (APP) survivorship clinic for patients who developed chronic radiation proctitis. Patients completed a detailed bowel questionnaire using a patient reported outcome (PRO) iPad device to assess their response to treatment for chronic radiation proctitis. The results were reviewed during follow-up visits by the APP.

Results

The results of the retrospective review identified 14 patients who developed chronic radiation proctitis after radiation therapy. For the initial treatment, all 14 patients were prescribed a hydrocortisone suppository 25mg twice per day for at least 12 days. Five patients continued to have rectal bleeding and an aminosalicyclic suppository 1000mg was prescribed every day for four weeks. There were nine patients who did not respond to these interventions and were referred to gastroenterology for further evaluation and treatment where they received Argon Plasma Coagulation (APC), Cryotherapy, and/or Radiofrequency Ablation (RFA). Unfortunately, four patients had more severe cases not responding to initial medication and procedures. These patients received 40 treatments of daily Hyperbaric Oxygen Therapy (HBOT). After the completion of medication, APC, Cryotherapy and/or RFA, 4/14 patients reported having a reduced incidence of rectal bleeding and overall improved radiation proctitis symptoms. Ten patients reported they no longer had rectal bleeding.

Discussion

Initiating treatment with medication and/or referring patients to gastroenterology for the evaluation and management of chronic radiation proctitis is important for the well-being and quality of life for patients with late radiation side effects. Identifying and treating patients early can reduce the incidence of more severe complications like fistulas, anemias, and secondary cancers.

Oncology Nursing Forum. 2025 Mar 1;52(2):128.

P211. Implementing Mid-Shift Huddles to Improve Quality Care in A Mixed Oncology Acute Care and Critical Care Unit

Kate Gaspar ¹, Jasmine Redd ²

Management

Significance & Background

Within an oncology unit, challenges persist in aligning patient acuity with staff skill mix, particularly in the context of administering antineoplastic therapy. This 16-bed unit, which provides both acute and critical care, utilizes float pool nurses who are trained in critical care but lack specific chemotherapy training. New graduate nurses complete oncology chemotherapy orientation first and attend critical care orientation 6–12 months later. Because of this gap, critical care patients are often assigned to critical care float pool nurses who are not trained to administer chemotherapy. This situation increases the workload for charge nurses and other staff nurses and poses potential risks to patient safety.

Purpose

This quality improvement project addresses the identified challenges through comprehensive assessment and strategic intervention planning.

Interventions

We conducted a survey among 19 charge nurses to assess their experiences and challenges in patient assignment processes, focusing on antineoplastic therapy coordination. Insights from this survey, along with signals from the Hero system, informed the development of targeted interventions aimed at optimizing the patient assignment process. We implemented interventions that included staff education sessions on resource utilization through electronic medical record tools and initiated a mid-shift huddle on the unit to improve communication regarding acuity changes and new antineoplastic orders.

Results

15 out of 19 charge nurses responded to the survey, providing valuable insights into their experiences and challenges in patient assignment processes. When asked about the ease of making patient assignments, 20% disagreed, 26.7% were neutral, 40% agreed, and 13.3% strongly agreed. Similarly, responses to the question regarding the availability of necessary tools and resources revealed that 6.7% disagreed, 60% agreed, and 33.3% strongly agreed. These findings underscore the variability in charge nurses’ perceptions and highlight areas where improvements are needed to enhance patient assignment processes and resource utilization. Staff found the implementation of a mid-shift huddle helpful in improving real-time communication, particularly regarding patient acuity changes, new antineoplastic orders, and overall workflow coordination. The huddle created a structured opportunity for team members to discuss updates and anticipate needs.

Discussion

We will monitor the effectiveness of these interventions through ongoing measurement and feedback mechanisms making adjustments as necessary to further optimize chemotherapy coordination processes. Another recommendation is to identify ‘chemo buddies’ or resource nurses to administer new antineoplastic therapy orders during shifts.

Oncology Nursing Forum. 2025 Mar 1;52(2):128–129.

P212. Nurturing Expertise: A Pathway from Novice to Experienced Ambulatory Chemotherapy Nurses

Tatiana Gastrock ¹, Patricia Guerrero Huertas ², Kimberly Beringer ³, Catherine Jansen ⁴

Professional Development

Significance & Background

As oncology nursing evolves and experienced professionals retire, training novice nurses becomes increasingly critical. Initial training programs offer foundational knowledge but may fall short in fostering the expertise and confidence required for specialized oncology and chemotherapy practice. In 2022, we introduced a new orientation process aimed at training novice nurses without prior chemotherapy experience. We continuously gathered feedback from trainees and mentors to refine this training program and address ongoing learning needs. Despite ongoing efforts to train novice chemotherapy nurses, there remains a need for continued guidance to enhance their expertise in oncology and support them in becoming future mentors.

Purpose

This project aimed to: 1) explore strategies for gaining practical experience and building confidence among oncology/chemotherapy nurses new to the field; and 2) examine the interventions and support mechanisms that contribute to their professional development.

Interventions

Our leadership team conducted a comprehensive review of the existing training program, mentorship model, and educational opportunities. We solicited feedback from novice nurses who had completed the initial training to assess its effectiveness and identify areas for enhancement. Insights were also gathered on their transition into their roles, their development of expertise, and their confidence levels.

Results

Key themes identified by our initial cohort included the importance of building confidence, compassion, curiosity, and a continuous desire for improvement. Successful strategies included fostering a supportive environment, effective teamwork, and providing readily accessible resources for answering questions, offering guidance, and sharing emotional support. These elements are crucial for promoting professional growth and expertise in oncology as evidenced by several of our novice nurses taking on leadership roles within the Infusion Center. This initiative highlights the need for an iterative approach to training and mentoring novice oncology/chemotherapy nurses. By refining training programs and implementing targeted support mechanisms, we can better equip new nurses with the skills and confidence necessary for effective patient care and professional development.

Discussion

Effective development strategies for novice oncology/chemotherapy nurses involve ongoing mentorship, targeted educational interventions and maintaining a supportive environment. These strategies are vital for building confidence, advancing practical skills, and encouraging professional growth in oncology nursing.

Oncology Nursing Forum. 2025 Mar 1;52(2):129.

P213. Comparing Employee Engagement in the Virtual Care Setting with Traditional Nursing Roles: A Cross-Sectional Analysis

Angela Geistkemper ¹, Emily Eisaman ², Blake Hoegger ³, Lance Ortega ⁴

Management

Significance & Background

As healthcare continues to shift toward virtual care models, we are continually implementing new strategies to strengthen virtual connections and developing new ways to keep the team engaged and improve any deficits in our current practice. Maintaining employee engagement in the virtual setting can be challenging without daily face-to-face interactions. Developing a strong sense of connection and motivation while relying on digital communication tools can be a complex task.

Purpose

This study was developed to compare employee engagement between nurses working in our virtual care setting and their experience in previous nursing roles to ensure we are maintaining employee engagement across the team.

Interventions

Our team has several key methods for maintaining employee engagement related to job satisfaction, teamwork, communication effectiveness and perceived support from the leadership team. Our nurse supervisors utilize standardized guidelines which include daily huddles, monthly one-on-one meetings that provide constructive feedback of nurse metrics, and quarterly performance evaluations, to maintain a real-time understanding of how our staff is performing and where they may need improvement. We meet monthly for an all-team huddle to engage our whole nursing team. Our director and manager also have one-on-one meetings with the triage nurses. We utilize a weekly newsletter as an additional mode of communication. Examples of our engagement activities include daily mindfulness moments, an all-staff mug exchange, a cookbook comprised of our own family recipes (with proceeds donated to our patients), as well as oncology jeopardy games and quizzes.

Results

The team was offered an optional survey, resulting in an 87% participation rate. From the survey, we found 95% of the team reporting improvement in their work-life balance and job satisfaction since joining the team. 94% of employees reported their leaders are more readily available in a remote setting to resolve conflicts in real time and 95% felt that pertinent information is effectively shared in a timely manner. Overall, 96% of the team agreed or strongly agreed that the leadership team ensures that we build strong connections despite the physical distance between us.

Discussion

Through the survey we have found that our current practice for maintaining employee engagement has been proven to be effective. This can be beneficial in today’s healthcare environment where nursing has shifted to the virtual setting, and we can provide recommendations to other virtual oncology nurse leaders.

Oncology Nursing Forum. 2025 Mar 1;52(2):129–130.

P214. Leading the Way: Nurse-Driven Expansion of After-Hours Tele-Triage for Oncology Subspecialty Care

Carol Gemignani ¹, Jaclyn Andronico ², Kelly Bonenfant ³

Symptom Management and Palliative Care

Significance & Background

Oncology care continues to expand in the outpatient setting which in turn has become more demanding for institutions to respond to patients after clinics close. After-hours triage nurses are critical in triaging, educating, and managing symptoms for oncology patients. At one National Cancer Institute (NCI) designated cancer center, the after-hours triage nursing team began to expand their coverage outside of the traditional medical oncology patient populations. This included sub-specialties such as interventional radiology, endocrine, gastrointestinal procedures, dermatology, and cardiology.

Purpose

The purpose of this initiative is to provide patients 24-hour, 7 day a week access to oncology-trained nurses for subspecialty patients through expanded after-hours tele-triage services.

Interventions

In 2021, a team of nurses, nurse manager, nursing profession development specialist and clinical nurse specialist developed a strategic plan to efficiently educate the after-hours nurses when new subspecialties were added. They collaborated with the nursing profession development specialist, clinical nurse specialist and experienced nurses working within that specialty. The team would meet weekly for a month to identify calls the after-hour nurses would be triaging and develop education to give to the nurses. Education was provided in a virtual didactic power point lecture which gave the opportunity for staff to ask questions with the experts. Weekly meetings after implementation with the subspecialty team were conducted to gather feedback on the types of calls and address any issues that arose.

Results

Currently, the after-hour triage nursing team now cover 5 subspecialties. A total of 34 nurses have been educated on all these subspecialties and are currently triaging these patients after-hours and weekends. In addition, the nurses have triaged over 658 patient symptom calls from these specialties. The program continues to grow and more subspecialties are being added such as supportive care, geriatrics, pulmonary, infectious disease, general medicine and integrative medicine.

Discussion

Cancer patients need support and resources during their care even when this occurs after-hours. Nurses play a vital role in in providing symptom management, education, and ensuring patient safety. The after-hours triage program can streamline communication and support for patients and families, offering them reassurance and guidance when they need it most. This model not only enhances patient care but can also be adapted to various healthcare settings, improving overall access and efficiency.

Oncology Nursing Forum. 2025 Mar 1;52(2):130–131.

P215. Nurse Navigator: Bridging the Gap to Reduce Healthcare Disparities from Initial Diagnosis to Oncology Care in A Healthcare System

Colby George ¹, Aya Sato-DiLorenzo ², Jessica Zerillo ³, Sharon Renzi ⁴

Coordination of Care and Navigation

Significance & Background

Patients facing a new malignancy can often feel overwhelmed and unsure of the steps that follow diagnosis. They may feel anxious due to uncertain plans of care and isolated without consistent support from oncology clinicians. Those with psychosocial barriers have greater difficulty establishing oncology care and experience treatment delays, which could negatively affect their clinical outcomes.

Purpose

Our nurse navigator program aims to facilitate a patient-focused transition to oncology care by screening for and assisting with care barriers. Early interventions by oncology nurses will improve the timeliness of cancer treatment, enhance the patient experience, prevent missed visits, and assure patients’ adherence to care plans.

Interventions

The nurse navigation service can be requested for all patients in the hospital system regardless of departments, inpatient or outpatient setting, or institutions. Nurse navigators receive patient referrals from the inpatient oncology consultation service, primary care clinicians and other members of the patient’s care team. The patient is contacted within 1–2 days of the referral and through a one-on-one conversation, navigators identify patients at risk for a delay in care. Questions regarding the plan of care are discussed, referrals to support services or other departments are made as needed, and communication is facilitated between the patient and their providers. The navigator will stay in contact with the patient until oncology care is established, continuing to assist with new or ongoing barriers they may face.

Results

Since the start of the program in March 2024, nurse navigators have cared for 86 patients. These patients experienced various barriers including language concordance, lack of transportation, physical disability, and psychiatric history. Navigators coordinated new patient oncology visits, assisted patients with emotional, transportation, and financial concerns, and provided logistical and educational support when a change of care was needed. Feedback from patients and primary care providers indicates that individualized care by oncology nurses improves patient experience.

Discussion

We successfully implemented a nurse navigation service to support newly diagnosed patients. Patients were referred to address gaps in transitions from inpatient to outpatient care and from primary care referrals to the first oncology clinic visit. We continue to investigate the program’s impact on access to care, patient experience, and provider experience and results are forthcoming.

Oncology Nursing Forum. 2025 Mar 1;52(2):131.

P216. Utilizing Hazardous Drug Surface Wipe Sampling to Advocate for Safety

Kimberley George-Shields ¹, Jean Ward ²

Quality and Safety

Significance & Background

Oncology nurses are at high risk of hazardous drug (HD) exposure. USP General Chapter <800> provides standards and best practice recommendations for HD management. To ensure quality and control, USP <800> recommends engaging in HD surface wipe sampling. Surface wipe sampling offers valuable data regarding the effectiveness of current work practices. Our current policy included sampling procedures in compounding areas but excluded patient treatment areas and nursing high touch surfaces.

Purpose

We sought to identify additional areas of hazardous drug (HD) contamination within the outpatient infusion setting by using sequential wipe sampling. It was hypothesized that sampling results would lead to collaborative, interdepartmental discussions resulting in policy change and a more comprehensive HD ‘safe handling’ program increasing staff and patient safety.

Interventions

In collaboration with pharmacy, 6 common-touch areas were selected for sampling. Each area was tested for the presence of 5 chemotherapies (Paclitaxel, Cyclophosphamide, Doxorubicin, Irinotecan, Gemcitabine). Initial sampling results were presented to nursing, industrial hygiene, pharmacy and infection control key stakeholders. Cleaning agents for contaminated surfaces were changed to contain bleach as the HD deactivating agent. Infusion Nurses participated in training that included review of ONS “Toolkit for Safe Handling of Hazardous Drugs for Nurses in Oncology” and a summary of the online ONS course “Safe Handling Basics” by unit educators. Post education, nurses were surveyed to assess perception and feasibility of proposed workplace changes required to minimize HD exposure. A post intervention wipe sampling was conducted to assess intervention effectiveness.

Results

Initial wipe results revealed the presence of HD contamination in patient bathrooms and medication dispensing counter tops. The collaborative group identified the lack of deactivating agents in cleaning products for these high-risk areas. Nurses reported positive acceptance of practice changes and were empowered to promote increased safety for ancillary staff and patients by minimizing HD exposure. Post intervention sampling showed no further HD Residue in the infusion room.

Discussion

Sequential wipe testing results were a useful addition to our nursing initiated hazardous drug safety program. Identifying additional safety risks facilitated mitigation of patient and staff exposure to potential HD surface residue. A comprehensive HD safe handling program should be supported within our facility’s policy and procedures, to include ongoing enhanced annual staff education.

Oncology Nursing Forum. 2025 Mar 1;52(2):131–132.

P217. Cancer Clinical Trials Phlebotomy Process Improvement

Gabrielle Gerber ¹, Jindu Wilson ², Erin Tuffy ³

Coordination of Care and Navigation

Significance & Background

The ambulatory oncology clinic comprises twelve multidisciplinary cancer teams and an RN-driven lab access room to expedite patient care and treatment, including research patients seeking new cancer treatments. Cancer clinical trials have very stringent protocols to be followed, including pre-and post-treatment specific research labs that require timely lab processing to avoid any study deviations. Nurses felt the clinical trial phlebotomy process was complex due to multiple patient encounter care sets, paper treatment orders, inconsistent workflow, and inadequate communication. The existing process was stressful, leading to study deviations, revenue loss, and unintentional errors, which underscore the need for process improvements to improve protocol adherence, patient safety, and the nurse’s clinical trial knowledge and competency.

Purpose

The project aimed to enhance the phlebotomy workflow in clinical trials, improve nurses’ knowledge, and improve staff communication to reduce study deviation and ensure effective patient care delivery.

Interventions

Some of the Interventions included a revised order template, RN education, and an audiovisual educational aid. In addition, the implementation of standardized clinical trial phlebotomy process guidelines provided a clear framework for the phlebotomy process. A global email system was created for communication purposes between the multi-D clinic and clinical trials team. Daily audits of the clinical trials phlebotomy process, reporting of patient safety issues, and study deviations in the organizational safety net system were implemented for continuous quality improvement.

Results

Different quality tools, such as a non-punitive open reporting electronic system and audit, were utilized to optimize the overall process. Post-intervention, the workflow process audit demonstrated 100% improvement. Revenue issues, communication, and lab protocol adherence improved. Additionally, the electronic patient safety system had no reported study deviations or patient safety issues associated with RN research labs.

Discussion

Pharmacokinetics in clinical trials is crucial to understanding drug safety and efficacy, and nurses have a pivotal role in precisely collecting blood to assess pharmacokinetics for monitoring the effect of clinical trials treatment. By following standardized phlebotomy processes and best practices, nurses can ensure safe patient care and contribute to the success of the trials. The quality improvement project created a culture of prioritizing communication as a top priority to prevent study errors and improve team collaboration and engagement, focusing on patient safety and quality care in clinical trials.

Oncology Nursing Forum. 2025 Mar 1;52(2):132.

P218. Bridging Knowledge GAPS: Advancing Nursing Practice in Hepatic Arterial Infusion Delivery

Caroline Getting ¹, Debby Italiano ², Mary Stinziani ³, Jaclyn Andronico ⁴

Treatment Modalities and Managing Administration

Significance & Background

Targeted treatment modalities like the hepatic arterial infusion (HAI) pump enable the direct delivery of high-dose chemotherapy to the liver, offering critical treatment options for patients with metastatic colorectal cancer and cholangiocarcinoma. Administering chemotherapy via the HAI pump requires infusion nurses to develop specialized skills and competencies. With the expansion of treatment to multiple outpatient sites, a National Cancer Institute-designated cancer center developed a standardized orientation process to train infusion nurses on HAI pump administration, ensuring safe and effective care delivery across all locations.

Purpose

The purpose of this presentation is to discuss the development and implementation of a subcommittee of nurses across eight outpatient sites, tasked with standardizing the practice and education for nurses caring for patients receiving chemotherapy through HAI pumps.

Interventions

A committee consisting of 10 nurses, a Nursing Professional Development Specialist, and Clinical Nurse Specialists meet quarterly to discuss educational needs, standardize workflows, and formalize policies related to the care of patients with HAI pumps. During these meetings, a knowledge gap was identified regarding the procedures for accessing the HAI pump and administering medication through the bolus injection port. In response, the committee developed an interactive virtual learning module designed to educate infusion nurses on key aspects of HAI pump care, including pathophysiology, complication management, patient education, pump access, and chemotherapy administration. Additionally, the taskforce created instructional training videos, which are accessible through the institution’s policy and procedure manual, offering nurses ongoing support in this specialized practice area.

Results

As a result of the subcommittee’s efforts, over 100 infusion nurses across the institution have successfully completed the learning module and are better equipped to care for patients with HAI pumps. The subcommittee also updated the nursing policy and procedure manual to align with the latest evidence-based practices. Additionally, the subcommittee collaborated with the pharmacy to update the institution’s chemotherapy guidelines, improving dose calculations for patients receiving treatment through their HAI pumps.

Discussion

Oncology nurses play a critical role in administering complex treatment modalities such as the HAI pump. By leveraging a shared governance structure, fostering collaboration, and identifying education needs, nursing teams can standardize care and enhance practice. As the demand for targeted treatment regimens increases and outpatient services expand, similar models can be implemented in other healthcare settings, promoting consistency in care delivery and optimizing patient outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):133.

P219. Nursing Assessment for Early Identification of Post Operative Gastrointestinal Dysfunction (POGD) in Patients Undergoing Colorectal Surgery and Improving Patients’ Outcomes

Shahnaz Gillani ¹, Bindu Varghese ²

Quality and Safety

Significance & Background

Postoperative gastrointestinal dysfunction (POGD) is one a common morbidity after gastrointestinal surgery. Postoperative gastrointestinal dysfunction is associated with delayed hospital recovery, increased length of stay, poor patient satisfaction and experience, and increased financial hardships.

Purpose

The tool was used to assess intake, nausea, emesis, examination of abdomen for distention, and duration of symptoms (I-FEED). This scoring system was created by a group of experts to address the lack of a consistent objective definition of POGD. However, the I-FEED instrument needs clinical validation before it can be adopted into oncology nursing clinical practice. The scope of this phase 1 Quality Improvement initiative involves the feasibility of implementing percussion while performing abdominal assessment into the nursing workflow without additional burden.

Interventions

All gastrointestinal/colorectal surgical unit nurses underwent comprehensive education about the abdominal percussion. This involved understanding the technique, its application in postoperative gastrointestinal dysfunction assessment (oral intake, abdominal distention, nausea, and vomiting), and its integration into the existing nursing documentation in the Electronic Health Record (EHR). After six months of education and practice, a six-question survey was sent to all inpatient GI surgical unit nurses about incorporating the percussion assessment into their routine workflow and documentation.

Results

Methods

Responses were received from 91% of day-shift nurses and 76% of night-shift nurses. Overall, 95% of the nurses were confident in completing and documenting the abdominal percussion during their daily assessment.

Conclusion

Nurses’ effective use of the I-FEED tool may help improve patient identification, management, and outcomes after surgery. The tool could also be an effective instrument for the early detection of POGD in surgical patients.

Discussion

Initiative for the I-FEED tool education, practice, and follow up survey, highlights the importance of improving the oncology nursing practices in gastrointestinal surgical units. By educating nurses to perform abdominal percussion, integrating practice of timely documentation, and by informing the providers for abnormal findings, hospitals aim to identify and intervene cases of POGD at an earlier stage. This has potential benefits in improving patient outcomes, reducing suffering, decreasing the length of hospital stays, increasing patient satisfaction, and controlling healthcare costs.

Oncology Nursing Forum. 2025 Mar 1;52(2):133–134.

P220. Oral Anticancer Agents Revisiting and Revamping

Liz Gineo Emmons ¹, Nicole Bocchetta ², Evanica Rosselli ³, Elizabeth Wright ⁴, Kristina Capretti ⁵

Management

Significance & Background

This project was initiated after a report determined that ~80% of our oral anticancer (OAC) treatment plans were not being verified by a nurse. ASCO/ONS standards state that all new oral anticancer treatment plans or dose changes must be verified by three chemotherapy competent providers. Despite having a process in place since 2018, we were not meeting this standard and needed to revisit and revamp our process for OAC agents.

Purpose

This initiative’s purpose was to increase nursing knowledge and compliance on verification of OAC agents.

Interventions

A workgroup of pharmacists, epic analysts and nurses was formed. The workgroup conducted interviews and surveys of pharmacists/nurses to determine barriers to verification. Multiple areas for improvement were found:

■ Nurses were not onboarded in a standardized way - different levels of knowledge
■ Multiple steps in the process of verifying OAC agents were manual
■ No easy compliance tracking report
■ No easy way to track these patients

The first intervention was a full reeducation for staff who are part of the OAC process. The reeducation focused on the process/role responsibilities for each person. The workgroup worked with data analytics to create a more accessible, user-friendly compliance report that was distributed to leadership with the expectation that department compliance be monitored. The workgroup created a centralized nursing pool for all departments across the system that gets an automatic message sent each time a new OAC treatment plan is signed. We assigned a “pool monitor” to each department. The nurses were all placed into this pool and education sessions were held on how to work out of a multidepartment pool. The NPDS team also created a 3-hour Practice Nurse (PN) Chemotherapy Skills Course, which is now a part of the onboarding of all PN’s and existing nurses who were found to be noncompliant.

Results

Compliance for verification started at 14%, currently (9/2024) 48%.

Discussion

We have had successes in creating a multidepartment pool that receives an automatic message. We have had multiple “great catches” of nurses identifying patients who were dosed incorrectly/ordered for inappropriate treatments. The PN Course has received positive feedback from all participants. We still face challenges working out of a centralized multidepartment pool, we continue to update leadership every month and involve more departments to become champions with the hope of further increasing our compliance.

Oncology Nursing Forum. 2025 Mar 1;52(2):134.

P221. Care of the Maternal Surgical Oncology Patient in the Perioperative Department

Abigail Givens ¹, Angela Drake ²

Coordination of Care and Navigation

Significance & Background

In the perioperative department, we manage a diverse patient population, including pregnant surgical oncology patients who require specialized care and adherence to specific policies. Due to the infrequent and complex nature of their cases, communication issues and procedural uncertainties have arisen. Over the past five years, we experienced two sentinel events involving this group. Post-incident debriefings revealed that unclear communication, varied interpretations of protocols, and outdated policies contributed to inadequate emergency response and care. This highlights the need for improved clarity and consistency in managing these high-risk patients.

Purpose

To enhance communication, expertise, and care for pregnant surgical oncology patients and to update the policies regarding gestational age and viability to align with more current research.

Interventions

Our nursing staff developed a resource binder to serve as a specialized reference guide, aimed at providing comprehensive education, facilitating easy access to resources, and ensuring clear communication and expectations among the care team. The resource binder includes a checklist for tasks before, during, and after surgery, detailing procedures, communication protocols, and equipment requirements. It also features a new communication tool that highlights key information such as gestational age, fetal heart monitoring plans, and contact details for essential care team members. Following a literature review, we updated the Pregnant Patients Undergoing Non-Obstetric Surgical Procedures Policy to incorporate the latest guidelines on gestational age and periviability, ensuring staff are equipped to provide optimal care for both mother and baby during surgery.

Results

This resource binder is now being utilized and has significantly improved communication and expertise throughout the perioperative process. Additionally, the updated policies are being recognized system-wide, ensuring optimal care for this specialized patient population based on current research.

Discussion

Ongoing discussions and literature reviews of current data are necessary and essential to maintain best practice. Additionally, interventions and special considerations to address patient-specific needs should also be considered.

Oncology Nursing Forum. 2025 Mar 1;52(2):134–135.

P222. Impact of Different Antineoplastic Infusion Fluid Topologies on Patient Safety, Workflow, Staff Exposure Risk and Residual Volumes – A Comparative Analysis Between the us and Germany

Sally Golingay ¹, Carolin Dietze ², Encarnita Aranda ³, Erica Gary ⁴, Isabel Gärtner ⁵, Luise Ramsch ⁶

Treatment Modalities and Managing Administration

Significance & Background

The infusion setup is central to the administration of antineoplastic therapies. It has profound impact on i) the work profile of nurses, ii) the time needed to stop antineoplastic agents and switch to hydration – i.e. patient safety iii) the risk of hazardous drug exposure, iv) the reliability of complete dose application and v) residual antineoplastic medication in consumables at disposal. These factors interact and require trade-offs between objectives.

Purpose

We aimed to analyze the fluid setup and workflow in hematology oncology institutions in the US and Germany, their impact on workload, safety, environmental footprint and therapy standardization.

Interventions

Processes and infusion setups were evaluated at five German (5,000–15,000 infusion therapies/yr), three US infusion centers and one US research unit (2,500–50,000 infusion therapies/yr). Structured interviews with nurses, physicians and pharmacists were performed. Infusion setups and manual drug change steps for typical therapy protocols were recorded. Peer experience with other national centers was assessed by interviews to determine national variation.

Results

Although antineoplastic therapy protocols are internationally standardized (e.g. FOLFOX), infusion setups and nursing workflows vary significantly between the two countries (see figure). In the US, the protocol is realized through sequential drug connection and disconnection during therapy using legally required closed system transfer devices (CSTD) to avoid hazardous drug exposure. In Germany, the drugs are connected step by step to a “tree-like” infusion system, which is flushed in-between from the top. Fluids are controlled through opening and closing of clamps without disconnecting empty medication containers until final disposal of the whole system. Removal of all residual antineoplastic therapy from the infusion system and thus complete application is inherent for both countries. In the US, depending on the flushing method, small residual volumes may remain in the consumables. In an emergency, the antineoplastic can be disconnected using the CSTD and hydration can be started immediately without prior connection in the US. In Germany, the tree-like setup is replaced by a new hydration line, potentially exposing nurses to hazardous drugs. In the US, new IV sets and CSTDs are required for each drug, resulting in approximately two to three times more consumable waste and costs.

Discussion

Our findings reveal interesting insights into varying procedures and trade-offs between the two countries. Future best practices may benefit from evaluation and selective adoption of respective international procedures.

Oncology Nursing Forum. 2025 Mar 1;52(2):135.

P223. Engaging the New to Oncology Nurse: Developing A New Hire Curriculum

Katelyn Gomach ¹

Professional Development

Significance & Background

Orienting new to oncology nurses is essential for ambulatory infusion centers. The oncology nurse educator has a unique and impactful role in this process. The goal of the oncology nurse educator is to provide evidence based, effective education to the nurse learner while ensuring it is impactful and engaging.

Purpose

Feedback about the original curriculum was provided to the oncology educators and adjustments were made to meet the needs of the nurse learners by utilizing evidence based learning strategies.

Interventions

The curriculum originated as 12 modules given in the LMS upon hire, followed by the Oncology Nursing Society Chemotherapy and Immunotherapy Certificate Course, and an in-person institution specific 8 hour single day course consisting of mainly PowerPoint lecture and skills stations. Feedback from learners was this was a lot of information up front and overwhelming. The curriculum was changed to 6 modules in the LMS, the Oncology Nursing Society Fundamentals of Chemotherapy and Immunotherapy Course, and two 4 hour classes a week a part. The first day focuses on institution policy and how to implement the information from the ONS course into clinical practice, how to perform the dual verifications and the why behind them. In between the classes, learners are given a packet of case studies to complete which includes drug regimens and requires the learner to find drug information, complete dose calculations, and apply knowledge of adverse events and toxicities. During the second class, the case studies are reviewed, the EMR playground is utilized to walk through a treatment plan and the administration checks, safe handling and chemotherapy spill cleanup are reviewed as well as other required skills.

Results

The curriculum is new in the last 3 months. Feedback from evaluations with a n size of 7 states support of the change to two shorter classes. Learners stated the content was effective for new oncology nurses, and the case studies took the content from abstract concepts to practical application.

Discussion

Leaders and nurse learners have provided positive feedback for the curriculum change. We are progressing nurses through in a timely manner, while utilizing quality, evidence-based education content and methods. We would like to continue to adapt and include monthly educational session with a target audience of new to oncology nurses to focus on other topics besides administration in future.

Oncology Nursing Forum. 2025 Mar 1;52(2):135–136.

P224. Improving Nursing Staff Satisfaction and Reducing Burnout with A Rn Break Coverage Program

Carrie Goncalves ¹, Kathryn Wigger ², Diana Pasqua ³, Susanne Braun ⁴, Kathleen Feldmann ⁵

Management

Significance & Background

Burnout is a psychological condition resulting in an overpowering sense of tiredness, feelings of cynicism and ineffectiveness, along with a detachment from the job. It develops as a result of a sustained response to consistent workplace stressors. Highly stressful work environments leave oncology nurses at an increased risk of burnout which in turn impacts their patient care. Increasing nursing satisfaction is a key factor to assist in decreasing burnout, reducing turnover, and improving the quality of patient care. The impact of nursing satisfaction expands throughout an entire healthcare organization by influencing nurse retention rates and patient outcomes. To promote satisfaction and inhibit burnout it is essential for nurses to effectively manage job related stress and fatigue. A simple intervention is ensuring nurses have the allotted break time during their daily shift to decrease stress and restore energy.

Purpose

Create a nurse staffing schedule with an assigned nurse for break coverage to ensure staff receive a guaranteed break during every shift.

Interventions

A system was created at our NCI-designated comprehensive cancer center for a designated lunch coverage nurse. This nurse was assigned to go to each nursing station and provide coverage for a set timeframe to ensure each nurse had a scheduled break. The lunch coverage nurse would have no assigned patients from the hours of 1100 through 1500, leaving them fully available to manage handoffs from each nurse at every station and maintain patient continuity of care.

Results

Prior to this new break coverage assignment model, over 50% of nurses reported they were infrequently able to take a daily break during their shift. The post survey responses showed 96% of the nurses were able to take a daily break for lunch. Nursing staff reported feeling less stressed and more productive with the initiation of this lunch coverage program. Staff reported decreased feelings of anxiety, irritability, or decreased energy demonstrating a reduction in feelings associated with nurse burnout. Overall, 78% of staff wished for this program to continue and 22% wish for it to continue with adjustments or improvements.

Discussion

This intervention led to decreased feelings of burnout and increased nursing staff satisfaction on our unit.

Oncology Nursing Forum. 2025 Mar 1;52(2):136.

P225. What Can Your Local ONS Chapter Do For You?

Jennifer Goodman ¹

Professional Development

Significance & Background

Oncology Nursing Society (ONS) has approximately 200 local chapters which promote local networking and education of oncology nurses. The oncology nursing chapter in this major metropolitan city was founded in 1982 with 12 members and initially meetings were held monthly in the basement of a local hospital within the city center.

Purpose

This chapter has grown into an extra-large chapter with 390 members and a geographic area which encompasses 225 zip codes and six counties. Proximity of meeting locations due to the vast geographic area of the chapter and traffic in the metropolitan area impedes chapter members from attending meetings when held exclusively in the city center.

Interventions

Board leadership asked for participation in a survey of local chapter members to query interest in meeting expansion within the major metropolitan city. Chapter leadership contacted ONS chapter liaison to identify member numbers in counties within the local chapter to best meet the needs of chapter meeting locations.

Results

Unmet needs were identified in the North, West, and South areas of the city. This local ONS chapter now offers monthly meetings in the city center (4th Tuesday of each month) which started in 1982. The chapter incorporated meetings North of the city (2nd Thursday of each month) by 2016. Quarterly meetings were initiated in the West (3rd Wednesday of each quarter) in September 2022 and in August 2024 meetings were started South of the city (still defining which week these quarterly meetings will be held).

Discussion

The mission of ONS is to advance excellence in oncology nursing and quality cancer care. The local chapter in this major metropolitan city wants to engage oncology nurses within our community to have access to educational opportunities. The meeting expansions give oncology nurses within this metro area the flexibility to attend meetings on differing days and locations within the city to meet their needs.

Oncology Nursing Forum. 2025 Mar 1;52(2):136–137.

P226. An Exploration of the Perceived Barriers, Lived Experiences, and Perceptions of Oncology Registered Nurses Utilizing Artificial Intelligence in Current Practice

Micah Goodwin ¹

Healthcare Delivery

Significance & Background

Limited research studies on perceptions and knowledge of Artificial Intelligence can impact the dynamic of healthcare work environments. Exploring perceptions can create a smooth transition for implementing technological components within daily clinical practice. Properly adopting Artificial Intelligence requires addressing uncertainties, concerns and shared experiences amongst clinicians and patients. Once experience and uncertainties are examined there can be an expansion on acceptability of Artificial Intelligence (Chew & Achananuparp, 2022). Having clear and concise comprehension of perceived thoughts can improve the utilization of technical systems. Advances in healthcare information technology, in conjunction with Artificial Intelligence, has led to improvements in quality of care (Abdullah & Fakieh, 2020). The development of Artificial Intelligence offers several benefits when applied within a healthcare setting (Abdullah & Fakieh, 2020). Having the ability to replicate human cognitive functions is considered a change in basic assumptions leading to rapid technological progression (Abdullah & Fakieh, 2020). Introducing Artificial Intelligence in the proper manner can increase efficiency and effectiveness, leading to improvements in clinicians’ satisfaction and delivery of patient care (Chew & Achananuparp, 2022).

Purpose

The purpose of this doctoral project is to gain insight and spread knowledge amongst healthcare professionals surrounding perceptions, barriers and experiences related to using Artificial Intelligence. Implementation of Artificial Intelligence provides healthcare solutions and assists with time management. Artificial Intelligence corresponds to informatics because this technological advancement manages information, for example electronic health records and treatment options. Artificial Intelligence contributes to physicians providing care on a higher level depending on the clinical settings (Bi et al., 2019). The aim of this project is to examine literature on knowledge and attitudes towards Artificial Intelligent systems. This project will address uncertainties of thoughts and perceptions amongst clinicians and patients when utilizing Artificial Intelligent systems on a consistent basis.

Interventions

Focus group Interviews and Open-ended questions. Inclusion Criteria: Clinicians and Nurses utilizing Artificial Intelligence.

Results

Determination of the effectiveness of Artificial Intelligence in relation to the use amongst healthcare professionals.

Discussion

Positive impact of Artificial Intelligence within clinical practice.

Oncology Nursing Forum. 2025 Mar 1;52(2):137–138.

P227. Optimizing Infusion Center Efficiency: Leveraging Data Analytics for Enhanced Capacity

Karly Goozee ¹, John Bourgeois ², Yolanda Camon ³

Healthcare Delivery

Significance & Background

Cancer treatment options given in oncology ambulatory infusion centers (AICs) is rapidly growing. As more patients receive treatments in an outpatient setting, AICs are confronting significant capacity challenges. With increasing demand and limited options to expand chair availability, AICs must be innovative to create additional capacity.

Purpose

In 2023, our Magnet recognized, National Cancer Institute designated 72-chair AIC treated 35,000 patients. Historically, 15 chairs were dedicated for clinical trial (CT) patients with a separate scheduling template and process. Over the past three years, scheduled CT appointments decreased, leaving templated infusion slots unused, and not enough standard of care (SOC) slots available. This report details the use of data analytics to overcome capacity constraints and rapidly increase patient volumes and template hours utilized.

Interventions

Previously, our workflow impeded utilization, and we had different processes for scheduling CT infusions. As many as 15 communications per day took place among key stakeholders, focused on making decisions regarding when and where to treat patients based on capacity constraints. Schedulers lacked the clinical background to know when an overbook was appropriate, leading to emails and frustration over lack of availability. A template update was completed to combine the CT template with the SOC template, with a goal of increasing AIC capacity and streamlining appointments. Leadership collaborated with capacity management, operations, and CT teams to create updated templates, educate scheduling teams, and ensure CT requirements were met. To meet institutional regulatory requirements, AIC nurses completed clinical trial education through an online learning platform, with the training taking one hour and 45 minutes to complete. CT staff were educated on the physical location of their patients, and how to schedule patients. Order based scheduling was implemented, and any scheduler was able to schedule CT patients for clinic and infusion visits seamlessly, reducing dedicated CT scheduling labor. This decreased back and forth between CT schedulers and clinic schedulers, increased infusion scheduling visibility, and freed up personnel for other operational tasks.

Results

After implementation, completed patient volumes increased by 17%. Completed patient hours increased by 30.8%, and utilization of template hours increased by 13.8%.

Discussion

Regularly reviewing template usage, scheduling workflows, and patient volumes can further enhance operations, address capacity challenges, and ensure infusion availability for all patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):138.

P228. Maximizing Infusion Capacity: Optimizing Transfusion Appointment Scheduling for Enhanced Efficiency

Karly Goozee ¹, John Bourgeois ²

Healthcare Delivery

Significance & Background

Capacity of ambulatory infusion centers (AIC) is often a scheduling constraint, especially for acute patients needing transfusion support. As outpatient treatments options increase without expansion plans for AICs, being creative to find unused space is key. After noticing high volumes of no-showed appointments and same day cancellations (SDC), we started to do a deep dive into missed appointments and wasted capacity.

Purpose

In 2023, our Magnet recognized, National Cancer Institute designated 72-chair AIC treated 35,000 patients. The number of patients scheduled for transfusion support ranged from four to 12 patients per day, and each transfusion chair was reserved for four hours. However, we noticed that on average, only half of the patients scheduled needed their transfusion chair, and often they did not need that chair for four hours. This was reserving unnecessary chair time for these patients, and leaving patients who needed chemotherapy delayed to other days.

Interventions

To do this pilot, we needed a few things—a dedicated person to draw labs, analyze results and relay information to the charge nurses. We needed a dedicated space for this person to work, and standard work for them to follow. Partnering with operations and lab resources, we identified two dedicated licensed practice nurses (LPN) for this role.

Results

Once personnel, space and responsibilities were identified, we began our pilot. During the two-week period, 65 patients were scheduled for possible transfusion support. Only 30 patients needed transfusion support, utilizing an average of 8.22 hours of chair time per day. This demonstrated the need for a better workflow for scheduling and transfusing these patients.

Discussion

Our pilot was successful, but we lacked key necessary components to mandate as future state. We need a dedicated RN FTE to ensure closed loop communication between lab draw results, charge nurse notifications and patients. We need EMR workflow enhancements to ensure lab results are easily visible. Physical space for this work, a template update and scheduling education for system schedulers is needed. Since patients are scheduled up to six weeks in advance, the timeline of implementation presented a challenge-as any updates would create re-work for some teams. Although we experienced challenges, we are hopeful that our pilot will allow for an optimized future state for transfusion patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):138–139.

P229. Transitional Care Interventions to Reduce Unplanned Hospital Readmissions

Neethu Gopinadh ¹

Coordination of Care and Navigation

Significance & Background

Transitioning to home after hospital discharge is a vulnerable time for patients and families. Oncology patients are at increased risk of hospital readmission compared to the general patient population due to symptom burden and treatment-related side effects. Evidence from the literature indicates that suboptimal and fragmented care coordination negatively impacts patient outcomes and contributes to hospital readmissions and increased healthcare costs. Transitional care interventions (TCIs) are a set of actions designed to improve coordination and continuity of care as patients transition to various levels of care.

Purpose

This Evidence-Based Practice project aimed to conduct a literature search and identify TCIs that reduce hospital readmissions.

Interventions

A PICO question was formulated to search for evidence from the literature. PICO: In adult admitted patients at risk for readmission, how do TCIs compared to current practice impact unplanned hospital readmissions? A literature search was conducted using the CINAHL, PubMed, ClinicalKey, and Google Scholar databases. The initial search yielded 182 articles. The title and abstract screening of 182 articles and a full-text review of 42 articles were done. Five articles were selected for data extraction based on the level of evidence. Articles were critically appraised using the Critical Appraisal Skills Programme (CASP) tools. To synthesize the evidence, a Table of Evidence, a Levels of Evidence Synthesis Table, and an Evidence Outcome Summary Table were completed. The quality and strength of the evidence were determined using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) tool.

Results

The measurable outcomes include reduced unplanned hospital readmissions.

Discussion

The recommendations table yielded high-level, high-quality evidence with strong recommendations. The TCIs include (1) discharge planning, (2) disease and self-management education of patients and families at discharge, (3) post-discharge phone calls, (4) home visits by nurses or nurse case managers, (5) pharmacist-led medication reconciliation at discharge and pharmacist-led patient counseling at discharge and post-discharge, (7) multidisciplinary collaboration, and (8) healthcare provider follow-up.

The evidence from the literature suggests that transitional care programs with multiple components are more effective than single-component programs. The goal of TCIs is to improve collaboration and care coordination to better engage healthcare providers and patients in discharge planning. The findings from this literature review highlight TCIs that healthcare institutions can utilize to implement new transitional care programs or revise existing programs.

Oncology Nursing Forum. 2025 Mar 1;52(2):139.

P230. Expanding Shared Governance: The Creation of Nursing Communication Council

Jeanine Gordon ¹, Chasity Walters ², Cortney Miller ³, Emily O’Donnell ⁴, Nicole McNamara ⁵, Alison Irvine ⁶

Professional Development

Significance & Background

The timely and coordinated dissemination of information across a Department of Nursing (DoN) that spans two states, 17 patient care sites, and more than 4,500 oncology nurses and 800 support staff creates significant challenges. While technology enables information-sharing across several channels, it does not solve for the redundant efforts of multiple groups creating similar content. Furthermore, inconsistent messaging and information overload pose challenges.

Purpose

Using the shared governance model, staff at an NCI-designated Comprehensive Cancer Center, created a Nursing Communication Council to develop and implement an effective communication strategy that is resourceful, sustainable, and replicable across all our sites.

Interventions

In November 2023, the DoN and the Marketing Clinical Communication team partnered to form a taskforce to define the scope and purpose of a Nursing Communication Council. In December 2023, DoN staff across the organization were invited to apply to be members of the council based on their interest and experience. Twenty-one applicants applied and 17 qualified nursing staff were selected to participate. In January 2024, the council launched and met monthly to create objectives, bylaws and delineate members’ roles and responsibilities. In July 2024, the council was officially adopted as part of the DoN Shared Governance structure reporting directly to Nursing Board. The council determined that a multimodal approach for sharing information would be most effective. The channels for communication included a quarterly virtual Town Hall meeting facilitated by the Chief Nurse Executive, a Nursing News newsletter produced eight times annually, internal intranet, external internet, and social media.

Results

To date, four Town Hall meetings have been held in 2024. Over 2000 DoN members joined, with 1334 replays of the recording. The council has also published five issues of Nursing News. Each issue is posted on the intranet and shared via e-mail to the DoN. Council members promote the newsletter by word of mouth, in meetings, and by posting fliers with QR codes to each issue in their respective units. A review of engagement metrics show viewership of the newsletter increased 49% from January to July 2024.

Discussion

As oncology care evolves, it is imperative to engage nursing staff in clinical, non-clinical, organizational and recognition communication. Creation of this council serves as an excellent initiative to enhance nursing staff recruitment, retention, recognition and can easily be replicated in other oncology settings.

Oncology Nursing Forum. 2025 Mar 1;52(2):139–140.

P231. Mastering Community Cancer Clinic Patient Flow: What Works and How to Succeed

Glenda Gottfred ¹, Kathleen Shannon Dorcy ²

Healthcare Delivery

Significance & Background

National Designated Cancer Institute’s often have affiliated Community Cancer clinics (CCC). A NIH CCC in the northwest (n = 8,612 annually) had a model of care and staff utilization with patient flow, operating with fewer staff and space limitations such as not having a centralized lab draw space, consultation rooms, and appropriate spaces for Telehealth). The model of care and clinic design were built on assumptions used in larger NCI clinic (n = 40,050 patients) and lead to gaps in CCC best practices, staffing, access, and timely care delivery.

Purpose

To describe CCC’s quality improvements efforts developed to optimize workflows and increase staff utilization and efficiencies assuring best oncology patient care.

Interventions

Oncology nurse leadership led a collaborative team (physicians, pharmacy, laboratory, and nurse educators) in analysis of patient flow and clinical care delivery. Data was collected to inform quality improvement initiatives, focusing on reducing delays in patient care, minimizing wait times, and improving space utilization. Assumptions that single model of care was necessary in different geographic community settings imposed unnecessary limitations.

Results

Systematic allocation of space, altering patient scheduling to avoid lab delays and staff assignment changes to flow facilitated more efficient processes for IV placement, lab draw, and delivery of short treatments (injections). Staff were cross trained for similar tasks preventing gaps in patient care. These changes optimized the use of available space, improved access to care, and improved the overall patient experience.

Discussion

Targeted quality improvement efforts enhanced timely cancer care delivery, maintaining highest quality standards while accommodating the constraints inherent to smaller, decentralized facilities. CCC’s are vital resources for rural communities and essential clinical settings for NCI designated cancer centers to assure accessibility and excellence regional oncology care delivery.

Oncology Nursing Forum. 2025 Mar 1;52(2):140.

P232. Freezing Chemo Induced Neuropathy in its Tracks

Andrew Granada ¹, Adrienne Turri ²

Symptom Management and Palliative Care

Significance & Background

Chemotherapy is known to cause peripheral neuropathy (PN) in 30–60% of patients, with no effective treatments once symptoms occur. Chemotherapy-induced peripheral neuropathy (CIPN) can lead to treatment delays, dose reductions/discontinuation, poor treatment outcomes, and reduced function and quality of life. Cryotherapy is thought to limit circulation of chemotherapy into periphery limiting nerve damage. Prophylactic cryotherapy has been shown to reduce CIPN.

Purpose

PICOT

In adult cancer patients initiating chemotherapy (P), what is the effect of implementing an evidence-based cryotherapy intervention during chemotherapy treatments (I), compared with standard care (C), on patient-reported sensory peripheral neuropathy (toxicity symptom) (O) during chemotherapy treatment (T)?

Interventions

This evidence-based practice (EBP) implementation project guided by the Iowa Model (2018) was initiated at a 16-bed infusion clinic in Chicago that delivers chemotherapy based on Quality Oncology Practice Initiative (QOPI®) standards with toxicity monitoring. An implementation team, including manager, clinical nurses, providers, and product vendor, collaborated to review literature and create an evidence-based protocol for cryotherapy (FDA approved) to guide product storage, proper use, and patient education. Nurses were trained to apply gel-packs/sleeves 15 minutes before, during, and 15 minutes after Taxane infusions, with pack-change every two hours. Patients received verbal and written cryotherapy information during orientation with option to participate. A retrospective chart review was conducted to identify CIPN incidence without intervention.

Results

Baseline chart review (n = 69, Q3&4 2022), many patients (n = 44, 62%) reported CIPN with 54% (n = 38) Grade 1 and 9% (n = 6) Grade 2. Cryotherapy was implemented in May 2023 for patients who received Taxane-based chemotherapy. After implementing the cryotherapy, from May 2023 to July 2024, patients (n = 41), only 1 (2%) developed CIPN Grade 2, 24 (59%) developed CIPN Grade 1 and 16 (39%) remained at CIPN Grade 0. It was noted that less adherence to cryotherapy, white race, longer chemo hours, and prior chemo were associated with higher CIPN outcome. Patients with consistent adherence had better results.

Discussion

Strategies to improve cold tolerance included gloves/towels next to skin, warm blankets, and distraction. Cold intolerance is a significant barrier to starting and maintaining cryotherapy. Data collection continues with strategies to improve cold tolerance.

Oncology Nursing Forum. 2025 Mar 1;52(2):140–141.

P233. Utilizing Evidence Based Practice to Increase Safe Medication Administration in the Outpatient Oncology Setting

Adriana Grandpre-Aguiar ¹, Emmille Tubadeza ²

Quality and Safety

Significance & Background

The absence of standardized medication administration has resulted in the nurse administering high-alert medications leading to medication errors. Barcoding medication administration (BCMA) has shown to significantly decrease medication errors and enhance patient outcomes (Post et al., 2023). According to Macias et al., in 2018, antineoplastic medications were the most prevalent causes of mortality resulting from medication errors. Despite the integration of BCMA throughout our academic medical center, the outpatient hematology oncology community clinics, have not adopted this best practice, resulting in an ongoing prevalence of errors particularly associated with biosimilar immunotherapies.

Purpose

This evidence-based practice initiative aims to mitigate medication errors in hematology oncology community clinics through implementation of barcode medication administration.

Interventions

The number of medication errors within ambulatory community practices over the past three years were surveyed and categorized into three categories: incorrect drug, dosage, and rate. The Risk-Frequency Matrix results indicated a high frequency/high risk of medication errors, necessitating a requirement for improvement within the department. The nursing leadership conducted a literature review on evidence-based practices for safe medication administration. The integration of BCMA showed statistical and clinical significance in mitigating the incidence of medication errors. A multidisciplinary team was formed which included nursing leadership, pharmacy and other department stakeholders. This team met monthly to establish a strategic plan to integrate BCMA among 19 oncology clinics using a systematic approach; monthly surveillance of the rollout; and evaluation of prospective medication errors.

Results

This project is still in progress. The use of implementing a medication dispensing machine with BCMA capabilities was agreed upon by stakeholders to mitigate medication errors. The organization is currently identifying a process of replacing the current system in a series of phases. Currently, nursing leadership is procuring staff education curriculum on the utilization of BCMA and pharmacy is addressing the necessary preparations to accommodate a new medication dispensing system.

Discussion

High Alert medication error have the potential to cause great harm to a patient. Safe mediation administration requires multidisciplinary, evidence-based structure to improve patient safety and quality in the outpatient oncology settings. Utilizing a multidisciplinary quality improvement process using BCMA can optimize nursing workflow to minimize errors potential and safeguard patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):141.

P234. Effectiveness of Supportive Care Interventions on Quality of Life In Cancer Patients

Aleksandra Grbic ¹

Coordination of Care and Navigation

Significance & Background

Cancer is not only a physical disease but also a profound emotional, psychological, and social challenge. Supportive care is designed to complement medical treatment, focusing on symptom management, emotional, social support and physical rehabilitation. The effectiveness of different support measures is key to providing comprehensive care for cancer patients. Enhancing quality of life has become a critical focus in oncology care, emphasizing the importance of supportive interventions that address these multidimensional needs.

Purpose

The purpose of this study is to determine the effectiveness of supportive interventions on improving psycho-physical-social well-being and quality of life in cancer patients. Coordinator nurse in supportive care can tailor care plans to better meet the unique needs of cancer patients by identifying the most effective support strategies.

Interventions

Data will be retrospectively analyzed from May 2024 to January 2025 at the Institute of Oncology Ljubljana, using the EORTC QLQ C30 questionnaire. Assessments will be collected before and after 4 months of the start a comprehensive care of cancer patients, where different supportive interventions will be used depending on the individual symptoms and problems. Descriptive and inferential statistics will be used.

Results

The interpretation of the results will be a comparison between baseline assessments and after 4 months in cancer patients where different supportive interventions such as counseling or follow-up with different specialists have been used according to the symptoms and problems expressed.

Discussion

Comprehensive care improves quality of life, ensures that oncology patients achieve optimal benefit from their treatment, and involves a coordinated, and integrated approach based on the patient’s wishes and needs. The role of a coordinator nurse in supportive care for cancer patients is crucial for managing the complex, multidisciplinary care that patients with cancer require. This role involves addressing both medical and psychosocial needs and ensuring a patient-centered approach throughout the cancer care continuum.

Oncology Nursing Forum. 2025 Mar 1;52(2):142.

P235. Enhancing Oncology Patient Care Through Interprofessional Collaboration: A Multidisciplinary Team Approach

Cassandra Green ¹, Katherine Grannemann ², Georgia Motter ³, Allison Gibson ⁴, Syritta Doughty ⁵

Coordination of Care and Navigation

Significance & Background

Oncology patients receive care from multiple departments. Clinic, infusion, and radiation vary in cadence and length causing work silos. It was noted that some patients were sharing information and concerns with each nurse encounter while others only sparingly. This left gaps in knowledge vital to providing excellent nursing care. The literature reports that everyone on the inter-professional team plays an integral part as they contribute their own unique, skills, knowledge and expertise to deliver high quality cancer care. Effective communication is essential to adequately meet the needs and preferences of patients and families throughout their journey. There was a need to bridge the gap and ensure all clinicians have the same information that may impact patient success. The team was tasked with determining a way to bridge the gap and eliminate the silos.

Purpose

To address the communication gaps and improve patient outcomes, our initiative focused on establishing regular inter-professional team meetings. These meetings aim to facilitate the exchange of critical patient information, discuss social determinants of health, identify barriers and develop actionable solutions to assist the patient in having a successful cancer journey.

Interventions

A structured, multidisciplinary meeting was implemented involving key representatives from each department engaged in oncology care. The team reviewed patient cases, shared observations, and collaborated to identify challenges and opportunities for improving patient care. Focus was given to ensure social determinants of health were comprehensively addressed and barriers to care were identified and mitigated. Results

The interprofessional team meetings have significantly improved communication across departments, ensuring that critical patient information is consistently shared. The collaborative approach has led to more cohesive care plans, better patient outcomes, and a more integrated healthcare experience. A decrease in delays for patients receiving concurrent chemoradiation resulting in patients starting at the date proposed at consult. At our first meeting in November 2023, patient satisfaction score was at its lowest 82.9%. In December 2023, scores were 88.6% with patients responding 9/10 on “My team works well together.”

Discussion

Regular inter-professional team meetings are essential in bridging communication gaps among oncology care teams. By fostering collaboration and focusing on comprehensive patient care, this approach can enhance the quality of care delivered to oncology patients, addressing key barriers and improving overall outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):142–143.

P236. Training Remote Oncology Nurses for Success

Kaila Green ¹

Professional Development

Significance & Background

Due to an increase in demand for accessible healthcare options, the need for remote triage of patient symptoms is on the rise. Healthcare industry standards have by enlarge shifted cancer care from the inpatient to the outpatient settings. Effective training of remote triage oncology nurses is vital to ensure continuous high-quality coordination of healthcare.

Purpose

Implement strategies for successful training of remote oncology nurses focusing on technological proficiency, clinical skills, communication, and collaboration.

Interventions

Required training program includes didactic lectures, case-based simulations, and resources to corroborate delivery of effective, safe patient-centered care. George Washington University Oncology Patient Navigator Training

■ Increase adherence to treatment plans
■ Patient navigator can help understand and follow their treatment regimens, which leads to better patient outcomes

ONS Triage Guidelines

■ Triage guidelines provide a clear framework for decision-making and reduce stress associated with prioritizing patient care
■ Essential tools for ensuring that healthcare resources are used effectively, and patients receive the care they need in a timely manner

Standard Operating Policies & Procedures

■ Review Electronic Medical Records (EMR) system in detail
■ Ensure nurses are proficient in using EMR system, and telehealth portal.

Care Coordination Algorithm, & Workflows

■ Review processes that are completed in a specific order
■ Providing effective communication with patients, families, and healthcare providers

SharePoint Resources for Nurses & Patients

■ In collaboration with Supportive Services team, Oncology Nurses can help patients overcome barriers to care, such as language barriers, transportation issues, or behavioral health/dietitian needs.
■ Telephone Triage for Oncology Nurses-with evidence-based practice, Remote Triage nurses of all experience levels can utilize these resources as an essential tool for navigating telephone calls.

Results

Method

■ Microsoft Teams poll

Respondents

■ 19 nurses Remote Triage Nurses who completed the above orientation.

Discussion

In conclusion, training remote oncology nurses requires a multi-faceted approach to address technology, clinical, and communication aspects of patient-centered care. By implementing the policies, workflows, and resources provided can effectively prepare remote triage nurses to deliver high-quality oncology care in the remote settings.

Oncology Nursing Forum. 2025 Mar 1;52(2):143.

P237. Decreasing Barriers to Enrollment in Cancer Clinical Trials: An Education Intervention

Leslie Greenberg ¹

Patient Education

Significance & Background

Cancer is a public health problem and the second leading cause of death in the U.S. Cancer clinical trial (CCT) participation is needed to create new therapies and treatments to improve cancer care and reduce the cost and emotional and physical burden of cancer in the U.S. Historically, adult participation in cancer clinical trials is low, with only about six percent of patients treated at Community Centers participating in clinical trials. Patient-related internal barriers to CCT enrollment may include personal beliefs and reservations about clinical trial participation.

Purpose

The purpose of this project was to measure the impact of CCT education on CCT knowledge and attitudes in patients with cancer.

Interventions

It was a quality improvement project with a pre-post design. Eleven participants were recruited and enrolled. They watched the PRE-ACT (Preparatory Education About Clinical Trials) web-based videos designed to improve preparation for decision making in CCTs and attended a question-and-answer session with CCT staff. Before watching the videos, participants completed the Knowledge Statements about Clinical Trials survey and Attitudes to Randomized Trial Questionnaire (ARTQ) survey. After watching the videos, participants completed these two surveys again along with the Preparation for Decision Making (PrepDM) Scale.

Results

CCT Knowledge scores did not differ significantly from pre- to post-education (Z = 1.73, p = .084). This was due in part because of the high pre-education scores. For the ARTQ survey there were no significant changes in these responses from pre- to post-education. The PrepDM scale overall score ranged from 57 to 100, with a mean of 83.9 (SD = 14.4) and a median of 80.0. This suggests a high level of preparedness to make a decision. The sample was underpowered limiting the ability to determine statistical significance. However, all participants stated that they saw value in the CCT education.

Discussion

Many participants were aware of CCTs but had not considered CCTs as a potential treatment option. One participant enrolled in a CCT post-education. CCT education helps to address patient barriers to participation in CCTs. This project showed that patients with cancer find CCT education valuable and may consider current and future participation after CCT education.

Oncology Nursing Forum. 2025 Mar 1;52(2):143–144.

P238. Blood Draw Charge Nurse (BDC) – Transforming the Patient Experience with A New Role

Mary Griffin ¹, Melissa Tamburro ², Alexia Perry ³, Jasmine Gibson ⁴, Erin McGarry ⁵, Jaclyn Andronico ⁶

Healthcare Delivery

Significance & Background

Oncology care is expanding and demand for care in the outpatient setting is increasing. Oncology patients need baseline testing prior to and during cancer treatments like chemotherapy, radiation, surgery and radiologic diagnostic procedures. At one National Cancer Institute designated center’s regional location, the phlebotomy area, where these tests are performed had high wait times and low patient and staff satisfaction. With space constraints and volume growth, nursing leadership worked with front line nursing staff to find ways to improve throughput and create capacity, while centering patient safety and experience.

Purpose

A working group of 5 clinical nurses, a clinical nurse specialist, an administrative representative and nursing leadership developed and implemented a Blood Draw Charge (BDC) nurse role to standardize patient care, unit workflows, decrease wait times and increase nurse and patient satisfaction.

Interventions

A core group of 5 clinical nurses, nurse leader, clinical nurse specialist and administration representative developed a BDC nurse role in the phlebotomy unit. Regularly scheduled meetings were held to discuss the new role and responsibilities, creating standardized resources, scheduling needs and unit workflow. The BDC nurse was removed from patient assignments to allow them to focus on clinical escalations from nursing support staff and to improve the patient experience. In addition, patient assignments were shifted from a push to a pull model.

Results

The BDC nurse role went live February 2024. Since the implementation of the role patient wait times have decreased by 60%, from a high of 19.05 minutes in March 2024 to 7.63 minutes in August of 2024. Nursing support staff and nurses reported positive anecdotal feedback on the role and improved efficiency on the unit. Further data showed a decrease in the institution’s event reporting system.

Discussion

Patients desire to receive care closer to home. Volume at this regional location continues to increase in 2024 without incremental space. This initiative allowed nursing to create capacity at this site while improving patient and staff experiences. Similar workflows can be modeled at other institutions that manage a high-volume of phlebotomy patients. An unanticipated benefit was the opportunity for increased real-time feedback and just-in-time education for nursing support staff with the implementation of this role.

Oncology Nursing Forum. 2025 Mar 1;52(2):144.

P239. Expanding the Toolbox: Subcutaneous Infusions in Oncology Nursing

Elaine Griffin ¹, Sidra Iqbal ²

End of Life

Significance & Background

End-of-Life (EOL) care is a component in the journey of many oncology patients. A major goal in EOL care is to provide good symptom control. Oral route is the preferred method for medication delivery at the end of life, but is not always not always a viable option. IV access can be difficult to obtain and maintain at this stage of life and can become burdensome for some patients. Subcutaneous infusion access, used in many hospice organizations, can provide an alternative for EOL medication delivery in the acute care setting.

Purpose

The Purpose of this project was to establish a process of subcutaneous access for medication administration in EOL care provided in a large academic medical center.

Interventions

The literature was reviewed to determine best practices for the procedure and confirm that medications for EOL care commonly used by the hospital were appropriate for the subcutaneous route. Available devices were reviewed and selected based on what was obtainable based on current contracting. A policy for subcutaneous administration of opioids existed, and was updated to include non-opioid medications and current best practices appropriate for EOL care. It was decided that oncology nursing staff as the primary users of the product would maintain responsibility for stocking the product and placing any lines used in the facility. Resource materials were developed for the nursing staff. An education plan was developed for nursing, pharmacy, and medical staff.

Results

90% of unit nursing staff were credentialed within 6 weeks. Use of subcutaneous infusions began the day the product became available on the nursing unit. The primary learning hurdle for all healthcare professionals was understanding the need for a separate device for each medication to be delivered and the process of ordering a priming volume for the device. The product is being used on 2–3 patients per month. Staff report satisfaction at having more options for providing EOL care.

Discussion

Subcutaneous infusions provide an additional tool for providing good symptom control in EOL care. One initial complexity was coordinating implementation plans between stakeholders to reduce confusion. Some concerns were expressed by secondary stakeholders that the requirement for a separate line for each product places undue burden on the patient have been difficult to address and requires ongoing efforts.

Oncology Nursing Forum. 2025 Mar 1;52(2):144–145.

P240. Developing A Practical GYN Oncology Nurse Orientation Curriculum in An Outpatient Setting: Connecting the Dots to Optimize the Provider and Patient Experience

Lindsay Groet ¹

Patient Education

Significance & Background

There are numerous tools that educators can use to assist new outpatient oncology nurses and it is imperative that you investigate how they would best absorb the information. Creating a safe learning environment is key to a successful orientation.

Purpose

Outpatient Gynecology Oncology is a specialized category of oncology and with that comes the need to re-design a typical orientation. In this role, there is a great deal of patient teaching. Teaching orientees how to effectively and confidently go in and teach the patient is pivotal. Giving orientees mock teaching sessions is crucial, as it allows them to take what they have observed thus far and put it into action. This also gives them the ability to ask questions in real-time and receive feedback.

Interventions

For this project, I designed mock patient teaching scenarios for both surgeries and chemotherapy that uses an actual patient to standardize the information used for the teaching and for the educator to be able to ask the learner targeted questions. The orientee gets the patient’s information and the type of teaching, as well as leading questions to make them think about what is needed from the chart and what orders they will need to place.

Results

They will have time to look up information. As the educator posing as the patient, I would ask real questions that often come up during teaching. I found that orientees felt much more comfortable doing their first few teaches with me, as their patient, than they would teaching an actual patient with me observing. They felt empowered to ask questions and didn’t feel like they were going to lose the trust of the patient in this safe space. Orientees reported these sessions as a positive experience.

Discussion

Despite how orientees stated they learned best, they felt safe and able to engage when doing mock patient teaches. They felt like these sessions provided them with a positive learning environment and allowed them to be open to constructive criticism. To date, I have only oriented one nurse in the outpatient setting. It is important to continue to utilize this teaching method and proceed with evaluating its effectiveness.

Oncology Nursing Forum. 2025 Mar 1;52(2):145.

P241. Creating and Implementing an Oncology Focused Onboarding Program for All New Clinical Staff to Improve Oncology Knowledge and Confidence

Janis Gunnell ¹, Kylee Nelson ², Julia Beynon ³, Mckell Gubler ⁴, Jennifer Jones ⁵

Professional Development

Significance & Background

Cancer is the second leading cause of death in the United States, yet there is little focus on oncology topics in nursing programs. Staffing shortages and the cancellations of classes during COVID exacerbated the lack of oncology preparation for clinical staff. A needs assessment was performed on newly hired clinical staff in an academic oncology hospital which identified numerous educational gaps in the field of oncology.

Purpose

Our purpose was to create a standardized program that would give all clinical staff the same foundational oncology understanding and create a unified high standard of care for oncology patients in our institution.

Interventions

We collaborated with hospital administration and clinical managers to set expectations of learning and time commitment for learners. We met with new clinical staff to identify knowledge gaps. We reviewed incident reports to determine areas which needed further education. Our clinical staff education department worked together to incorporate the above finding and ONS criteria to develop a week-long foundation oncology course with generalized oncology information, role specific training, and unit specific education.

Results

Prior to the oncology course, clinical staff did not feel confident in caring for the unique needs of oncology patients. Pre and post assessments were given to staff to identify if the interventions were effective (see attached image). Daily assessments were also given to gauge usefulness of topic, presentations, activities, etc. Small changes were made to presentations and activities; however, all topics were deemed needed by learners. Pre and post assessments indicated statistically significant results in increasing participant’s confidence and knowledge in caring for oncology patients.

Discussion

As the data indicates, it was necessary to provide a foundation of oncology education for clinical staff to provide knowledge and confidence to care for the complex needs of an oncology patient. When provided oncology-focused educational opportunities staff felt better prepared to give high quality care to our patients. In empirical data received, learners expressed appreciation for the foundational learning opportunity. Managers stated they felt their new employees were more prepared in oncology care. To evaluate future impact, we would like to analyze how this course affects patient outcomes and staff retention.

Oncology Nursing Forum. 2025 Mar 1;52(2):145–146.

P242. Exploring the Relationship Between Chronological Age and Communication in Newly Diagnosed Cancer Patients

Irene Guterman ¹, Jessica Keim-Malpass ², Wendy Cohn ³

Psychosocial Dimensions of Care

Significance & Background

Adults aged 65 and older represent over 60% of newly diagnosed cancer patients and often face worse outcomes than younger patients. Communication is crucial in cancer care, yet older adults encounter barriers due to physiological, cognitive, and social factors, which can impact decision-making and patient involvement. Little is known about how chronological age specifically affects communication in newly diagnosed cancer patients, and understanding this relationship is key to improving care.

Purpose

This study aimed to explore the association between chronological age and communication challenges in newly diagnosed cancer patients. Five key communication outcomes were examined: (1) discussing healthcare wishes with the medical team, (2) talking with family about illness, (3) making appointments, (4) finding community support, and (5) understanding treatment options.

Interventions

A secondary analysis of de-identified data from 945 cancer patients was conducted at an NCI-designated Comprehensive Cancer Center. Communication outcomes were measured using a 17-item distress screener, and sociodemographic factors including sex, education, and income were considered. Logistic regression was used to examine the relationship between age and communication, controlling for these factors.

Results

Significant negative associations were found between age and both talking with family about illness (p = .036) and making appointments (p = .014). No significant associations were observed between age and communication with healthcare teams, finding community support, or understanding treatment options. Middle-aged patients (51–65) reported the most difficulty with making appointments (38%) and talking to family (37%).

Discussion

Older adults face specific communication challenges, particularly regarding family involvement and organizing care. Targeted communication interventions are necessary to address the unique challenges faced by older adults with cancer. Personalized communication strategies, patient navigators, and community support systems can help improve communication and health outcomes for older cancer patients. By considering factors beyond chronological age, including individual levels of health literacy and social capital, healthcare providers can better support older patients, improving their engagement and overall care experience.

Oncology Nursing Forum. 2025 Mar 1;52(2):146–147.

P243. Care of the Cellular Therapy Patient: Enhancing RN Education in A Rapidly Evolving Environment

Melissa Gutknecht ¹, Thea Malile ², Alexandra Dormal ³, Laurie Crouch ⁴

Management

Significance & Background

The use of cellular therapies is expanding beyond hematologic malignancies, with newly FDA approved gene therapies for sickle cell disease, tumor infiltrating lymphocyte (TIL) therapy for melanoma, and clinical trials using various cellular therapies in solid tumors, benign hematology, and non-oncologic diseases. The Foundation for the Accreditation of Cellular Therapy (FACT) outlines rigorous quality standards for cellular therapy programs, as well as strict treatment protocols for all elements of cellular therapy administration and related patient care. We found gaps in practice and missed opportunities for meticulous care, including nursing errors related to timing of medications, coordination of care with the cell therapy lab, and administration of cellular therapies. Based on increased numbers of safety events related to nursing care, our team identified the need for enhanced nursing staff education.

Purpose

To increase depth of understanding of cellular therapies, administration protocols, need for timely assessment, intervention, and side effect management, leading to increased nursing confidence and comfort in the provision of safe, quality patient care.

Interventions

Our team, comprised of two nurse educators, the cellular therapy program manager and quality manager, revised the existing Cellular Therapy Course. We expanded attendance requirements to encompass the widening range of nurses now caring for cellular therapy patients. The updated September 2024 class is two full days and incorporates different learning modalities including pre-class CAR-T therapy video and quiz, increased emphasis on experiential learning, interactive lectures, and participation in an extensive instructor-led content review to stimulate critical thinking.

Results

Using a 1–5 Likert scale, nurses completed a self-evaluation of their comfort level in caring for cell therapy patients pre and post the revised class. Of participating nurses, 100% rated their post class comfort level 4 or 5, related to administration of cellular therapies and management of adverse events, including CRS, ICANS and neutropenic fever. Pre to post rating increased in 38% of attendees.

Discussion

The ability to think critically and to synthesize clinical information is essential to self-efficacy of nurses providing complex patient care. Anticipated outcomes include continued self-report of increased post-class nursing confidence and comfort with provision of care for cellular therapy patients, supported by fewer nursing-related cellular therapy safety events reported.

Oncology Nursing Forum. 2025 Mar 1;52(2):147.

P244. Identifying Primary Palliative Care Educational Needs of Nurses

Karen Harden ¹, Jessica Spruit ², Heidi Mason ³, April Bigelow ⁴

Symptom Management and Palliative Care

Significance & Background

Primary palliative care (PC) is a newer concept that is defined as PC delivered by healthcare professionals who are not specialists in PC. As bedside nurses spend considerable time with patients and families with serious illness, they are in a position to deliver primary PC. Benefits of PC include transparent communication, clarification of misconceptions between hospice and PC, assistance with complex decision making, advocacy within the healthcare community, management of symptoms, and goals of care discussions.

Purpose

This project was initiated to determine nurses’ baseline knowledge and understanding of primary and specialty palliative care (PC), use of existing resources, and provision of basic principles of primary PC. This information will be used to inform the development of educational interventions that enhance PC strategies on individual patient care units in a tertiary care setting.

Interventions

The survey was created using Qualtrics and was approved by the IRB and the hospital Research and Translation committee. A survey was distributed to all inpatient nurses in the adult and pediatric hospitals. The questions included work setting, time as a registered nurse, familiarity with PC resources, general PC knowledge, response to symptoms, and preparation to engage in serious conversations with patients and families. The survey was distributed to nurse leaders on the designated units who in turn posted the QR code in strategic locations on the units. The researchers visited all units to meet with leaders and nurses and encourage completion.

Results

A total of 278 responses were received. Despite the availability of several PC resources in the institution the majority (92%) of responders identified their best resource as the specialty PC team members. Although a majority (~52.4%) of nurses surveyed agreed or strongly agreed that they felt prepared to engage in difficult conversations, there was a percentage of nurses who were either neutral (~23.4%) or disagreed or strongly disagreed (~23.4%) that they felt prepared.

Discussion

This survey reflects an important opportunity to deliver primary PC care throughout our institution and enhance utilization of available resources. To empower nurses with the knowledge and skill required, education in PC specific principles and practice scenarios will be developed.

Oncology Nursing Forum. 2025 Mar 1;52(2):147–148.

P245. Learning the Art of Early Palliative Care Through Simulation

Karen Harden ¹, Heidi Mason ², April Bigelow ³, Jessica Spruit ⁴

Professional Development

Significance & Background

Early palliative care (PC) is important for patients with serious illness and their families creating a valuable collaboration to optimize quality of life. PC skills training should be an essential aspect of the nursing curriculum, and learning through simulation can be a powerful way to introduce these challenging concepts.

Purpose

The purpose of this simulation was to provide a realistic scenario for graduate and undergraduate nursing students to practice palliative communication strategies and interventions in a safe environment.

Interventions

The simulation used standardized patients acting as the client and family ready to discuss their serious diagnosis with the healthcare team. The “phases and transition model for serious illness” framework was utilized to demonstrate how patients move through initial cancer diagnosis, active treatment and symptom management, and end of life phases of care. A learning plan used by the instructors included a pre-brief, expectations, instructor notes, simulation set-up, learning objectives, pre-sim instructions, standardized patient role, scene introduction, expected student actions, and debrief questions for each of the three scenarios.

Results

The two primary outcomes for this simulation were to provide a realistic environment in which students could apply knowledge, and practice key communication strategies to engage patients and families in difficult conversations. Students participated in groups of 2–3 with 2 actors, and engaged in realistic family meetings which lasted for 20 minutes. Debriefing was 15–20 minutes immediately after the simulation.

Discussion

The standardized patients portrayed the emotions of strength, disbelief, sadness, fear, hope and loss of hope, anger, confusion, and defeat to create a realistic experience that engaged and enveloped the students in the highly emotional state that patients often experience during difficult conversations. It required students to “think on their feet” and draw from the knowledge and experiences they obtained in their classes. One patient stated that she teared up during the conversation around poor prognosis. Students often reported it was so realistic that they were unsure how to respond and relied on silence as an effective intervention. Debriefing enabled them to analyze strategies that were used and hear from patients about how responses made them feel. Students shared that the experience provided an opportunity to practice their skills in a safe environment prior to translating them into the clinical setting.

Oncology Nursing Forum. 2025 Mar 1;52(2):148.

P247. Development of EMR Strategies to Prevent Inpatient Oral Chemotherapy Errors

Lisa Hartkopf Smith ¹

Quality and Safety

Significance & Background

Oral antineoplastic agents are high risk medications with serious adverse reactions, even death, if prescribed inappropriately. When patients on home oral antineoplastics are admitted to the hospital, patient condition can necessitate dose reduction or discontinuation. Prescribing errors have been reported throughout the US when hospitalists or emergency department providers re-order these medications from home medication lists without consultation from oncology. EMRs typically do not automatically restrict prescribing when agents are ordered outside of the chemotherapy treatment plan.

Purpose

The purpose of this project is to describe the development, implementation, and evaluation of an EMR safety strategy to prevent errors in inpatient areas through restricted oral antineoplastic prescribing.

Interventions

The healthcare system was evaluated for the type and number of oral antineoplastic errors originating from re-ordering from home medication lists by non-oncology providers. Literature and national standards were reviewed. A Best Practice Alert (BPA) was initially implemented. The BPA fired when an AHFS class 10:00 oral agent (antineoplastic) was ordered. The alert warned that an oncology provider must prescribe for cancer. The BPA did not physically restrict prescribing. Errors continued. It was determined that AHFS class 10:00 oral agents could be built in the EMR so that only providers with identified job codes (e.g., oncologist, oncology APRN) could prescribe. Other job codes would be blocked. Concerns were presented that non-oncology providers could not be blocked from ordering antineoplastic agents used for non-cancerous conditions. 12 oral antineoplastics were identified that could be used for both cancer and non-cancerous conditions. If ordered, the provider is asked if the indication is cancer or not cancer. If ordered for a non-cancer condition, the non-oncology provider can prescribe.

Results

Since implementation 12 months ago, there have been no errors reported.

Discussion

In an ideal world, only oncology providers would order oral antineoplatic agents for the treatment of cancer, and they would only be administered by chemotherapy qualified RNs. In reality, non-oncology providers may be unaware of the need to dose reduce or hold oral antineoplastic agents when the patient is admitted. Staffing, patient location in the hospital, and availability may limit the availability of chemotherapy qualified RNs to check and give oral antineoplastics. To overcome these hurdles and to promote patient safety, developing strategies using the EMR can prevent inpatient oral antineoplastic errors.

Oncology Nursing Forum. 2025 Mar 1;52(2):148–149.

P246. Foundations in Fitness: Establishing A Structured Exercise and Nutrition Program for Cancer Survivors

Lisa Hartkopf Smith ¹

Survivorship

Significance & Background

NCCN (2024) recommends that for optimal health, cancer survivors should be encouraged to set incremental as well as ultimate goals for physical fitness and nutrition. Participation in supervised exercise and nutrition programs have been found to improve adherence to meeting these goals.

Purpose

The purpose is to describe the development and evaluation of a supervised exercise and nutrition program for survivors. The program goal is to help those living with and beyond cancer learn and experience the benefits of physical activity and healthy nutrition in a medical certified fitness facility under the supervision of a clinical exercise specialist and oncology certified dietitian.

Interventions

The cancer survivorship advanced practice provider, exercise specialists, and oncology dietitians established a team to determine goals, eligibility criteria, and content. A referral was built in the electronic medical record and includes inclusion and exclusion criteria for the provider to complete. Criteria were based on American College of Sport Medicine guidelines. Exercise specialists completed the American Cancer Society –American College of Sports Medicine Cancer Exercise Specialist Program. Each patient has an initial assessment by an exercise specialist . The trainer develops an individualized exercise program. The program is two 1 hour sessions, twice a week for 8 weeks. Weekly educational handouts are reviewed. At week 2 and 6, the dietitian presents an informational session. After completion of the 8 weeks, a fitness assessment is completed by the exercise specialist. Pre and post program findings are documented in the electronic medical record. The program is funded by the health system’s cancer program.

Results

48 patients have completed the program (August 2023–September 2024). Post-test assessment indicated a 30 % improvement in heart rate, blood pressure, Ebbeling treadmill walk test (VO2Max), sit and reach, push-ups, bodyweight max squat test, fatigue score, and Profile of Mood States. There were no significant changes in body composition (weight, BMI, waist/hip ratio). Fatigue scores decreased and Profile of Mood States scores improved.

Discussion

This program supports previous findings that participation in a structured exercise and nutrition program improves wellness. Patients improved on all parameters, excluding body composition. Lack of improvement in body composition may be related to program length. Program success may be related to incorporation of standards from national organizations, exercise specialists completion of a cancer exercise education program, and individualized exercise plans.

Oncology Nursing Forum. 2025 Mar 1;52(2):149.

P249. The Oncology Nurse Perspective on Education Needs in Genetic Testing

Elizabeth J Heller ¹, Keira P Smith ², Eden ED Maack ³, Lyn F Brook ⁴, Madelyne Fabrizio ⁵, Amy Karfonta ⁶

Screening, Early Detection, Genomics

Significance & Background

Genetic testing and counseling are crucial components of oncology care. Oncology nurses act as an integral source of information for patients regarding all aspects of their care, including genetic counseling services, genetic testing, and how genetics impact cancer treatment and cancer risk assessment for patients and their families.

Purpose

The purpose of this study is to gain insight into oncology nurses’ understanding and confidence in their ability to address genetic counseling with their patients as well as the needs of oncology nurses for education on these topics.

Interventions

Oncology nurses complete a short survey about genetic testing and counseling in their clinical practice. Data collection and analysis are ongoing.

Results

Survey data from 349 attendees at the 2024 Oncology Nursing Society (ONS) Congress evaluated educational needs among respondents regarding genetic testing and counseling in oncology practice (Table 1). More than half of oncology nurses surveyed (56%) referred patients for genetic testing and counseling in their current practice. Only 9% felt very confident in discussing the basics of genetic testing and counseling with oncology patients. An interest in further training and education about genetic testing and counseling was expressed by 78% of participants.

Evaluation/Discussion

Nurses are at the frontline of care for patients with cancer. They are pivotal in helping refer patients to genetic counseling, and it is therefore critical that nurses understand the implications of genetic counseling for cancer treatment and risk; however, oncology nurses and nurse practitioners often have no formal education in genetic testing and counseling. Based on these survey results there is a need to develop nursing education on the benefits of genetic testing for patients, the types of genetic testing available, interpreting test results, and providing support to patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):149–150.

P248. Effectiveness of New Educational Task Force Format to Extend Reach of NCPD

Elizabeth J Heller ¹, Keira P Smith ², Eden ED Maack ³, Lyn F Brook ⁴, Madelyne Fabrizio ⁵, Amy Karfonta ⁶

Management

Significance & Background

The most cited barriers preventing clinicians from obtaining continuing medical education are time and expense, with most clinicians surveyed reporting that they completed professional development activities on their own time. It is important to develop new educational formats that are easily accessible to educate oncology nurses and other clinicians. Streaming videos on platforms such as YouTube and podcasts are emerging as convenient methods for delivering content.

Purpose

To determine if the introduction of a new educational format could extend the reach of CME/NCPD-approved activities and address gaps in oncology nurses’ knowledge regarding the treatment of patients with cancer.

Interventions

We developed a new activity format that convenes an interprofessional Task Force consisting of a panel of subject area experts including oncology nurses, oncologists, pathologists, and patient advocates to address an identified practice gap in oncology. The Task Force is charged with reviewing the latest clinical trial data, practice guidelines, and real-world evidence to formulate recommendations to address gaps in diagnosis, treatment, and interprofessional cooperation. The Task Force discussion is broadcast on YouTube Live. Following the Task Force discussion, the Task Force recommendations will be published in a peer-reviewed journal and discussed in a CME/NCPD-approved podcast episode with a downloadable transcript. Audience reach and knowledge gain will be determined based on the viewer and listener demographics and responses to an evaluation completed by learners to receive CME/NCPD credit.

Results

Faculty, including oncology nurses, were very enthusiastic about the task force format and excited to become involved. Two Task Force discussions have been broadcast on YouTube Live: Mitigating Disease Burden and Health Care Disparities in Relapsed/Refractory Multiple Myeloma, and Challenges and Innovations in Biliary Tract Cancer. Both will exceed the estimated reach of 500 viewers on the livestream and published video before conclusion. The first CME/NCPD-approved podcast discussion is currently available to learners, and learners are being given a posttest consisting of case-based questions that will gauge their ability to apply discussed concepts to clinical decision making.

Discussion

The Task Forces have been well-received by our faculty and audience. We expect to exceed the estimated reach of the Task Force Discussion on YouTube, and we look forward to presenting the results of the podcast reach. New formats of continuing education such as Task Force formats should be developed to engage learners.

Oncology Nursing Forum. 2025 Mar 1;52(2):150–151.

P250. Implementation of An Electronic Distress Questionnaire for Improved Distress Screening Practices

Meg Helsley ¹, Caitlin Jester ², Courtney Lamontagne ³, Cheyenne Corbett ⁴

Healthcare Delivery

Significance & Background

Recognizing that cancer patients experience varying levels of distress, this institution’s longstanding distress screening practice aimed to provide patient-centered care. Using the NCCN Distress Thermometer and Problem List for screening of all patients at each oncology provider visit, results were manually entered into EHR and documented when an oncology nurse/provider addressed distress ≥4. Staff frustration, decreased compliance, and patient feedback indicated that screening was too frequent, warranting practice changes.

Purpose

Create a distress-screening electronic questionnaire (e-questionnaire) within the patient portal to reduce clinic time, screening frequency, increase compliance, and enable screening of only patients with a cancer diagnosis.

Interventions

A distress-screening committee, led by psychosocial and nurse leaders, engaged informaticists to: build the distress-screening e-questionnaire within patient portal, create EHR criteria for intervention management, limit use to patients with confirmed cancer diagnosis. E-questionnaire in four clinics was sent maximum of once weekly, 48 hours before visit. Distress results were available via staff inbasket and auto-populated flowsheet. Staff verified patient’s results if completed via e-questionnaire; as some patients don’t use the portal, paper screening were manually entered. Regardless of method, further action expected if distress ≥4. Distress committee leaders monitor data of distress results, screening, and compliance for ongoing improvements prior to widespread implementation in the remaining 34 clinics.

Results

E-questionnaire was piloted for nine months. Baseline paper screening averaged 80% of patients across all 37 clinics. Pilot clinics increased compliance from 88% to 91%. Staff reported satisfaction with new process. With the widespread implementation, initial two-month data showed 5% improvement in screening. Estimated savings of 3,160 hours of nursing staff time by e-questionnaire use rather than paper. One-third of patients completing screening in patient portal, consistent with other institution-wide e-questionnaires. Distress ≥4 is averaging 23%. Despite improved screening compliance, documentation of distress management has lagged since initiating the electronic methods.

Discussion

With updated procedures, screening rates have increased. Opportunities remain for ensuring consistent documentation of response to high-distress. Future enhancements include a simplified decision tree and automated referrals for accessing psychosocial resources for clinicians, as well as solutions for proactive distress intervention planning upon receipt of pre-visit high distress results.

Oncology Nursing Forum. 2025 Mar 1;52(2):151.

P251. Streamlining Oncology Services: A Fast-Track Approach to Improve Efficiency and Patient Satisfaction

Brandi Henderson ¹, Heather Figary ²

Healthcare Delivery

Significance & Background

The oncology population is more susceptible to infection and complications; thus, it is important to make their care as efficient and safe as possible. As daily patient volumes increased by 20% (over several months) within an outpatient cancer clinic, complaints of long wait times and multiple intravenous sticks for labs and treatment led to decreased patient satisfaction. The need to address issues arising from increased patient volumes, without increasing treatment space or patient chairs, led to implantation of the Fast-track practice initiative in April 2024, moving eligible patients through the clinic more efficiently.

Purpose

The purpose of this clinical practice Fast-track initiative is to increase capacity, decrease wait times, and increase patient satisfaction at an NCI comprehensive outpatient cancer clinic within a large academic medical center in the Midwest.

Interventions

An interdisciplinary team of nurse, pharmacy and leadership created a Fast-track process by determining patient eligibility criteria (needed for central line access or peripheral intravenous access, injections not needing compounded by pharmacy, or removal of take-home infusion pumps), then establishing a dedicated space, and training staff on the Fast-track process.

Results

After five months of launching Fast-track, average completed appointments increased from 62 to 82 daily appointments; average daily infusion numbers increased from 40 to 43 appointments; average wait time for pharmacy to compound drugs decreased from 31 to 20 minutes leading to decreased chair time and increased chair capacity of 7.69 %. Of patients surveyed 82% rated their Fast-track experience as ‘excellent’. A quarterly nursing survey showed Fast-track has helped with patient satisfaction and decrease in needle sticks.

Conclusion/Discussion

Implementing Fast-track has decreased wait times, increased patient satisfaction and increased numbers of treatments completed. Concerns with imbalanced nursing assignments arose, with quick adjustments made to scheduling processes, leading to improved efficiencies and staff satisfaction. The Fast-track clinical practice process is now spreading to other cancer clinics within the medical center.

Oncology Nursing Forum. 2025 Mar 1;52(2):151–152.

P252. Implementation of A Last Day of Chemotherapy Photo Frame for Outpatient Chemotherapy Patients

Victoria Henney ¹, Clara Beaver ²

Psychosocial Dimensions of Care

Significance & Background

Our current Outpatient Chemotherapy Infusion Center did not have a celebratory bell or way for patients to celebrate their last day of chemotherapy. There is concern for having a loud celebration which could take away from the treatment of other patients, as well as affect the morale of other patients who might be on lifelong therapy. In our infusion center we see patients that may never have the chance to ring the bell despite trying all therapy options. Often, patients would ask if there was a bell to celebrate, and we would educate them on why we did not have one. While researching the best way to celebrate our patient’s I have created a photo frame board.

Purpose

The purpose of this project was to implement an effective way to celebrate our patient’s last day of chemotherapy that did not distract the treatment of other patients in the infusion center, but made the patient’s last day feel unique and special.

Interventions

A large “I finished my last day of chemotherapy” photo frame was made and brought into the infusion center. The nurse taking care of the patient would make sure that sign was presented to the patient at the end of their infusion. Nurses and Care Associates come over and congratulate the patient and make sure that the patient has a photo opportunity, if they wish, with the photo frame.

Results

Through the reactions of our patients and staff members, we have found that our “Last Day of Chemotherapy” photo frame to be a success. Our patients like having the chance to celebrate their hard work during their treatment. They can share their time with infusion by sharing the photo with family and friends. The staff members enjoy being able to celebrate without hindering the treatment of our other patients.

Discussion

During the past year of using the photo frame to celebrate the last day of chemotherapy, we have found that there are other options that can be done without hindering treatment or morale of our other patients. As an infusion unit, we have discussed implementing “last day of immunotherapy” photo frame, making certificates to celebrate accomplishments patient might have throughout their infusion experience (i.e. clean CT scan, a decrease in their cancer antigen).

Oncology Nursing Forum. 2025 Mar 1;52(2):152.

P253. Rethinking Lines: A Shift in Stem Cell Collection Strategies

Brooke Henry ¹, Judy Kauffman ², Renee Harris ³, Dara Cole ⁴, Sandra Cyphert ⁵, Elizabeth Fitzgerald ⁶

Quality and Safety

Significance & Background

Between January and May 2023, at our academic medical center, peripheral blood stem cells (PBSCs) were predominantly collected from autologous and allogeneic donors using tunneled central venous catheters (CVCs). Notably, only 24% of PBSCs were collected peripherally, with just 13% from autologous donors. Autologous patients often managed CVCs at home for 2–3 weeks before initiating their conditioning regimen, leading to increased central line-associated bloodstream infection (CLABSI) risks. The unnecessary prolongation of CVCs, even when not actively in use, heightened infection susceptibility, highlighting the urgent need for standardization in practice.

Purpose

The initial goal was to increase the percentage of PBSCs collected peripherally by 5%, thereby reducing reliance on CVCs and unnecessary line days.

Interventions

In May 2023, several targeted interventions were implemented: monthly reviews of peripheral collection data during Apheresis Quality Meetings, an IV insertion training course for Apheresis Registered Nurses (RNs), and hands-on training through collaboration with the IV Team and infusion center RNs. Additionally, a protocol was established for the timely removal of CVCs for patients not scheduled for admission within one week.

Results

From June 2023 to May 2024, the overall average percentage of PBSCs collected peripherally increased to 52%, surpassing the initial goal by 23%. Within the autologous cohort, 44 out of 124 patients (35%) were collected peripherally, significantly reducing line days by 2–3 weeks per patient and potentially decreasing overall line days by 616 days.

Discussion

Enhancing RN skill sets and refining collection protocols, resulted in a marked increase in peripheral collections and a notable reduction in line days. Ongoing monitoring and protocol adjustments are vital for sustaining these improvements and optimizing patient care in the apheresis setting. Moving forward, we aim to integrate ultrasound technology to enhance the accessibility and reliability of peripheral line placements, ensuring a more comfortable experience for our stem cell patients facing challenging vascular access.

Oncology Nursing Forum. 2025 Mar 1;52(2):152–153.

P254. Answering the Call: Staff Burnout and Disengagement

Rhona Henry Terrell ¹, Rhona Henry Terrell ²

Management

Significance & Background

Staff burnout and disengagement is an unwavering challenge that is affecting not just our unit but our entire institution. Burnout is costly and this challenge has led to high turnover rates, increase workloads, and employee dissatisfaction and disengagement. The average cost of losing an experienced nurse is $40,038.

Purpose

Identify strategies to decrease burnout, enhance engagement, foster our workplace and infrastructure to promote job satisfaction, patient safety, efficiency, and retention leading to better patient and family centered care and outcomes. To build and promote an empowered team environment to promote commitment, engage accountability, respect, and retention.

Interventions

Over a six-month period, talented staff were identified, supported, and empowered to promote teambuilding activities and a shared governance committee was established to promote professional development and quality improvement.

Results

Staff have expressed when they feel heard and supported it motivates them to be involved and empowers them to take initiatives. At the beginning of the project 60% of staff were in-house agency and 50% expressed uncertainty about staying. To date - 10% have left the in-house staffing program but decided to stay on the unit and are now working towards promotion. 95% of staff remained July–April 2024. For team building activities completed, 80% of staff attended and did so on their personal time/day off.

Discussion

Addressing employee burnout and disengagement is meaningful because it is important that our staff feels supported, valued and invested for our institution to maintain the ability to meet and provide the healthcare needs of our patients and community. Enhanced employee engagement will decrease burnout, increase job satisfaction, increase productivity, and promote better and safer patient care and quality outcomes resulting in profits for the overall institution.

Leaders play an influential role in effective change and implementation process. For continued success of our healthcare system and safe patient care, leaders must be innovative with their style of leading and mentoring. My submission addresses a significant issue affecting our healthcare environment and gives quick but effective wins to address and strengthen the challenge of staff burnout and disengagement.

Oncology Nursing Forum. 2025 Mar 1;52(2):153.

P255. Design & Development of A Dashboard to Track Shared Governance Participation

Alec Henson ¹

Management

Significance & Background

Shared governance (SG) empowers nurses at all levels to participate in decision-making processes which directly impact nursing practice and patient care. Research shows that engaging nurses in SG leads to higher quality care, greater patient satisfaction, and improved nurse retention. An assessment of council attendance was performed to evaluate attendance by frontline nurses. This assessment illuminated a need for interventions to increase the involvement of frontline nurses, as they are key in achieving optimal outcomes.

Purpose

To identify gaps in frontline nurse attendance at SG council meetings and to provide nurse managers with the ability to report on their staff’s attendance for use in performance evaluation.

Interventions

Using extract, transform, load (ETL) and data visualization tools from Tableau Software LLC, a dashboard was created to monitor council attendance. Attendee information was collected using a one-time registration form and attendance was recorded using a separate, repeating form. All information was stored in a database including information about each council and all meeting dates. This dashboard was distributed to nurse leaders, and training was provided on how to create individual and group attendance reports for leaders’ direct reports and areas of oversight.

Results

Analysis of attendance for each of 5 main councils from January to August 2024 showed an average of 8–9 frontline nurses present at each council’s monthly meeting. The expected number of frontline nurses is around 20 for each council, as each location sends one or more nurses depending on the number of subspecialties housed at each location. Unfortunately, occasions where a specific location had no frontline nurse representation were common, with of 18 locations having no representation at one or more councils.

Discussion

The findings highlight critical gaps in frontline nurse engagement in SG. The average attendance of 8 to 9 frontline nurses per meeting is low considering the expected attendance of about 20 per council. With the implementation of the dashboard and resulting socialization of attendance targets, we do expect to see some increase in attendance rates. Future work will involve using information from the dashboard to guide a more thorough exploration of the drivers of non-attendance and poor engagement.

Oncology Nursing Forum. 2025 Mar 1;52(2):153–154.

P256. A Date with Central Lines: Standardizing Care to Decrease Central Line Associated Infections

Suzanne Henss ¹, Patricia Hegerich ², Tavia Sherman ³

Quality and Safety

Significance & Background

Central line associated bloodstream infections (CLABSI) are the most common healthcare-associated infections (HAI), many of which can be prevented through appropriate care. More than 250,000 CLABSI events occur in the US each year and are costly to both patients and institutions, costing approximately $48,000 per case, with 12%–25% mortality. Oncology patients are at a higher risk for CLABSI due to increased usage of central lines and patients being immunocompromised. Unit leadership recognized CLABSI rates exceeded expected benchmarks that warranted intervention.

Purpose

The purpose of this project was to implement standardization of care to decrease CLABSI rates on a medical oncology unit.

Interventions

Infection control performed weekly audits on patients with Central lines and documented the compliance of the central line bundle. Areas of greatest opportunity for improvement included cap changes, dressing changes, Huber needle changes and CHG baths not being completed on time as per policy. Education was provided to staff on the unit regarding implementing standardization of care with the care bundle, which included set days and times for daily chlorhexidine gluconate (CHG) baths, dressing changes, and connector and tubing changes. The charge nurse for each shift was also tasked with performing audits on the central line bundle.

Results

Central line audits each shift allow the charge nurse to recognize care not performed and have it planned for completion before the shift is over. Since the standardization of care has been implemented, our CLABSI rate went from 1.56/1000 central line days to 0/1000 central line days. CHG baths for even numbered rooms having CHG completed on day shift and patients in odd numbered rooms done on night shift has increased compliance from 71.4% to 90.5% in one month.

Discussion

Scheduling of CLABSI care bundles has shown to be feasible and easily adopted in this inpatient medical oncology unit. Scheduling a set day, Tuesday, for dressing changes, Huber needle changes, tubing changes, cap changes, and all additional care completed on Fridays has increased. compliance. This standardization was not only successful for this unit but has recently been expanded and adopted across this hospital.

Oncology Nursing Forum. 2025 Mar 1;52(2):154.

P257. From Generation to Generation

Robin Herman ¹

Management

Significance & Background

I am a baby boomer generation RN, working as a CNS. My responsibility includes Chemotherapy education for RN,s on the Oncology units. As I age and educate, I experience differences in learning characteristics among the different generations Y and Z. A review of age-related learning characteristics can improve understanding of generation learning needs and develop educational tools to assist them in learning.

Purpose

Generations of people are defined by the shared patterns of behavior, attitudes, and beliefs that emerge within a group born within a specific time period. To understand who we are as individuals at that time can assist educators to develop education tools to assist them with their learning needs.

Interventions

Millennials (Y) – born 1981–1996. They are confident, having high expectations and question everything. They are labelled as, self-centered and question authority. Want control, success, and recognition. They are more independent and less interested in teamwork! Generation Z – born 1996–2012. Has been called Generation Y on steroids. Difficult to work with or manage, independent, competitive and have high anxiety . Both generations want their employers to invest in them. Although there is no company loyalty. Both use devices to communicate. Both switch tasks often and have shorter attention spans. Set clear goals and a deadline. Have evidence for your teachings. If they feel you are not knowledgeable, they will let you know. Provide all education online. Get them to focus on the patient more then the me factor. Provide short education topics to not lose their attention. Make them slow down and understand what they are learning.

Results

For both generations using a nurturing atmosphere helped convey the need for safety when administering chemotherapy. Spending enough time with each RN, to satisfy their need for safe learning assisted in a positive learning experience.

Discussion

By providing experiences that shaped who we were as individuals at the time, including meaningful work and an inclusive environment, we can harness the individual’s potential and transform our workplaces for the better!

Oncology Nursing Forum. 2025 Mar 1;52(2):154–155.

P258. Utilizing Transanal Irrigation to Manage Lower Anterior Resection Syndrome in Patients with Rectal Cancer

Yulia Hernandez ¹, Catherine Jansen ², Sheena Gabriel ³, Kimberly Beringer ⁴

Symptom Management and Palliative Care

Significance & Background

Colorectal cancer is the third most common cancer in the United States, with rectal cancer constituting 30% of these cases. Approximately 80% of rectal cancer patients undergo low anterior resection (LAR) to preserve sphincter function and avoid a permanent colostomy. However, up to 90% of these patients experience Low Anterior Resection Syndrome (LARS), a constellation of multiple symptoms such as fecal incontinence, urgency, frequency, loose stools, and constipation, which significantly impact their quality of life. Traditional management strategies include diet modifications, fiber supplements, and physical therapy. Transanal irrigation (TAI) has emerged as a potential solution for LARS refractory to conventional treatments. TAI is a minimally invasive procedure involving fluid introduction into the bowel to restore controlled bowel function.

Purpose

This project aimed to 1) assess the feasibility of training patients to perform TAI, 2) use a validated tool to evaluate LARS symptoms at baseline, 3) establish patient selection criteria for TAI, and 4) develop routine follow-up assessments post-TAI initiation.

Interventions

Multidisciplinary stakeholders conducted a literature review on TAI for LARS and subsequently developed workflows, staff training programs, documentation templates, and patient education materials.

Results

Initial training of a small cohort of patients in utilizing TAI has yielded promising outcomes. Seventy-five percent of patients reported at least a 90% improvement in LARS symptoms from baseline as measured by the IMPACT survey and LARS score. Preliminary experience also revealed potential barriers to widespread implementation of this strategy, necessitating further refinement of our patient selection criteria.

Discussion

This ongoing project continues to track patient progress with TAI and refine our workflow strategies based on longitudinal evaluations. However preliminary findings suggest that TAI is a viable intervention for select patients with LARS.

Oncology Nursing Forum. 2025 Mar 1;52(2):155.

P259. Mentoring New Leadership Across New Network Sites: Sharing Knowledge and Experience

Kathleen Hess ¹, Marie Riehl ², Nicolas Hoover ³

Healthcare Delivery

Significance & Background

Expanding oncology services to communities in need of access to oncology care is a priority. Multi-disciplinary leadership to spearhead these endeavors are essential to the success of the institution. Oncology nursing professionals throughout their career path benefit from mentorship. The focus of starting a new site of service within an academic health system led to professional growth opportunities for new nursing leaders. Effective mentorship fosters an inclusive environment, trust, competence and independence. The importance of mentorship programs in developing new oncology leaders enhances both the success of the new leader and institutional growth.

Purpose

Sharing knowledge, experiences, and challenges empowered leaders across ambulatory network sites to effectively build a strong pathway for communication and guidance during growth. Creating opportunities to learn, share, and enhance workflows was essential to continued successful outcomes in new settings. The collaboration among the network sites helps ease the growing pains of creating new practices. Learning from past triumphs and misconceptions helped ensure the best strategy was met going forward.

Interventions

A nursing leadership team in ambulatory care across network sites was formed. This team meets daily for a safety huddle and a forum to ask questions and share insight. New leaders were sent to every network office to learn from individual leaders as well as at the main campus. Management training classes via human resources were offered. A mentor/mentee relationship was formed between experienced and new leaders.

Results

This network team was able to collaborate to create policies, work queues, contact lists and staffing plans across the network sites. Weekly meetings conducted to review goals both achieved and creation of new goals. This atmosphere of teaching encourages new leaders to feel inclusive and empowered, contributing to their professional development.

Discussion

Professional relationships built on trust and respect led to the achievement of a model to opening network clinic and infusion centers, while creating a template for future growth. The strengths and weaknesses lead to a SMART goal creation to overcome any challenges. Inspiring and creating a sustainable relationship sharing goals and vision to enhance satisfaction and outcomes while empowering and nurturing leadership potential.

Oncology Nursing Forum. 2025 Mar 1;52(2):155–156.

P261. Revitalizing Care: Leveraging PIP to Enhance Nursing Quality and Patient Outcomes

Ashley Heupel ¹, Robin Randall ², Jennifer Biteler ³

Quality and Safety

Significance & Background

COVID-19 significantly disrupted healthcare systems, impacting the nursing workforce, supplies, and patient care delivery. Basic nursing care was missed due to this disruption, and nursing has been slow to recover post-COVID. The need for innovative strategies to regain quality outcomes to the pre-pandemic level has been well documented in the literature.

Purpose

A back-to-the-basics approach was a common approach to reestablishing normalcy in nursing care post-pandemic. Nursing cares such as timely repositioning, bathing, fall prevention, and CAUTI and CLABSI maintenance bundles gained extra attention, yet a way to follow up to ensure accountability was lacking. Having a mechanism for follow-up on crucial nursing cares and engaging staff in conversations to reduce the risk of harm is critical to providing quality care and driving patient satisfaction.

Interventions

Patient Injury Prevention (PIP) rounds were introduced to foster intentional conversations and ensure the consistent delivery of essential nursing care. The charge nurse and bedside nurse collect information during the unit patient report on each shift. During the conversation with each nurse, the charge nurse documents this data and focuses the discussion on quality indicators and the tasks needed to reduce the risk of patients developing a preventable injury. The collected information is then transferred to a data collection system, Red Cap, which generates compliance percentages.

Results

Following the implementation of our PIP Rounding tool, we have observed improvements in reducing CAUTI, HAPI, fall with injury, and CLABSI rates. These advancements have significantly impacted outcomes for our oncology patients, contributing to a safer hospital environment for those undergoing treatment for their disease. Our focus on reducing CLABSI infections is vital, especially considering the unit had an increase in this nursing-sensitive indicator in early 2024. These observed improvements reassure the effectiveness of this new approach and instill confidence in its potential to drive further progress.

Discussion

Since the tool has been implemented, staff have gained a deeper understanding of the rationale behind even the most minor tasks such as brushing a patient’s teeth and ensuring curos caps are on each access port of every line. Staff now recognize that something as simple as brushing a patient’s teeth can profoundly impact an oncology patient’s overall health. By having conversations with staff and reiterating the importance of simple tasks, patients can be significantly impacted.

Oncology Nursing Forum. 2025 Mar 1;52(2):156.

P262. Closing the Gaps in Patient Safety for Acute Care Patients Receiving Radiation

Amy Hicks ¹

Radiation

Significance & Background

Radiation therapy is an important tool in the treatment of malignant disease. A significant number of cancer patients require radiation for emergency conditions, such as SVC syndrome, palliative care, bleeding, and spinal cord syndrome, during an acute care admission. These patients are often very ill and require advanced monitoring such as telemetry, frequent vital signs, or continuous pulse oximetry. They may also be receiving high risk infusions, such as chemotherapy or blood transfusions. Most radiation departments are located outside of the hospital. This creates potential patient safety issues such appropriate transportation, lack of appropriate patient care equipment available in the department, and lack of radiation oncology staff able to provide appropriate care. The nurses are also rarely involved in the treatment area, further increasing the safety risks of patient during treatment. Across a large 10 site radiation oncology service line, there was no standardized approach to caring for inpatients leading to several safety events reported.

Purpose

The purpose of the project was to create structure and process around the care of acute care patients needing radiation therapy to reduce safety events.

Interventions

A standing operating procedure (SOP) was developed to provide guidance on the process for caring acute care patients needing radiation. This SOP outlined the process for handoff of care between the inpatient department and radiation oncology and defined specifics that were critical to address prior to the patient going to radiation. This information was used to make key decisions including appropriateness of the patient to receive treatment, transportation mode, special precautions needed and general patient info. Patients who were not able to be safely transported and cared for were transferred to a site where radiation therapy was available inside the hospital. At the largest facility with high inpatient volumes, an inpatient nurse coordinator was put into place to provide oversight inpatient care.

Results

After implementing the new SOP, no serious safety events related specifically to gaps in providing inpatient care appropriately in radiation oncology.

Discussion

The unique nature of radiation and the location of the department makes it imperative to provide guidance for inpatients who need treatment. Developing an SOP closed the gap on safety risks that existed. Unique nursing roles like the inpatient coordinator need to be considered for departments with high volumes of acute care patients needing radiation.

Oncology Nursing Forum. 2025 Mar 1;52(2):156–157.

P263. Pipeline to Success: Providing Early Entry into Oncology Nursing Practice

Mary K Hill ¹, Leslie Twitchell ², Jamie Myers ³, Elaine Griffin ⁴

Management

Significance & Background

The shortage of oncology nurses is ongoing. It critically impacts quality cancer care (ONS 2022). Attracting nurses into oncology is challenged by long onboarding times and availability of clinical experiences and qualified preceptors. Nursing Pipeline programs are one method to address this. Pipelines partner academic experience with paid employment to attract and train nurses.

Purpose

To create a LPN to RN pipeline from a LPN to Associate Degree Nursing (ADN) program into oncology nursing at an academic medical center.

Interventions

Nursing faculty at a local university met with outpatient Hematology/Oncology administrators and reviewed the state’s LPN Scope of Practice. Organizational policies were modified to allow LPN practice in outpatient oncology. Two LPN positions were created in the infusion center and primary nursing respectively; completion of LPN year and enrollment in the final year of the ADN program was a hiring requirement. The LPN’s worked part-time in outpatient oncology while attending college full-time. They enrolled in relevant ONS courses to learn basic oncology care. Upon completion of their ADN degree, the nurses onboarded into full time RN positions through the Nurse Residency program.

Results

The program is now in its third year. Three nurses have completed the pipeline and continue to work full time in oncology nursing. Two of the three RN’s continue to work in their original area of hire. The third RN transitioned into Inpatient Oncology/Hematology. One of two posted positions in this year’s cohort has already been filled. The program is expanding into Surgical Oncology. The RN’s report they feel well-prepared for their roles in their respective environments. Peer feedback on the inpatient RN credit her outpatient experience as giving her a more holistic approach to her patients. Investigation into any impact on onboarding times is ongoing.

Discussion

An LPN to RN pipeline can successfully transition nurses into oncology practice with support. Scope of practice support from administration and teaching faculty has been critical to the success of this program. We are now in the process of expanding the pipeline into other areas of nursing practice. Allowing more LPN’s to work within the oncology clinical environment supporting oncology patients and RN’s enhances the transition into RN practice. Evidence suggests transitioning from outpatient to inpatient worlds connects the oncology practice environments and leads to improved understanding of holistic oncology care.

Oncology Nursing Forum. 2025 Mar 1;52(2):157–158.

P264. Beyond CAR T: CRS and ICANS Education for All Oncology Nurses

Hannah Hill ¹, Anna McClenny ², Trisha Harmon ³, Jenae Franklin ⁴, Phuong Huynh ⁵

Management

Significance & Background

Cytokine Release Syndrome (CRS) and Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) have predominantly been associated with CAR T cell therapy. Expertise in these syndromes has historically been siloed to a subset of specialized oncology nurses. With the use of Bispecific Antibody Therapies (BsAbs) in a broad patient population and their prevalence expanding to the ambulatory setting, knowledge of CRS and ICANS is essential for all oncology nurses, especially nurses who consistently follow patients across their treatment trajectory. Understanding of these syndromes is similarly critical to that of common oncologic emergencies, such as Tumor Lysis Syndrome (TLS) and sepsis. Ambulatory oncology nurses are well positioned to assess for CRS and ICANS, but low volumes of at-risk patients have limited exposure and skill development.

Purpose

To provide nursing education and cultivate clinical expertise on BsAb-related CRS and ICANS in the ambulatory setting.

Interventions

A team of oncology nurse educators created a curriculum utilizing in-service didactic content, video recordings, and education handouts to deliver CRS and ICANS education. Content included pathophysiology related to BsAb-mediated cytokine release, including a focus on the function of cytokines in promoting fever, inflammation, and increased vascular permeability. Early and late clinical manifestations of CRS and ICANS were discussed, with an emphasis on hallmark symptoms of fever for CRS and expressive aphasia for ICANS. The importance of considering differential diagnoses when assessing these patients, such as neutropenic fever, sepsis, and stroke was delineated. Pertinent assessment questions and how to use ICE scoring for evaluation of neurotoxicity were discussed. Additionally, appropriate interventions based on severity were reviewed to support nurses in anticipating plan of care.

Results

Nurses demonstrated high engagement with the education content, sharing that it was valuable and relevant to their practice. Baseline reporting demonstrated nurses had minimal to no understanding of CRS or ICANS prior to this curriculum, despite caring for at-risk patients.

Discussion

As innovative, cutting-edge therapies continue to emerge in the field of oncology, provision of relevant and tailored nursing education is crucial, especially for nurses performing frequent assessment of patients throughout their oncology treatment. Development of clinical expertise on BsAb-related CRS and ICANS ultimately promotes best patient outcomes across the care continuum.

Oncology Nursing Forum. 2025 Mar 1;52(2):158.

P265. In Adult Oncology Patients, Does Providing A Nursing-Created Video on Urinary Catheter Care Reduce the Incidence of Cauti Over A 3-Month Period?

Makenzie Hires ¹, Mia Gagliardi ², Mackenzie Wainwright ³

Patient Education

Significance & Background

Postoperative oncology patients are at increased risk for infection, especially when previously receiving chemotherapy prior to surgery. Many of our patients require to be discharged with a urinary catheter to remain in place due to the nature of their surgery, further enhancing their risk for infection. Given the stress of a cancer diagnosis and the changes following surgery, managing medical devices may be overwhelming for the patient.

Purpose

This study was conducted to determine if nurse-specific education, specifically easy-to-access video instructions, will lead to decreased incidence of catheter associated urinary tract infections in postoperative oncology patients being discharged with urinary catheters.

Interventions

A QR code directing to a video of urinary catheter care was distributed to patients prior to being discharged. Nurses on the surgical oncology floor were educated and encouraged to participate. Patients were encouraged to watch the video before discharge teaching to further implement the education.

Results

A Pre and Post survey was distributed to clinic nurses who frequently see patients present with urinary catheters at follow up appointments. Clinic nurses answered that patients had improved patient outcomes after the 2 month period of distributing the video.

Discussion

Staff have requested continuing distributing the video to patients going home with a urinary catheter. Patients have expressed their gratitude for including the video within their education upon discharge. Further goals include distributing the video at patients’ pre-surgical appointments in order to familiarize them with the medical device.

Oncology Nursing Forum. 2025 Mar 1;52(2):158–159.

P266. Improving Oncology Referrals to Mental Health Specialists Using the PHQ-9 Depression Screening Tool: A Quality Improvement Study

Elizabeth Kotenko ¹, Bradley Hix ²

Quality and Safety

Significance & Background

Of the nearly 2 million people in the United States diagnosed with cancer in the year 2021, roughly 25% of those people will develop depression secondary to their cancer diagnosis. Of those 25%, only 5% will seek mental health treatment from a professional. The risk of suicide doubles within the first year of cancer diagnosis and triples within the first six months of diagnosis.

Purpose

This project aims to increase the number of depression screening and referrals to mental health professionals using the United States Preventative Services Task Force (USPSTF) “Depression and Suicide Risk in Adults: Screening” guideline recommendation. This recommendation asks that all U.S. adults, especially those in vulnerable populations (disease, pregnancy, elderly), receive depression screening, as their guideline suggests that by using the screening for proper evaluation based on the score of their screening tool, appropriate mental health referrals can be places and this will help reduce depression-related morbidity statistics. The screening tool used is the Patient Health Questionnaire (PHQ) - 9, from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders - IV (DSM-IV).

Interventions

The setting is an oncology office in Farmington Hills, Michigan that does give out the PHQ-2 and PHQ-9 to their patients but has no systematic model for using the scores from the PHQ-9 for mental health care. It currently is provider-determinant, meaning each provider independently determines the severity of the scores and how to follow up with that score. For 90 days, providers will issue PHQ-9 questionnaires to every patient with a new cancer diagnosis over 18 years old. Scores will then be classified either as Mild (5–9), Moderate (10–14), and Severe (15+). Providers will then recommend mental health referrals based on the classification: Mild patients are referred to social workers, and Moderate and Severe patients are referred to psychiatry or psychology physicians. Comparing the statistics of the 90 days before implementation starts, we anticipate a stronger appropriation to patient referrals with the implementation in place.

Results

Currently, the project’s implementation section has just begun, and data is unavailable.

Discussion

While our implementation is just starting, our preliminary estimates show that we will confidently be able to positively promote the use of the implementation guideline with statistical significance.

Oncology Nursing Forum. 2025 Mar 1;52(2):159.

P267. Specialty Nurses Leading the Care Coordination and Clinical Navigation of Complex Cancer Patients in Oncology

Jill Hoffman ¹, Tierra Joseph ², Laura Kress ³

Coordination of Care and Navigation

Significance & Background

Through a meticulous and specialized triage process, and using an in-depth knowledge of gastrointestinal (GI) cancer disease processes, our surgical oncology nursing team streamlines the patient journey for individuals diagnosed with GI cancers at our academic medical center and comprehensive cancer center in an urban setting.

Purpose

Previously this function was incorporated into the role of the Advanced Practice Providers (APPs), who would review scheduling requests from the administrative staff at the end of each day. Delegating this review to a specialized group of registered nurses (RNs) experienced in GI oncology care allowed for the APP group to have more time for their clinic follow up and the care of current patients.

Interventions

The nurse-led triage processes include comprehensive record gathering to create a detailed timeline of events, tests, and treatments up to the point of initial contact with our office. Nurses then conduct a thorough review of all clinical information to identify and request any missing or necessary tests to complete for the patient’s diagnostic profile. This gathered medical information is then summarized into a detailed patient history, and the nursing team initiates the most appropriate care pathway within the institution based on the information collected. Applying their specialized decision-making skills, the nurses make targeted triage decisions to ensure patients are directed to the correct oncology specialty within our institution.

Results

This thorough screening process has improved the efficiency of the scheduling new patients and optimizes the effectiveness of oncology care pathways. This specialized nursing-led process, we are able to make initial contact within 48 hours of the initial referral, expedite the confirmation of definitive treatment plans, which enables patient to have specialty consultations and treatment initiation within 1–2 weeks of initial contact. This often involve multi-disciplinary referrals to GI, medical, radiation and surgical oncologist and by directing patients to the right specialties from the outset, we maximize the utilization of limited clinic time and specialist resources.

Discussion

Specialty nurses serve as a crucial link between patients and a variety of oncology specialties to facilitate coordinated care that minimizes delays in treatment and potentially improves outcomes in cancer care. In addition, this model of practice supports the professional development of both the APPs and RNs that are able to practice at the highest level of their scope of practice.

Oncology Nursing Forum. 2025 Mar 1;52(2):159–160.

P268. Increasing Nurse Confidence in Emergency Management with the Implementation of in Situ Mock Codes Throughout an Inpatient Oncology Department

Dena Hofmeister ¹, Jamie Ferrell ²

Professional Development

Significance & Background

Historically, staff have received emergency management education through the renewal of their Basic Life Support (BLS)/Advanced Cardiovascular Lifes Support (ACLS) courses and during new nurse orientation. An educational gap was noted with the implementation of multiple practice changes in emergency management including new crash carts, emergency nurse managed order sets, in addition to an increasing number of inexperienced bedside staff. This knowledge gap, along with supporting literature, suggested that standardized and consistent clinical emergency management education and training was needed to improve response to emergency situations.

Purpose

The purpose of this quality improvement project is to improve response to emergency situations within the inpatient oncology department through standardized and consistent clinical emergency management education.

Interventions

There were three core objectives established as the foundation for this project including; the identification of superusers for each inpatient unit, performing monthly in-situ mock codes, and providing bi-annual continuing education by reviewing existing “First Few Minute” curriculum with staff. Bedside nursing staff volunteered to become superusers to collaborate with unit educators and provide at-the-elbow support for the project. Superusers helped facilitate monthly mock codes and gave educational presentations at unit staff meetings. The “First Few Minute” curriculum was reviewed with frontline staff bi-annually during departmental and hospital-wide skills days. This project was supported by a multidisciplinary team including hospital-wide educators, simulation educators, quality improvement team members, and nurse management.

Results

The initial success of the project included 75% staff participation and involvement of superusers. Superuser participation has continued with 100% attendance at in-situ mock codes. Monthly in-situ mock codes have been successfully completed since May 2024. Data from pre-and post-survey showed an increase in 41% of participants contextual knowledge regarding sequence of connecting patient to the Zoll, a critical first step in the “First Few Minute” curriculum. The next phase of this project will include monitoring the success of improving nurse confidence and with performing consistently to American Heart Association standards.

Discussion

This quality improvement project has facilitated increasing staff and leadership engagement in providing improved emergency management care to our inpatient oncology patients. The use of peers as superusers was well received by bedside staff. The success of this quality improvement project will continue to be evaluated by reviewing Zoll monitor code data and with the completion of staff post-survey one year after project implementation.

Oncology Nursing Forum. 2025 Mar 1;52(2):160.

Timely Treatment for Adverse Drug Reactions in an Infusion Unit

Andrea Hojnowski ¹, Joanne Seip ², Nicole Gares ³, Sara Glyn ⁴, Jan Norkis ⁵, Kara Conrad ⁶

Treatment Modalities and Managing Administration

Significance & Background

A 27-room ambulatory infusion unit administers a wide range of anti-oncological agents, some of which cause adverse drug reactions (ADR’s). Possible ADR’s range in severity from mild symptoms to anaphylaxis requiring interventions and hospitalization. With no access to a Rapid Response Team, the time to react to these ADRs is crucial for safe and effective patient care. A watershed moment occurred when infusion nurses treated two patients with ADRs within minutes of each other. Time did not allow for restocking of the only code cart for use during the second ADR. Nurses treating the second patient were forced to retrieve emergency medications from the pharmacy stock cabinet. This extended response time moved several nurses to voice concerns about the possibility of a similar scenario occurring again, leaving them poorly prepared.

Purpose

To create a program that ensures immediate availability of and access to emergency medications and supplies for treatment of ADR’s and similar emergencies occurring on the infusion unit.

Interventions

Our standing Pharmacy/Nursing Workgroup chose to create hypersensitivity toolboxes for the unit. Using the geography and workflow of the unit, they decided on the number of boxes needed and what medications and materials to include as stock items within them. The toolboxes hold emergency medications such as epinephrine, diphenhydramine, and select emergency supplies. Pharmacy stocks and maintain the toolboxes, using a breakaway lock and placing the boxes in a secure area accessible to nurses at any time. Implementation of the toolbox program began with in-service education for all nurses.

Results

Nurses on the unit completed a post-implementation survey. Results showed, 100% of nurses responded that the response time to treat ADR’s improved since implementation of the toolbox. In addition, 67% of nurses felt that their confidence in treating an ADR increased since creating the toolbox program.

Discussion

Fast response times when treating an ADR is extremely important for both nurses and patients. Ensuring rapid intervention supports the nurse’s confidence given the likelihood of anxiety for both the patient and nurse as they respond to high-risk events. Having direct access to emergency medications and supplies enables nurses to react to these emergent situations promptly and confidently. Evaluating the needs of the unit and working with an interdisciplinary team to create solutions enables nurses to practice with autonomy and assertiveness when caring for patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):160–161.

P270. Don’t Touch that! Evaluating Nurse Compliance with Hazardous Drug Administration Policies before and After A Demonstration Using Glo Germ

Erika Holland ¹

Quality and Safety

Significance & Background

Occupational exposure to hazardous drugs carries an increased risk for adverse health effects including increased occurrence of cancer, reproductive issues, and acute symptoms. Exposure is likely related to dermal absorption from surface contamination. Over time knowledgeable staff can drift from expected practices related to personal protective equipment (PPE) usage.

Purpose

To assess and improve compliance practices among nurses related to PPE usage and reduce surface contamination when handling hazardous drugs at 13 outpatient oncology infusion clinics.

Interventions

Nurses were visually audited for policy compliance when handling, administering, and discarding hazardous drugs before and after a demonstration that utilizes Glo Germ and education surrounding safe handling practices in the clinic setting. A survey asked participants about their perception of the need for PPE and how often guidelines are followed. During each demonstration, Glo Germ was placed on two bags of saline to simulate trace chemotherapy. Both bags of saline were administered in a simulation. The first was administered with the proper workflow and use of PPE. The second was administered using noncompliant workflows or common shortcuts in practice. The Glo Germ contamination on surfaces was highlighted with black light after the demonstration. There was no contamination with proper workflow compared to considerable contamination in the second simulation. Education regarding risks of exposure and proper handling precautions was discussed.

Results

The post-demonstration visual audits of practice showed improved compliance in proper PPE usage by 2% when handling, 5% when administering, and 7% when discarding hazardous drugs. There was a 26% improvement in absence of observed surface contamination. The nurse survey showed an increase in perception of a nurse’s risk of exposure from 19% to 65%. See graphs for further details. Over 80% of participating nurses felt the demonstration changed their practice.

Discussion

Related to the treatments used for many cancers, nurses in oncology are at an increased risk of adverse health effects related to exposure from hazardous drugs. There are engineering and administrative controls in place for protection, but the use of PPE, places the primary responsibility on the nurse. Over time, the nurse may drift from expected practices or become numb to the risks associated with exposure. The innovative use of Glo Germ in a simulation and demonstration, coupled with education on the risks, showed an increase in compliance and improved safety.

Oncology Nursing Forum. 2025 Mar 1;52(2):161–162.

P271. It Takes A Village: Quality Improvement Project Focused On Improving the Patient Experience for those Undergoing Concurrent Chemoradiotherapy at Network Locations

Nicolas Hoover ¹, Marie Riehl ², Maureen Sims ³

Coordination of Care and Navigation

Significance & Background

Coordination of care in the oncology setting is crucial for ensuring patients receive comprehensive and seamless support throughout their journey. The complexity involved in providing care to patients undergoing chemoradiation at a network location encompasses clear communication and coordination among modalities. The addition of infusion services at a network site, where radiation was established, provides the community with expanded options when accessing care. Communication among all team members including radiation therapists, nursing, physicians and the patient is a priority to promote positive patient outcomes. A clear process of communicating and coordinating appointments was lacking, leading to confusion and the need to coordinate and reschedule complex appointments. Rescheduling the appointments negatively impacts patient and staff satisfaction, as well as delaying care.

Purpose

The need to establish a strategic, well-coordinated and focused workflow was identified as essential to reduce barriers to care, miscommunication and rescheduling. In return, reduced delays in care and increased patient and staff satisfaction is expected.

Interventions

Collaboration among key stakeholders identified gaps in communication as each team was focused on their role. Representatives from nursing, radiation and leadership identified the need for a quality improvement project focused on improving the patient experience. Basic communication methods were discussed to improve the current process. Initiation of weekly huddles, checklists and a shared drive showed improvements in care coordination and scheduling. A virtual whiteboard allowed for real time communication and the sharing of updates between teams.

Evaluation

Patient satisfaction surveys are monitored for increases in percentile rank of indicators; staff worked together and timeliness getting appointments scheduled. Staff feedback assessed for increases in staff satisfaction and recommendations for improvement. Rescheduling instances were tracked and monitored for decreases over time.

Results

Ongoing evaluation of metrics related to scheduling and patient satisfaction surveys. Weekly huddles continue allowing for real time adjustments.

Discussion

Weekly huddles between key stakeholders have been shown to be a vital tool in improving communication between teams. Ongoing staff and patient feedback reviewed during huddles have proven to be helpful in identifying and addressing problems quickly. A virtual whiteboard to track progress on problems and provide updates is helpful in closing communication gaps between huddles. Shared drive stores key notes, ongoing satisfaction scores and rescheduling data to allow easy access for stakeholders to track progress.

Oncology Nursing Forum. 2025 Mar 1;52(2):162.

P272. Standardization of Nurse Onboarding Throughout A Large-Scale Ambulatory-Based Organization

Kari Hopkins ¹

Professional Development

Significance & Background

Florida Cancer Specialists and Research Institute (FCS) is a large ambulatory clinic-based organization spanning the entire state of Florida. Standardization of onboarding of new nurses to successful independent practice requires a dynamic approach to ensure that nurses are meeting competency requirements while being supported throughout their orientation.

Purpose

The objective of the project was to review and revise current nurse onboarding, utilizing the use of technology, to expand reach and scale nurse orientation across 85 clinics. Blended with in person precepting, technology was instrumental in the success of higher nurse satisfaction, increased nurse competency resulting in better patient outcomes, and ultimately higher nurse retention in the 30-60-90-day orientation window.

Interventions

■ Review Current Onboarding Practice Including:
- Skills Checklist and Post Orientation Competency
- Medication Double-Check Process
- Medication Administration
■ Revise Onboarding Program to Include the Following:
1. Implementation of Mandatory ONS Fundamentals of Chemotherapy and Immunotherapy Administration™ Course for all Newly Hired Nurses
2. Incorporating a New Virtual Clinical Orientation in Collaboration with Departmental Expert Teachers:
  - IT and Cybersecurity
  - Electronic Health Record
  - Introduction to Oncology (Care of the FCS Oncology Patient)
  - Clinical Resources
  - Prevention and Treatment of Oncologic Side Effects
  - Oncology Treatment Options
  - Patient Education Resources
  - Research and Clinical Trials
  - Medication Administration
  - Research and Clinical Trials
3. Clinical Skills Orientation:
  - Meet and begin working with the assigned preceptor and/or Clinical Nurse Educator
  - Set individualized goals for transition to independent practice
  - Enculturation to the clinic team, the workflow, and understanding their role in patient care
  - Skills competencies assessment
  - Continuation with OncoEMR health record training and medication administration
4. Implementation of Bi-Weekly Educator Check-ins with the Newly Hired Nurse Throughout the 90-Day Orientation Period:
  - Assessment of Practice Progress
  - Ensuring Preceptor/New Hire Relationship is Positive
  - Learning any Additional Developmental Needs
  - Managing any Flight Risk Potential

Discussion

The standardized nurse onboarding project included additions of virtual orientation, mandatory ONS Fundamentals of Chemotherapy and Immunotherapy Administration Course completed within the orientation window and prior to independent practice, as well as adding Bi-Weekly Educator Check-ins ensuring higher nurse satisfaction, increased nurse competency, and ultimately higher nurse retention throughout the 30-60-90-day orientation window. Results indicated a sustainable and incremental increase of 8–10 percent per quarter from CY2023 baseline to present. Since program roll out has been so successful so quickly, a similar program was expanded to Medical Assistant onboarding as well.

Oncology Nursing Forum. 2025 Mar 1;52(2):162–163.

P273. Easing Covid-19 Isolation Restrictions for Inpatient Hematologic Population

Tracey Hosack-Bartnick ¹

Professional Development

Significance & Background

Patients who are being treated for cancer may be at increased risk of developing severe COVID-19, and clinical outcomes are worse in people with cancer than other patient groups. Several studies have suggested that patients with hematological malignancies are at a greater risk of dying from COVID than those with solid tumors. Given the rapid evolution of SARS-COV-2 and emerging research, it can be difficult for nurses to stay abreast of the frequently updated evidence-based guidelines.

Purpose

The purpose of this presentation is to educate nurses on the current guidelines regarding the infection control practices for COVID positive patients with hematological malignancies. Nurses can then use this information to better communicate with patients and families regarding any questions or concerns about the perceived risk the virus poses to this immunocompromised population.

Interventions

With recent changes in patient placement practices on a Bone Marrow Transplant/Hematology floor, a lunch and learn will be conducted for staff members to educate about transmission risk and infection control practices utilizing current high-quality evidence-based guidelines.

Results

Nurses will be able to summarize the CDC and OSHA guidelines for healthcare workers caring for COVID-19 patients. This presentation will also help nurses understand the National Institutes of Health guidance for risk stratification in patients with hematologic malignancy.

Discussion

Since the beginning of the pandemic, the transmission of COVID-19 has not been well-specified. This unclear characterization has added stress to bedside nurses. The rapidly changing landscape in available information for treating COVID patients has also undermined confidence in hospital policy changes. Empowering nurses with the most recent information and explaining the contextual factors for patient placement changes will dispel misinformation and potentially reduce distress.

Oncology Nursing Forum. 2025 Mar 1;52(2):163.

P274. Enhancing CAR-T Therapy Training: Developing and Implementing A Hands-On Curriculum for Improved Nursing Competency and Patient Care

Katherine Houdek ¹

Management

Significance & Background

CAR-T therapy has significantly advanced cancer treatment, with infusions increasing by 4,000 percent since 2016 at our tertiary academic medical center. This rapid expansion has presented challenges in delivering comprehensive and accurate training to nurses. Previously, nurses were required to complete an 8-hour cellular therapy course and demonstrate competency with a patient, but this approach did not include opportunities for low-acuity practice, causing considerable stress among trainees.

Purpose

The goal of this project is to enhance CAR-T therapy training by developing and implementing a two-part, hands-on curriculum integrated into an existing chemotherapy training program. This curriculum aims to provide experienced chemotherapy nurses with a 4-hour class focused on practicing the administration of various simulated CAR-T products. Additionally, the simulation will address the management of Cytokine Release Syndrome (CRS) and neurotoxicity in a controlled, low acuity setting before they complete their competency with patients.

Interventions

Over four months, a multidisciplinary team, including a Nursing Education Specialist, a Clinical Nurse Specialist, and two staff nurses, collaborated to develop curriculum materials. We consulted with simulation center staff for the integration of CRS and neurotoxicity scenarios and partnered with the nurse staff education committee to facilitate the 4-hour class and conduct simulation debriefings.

Results

The effectiveness of the new CAR-T curriculum will be assessed through pre- and post-training questionnaires designed to evaluate trainees’ comfort levels and proficiency with CAR-T infusion. These questionnaires will measure changes in confidence and competency in the administration of CAR-T and in managing two significant associated complications, CRS and neurotoxicity. The results will be analyzed to determine the impact of the low-acuity hands-on training on nurses’ preparedness in administering CAR-T therapy.

Discussion

The implementation of a hands-on CAR-T curriculum offers a promising strategy to improve nursing education and patient care in a rapidly evolving subspecialty. By addressing previous training gaps and incorporating simulation-based learning, this project aims to better prepare nurses for the risks and complexities of CAR-T therapy, ultimately improving nurse satisfaction and patient outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):163–164.

P275. Improvement Project to Reduce Cancer-Related Fatigue in Breast Cancer Patients

Wen-Chuan Hsu ¹

Symptom Management and Palliative Care

Significance & Background

Breast cancer patients are a group prone to cancer-related fatigue. Failure to diagnose and treat in time may easily lead to postponement or interruption of cancer treatment, worsening the disease, and seriously affecting the patient’s quality of life and survival rate.

Purpose

This project aims to reduce cancer-related fatigue in breast cancer patients.

Interventions

The current cancer-related fatigue level of breast cancer patients ranged from 7.2 points. The analyzed reason is the lack of health education operating standards for breast cancer patients with cancer-related fatigue, as well as health education teaching materials and personnel education and training. From May 10 to September 30, 2021, we will formulate health education standards for cancer-related fatigue in breast cancer patients, plan personnel education and training, and produce health education materials.

Results

After the implementation of the project, the cancer-related fatigue level of breast cancer patients dropped from 7.2 points to 3.1 points, the nursing staff’s care awareness increased to 95%, and the breast cancer patients’ satisfaction with the staff’s care content increased from 1.7 points to 4.3 points, achieving the purpose of the project.

Discussion

The results of this project effectively reduce the level of cancer-related fatigue in breast cancer patients and can be implemented in parallel with other cancer patients to make patients more motivated and confident to continue future treatment and improve the overall quality of cancer care.

Oncology Nursing Forum. 2025 Mar 1;52(2):164.

P276. Cauti Reduction by Updating Hazardous Urinary Incontinence Management

Vivian Huang ¹

Quality and Safety

Significance & Background

Historically, oncology practices have commonly placed indwelling urinary catheters (IUCs) in incontinent patients receiving hazardous drugs to prevent exposure to patients and staff. This practice places patients at risk for catheter-associated urinary tract infection (CAUTI) when there are other methods to manage urinary incontinence.

Purpose

CAUTI prevention greatly impacts quality and safety initiatives and patient throughput. By addressing the potentially unnecessary use of IUCs to manage hazardous excreta in patients with urinary incontinence, the goal was to decrease the persistently high CAUTI rate on adult hematology/oncology/BMT inpatient units from FY23 rate of 3.29 to SIR goal of < 1 in FY24.

Interventions

Institutional practice for incontinence risk assessment and management were updated after a review of current evidence, which included recently published ONS 2023 Guidelines and Recommendations, expert consultation with a hazardous drug specialist, and a survey of community practice. Nursing guidance was provided to assess patients with urinary incontinence for exposure risk based on hazardous drug category and pharmacokinetics. In low-risk cases, IUC placement was prevented, or early removal was initiated. Hazardous excreta was removed from list of indications in IUC policy, and external urinary collection device use was expanded to hazardous excreta. An algorithm was created to further guide nursing in incontinence management. Ongoing education included IUC indications, CAUTI prevention bundle, external urinary collection device use, and incontinence care.

Results

In FY24, compared to FY23, units reported a 57% decrease in CAUTI cases and a 50% reduction in IUC utilization, despite a steady CAUTI rate. No patient skin toxicities or staff incidents related to hazardous urine exposure were reported.

Discussion

Nursing understanding of urinary incontinence management methods, IUC indications, and the CAUTI prevention bundle are critical to CAUTI prevention and patient safety. Ongoing review of best practice guidelines and recommendations advances clinical practice and patient care as evidence emerges. Safe handling principles and personal protective equipment (PPE) remain cornerstones in minimizing exposure and environmental contamination. As hazardous drugs are given in many populations beyond oncology, this guidance is relevant across care areas and would serve well integrated into existing nursing guidelines. Transdisciplinary strategies are needed to optimize hazardous drug awareness and PPE use, both vital in staff safety and satisfaction.

Oncology Nursing Forum. 2025 Mar 1;52(2):164–165.

P278. Cognitive Function Changes in Head and Neck Cancer Patients Pre- And Post-Radiotherapy

Evan Huang ¹, Gayeong Kim ², Canhua Xiao ³

Radiation

Significance & Background

Head and neck cancer (HNC) is a global health issue. Radiotherapy, a common treatment option, is associated with multiple side effects. However, it is unclear whether cognitive function may change over the course of radiotherapy.

Purpose

This study aimed to assess the changes of cognitive function using objective measures from pre-radiotherapy (baseline) to one-month post-radiotherapy among patients with HNC.

Interventions

Patients completed three cognitive function tests: Color Trail Test (CTT), Hopkins Verbal Learning Test-Revised (HVLT-R), and Digit Symbol Substitution Test (DSST) at one week prior to and one-month post-radiotherapy. The CTT is a measure of executive function, including planning and organization. The HVLT-R tests for verbal learning capabilities and memory. The DSCT measures motor speed, attention, and visuoperceptual functions. Descriptive statistics were performed on the sociodemographic and clinical characteristics. Paired t-tests were used to examine differences in each cognitive function test score between baseline and one-month post-radiotherapy. A two-tailed test of significance with a significance level of 0.05 was employed. Statistical analyses were performed using IBM SPSS Statistics 29.0.

Results

A total of 30 participants completed the cognitive tests at both baseline and one-month post radiotherapy. The average age of the participants was 59.27 years (SD = 11.49). Of the 30 participants, 10 underwent radiotherapy and surgery, 10 underwent radiotherapy and chemotherapy, and 10 underwent radiotherapy, chemotherapy, and surgery. The average radiation dose received by participants was 65.96 Gy (SD = 5.08). There were no statistically significant differences of cognitive scores on the CTT, HVLT-R, and DSST except for recognition false-positive scores on the HVLT-R. The total number of false-positive errors increased from 0.58 (SD = 0.62) before treatment to 1.06 (SD = 1.09) after treatment (p = 0.024).

Discussion

Patients with HNC may report more false positive recognition on the HVLT-R after radiotherapy than baseline, suggesting decline in memory after treatment. No other significant differences were observed in CTT and DSST scores post radiotherapy, compared to baseline, suggesting a relatively stable cognitive functions related to executive function, motor speed, attention, and visuoperceptual functions. The small sample size and only one-month post-treatment follow-up may have biased the results. In future studies, a larger sample size and longer follow-up periods should be included.

Oncology Nursing Forum. 2025 Mar 1;52(2):165–166.

P279. Navigating the Future of CAR-T: Shaping Post-CAR-T Care Through Trandisciplinary Coordination and Education

Vivian Huang ¹, Samantha Shenoy ², Mimi Lo ³

Healthcare Delivery

Significance & Background

CAR-T therapy, while highly effective, poses significant risks such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). These complications can rapidly progress and lead to severe morbidity and mortality if not recognized and managed promptly. The potential for delayed CRS and ICANS and the increasing use of CAR-T therapy in the outpatient setting have created new challenges for patient management. Early detection and management, especially in the ED, are crucial. However, institutional gaps in knowledge and communication hinder timely care. Research and society guidelines highlight the importance of early recognition and management and emphasize the need for multidisciplinary collaboration in the care of patients undergoing CAR-T therapy. Implementation of standardized care pathways and protocols has been shown to improve patient care and reduce variability. As nursing is on the front lines in triage for both outpatient and ED, swift identification and treatment of post-CAR-T CRS and ICANS requires smooth workflows and staff training.

Purpose

A multidisciplinary team aimed to improve timely recognition and intervention for CRS and ICANS in patients presenting to the ED after receiving CAR-T cell therapy.

Interventions

Nursing leadership, providers, and clinical pharmacists from both Cellular Therapy and ED met to discuss current state and barriers to CAR-T management in the ED. The team developed a plan to:

■ Train ED providers and nurses in early recognition and management of CRS and ICANS.
■ Optimize care coordination between Cellular Therapy clinic and ED.
■ Track staff feedback and time-to-tocilizumab as a measure of timely intervention.

Results

Since implementation, ED providers and nursing staff have received education, Cellular Therapy clinic staff have reliably written clear ED referral notes, and just-in-time CAR-T resources are available in the ED. No delays in care have been noted to date. These positive results mirror existing research in multidisciplinary collaboration, where training and standardization strengthen consistency and patient care outcomes.

Discussion

Transdisciplinary coordination and education are essential for optimal care of patients receiving CAR-T therapy. By addressing these evidence-based recommendations, healthcare institutions can enhance patient care and improve outcomes. Ongoing monitoring and evaluation are crucial to ensure sustained improvement. Future efforts will include expanding education to critical care clinicians and addressing other novel therapies that present unique care considerations.

Oncology Nursing Forum. 2025 Mar 1;52(2):166.

P280. Prism: Palliative Radiation in Supportive Medicine, A Comprehensive and Humanistic Approach to Providing Palliative Radiation

Megan Humphrey ¹, Roberta Anderson ², Annie LaVigne ³, Annie LaVIgne ³, Ella-Mae Shupe ⁴

Radiation

Significance & Background

According to the CDC, the life expectancy has grown to an average of 77.5 years. Cancer remains the second leading cause of death. Approximately 40% of people with advanced disease receive palliative radiotherapy. Palliative radiation is given to manage symptoms, control disease, and treat oncologic emergencies. As cancer diagnoses rise, there will be an increased demand for palliative radiation. Most radiation oncology clinics lack a dedicated palliative radiation therapy program, or the infrastructure needed to ensure timely, comprehensive care. Patients with advanced and metastatic disease face a spectrum of physical, psychosocial, and spiritual issues. Radiation can play a crucial role in alleviating symptoms, preserving function, preventing suffering, and enhance quality of life, and is often an integral component in providing comprehensive palliative oncologic care.

Purpose

To establish a dedicative palliative radiation oncology service in an academic hospital setting.

Interventions

The PRISM service was pioneered by physicians who advocated for its creation through previously collected data that demonstrated a need and benefit for such a service. In the summer of 2023, a team that included nursing, discussed, and delineated the goals, visions, and determine logistics of the service including workflows to address referral lines, care coordination, and interdisciplinary education. Input was sought by a multidisciplinary approach with teams such as medical and surgical oncology, palliative medicine, social work, and case management.

Results

Since launch in September 2023, the PRISM service has triaged several hundred consults, with nearly 100 patients pursuing and completing palliative radiation in both inpatient and outpatient settings. Referrals have come from inpatient medicine and surgical services, emergency providers, and outpatient oncology.

Discussion

The PRISM program provides a framework and connection with the multidisciplinary team dedicated to providing timely and holistic care. Its structure and integrated approach position it to address diverse needs of patients thereby enhancing their quality of life. Further development and expansion of the program will be essential to meet growing demands for palliative radiation in oncologic care. The PRISM service model may serve as a valuable framework for other institutions seeking to strengthen comprehensive and integrated palliative care for patients with cancer. A patient commented, “I want to let you know that your kindness and support has been a bright light.”

Oncology Nursing Forum. 2025 Mar 1;52(2):166–167.

P281. Decoding Lymphadenopathy: A Systematic Route to Timely Cancer Detection

Margarita Huober ¹, Lauren Janchenko ², Mohana Roy ³

Healthcare Delivery

Significance & Background

With an aging population, cancer diagnosis and treatment are becoming more complex, which often necessitates specialist opinions and recommendations for a thorough evaluation. This is an issue that is affecting patients’ access to care. Delayed cancer diagnosis significantly affects patients’ experiences, quality of life, and healthcare expenses, and, in some instances, may increase morbidity and mortality risk.

Purpose

Presently, the appointment wait time for this institution’s specialty clinics is approximately 22 days. Some medical centers around the globe have attempted to solve this problem by adopting rapid cancer diagnostic clinics to streamline patients’ workups and improve timely access to medical care. This has led to a new problem, as one of the most common referral diagnoses to such clinics was “unexplained lymphadenopathy (LAD)”. LAD has a broad differential diagnosis, therefore many possible diagnostic tests that are costly, invasive, or challenging to schedule, may be needed. This could pose a significant delay in patients’ care.

Interventions

We created an algorithm that helps expedite the diagnostic process for patients with unexplained LAD in the newly established Diagnostic Clinic. We implemented the LAD Diagnostic Algorithm in the clinic, with the goal patients referred to the Diagnostic Clinic for a New Patient Visit will be scheduled for an appointment within an average of 7 business days of the referral. The implementation process was facilitated by the creation of an Epic SmartPhrase which was easily accessible to clinicians conducting patient visits.

Results

Post-intervention data will include patients aged ≥18 years, referred to a newly established Diagnostic Clinic. Preliminary data suggests that the average days to appointment 5.8 business days. In addition, we will measure the following outcomes: time to appointment (in days), time to diagnosis (in days), number and type of diagnostic studies ordered, and time to subspecialist (if applicable).

Discussion

We expect that the implementation of the LAD Diagnostic Algorithm in a newly established Diagnostic Clinic will help to expand patients’ access to care by streamlining the diagnostic process and decrease the overall financial, physiological, and psychological burden that patients experience while they undergo lengthy diagnostic processes. We believe that the LAD diagnostic algorithm can be adopted in other institutions and help clinicians streamline the diagnostic process.

Oncology Nursing Forum. 2025 Mar 1;52(2):167.

P282. Enhancing Patient Care: Implementing a Sustainable NJC Program within the Oncology Units. Performance Improvement Project

Abeer Hussain ¹

Management

Significance & Background

Despite the benefits of Nursing Journal Clubs (NJC) for driving continuous learning, ensuring evidence-based practice, and enhancing patient outcomes, a significant number of units within our organization lack active NJCs. This leads to missed opportunities for professional development, decreased staff engagement, and concerns about patient care due to limited access to best practices.

Purpose

To implement a strategic plan to reactivate and maintain ongoing, frequent NJCs in all units, fostering a culture of continuous learning and evidence-based practice.

Interventions

A rapid performance improvement (RPI) project was launched in January 2024 with the goal of increasing the number of active Nursing Journal Clubs (NJC) from 12 to 60 out of 95 units. Notably, only 2 out of 15 oncology units were consistently conducting NJCs at that time.

Drivers and Actions

■ Lack of dedicated resource:
- Action: Appoint a dedicated NJC coordinator or champion for each unit to oversee the planning, facilitation, and evaluation of NJC activities.
■ Lack of platform:
- Action: Establish a centralized platform or online community for sharing resources, discussing articles, and facilitating collaboration among NJC members across units.

Results

As of September 2024, a significant number of nursing units within the organization have successfully revived and are actively participating in Nursing Journal Clubs (NJC). Specifically, 75 out of 92 units have been reactivated, including all 15 units specializing in oncology, hematology, and radiation therapy. These Oncology/Hematology NJCs have yielded tangible outcomes, with the development of 7 rapid performance improvement (RPI) projects and 10 research studies led by clinical nurses. Moreover, the initiative has fostered a culture of continuous learning and improvement, contributing to enhanced clinical practice, heightened patient satisfaction, and increased nursing satisfaction.

Discussion

By addressing these drivers and implementing the proposed actions, we aim to create a sustainable and thriving NJC program that empowers nurses to stay up-to-date with the latest evidence, improve patient care, and contribute to a culture of continuous learning within our organization.

Oncology Nursing Forum. 2025 Mar 1;52(2):167–168.

P283. Dedicated Urgent Palliative Radiation Team at Large Academic Medical Center

Alison Hutson ¹, Andrea Kelly ²

Radiation

Significance & Background

The number of people living with cancer has incrementally increased over recent years due to the explosion of research, earlier detection, and new therapies, allowing patients to live longer. This increase has caused a rise in the need for palliative radiotherapy. Most radiation centers are not equipped to treat patients that need urgent radiation.

Purpose

Having a dedicated urgent palliative radiation team provides faster access and better quality of care for this large and growing population of cancer patients.

Interventions

Our main team consists of 2 dedicated NPs; a dedicated RN and admin. Attending physicians and residents rotate through weekly. Our team can mobilize to see, simulate, and treat patients on the same day for true radiation emergencies (bleeding, SVC syndrome, malignant cord compression) and in the same week for other palliative treatments (painful bone mets, subcutaneous mets). We are experts in supporting our patients through these treatments, ensuring they receive the highest quality of care in one of of the most vulnerable populations.

Results

The number of referrals to our team has steadily increased since its inception. We can now see and start about 15 patients a week. This allows treatments to start faster, allowing for faster resolution of symptoms and improvements in quality of life. Having a dedicated team also allows for NPs and RNs to become experts in management of symptoms caused by radiation treatments, again leading to improvement in quality of life for patients.

Discussion

While many large academic centers have specialists in every disease site, there are few that have specialists in palliative radiotherapy. We believe our patients receive unmatched care because of our team.

Oncology Nursing Forum. 2025 Mar 1;52(2):168.

P284. Just the Beginning: Incorporating Non-Clinical Patient Navigation into Oncology Nurse Navigation Team

Jill Hyson ¹

Coordination of Care and Navigation

Significance & Background

Most cancer centers are staffed with traditional navigation by oncology nurses. Our NCI designated comprehensive cancer center is staffed with oncology nurse navigators (ONN) as well as population health non-clinical navigators that support African America, Rural, Hispanic, Adult and Young Adolescent patients. Non-clinical needs not served by the population health navigators are most often absorbed by the ONN.

Purpose

To evaluate the need for additional support for oncology nurse navigation.

Interventions

Utilizing our documentation with flowsheets via the electronic medical record, we were able to evaluate the total number of encounters per patient per navigator for calendar year (CY) 2023. The total number of patient encounters for the ONN was 9427 with average of 2 encounters per patient. Through our data collection it was determined that the leukemia/multiple myeloma and thoracic ONN had the most encounters per patient, averaging 3–6 per patient. Within the flowsheet data we were able to investigate the most common barriers observed within those disease populations. The top barriers identified were non-clinical barriers of financial cost for appointments, transportation and medical and household bills.

Results

With the leukemia/multiple myeloma and thoracic ONN navigating non-clinical as well as clinical needs, we were able to use our supporting flowsheet documentation to justify adding non-clinical patient navigators to our team. We created a job description and successfully hired two patient navigators to work in parallel with the leukemia/multiple and thoracic ONN. Over CY 2024 thus far, the total number of encounters for the non-clinical navigators was 1009 which accounted for 178 unique patients. This has significantly decreased the workload of non-clinical needs for the ONN.

Discussion

The nature of hematological and thoracic malignancies is for patients to live chronically with their disease which includes frequent office visits for assessments, treatments, and supportive management. Because of the chronic nature of these diseases and acuity of these patients, patients require extensive coordination of care and assessment of non-clinical and clinical barriers within the healthcare system. With this added support of non-clinical patient navigation, the ONN is able to function at the top of their license with coordination of care, education of disease, treatment and symptom management.

Oncology Nursing Forum. 2025 Mar 1;52(2):168–169.

P285. Interactive Staff Education

Asma Ibrahim ¹, Jeannine M Brant ², Cynthia Huff ³

Management

Significance & Background

Ambulatory oncology nurses practice within an environment that is fast paced and constantly changing. Ongoing education is essential to ensure that oncology nurses are competent in safe handling of chemotherapy and in providing optimal care. As an oncology nurse educator to six different ambulatory clinics, providing timely and quality education to staff has been a challenge in terms of carving out time to provide education and keeping adult learners engaged in the educational topics.

Purpose

The purpose of this presentation is to provide an overview of a successful educational program that delivers monthly relevant and interactive education to ambulatory oncology nursing within several ambulatory clinics.

Interventions

A monthly education series with relevant topics was created using a combined didactic lecture and an engagement activity to reinforce learning. Each x-minute didactic presentation was prepared using a voice over PowerPoint. Nurses reviewed the presentation prior to the nurse educator’s monthly educational visit. During the live visit, the nurse educator led an activity that accompanied the didactic content. For example, for the topic of safe handling and hazardous drug waste management, a poster board was developed with different disposal bins. Nurses were provided a series of flash cards with photos of cytotoxic waste, regular waste, and biological waste, and staff were asked to discard the flash card into the appropriate bin they would use for each item. A second example is the use of PPE in the administration of hazardous drugs. After presenting the education, the activity will be Donning and Duffing appropriately with a use of a checklist. The nurses will use a buddy system of two staff members; one will observe and check off while the other is completing the tasks.

Results

A post survey conducted to explore staff perceptions and satisfaction of the education and activities following the first event (n=x) revealed positive results; staff thought the video was just the right amount of time and the activity was a great refresher, and fun! The activity created an opportunity for an open discussion with the staff and educator.

Discussion

This creative ambulatory clinic educational series has engaged nurses to review important competencies and learn new material in a creative and interactive way. Other nurse educators can use these examples to develop their own educational programs that are both informative and engaging.

Oncology Nursing Forum. 2025 Mar 1;52(2):169.

P286. Development of a Research-Specific Patient Acuity Tool for an Outpatient Multi-Specialty Clinical Trials Unit

Alyssa Ingurgio ¹

Quality and Safety

Significance & Background

The Clinical Trials Research Unit (CTRU) opened in July 2023 to advance the organization’s research mission in Arizona. The CTRU provides a dedicated space and specialized care team that prioritizes early-phase clinical trials due to their complex assessment and monitoring procedures. When comparing CTRU patient volumes, appointment load, and unit capacity to staff allocation between August 2023 and December 2023, irregularities and incongruencies are observed, directly impacting resource distribution, team workload, and scheduling policies.

Purpose

In search of a solution, a field inquiry was conducted with like infusion centers, research departments, and available literature. Evaluation of an existing internal tool, the Hematology and Oncology Balancing Tool for SOC (HOBTSOC), concluded that 49% of research patient acuity scores were underestimated because HOBTSOC does not account for treatment variables associated with clinical trials. Development of a research-specific acuity assessment is critical for maintaining safety and upholding protocol integrity in early-phase clinical trials, addressing the specific needs of both patients and staff.

Interventions

One article presented a model that became the CTRU’s early blueprint as it was developed for an outpatient research unit, with a focus on study-specific tasks¹. Using this model and several brainstorming sessions, research variables that impact unit workflow and clinical decision-making were identified and categorized. Variable categories were weighted according to CTRU survey worksheets completed by nursing staff. These values, plus the patients HOBTSOC score, were built into an Excel spreadsheet designed to function similarly to a calculator. The spreadsheet, referred to as the Research Patient Acuity Tool (RPAT), calculates a score of 1–100 that correlates to an acuity level.

Results

A sample of 100 CTRU treatment encounters were evaluated using RPAT and compared to the acuity score previously recommended by the respective treating research nurse. RPAT corrected HOBTSOC underestimation and improved acuity accuracy to 88%.

Discussion

By integrating insights from literature, internal processes, and stakeholders, RPAT is designed to better convey the unique workload associated with treating research patients. With special consideration for RPAT’s scale and long-term feasibility, it was determined that acuity scores would be calculated on a per-encounter basis via the CTRU’s RN Navigator role. Ongoing measures of success include balanced division of workload and end-of-day morale through retrospective staff self-assignment surveys. Future projects may involve assessing RPAT’s effect on study subject retention and minimizing protocol deviations.

Oncology Nursing Forum. 2025 Mar 1;52(2):169–170.

P287. Development of an Acuity-Based “Fast Track” INFUSION Unit: Efficient Scheduling to Enhance Nursing Workflow

Kimberly Ito ¹, Rachel Dupree ²

Healthcare Delivery

Significance & Background

Outpatient infusion nurses in an NCI-designated comprehensive cancer center reported increased patient care workload during weekend shifts. Contributing factors included demand for patient care access, increasing patient acuity thresholds for outpatient oncology care, and continuing patient hesitance for hospital admission amid the ongoing COVID-19 pandemic. Distribution of high and low acuity patients in nursing assignments had been the traditional practice. Nurses reported that the workflow including high and low acuity patients for their assignment resulted in conflicting priorities. The patient volume and reported priority conflicts revealed a gap in patient allocation for efficiency and optimal care.

Purpose

To design an acuity-based scheduling and allocation system addressing nurse assignments, enhancing nurse workflow, decreasing nurse workload, and increasing staff satisfaction.

Interventions

Unit leadership performed a literature review of patient allocation models and validated nurse-reported conflicts in concurrently caring for low and high acuity patients. Challenging existing patient allocation practices, unit leadership recognized the need for a change to acknowledge current research findings supporting the separation of low and high acuity patient care. A workload tool was designed to predict an appointment’s workload, anticipated resource needs, and length of appointment based on the treatment a patient is scheduled to receive. Concurrently, an unit re-design repurposed existing space to create a Fast Track (FT) unit. The point values determined by the workload tool identified patients to be scheduled into the FT unit. An equitable distribution of workload was established between the FT and non-FT nurses, through the assessment of total number of patients assigned, patient acuity and safe patient ratios.

Results

Post FT unit implementation, workload allocation changes were evaluated through a staff survey conducted daily over two weekends. Themes from post-implementation surveys confirm overall satisfaction amongst the nurses working in the FT unit. Additionally, the infusion nurses working in the non-fast track unit reported a positive impact including decreased workload and improved workflow. Evaluation will be ongoing to identify further areas for optimization of staff satisfaction and best patient outcomes.

Discussion

There were unexpected findings post implementation. Both non-FT and FT nurses reported increased ease in finding an appropriate time for lunch and break coverage. Nursing assistants also reported these changes supported efficiency in workflow and job satisfaction.

Oncology Nursing Forum. 2025 Mar 1;52(2):170.

P288. Empowering Nurses: Essential Knowledge and Skills for Tagraxofusp-erzs Administration

Alexandria Ivanicki ¹, Samantha Parente ², Joelle Rubin ³

Treatment Modalities and Managing Administration

Significance & Background

According to the Dana-Farbar Cancer Institute, “Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive hematologic malignancy of the bone marrow.” In 2018, Tagraxofusp-erzs became the first Food and Drug Administration (FDA) approved therapy for adults and children with BPDCN. Tagraxofusp-erzs is administered through a syringe pump with a black box warning for capillary leak syndrome (CLS). In a large academic medical center, the leukemia unit was unfamiliar with Tagraxofusp-erzs, syringe pumps, CLS, and its monitoring. With an increase of Tagraxofusp-erzs administrations from 2020–2023, the leukemia team recognized the need for administration and monitoring education.

Purpose

To educate nurses on a 19 bed leukemia unit on the administration and safety profile of Tagraxofusp-erzs.

Interventions

In October 2023, a two part education for Tagraxofusp-erzs commenced. The first part focused on drug and safety monitoring. An education inservice on these topics was held for all nurses. In addition, the nurses created a smartphrase to capture key CLS labs and assessments. The smartphrase was added to the patient’s electronic medical record and updated daily. These labs and assessments were reviewed daily at interdisciplinary rounds for treatment clearance. The second part of education focused on training nurses to effectively operate and manage a syringe pump. A “train the trainer” model was utilized. For safety purposes, this drug was administered on day shift and therefore education was focused on day shift nurses. The nurse specialist was also present during the administration and re-educated nurses on the drug and safety profile at this time.

Results

From 2023-present, five patients received a total of 31 Tagraxofusp-erzs doses combined. This is an increase from 2020–2021 where only two patients received a total of 10 doses combined. No safety events occurred. All day shift nurses have been trained and feel confident managing syringe pumps. Both day and night shift nurses report feeling confident recognizing and managing CLS. Limitations to this study include the limited number of Tagraxofusp-erzs administrations.

Discussion

Oncology nurses play an important role in staying current on novel cancer therapies, delivery methods, and safety profiles. Through an education inservice and a “train the trainer” model, nurses were able to safely administer Tagraxofusp-erzs and monitor patients. In the future, we plan to educate new nurses on the drug during chemotherapy certification.

Oncology Nursing Forum. 2025 Mar 1;52(2):171.

P289. Setting the Foundation: Utilization of the Disc Profile to Create a Culture of Collaboration and Psychological Safety in Opening a Hospital-Based Outpatient Oncology Program

Abbie Ives ¹, Lindsey Pimentel ²

Management

Significance & Background

Opening a hospital-based outpatient oncology program is an opportunity requiring a sound infrastructure of skilled and best fit employees to ensure operational success. Executing this requires thoughtfulness and transparency around how each team member relates to their leadership team, fellow colleagues, and patients.

Purpose

As a nursing leadership team, an important foundational piece for success for our team members was ensuring that they felt seen, heard, and supported. In talking with team members about their history with prior leadership, opportunities were noted for a more psychologically safe environment. The purpose was to pave the way for our team to experience a culture that was free from punishment or humiliation, knock down the silos, and experience positive change.

Interventions

Team members completed a DiSC assessment during the onboarding process of new employee orientation. The DiSC model is made up of four regions, with a total of twelve subregions that delineate what style you lean to: (D)ominance, (i)nfluence, (S)teadiness, and (C)onscientiousness. This tool was utilized with the perspective of helping ignite a movement of positive culture and behavior changes that would have a positive impact on our employees and our patients. Each team member’s DiSC profile results were provided to them and discussed during a group exercise in collaboration with Organizational Development.

Results

Review of results

(D)ominance-0 (0%)
(i)nfluence-4 (23.5%)
(S)teadiness-9 (53%)
(C)onscientiousness- 4 (23.5%)

Discussion

After reviewing the collective vantage point of the DiSC styles exhibited, a platform was created to address how individuals might react to styles that were different from their primary style, and what the motivation for their behavior might be. More importantly, the thoughtful discussion and practice scenarios on how to connect with distinctive styles when problems arise and when things get tense allowed the team to find a common language, which ignited an environment of psychological safety. This allowed our employees to feel empowered, appreciated, and valued. Future implications and sustainability were also considered, leading to meaningful 1:1 touch points 30-60-90 days post hiring for team members and incorporating the DiSC assessment and unit-based discussions with the hiring of additional team members. As a leadership team there is overall awareness of new opportunities that arise to continue to provide psychological safety. We look forward to presenting our response to those new findings at ONS Congress.

Oncology Nursing Forum. 2025 Mar 1;52(2):171–172.

P290. Development of a Visual Cancer-Related Fatigue Scale

Terri Jabaley ¹, Elizabeth Russell ², Grenon Nina ³, Mary Lou Siefert ⁴, Holly Lopes ⁵, Debbie Soden ⁶

Symptom Management and Palliative Care

Significance & Background

Cancer-related fatigue (CRF) is reported by 25–99% of patients with cancer. Its duration can be short or long term, often lasting throughout survivorship. CRF interferes with daily activities and diminishes quality of life. It is a highly subjective experience, and periodic screening is recommended for all oncology patients. Correcting treatable contributing factors and providing evidence-based recommendations to address CRF is the standard of practice. There is strong evidence to support psychological interventions and physical activity to mitigate CRF and little evidence to support pharmaceutical interventions. Barriers to the use of existing validated instruments to evaluate fatigue include the impracticality of incorporation in the clinical setting and linguistic and interpretation challenges. Patients report difficulty using numeric rating scales alone to report symptom severity, including fatigue. The benefits of using pictorial images in addition to a numeric rating scale for self-reporting symptoms such as pain are well-documented. Patients’ self-monitoring of fatigue on a regular basis provides valuable information to guide care.

Purpose

Develop and test a visual fatigue scale for patients with cancer and survivors to self-report fatigue severity in order to promote better evaluation of fatigue and the interventions implemented to mitigate it.

Interventions

Images of four levels of fatigue were drafted based on an extensive literature review and appraisal. Nine oncology expert clinicians, including nurses at all levels of practice, and eight patient volunteers participated in five focus groups. Modifications were made based on focus group input. Four revised images depicting no, mild, moderate and severe fatigue were reviewed by focus group participants for final approval.

Results

Professional artist renderings of the final images were incorporated into a visual fatigue rating scale. The scale was incorporated into the patient activity log for self-tracking and self-report of CRF severity during an activity program.

Discussion

Using a shared decision-making approach, oncology nurses can collaborate with patients to identify CRF occurrence, trends in severity and the efficacy of interventions. A visual fatigue scale may promote greater engagement of diverse patients to report daily fatigue and participate in evidence-based plans of care to improve their CRF and associated quality of life.

Oncology Nursing Forum. 2025 Mar 1;52(2):172.

P291. Caring with Confidence: Enhancing Nurse Expertise in Lymphoma Care

Lisa Jackson ¹, Nicole Sennebogen ², Lisa McMasters ³

Management

Significance & Background

As healthcare advances rapidly, nurses must continuously update their expertise to provide optimal care. Lymphoma, a malignancy of the lymphatic system, requires specialized knowledge for accurate diagnosis and treatment. Oncology nurses, integral to patient care in clinics and infusion settings, often find it challenging to keep up with new developments in disease-specific treatment, especially in a community oncology setting. Improving nurses’ education in this area is essential for better patient outcomes. Enhanced knowledge enables nurses to offer more effective care, better symptom management, and more comprehensive patient support, thereby improving overall healthcare outcomes.

Purpose

This project aims to boost nurses’ knowledge and confidence in managing lymphoma patients. The educational initiative focuses on critical aspects of lymphoma care, including its types, symptoms, diagnostic procedures, treatments, and management strategies.

Interventions

The educational program utilized a hybrid approach, featuring both interactive face-to-face sessions with PowerPoint presentations and a Zoom-based option to accommodate varying schedules. The Nursing Professional Development Center (NPDC) provided 0.5 contact hours to encourage participation. Participants’ baseline knowledge and confidence levels were assessed via a nine-question pretest, and their progress measured with a post-test to gauge the effectiveness of the intervention.

Results

Participation in the study included twenty-four nurses, two medical assistants, and one pharmacy student. Evaluation involved a statistical analysis of pretest and post-test results to determine changes in knowledge and confidence. Results indicated a significant improvement. Participants scored 52% higher in their knowledge of lymphoma using the same questions pretest and post-test. Confidence levels rose from an average of 2.88 to 6.42 on a Likert Scale from 0 (no knowledge) to 10 (complete confidence).

Discussion

The combination of in-person and Zoom-based education offered flexibility and accessibility, addressing different learning preferences and schedules. Recorded Zoom sessions further ensured that future nurses could access the material. The notable increase in both knowledge and confidence among participants highlights the effectiveness of a targeted educational approach. This project demonstrates the potential of similar short, hybrid, targeted, disease-specific interventions to meet educational needs in other specialized areas of oncology nursing. Future research should explore the long-term impacts of such educational programs on clinical practice and patient outcomes as well as assessing knowledge retention for participants.

Oncology Nursing Forum. 2025 Mar 1;52(2):172–173.

P292. Implementing the IPASS Tool to Standardize Handoff Communication amongst Providers in a Lymphoma/Myeloma Unit, a Qi Project

Jinsu James ¹, Karla Ow ²

Healthcare Delivery

Significance & Background

Handoff communication errors are a leading source of sentinel events. Evidence from safety culture surveys, academic studies and malpractice claims suggests that healthcare handover quality is problematic, leading to preventable errors and adverse outcomes. In addition, the Centers for Medicare & Medicaid Services and the Joint Commission require health care facilities to follow a standardized handoff process. The inpatient lymphoma/myeloma unit in a large academic cancer hospital consistent of 48 beds. The unit is covered by 25 rotating physicians, 25 Advanced Practice Providers (APPs), and 10 to 15 rotating fellows. Given the complex hematological patient population accurate information exchange among them is critical. Having a standardized handoff communication amongst multidisciplinary team members is a crucial component of our efforts to Zero Preventable Harm.

Purpose

The handoff report-IPASS (Illness severity, Patient summary, Action items, Situational awareness, and Synthesis) is an evidence-based tool used to communicate patients’ conditions and immediate needs to the receiving team to reduce medical errors. The IPASS tool was implemented in the inpatient lymphoma/myeloma unit with a utilization rate of 24% in March of 2023. The aim of the quality improvement project was to increase IPASS utilization in the lymphoma/myeloma unit to a rate of 90% or greater by March 2024.

Interventions

From 5/1/2023 to 12/1/2023 the I-PASS training was initiated in the inpatient lymphoma/myeloma unit. Four advanced practice providers lead the project. A power point presentation was created and presented to all APPs, fellows, and physicians. The presentation provided evidence-based rationale for implementing the IPASS handoff tool which has been rigorously studied and validated. The training also included instructions on how to utilize the tool and when to complete it. Monthly utilization data was obtained post education to monitor the progress.

Results

Post-training utilization increased to 30%, 70%, and 90% at months 1, 2, and 3 respectively. At 12 months, the utilization rate continued to be above 90%.

Discussion

The IPASS handoff tool has improved communication between providers without negatively impacting provider’s workflow. Additionally, acute events are taken care of in a timely manner. Having a standard communication tool is vital in providing optimal care of complex hematological patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):173.

P293. Implementation of the “Three Wishes Program” On a Hematology/Oncology Unit

Ah Young Jang ¹, Michelle Guerra ²

End of Life

Significance & Background

The Three Wishes Program (3WP) on a hematology/oncology unit serves as a resource for nurses to improve the end-of-life experience for their dying patients. The goal of this program is to implement a patient’s three wishes by creating meaningful memories and honoring their lives during their final days.

Purpose

The 3WP is underutilized on this unit and the purpose of this project is to increase awareness about this resource by educating staff and encouraging their participation to boost the program’s utilization.

Interventions

The project aims to increase staff knowledge among the nurses in a hematology/oncology unit about the program through presentations at unit-wide staff meetings, individual educational sessions during downtime, and disseminating a quick information sheet for nursing staff on how to fulfill patient wishes. Once a patient is identified as an end-of-life patient, their name should be recorded on a running document by the charge and resource RN.

Results

The study assesses multiple factors. First, a survey will be distributed among the unit with a list of four questions that will assess staff knowledge and willingness to implement the 3WP pre and post information dissemination. Second, the study will determine if there was an increase in the number of wishes implemented for patients after the information session and quick sheet distribution.

Discussion

While data collection is still in progress, this project was essential to our unit due to the recent introduction of the 3WP. The 3WP has been well implemented and widely known amongst the intensive care units within the hospital. Despite being a hematology/oncology unit where there are many patients who transition to comfort care or end-of-life care, the program was only made known to the unit in March 2024. Consistent education and accessibility to information is needed for the successful implementation of any program. Thus, this study will help to provide improved implementation of the 3WP on the hematology/oncology unit to deliver meaningful end-of-life experiences to our patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):173–174.

P294. Facilitating Immediate Management of Irritant Infiltrations and Vesicant Extravasations

Catherine Jansen ¹

Treatment Modalities and Managing Administration

Significance & Background

Vesicant extravasations can be a high risk event, but fortunately they are a rare occurrence. Estimates of vesicant extravasation, from 0.001 – 6%, have been reported in the literature. However, the suspicion of a vesicant infiltration may lead to significant anxiety for nurses, potentially hindering critical thinking and clinical judgement. Since an extravasation may lead to tissue damage, it is pertinent that nurses are aware of how to manage an extravasation if it occurs. Historically our facility had a policy specific to chemotherapy extravasation. However, we concluded that it would be more ideal to provide an easily accessible guideline for vesicant extravasation management. Additionally, we proposed to include irritant infiltrations.

Purpose

to develop a guideline for the management of vesicant extravasation and irritant infiltration.

Interventions

Our current policy for chemotherapy extravasation was reviewed, in order to align with the updated ONS Chemotherapy and Immunotherapy Guidelines. In addition to the ONS guidelines, Lexicomp and the drug manufacturer website were reviewed to validate whether antineoplastics should be identified as irritants, irritants with vesicant potential, or vesicants. Based on feedback from key stakeholders, a guideline was formatted to distinguish between irritant versus vesicant groupings with clarification of management steps in the event of suspected infiltration or extravasation, including antidotes when indicated, and the use of warm versus cold compresses.

Results

The simplicity of the vesicant extravasation and irritant infiltration management guideline has been well received by staff. Color coding, based upon grouping, facilitates easy identification of drug classifications and interpretation of interventions for the potential drug involved. Another outcome of this project was documentation templates and patient education sheets that are available when needed.

Discussion

While extravasations are an uncommon occurrence, nurses need to be aware of vesicant properties of chemotherapy agents, in order to institute preventative measures and to act quickly if extravasations are suspected. The accessibility of providing the guideline at each chairside increases the ability of staff to take appropriate steps quickly if indicated.

Oncology Nursing Forum. 2025 Mar 1;52(2):174.

P295. Cultivating Symptom Management Champions

Catherine Jansen ¹, Alfred Yang ²

Symptom Management and Palliative Care

Significance & Background

Cancer patients can experience a variety of symptoms related to their cancer and/or cancer treatment. Inadequate symptom management can impact patients’ quality of life, as well as increasing morbidity and mortality. Navigators are often the first point of contact with patients newly diagnosed with cancer and an ongoing resource across the cancer continuum. Our San Francisco navigation team consists of nurses and advance practice providers from various backgrounds and years of experience. Additionally, our team provides navigation for multiple specialties: hepato-pancreato-biliary, pelvic floor disorders, breast, gynecology and medical oncology. Therefore, team members have varying levels of experience in cancer care (e.g., symptom management). While our navigators complete a baseline symptom assessment at the original intake, we wanted to empower all our navigators to be able to manage symptoms across the cancer care continuum.

Purpose

To develop an educational plan to empower our navigators to develop expertise in symptom management, in order to 1) conduct a thorough assessment, 2) identify the likely cause of the symptom(s), 3) implement appropriate interventions, and 4) complete consistent documentation.

Interventions

Feedback was solicited from various stakeholders to identify potential knowledge gaps and assess our navigators’ comfort level with symptom assessment and patient triage. Based on these findings, an educational plan was developed, beginning with enhancing knowledge of cancer treatments and related toxicities. Subsequently we transitioned our focus to symptom management, and the clinical nurse specialist created a symptom triage guideline and corresponding documentation template for pain. This example and key resources were shared with the entire navigation team, who were encouraged to partner and “own a symptom” to present to their peers with guideline and documentation recommendations.

Results

The exercise of adopting a symptom, researching, evaluating key assessment points, and engaging peers for feedback ~ was a powerful learning experience. Guideline and documentation templates underwent revisions based on team feedback after the initial group presentations, and later as they were utilized in practice. As a result, our navigation team was able to provide timely, appropriate care for patients experiencing cancer- and/or cancer treatment-related symptoms.

Discussion

Comprehensive knowledge and ongoing education are crucial for navigators to effectively manage symptoms throughout the cancer care continuum. Enhanced expertise in symptom management allows for improved patient care, ultimately contributing to better quality of life and outcomes for cancer patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):175.

P296. Increasing Infusion Nurses’ Knowledge and Confidence in Ambulatory Oncology Processes and Documentation Standards: Supporting the Success of QOPI Certification

Sandy Jellen ¹, Shelly Kane ², Jill Williams ³, Jennifer Schoenecke ⁴

Quality and Safety

Significance & Background

In an NCI-designated Comprehensive Cancer Center’s ambulatory Infusion Center (IC), a gap analysis identified opportunities for improvement in nursing practice and documentation to meet the standards for the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) recertification. ASCO standards are evidence-based guidelines designed to establish the framework for best practices in oncology care. Registered Nurses (RN) are integral in providing evidence-based, quality, and safe care to uphold QOPI certification standards which can enhance patient outcomes.

Purpose

The purpose of this project was to increase IC RN knowledge and confidence for the QOPI survey by implementing pre-survey preparation and utilizing standardized education on infusion processes and documentation standards to achieve recertification.

Interventions

A multidisciplinary team consisting of nursing, quality, pharmacy, and information services (IS) convened to develop a plan for survey preparation. A tip sheet outlining pertinent infusion standards based on the 2020 QOPI Manual was reviewed with staff monthly leading up to survey day. Nursing interdisciplinary note templates were revised to ensure compliance with documentation standards such as the 9 elements and chemotherapy administration dual verification processes. One month before the survey, daily education, documentation review, and mock surveys were conducted with the infusion RNs. A survey was sent to measure RN confidence pre and post survey preparation implementation.

Results

The sample included 9 Infusion RNs with a mean of 14.67 years of experience and a mean of 12.11 years in oncology. 67% of RNs are OCN certified. Before survey preparation, 22% of RNs reported being very confident or extremely confident with easily finding policies, verbalizing, and locating in the electronic medical record the QOPI manual certification standards for Infusion compared with 100% post survey preparation. Pre-implementation, 78% of RNs reported being very confident or extremely confident in performing all requirements of the dual verification process for chemotherapy administration compared to 100% post implementation.

Discussion

The implementation of a comprehensive pre-survey preparation increased knowledge and confidence in IC RNs. The resources created and revised documentation templates may be beneficial to other outpatient ICs interested in QOPI certification and always remaining “survey ready.” ICs that aim to meet QOPI standards can improve performance and ensure high standards of care.

Oncology Nursing Forum. 2025 Mar 1;52(2):175–176.

P297. Talk Toxicity! Implementing a Chemotherapy Toxicity Prediction Tool for Older Adults

Miho Jo ¹, Miho Jo ², Shane Gallagher ³, Toby Bressler ⁴

Quality and Safety

Significance & Background

Cancer incidence increases significantly with age. Older adults undergoing chemotherapy are at higher risk for severe toxicity. Validated geriatric assessment tools can lead to implementing preventive measures, guiding the decision-making process, and improving patient-centered outcomes. The Cancer and Aging Research Group (CARG) tool is a validated instrument designed to predict chemotherapy-related high-grade toxicity risks in older adults based on their clinical and functional status. Including geriatric assessment in oncology visits improves patient-centered communication about aging-related concerns. Its integration into routine clinical practice remains limited.

Purpose

This quality improvement project aimed to increase the CARG tool utilization by oncology nurse practitioners (NP) to enhance patient-centered communication.

Interventions

The project piloted the CARG tool utilization in a medical oncology clinic at a large urban academic medical center over 8 weeks. Biweekly plan-do-study-act (PDSA) cycles involved patients aged 65 and older initiating new chemotherapy as eligible for the CARG tool assessments. Following pre-implementation training for NPs, weekly chart reviews recorded patients assessed with the CARG tool and their care. NPs’ self-efficacy in patient-centered communication were surveyed before and after implementation.

Results

Advanced oncology-certified nurse practitioners (AOCNP) participated in pre-implementation training sessions and modules (N=4). The utilization rate of the CARG tool increased throughout the PDSA cycles. Of 17 eligible patients, 11 were assessed with the CARG tool, resulting in a 65% utilization rate. Assessments were documented using a smart-phrase within the EHR. Patient ages ranged from 66 to 89 (mean=75). Of the assessed patients, six (55%) were classified as high-risk for high-grade toxicity. These patients engaged in serious illness conversations, received dose-reduced chemotherapy, and were referred to social work services, nutritionists, and/or palliative care. NPs’ self-efficacy in communication with the patient increased post-training and implementation of the CARG tool (mean difference=0.58).

Discussion

This QI project demonstrates the feasibility of the CARG tool in the clinical setting. Increased NPs’ self-efficacy in communication with patients suggests the positive impact on clinical practice and improved patient care. The outcomes observed in this project confirm the need for a standardized approach towards anticipating untoward effects of administering antineoplastic agents in older adults. This project can provide guidance in standardized provider training programs and enhanced patient education on individualized risk assessment and care plans. Continued efforts are needed to scale utilization of validated geriatric assessment tools by a multidisciplinary approach.

Oncology Nursing Forum. 2025 Mar 1;52(2):176.

P298. Empowering the Next Generation of Leaders: Nursing Student Board Member

Kristin Johnson ¹, Joaquin Buitrago ², Joylyn Mae Estrella ³, Cassandra Green ⁴

Professional Development

Significance & Background

To align the Oncology Nursing Society’s (ONS) mission of advancing excellence in cancer care and the Houston Chapter of the Oncology Nursing Society’s (HCONS) Strategic Plan goal of empowering the next generation of ONS members and leaders, HCONS is mentoring nursing students, with the objective of identifying an upper-level nursing student to serve on the HCONS Board for one semester.

Purpose

To create a student board member position and glean feedback from participants over time on strategies to empower student involvement in HCONS, promote the oncology specialty, and offer the student valuable insight into the structure and activities of HCONS and ONS.

Interventions

HCONS offers two BSN scholarships annually. Scholarship recipients are not required to be HCONS members but are invited to be recognized at a chapter meeting where they can learn about oncology and disease-specific topics, chapter activities, and network with potential mentors and peers. Since 2021, HCONS has reached out to nursing schools located in or scheduling clinical rotations in the Texas Medical Center to invite students to attend the HCONS monthly membership meetings. HCONS members have also attended nursing school open houses including Texas Woman’s University College of Nursing (TWU) and the University of Texas Medical Branch at Galveston (UTMB) to talk to attendees about the oncology specialty and benefits of joining a professional organization. Since 2022, the HCONS Board has been participating in annual Zoom meetings with Student Nurses Against Cancer (SNAC) where HCONS members share their oncology experiences, answer questions about oncology and nursing in general, offer advice on job hunting and interview skills, and discuss the benefits ONS and HCONS membership.

Results

Nursing students have regularly attended HCONS membership meetings since January 2023. Beginning in February 2024, the Membership Committee disseminated a Qualtrics Survey to gauge interest in a student board member position to area nursing schools and received five responses. From these submissions, including a paragraph describing reasons the individual would like to serve on the board, one candidate graduating in December was chosen for the Fall 2024 semester.

Discussion

Feedback from student board members will guide student board recruitment efforts for the future, as well as suggest activities for chapter involvement to further mentor students. Over the next semesters we hope to expand participation to other nursing schools.

Oncology Nursing Forum. 2025 Mar 1;52(2):176–177.

P299. A Specialty Within a Specialty: Meeting The Unique Needs of Nurses in Oncology Clinical Trials Through an Oncology Research Nurse Education Council

Kathryn Johnson ¹, Daniela Delbeau ², Donna Catamero ³, Gillian Sanchez ⁴, Carly Sullivan ⁵

Professional Development

Significance & Background

Delivery of nursing care to patients with cancer is a unique practice, requiring dedicated professionals with specific expertise, leadership and training¹. Operationalization of clinical trial research is a complex process with numerous regulatory and clinical safety guidelines also requiring advanced nursing expertise, leadership and training². Clinical Research nurses (CRNs) within oncology represent a niche demographic with highly regulated, high-need areas of practice. To best aid in development of novel cancer therapeutics and safe delivery of patient care to those participating in cancer clinical trials, nursing representation in the shared governance of a cancer research enterprise is critical.

Purpose

To engage key stakeholders in promoting professional growth that leverages the expertise of our oncology research nurses while driving accountability through measurable contribution and services.

Interventions

In 2022 Research Nurse Education Council (RNC) development began and the council’s structure was refined through alignment of goals and expectations with hospital medical and administrative leadership. In 2023 we launched the RNC with established members, a clear charter and developed a list of actionable items. RNC membership is currently comprised of volunteers from the CRN community. The RNC represents a diverse group of backgrounds from solid and liquid tumor disease focus groups, registered nurses and nurse practitioners, experienced program managers and nurses new to the oncology profession. Additionally the committee has representation from a physician advisor and member of the cancer center’s quality assurance team. The council meets monthly as a full group and more frequently as needed for targeted initiatives in smaller working groups. The RNC has established 4 primary objectives and aims, included in Appendix A.

Results

The RNC’s focus is on self-identified needs as well as those brought to the team by leadership. Areas of focus to date have included:

■ Review and refinement of departmental policies, to incorporate nursing considerations
■ Creation of training and reference materials for standardized adverse event record management in the electronic medical system
■ Development and implementation of comprehensive credentialing tracker for enhanced management of multisystem licensing and regulatory requirements

Discussion

Niche skillsets require dedicated attention and development. In addition to the deliverables that have come from this team, there is a clear benefit from sharing best practices across disease groups. The RNC aims to extend their reach to other Institutional locations and facilitate shared learning across other institutions.

Oncology Nursing Forum. 2025 Mar 1;52(2):177–178.

P300. New Oncology Nurse Manager Learning Series: Improving Manager Readiness and Confidence to Lead an Oncology Unit

Jennifer Jones ¹, Mckell Gubler ²

Management

Significance & Background

Oncology Nurse Managers are vital to caring for oncology patients and staff in inpatient and outpatient units. They are key to operations, managing staff, and patient outcomes (Warshawsky, 2020). Historically there has not been a robust orientation process for new managers (Warshawsky, 2020). Lack of support and knowledge can lead to increased burnout and loneliness in new managers.

Purpose

In 2023, our hospital onboarded five new oncology nurse managers within a short timeframe due to hospital expansion and turnover. To improve new manager education and orientation, the inpatient and outpatient nursing directors created a New Oncology Manager Learning Series.

Interventions

Biweekly meetings were scheduled for the participants. Journal articles and other resources were sent to the group beforehand. Topics were initially selected by the inpatient and outpatient director and adjusted according to managers’ requests. Subject matter experts were invited for topics including Hospital Finance 101, navigating patient complaints, and improving unit culture.

Results

Managers completed a pre and post survey. 50–60% of respondents noted that prior to the manager series they felt either very unprepared or somewhat unprepared with having crucial conversations, managing workload, creating and managing culture, and creating boundaries at work. 100% of respondents noted that they were very unfamiliar or somewhat unfamiliar with financial resources. The post survey results showed a positive shift in every category. Respondents noted feeling very prepared or somewhat prepared in all categories outside of one respondent still feeling somewhat unprepared to manage unit culture.

Discussion

By creating a bi-weekly series, we created a forum for mentoring and coaching new managers, allowing for discussion and problem solving for many of the issues that managers encounter in the first year of leadership. The transition from peer to boss can be an isolating experience for a new manager. The new manager group created a safe space to discuss issues and situations as they arose. Next steps include creating an orientation for future managers and accessible resources for current managers to ensure continued support for nurse managers.

References

Warshawsky NE, Caramanica L, Cramer E. Organizational Support for Nurse Manager Role Transition and Onboarding. Journal of Nursing Administration. 2020;50(5):254–260. doi: 10.1097/nna.0000000000000880. [DOI] [PubMed] [Google Scholar]

Oncology Nursing Forum. 2025 Mar 1;52(2):178.

P301. Implementing a Resource Nurse Staffing Model to Improve Staff Well-Being and Operational Efficiency in an Outpatient Oncology Infusion Center

Carrie Jones ¹, Joshua Walls ², Raquel Luague ³

Management

Significance & Background

Outpatient oncology infusion centers face significant staffing challenges due to unpredictable patient needs and the complexities of chemotherapy administration. Inadequate staffing exacerbates stress and moral distress among staff. Traditional models often fail to manage these demands, highlighting the need for adaptable and innovative staffing approaches that support staff, maintain smooth operations, and reduce nurses’ workload.

Purpose

This study evaluated the impact of the ‘Resource Nurse’ model on nurse well-being and operational efficiency in the ambulatory infusion department of an NCI-Designated Comprehensive Cancer Center.

Interventions

We implemented the ‘Resource Nurse’ model, assigning a nurse without a patient load to cover breaks, prepare charts, optimize patient flow, and assist colleagues during unpredictable events. Collaboratively with leadership and staff, we developed clear role expectations. The model was applied over 4 months, covering 46% of workdays. Pre- and post-implementation surveys assessed its impact on Perceived Adequacy of Staffing (PAS) and moral distress. Time-stamp data was analyzed to determine changes in operational performance.

Results

The Resource Nurse model led to significant improvements in perceived staffing adequacy and reductions in all categories of moral distress. Key findings included a 44% decrease in nurses reporting patient overload, a 37% increase in lunch breaks taken, and a 53% reduction in administrative burden. Perceptions of patient care being negatively affected by resource shortages dropped by 44%. Operational improvements included a 7-hour increase in daily patient hours, a 2-minute decrease in average patient wait times, and a 5.2% reduction in patients waiting over 15 minutes.

Discussion

The Resource Nurse model shows strong potential in addressing the complex challenges of outpatient oncology infusion centers. Improvements in PAS, reduced moral distress, and enhanced operational efficiency suggest that this model could significantly improve nursing practice. As healthcare systems increasingly face staffing shortages, these findings are particularly relevant for improving nurse retention and patient care. Future research should assess its long-term impact on staff retention, patient satisfaction, and clinical outcomes, and conduct cost analyses to evaluate its sustainability for broader implementation in similar high-stakes healthcare settings. Implementing the Resource Nurse model not only enhances nurse well-being but also sets a precedent for innovative staffing solutions in oncology and beyond.

Oncology Nursing Forum. 2025 Mar 1;52(2):178–179.

P302. Utility of Longitudinal Circulating Tumor DNA (CTDNA) Detection in Patients with Various Sarcoma Subtypes

Cissimol Joseph ¹, Reshma Vilson ²

Screening, Early Detection, Genomics

Significance & Background

Sarcomas are very heterogeneous with over 100 subtypes with diverse biological behaviors. Current restaging includes frequent imaging, poses patients at risk for radiation, renal complications from contrast and financial burden. Recently, tumor informed CtDNA assays have emerged as a valuable tool in diagnosis, monitoring treatment response and recurrence in various solid tumors, but their utility is unclear in sarcomas. Literature search identified lack of data. The Signatera tumor informed ctDNA assay may detect CtDNA levels specific to patient’s unique tumor profile, enabling early identification of recurrence, therapeutic response, and disease progression.

Purpose

Identify sarcoma subtypes which reflect deviation from baseline ctDNA levels responding to recurrence, progression, and treatment response.

Interventions

Matched tumor and blood were collected from 51 patients of 13 sarcoma subtypes at various disease trajectory, followed at our sarcoma center. Tumor matched DNA was quantified using Signatera Minimal Residual Disease (MRD) test.

Results

Analysis identified Angiosarcoma (AS) (83 %, n =6), Leiomyosarcoma (LMS) (38%, n=13), 1 Triple negative Gastro Intestinal Stromal Tumor (GIST), 1 Myxofibrosarcoma, 1 Inflammatory myofibroblastic tumor, 1 carcinosarcoma, unclassified or high grade (UPS) sarcoma (1/4), Ewing sarcoma (2/2), Rhabdomyosarcoma (1/1 ) revealed CtDNA positivity corresponding to radiographical recurrence or progression. Subtypes with undetectable levels and absence of disease on imaging are: Angiosarcoma (1/6), LMS ( 6/13), Myxoid liposarcoma ( 1/2), GIST (11/11), synovial sarcoma (1/1), Osteosarcoma (2/2), UPS (2/4). 1 LMS patient failed to get sample at the time of recurrence, and tests after 2 months of treatment with positive response showed 0 CtDNA value. We also found that one recurrent myxoidliposarcoma, Dedifferentiated liposarcoma (1), DSRCT (1) failed to detect CtDNA levels to radiographical disease, but they were treated with chemotherapy extensively. One patient with metastatic high grade sarcoma of breast showed 0 CtDNA level post treatment with complete metabolic response.

Discussion

Study reveals potential utility of ctDNA assays for sarcomas, but a larger study is required to validate it, which should include samples at initial diagnosis, pre and post therapy and surveillance on all subtypes of sarcoma. Results indicate that while undetectable CtDNA may suggest a lower likelihood of relapse, CtDNA trends may indicate progressive disease, treatment response. This study was limited by random collection of blood samples for CtDNA assessment and failed to get pretreatment CtDNA levels in non-metastatic patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):179.

P303. Prioritizing Quality: A Healthcare System’s Approach to Integrating Excellence into Their Strategic Plan

Joy Joseph ¹

Quality and Safety

Significance & Background

High-quality healthcare is crucial for cancer patients as it ensures they receive effective, timely, and compassionate treatment, which significantly improves their outcomes and overall well-being. Hospital quality teams are vital for delivering this exceptional healthcare. Recognizing the complex needs of oncology patients, a large quaternary healthcare system recognized that to transform and advance cancer care, they had to prioritize quality as the cornerstone of their strategic plan by investing into the development of a dedicated quality team.

Purpose

The Oncology leaders of a large academic healthcare organization identified a need to build an oncology specific quality program focused on oncology quality to streamline processes, implement best practices, and continuously monitor and improve the quality of care provided to cancer patients.

Interventions

One of the initial steps was to allocate funds for the quality team. Securing funding for a quality team can be difficult within an organization with have multiple conflicting priorities. The demand for funds often surpasses available resources, especially when the financial benefits of a non-revenue generating team is unclear. By illustrating the team’s influence on cost-saving initiatives, such as reducing the length of stay and readmissions, leaders were able to allocate funding for 2 oncology nurse positions. Engaging a multidisciplinary team of physician leaders to collaborate with the quality team was another crucial element in constructing a high-standard structure to manage and steer change. Together they identified various quality measures and implemented quality improvement projects. Furthermore, the leaders assigned responsibility to this quality team to promote high standards and encourage a culture of continuous quality improvement across the entire cancer program.

Results

This team has led to multiple quality improvement initiatives that have improved the quality of care for our patients as well as decreased cost for the organization. Examples include establishing enhanced recovery protocols to decrease LOS, pathways to reduce admissions for multiple tumor sites and establish a system wide improvement to comply with CMS measures for admissions after outpatient chemotherapy.

Discussion

Since its inception, this team proven success and has grown from 3 to 7 members, including 5 oncology nurses and 2 data analysts The team has developed a robust quality platform that enables stakholders to monitor real-time data on various oncology-specific measures. They manage all oncology-related accreditations and lead multiple process improvements across the care continuum.

Oncology Nursing Forum. 2025 Mar 1;52(2):179–180.

P304. Best Practices for Protection from Hazardous Drug Excreta

Elizabeth Joy ¹, Alyssa Matra ²

Treatment Modalities and Managing Administration

Significance & Background

Hazardous Drugs (HD) include cancer treatments, bioengineered agents, antiviral and hormonal therapies. Exposure to HDs has been linked to adverse health effects including increased risk of cancers, organ damage, and reproductive harm. Approximately 8 million American healthcare workers are potentially exposed to HDs annually. After administration most HDs are excreted through sweat, urine, stool, saliva, emesis, vaginal secretions, and semen within 48 hours, and some may be present up to seven days. Protection from HDs through Personal Protective Equipment (PPE) is crucial for healthcare workers, patients, and caregivers to decrease exposure to these drugs.

Purpose

The focus was to identify the best protective measures for healthcare workers, patients, and caregivers when caring for HD-exposed individuals, specifically chemotherapy or biotherapy.

Interventions

A systematic search was conducted with a PICOT question and MeSH terms using PubMed, Scopus, Joanna Briggs, Cochrane, CINAHL, Embase, and Google Scholar. Filters included the last five years, human, peer-reviewed, and English, identifying 341 articles. Replicates were removed, critical appraisal performed, and 17 articles were reviewed.

Results

Synthesis of the evidence was performed, and recommendations were reviewed from organizations including the Oncology Nursing Society which aligns with the American Society of Clinical Oncology, the National Institute for Occupational Safety and Health, and the Occupational Safety and Health Administration. Safe handling of chemotherapy and biotherapy excreta was supported by numerous interventions, many of which our healthcare institution was already aligned with. Practice recommendations focused on the institution’s vulnerabilities including additional PPE when handling excreta, proper PPE disposal, toilet covers, and toileting practices like separate toilets, males sitting, double flushing and signage to create awareness for patients, caregivers, and healthcare personnel in areas HDs were administered. Patient education and policies regarding safe handling of HDs were updated to reflect these evidence-based practice recommendations.

Discussion

Limiting healthcare workers’ exposure to HDs is necessary to avoid health risks. Hospital policies and patient education need to align with the best available evidence, and updates need to be communicated across all departments. Effective use of signs creates awareness of the presence of HDs, and appropriate PPE use and disposal can decrease exposure risk. Also, toilet covers limit the aerosolization of HD biomatter during flushing. Incorporating these measures into practice can significantly improve healthcare workers’ safety and reduce health risks associated with handling hazardous excreta.

Oncology Nursing Forum. 2025 Mar 1;52(2):180–181.

P305. “Stop, Cover, Call, and Isolate”-Keeping Our Transporters Safe

Zaneta Juskowiak ¹, Anne Kolenic ², Jennifer Sullivan ³

Quality and Safety

Significance & Background

In a cancer hospital it is sometimes necessary to transport patients off the unit with hazardous drugs (HD) infusing. It is essential that staff who transport patients have skills to respond to a HD spill. Unlike nursing staff that receive routine HD training the transport department is often not trained or equipped to respond to HD spills. At our NCI-Designated Comprehensive Cancer Center a gap analysis identified communication and spill response deficiencies when patients are transported with HD infusions.

Purpose

The purpose of this quality initiative was to improve transporters’ knowledge and understanding of the action steps needed when an HD spill occurs.

Interventions

Individuals from nursing education and transport leadership met and identified the following gaps: lack of standardization regarding handoff between nurse and transporter, carrying a spill kit, and process of how to handle an HD spill. Educational content was developed, implemented, and included: process for patients going off the unit with HDs, new travel spill kits, infographics, and a handoff card. Content was presented to nursing and transport leadership and included a train-the-trainer session. Education for the transporters was completed by the transport educator and nursing unit education was completed through daily huddles by nurse educator. Transporter education focused on “stop, cover, call, and isolate” to help recall steps needed to take when a spill occurs.

Results

Staff on two units were trained through four staff huddles over two weeks. Participants included 20 nurses and four secretaries. Additionally, 96 transporters have been trained over three months. Upon completion of education, follow up discussion was conducted on both units and with transport leadership to identify progress and any further gaps. Both reported nurse to transport bedside handoff is occurring and that travel spill kits are being utilized. However, the nurse hand off card is not being utilized as they prefer Secure Chat through Epic for communication.

Discussion

Collaboration between nursing and transport leadership allowed for standardization and improved safety for staff that may come into contact with HDs. Identifying key stakeholders outside of nursing was imperative for the success of the training and implementation. It is important as nurses that we recognize other individuals within an institution that may be at risk for HD exposure and ensure that they are provided the necessary tools and processes to ensure their safety.

Oncology Nursing Forum. 2025 Mar 1;52(2):181.

P307. Bone Marrow Transplant Diet

Amy Kaiser ¹, Sally Hong ², Peter Scarperi ³

Quality and Safety

Significance & Background

Bone marrow transplants are widely used for a variety of conditions, including many cancers, to replace unhealthy marrow and promote the production of healthy blood cells. When a child undergoes chemotherapy conditioning prior to this procedure, they are at increased risk of infection. Therefore, their diet is heavily monitored to prevent risk of foodborne infections. Traditionally, children had to follow a strict regulatory diet that cut out many nutritious food options. This diet restricts food options for patients, many of whom already experience the challenge of eating with mucositis, nausea, and a lack of appetite. Furthermore, patients from diverse cultures face additional difficulty, as they often cannot eat home-cooked meals that may be more fitting for their appetites. Recent studies show that the traditional bone marrow transplant diet may not be necessary, and in fact may not have any benefit compared to a less restrictive diet.

Purpose

The purpose of this literature search was to find the best diet, compared to current practice, to influence infection rates in oncology patients undergoing a bone marrow transplant.

Interventions

A literature search was conducted using two databases: CINAHL and Cochrane. The inclusion criteria were within 10 years and English language. 5 total articles were evaluated.

Results

Each of the 5 articles compared a bone marrow transplant diet with a less restrictive diet. They all defined a bone marrow transplant slightly differently, illustrating the lack of standardized diets currently utilized at various institutions. All the outcomes (i.e. infection rates, mortality rates, quality of life, etc.) discussed were found to have a neutral effect with no significant difference.

Discussion

Overall, there is little to no evidence that a bone marrow transplant diet decreases infection rate. Therefore, the key is to focus on safe food handing per FDA guidelines rather than restricting certain foods through diet regulations. Some recommendations going forward are to move towards a less restrictive diet, to focus on safe food handling methods, and to conduct further research with a focus on pediatric BMT patients as the target population.

Footnotes

^*

This work was conducted by a student in the Flynn Fellowship program

Oncology Nursing Forum. 2025 Mar 1;52(2):181–182.

P306. The Importance of Sibling Relationships in Pediatric Oncology/Stem Cell Transplant Patients

Amy Kaiser ¹, Hanna Johnson ², Peter Scarperi ³

Psychosocial Dimensions of Care

Significance & Background

Sibling relationships hold a vital role in the emotional, psychological, and social wellbeing of Pediatric Oncology and Stem Cell transplant (SCT) patients, especially in inpatient settings. As children grapple with the intense physical and emotional burdens of a cancer diagnosis, their siblings often emerge as essential resources of emotional support, fostering a sense of normalcy and stability.

Purpose

This evidence-based practice project aimed to examine whether frequent sibling communication, as opposed to infrequent communication, enhances the quality of life and happiness of the ill child.

Interventions

A literature review using three articles in which qualitative interviews with siblings of children with cancer were conducted. Inclusion criteria were that the articles must be published after 2005 and be qualitative. Search terms included “Pediatric oncology”, “Sibling relationships”, and “Importance”.

Results

Research highlights that siblings desire to be actively involved in the care plan and daily routines of the patient, which can alleviate fears and promote a deeper sense of closeness. Siblings are closely intertwined and what affects one can also affect others living with the ill child. Furthermore, descriptive data suggest that siblings should be integrated into the child’s care team, as their involvement can be mutually beneficial. Doing this not only initiates therapeutic rapport with the patient but the sibling as well, creating a caring environment.

Discussion

Recognizing the significance of sibling relationships allows healthcare providers to deliver more holistic and family-centered care. Implementing programs such as the BEADS program can help create memories between siblings at special milestones in their cancer treatment. The BEADS program utilizes custom-made beads to represent milestones such as celebrating time with family for occasions like Make-A-Wish, recognizing sacrifices such as time spent away from parents/caregivers, and encouraging participation in sibling support programs. Siblings state that the standardization of including siblings in multidisciplinary team rounds and conversations is essential to their siblings’ care. Sibling relationships during a cancer diagnosis can provide emotional support, encouragement, motivation, role modeling and reduced isolation, offering a more holistic approach to cancer care.

Footnotes

^*

This work was conducted by a student in the Flynn Fellowship Program

Oncology Nursing Forum. 2025 Mar 1;52(2):182.

P308. Enhancing and Expanding the role of Nurse Practitioners in Ambulatory Palliative Care Within a Cancer Center

Neena Kapoor-Hintzen ¹, Shila Pandey ²

Healthcare Delivery

Significance & Background

Incorporation of specialty palliative care (PC) is recommended early in the disease course of patients with advanced cancer. With an aging population and advancing therapeutics, patients are living longer, increasing the demand for PC services. There is an ongoing shortage of PC specialists, exacerbated by the COVID-19 pandemic, for which nurse practitioners (NPs) have been identified as well suited to fill the gap. While there are established models for NPs in acute care settings, their roles and productivity in ambulatory PC are less explored.

Purpose

To describe the role of NPs in expanding specialty PC access for patients living with cancer and examine productivity of three types of NP-led PC clinic models.

Interventions

The adult PC team at this metropolitan, National Cancer Institute-designated cancer center includes inpatient and outpatient consultation services consisting of specialty trained physicians, NPs, nurses, chaplains, social workers, and pharmacist. Prior to 10/2015, ambulatory NPs conducted shared visits with physicians. With the goal of increasing patient access, organizational leadership supported NP-led clinics, allowing independent practice at the top of licensure. Between 10/2015–09/2024, the following NP-led clinic models were trialed: 1) embedded NP, no dedicated space or administrative/nursing support, 2) co-located NP with administrative support, 3) co-located NP with administrative and nursing support. Full-time employee (FTE) count, clinic sites, session (4-hour blocks) counts, and average annualized volume productivity were monitored.

Results

From 2015–2024, NP staffing increased from 1 FTE at 1 clinical site to 8 FTEs across 9 sites in 2 states. In model 1, 564 visits/NP/year were observed. In model 2, 649 visits/NP/year were observed (15% increase over model 1). In model 3, 1018 visits/NP/year were observed (80% increase over model 1, 57% increase over model 2). Year to date, NP-led clinics comprise 48/87 (55%) of clinic sessions and NPs are projected to see 6784/13144 (52%) of overall ambulatory PC visits for the organization in 2024.

Discussion

Expanding an ambulatory PC practice with co-located NP-led clinics is feasible and productivity is enhanced when resourced with administrative and nursing staff. Organizational leadership sponsorship is needed to support NPs functioning at the top of licensure. Palliative programs can strategically plan for growth by piloting various models, closely monitoring data, and composing a business plan to leaders. Additional data on patient reported measures may further the case for NP-led PC clinics.

Oncology Nursing Forum. 2025 Mar 1;52(2):182–183.

P309. Utilizing Wellness Retreats to Address the Psychosocial Needs of Young Patients Diagnosed With Breast Cancer

Cecilia Kasperick ¹, Carin Resseguie ², Pamela Johanson ³, Megan Chambers ⁴

Psychosocial Dimensions of Care

Significance & Background

Women diagnosed with breast cancer before age forty-five face unique challenges. Social isolation and lack of age-appropriate resources hinder young patients’ quality of life. Per the Centers for Disease Control, nine percent of patients are diagnosed with breast cancer under age forty-five. Oncology nurses recognized a gap between the psychosocial needs expressed by patients and the standard of care provided during medical appointments.

Purpose

The purpose of this quality improvement project was to create a safe space for young patients to socialize, support one another, receive age-appropriate resources, and enjoy evidence-based, wellness activities. The goal was to improve feelings of loneliness by twenty-five percent and feelings of being supported by twenty percent. Program impact would be measured by pre/post event evaluations.

Interventions

Twenty-five patients diagnosed with breast cancer before age forty-five were surveyed regarding their psychosocial needs and their interest in peer-to-peer support. Based on patient feedback, a five-hour wellness retreat was created. This nurse-led program included an icebreaker, keynote speaker, yoga, healthy lunch, and resource tables. Each activity addressed topics relevant to young survivors and provided time for patients to interact with peers and healthcare professionals. Gilead Sciences, Inc. helped to underwrite retreat expenses.

Results

Fifty-three patients took part in the program. A survey seeking perception of feeling less alone showed a fifty-five percent improvement after the retreat (see Box Plot). A thirty-nine percent improvement in feeling supported was also identified. The Wilcoxon signed-rank test found statistical significance (p=<0.001) for each measure. Themes found through the open-ended survey question included: community, support, connection, safety, and self-care.

Discussion

Nurse-led wellness retreats are an effective, age-appropriate intervention to address the psychosocial needs of young patients. Hosting the retreat off-site, in a non-clinical setting, fostered heart-felt sharing and relaxed the traditional patient/provider roles. This safe space allowed participants to release facades, laugh, cry, and learn from one another. Going forward, we will include patients in retreat planning and incorporate feedback from post-retreat evaluations. These steps will ensure program content stays relevant to the interests and concerns of young survivors. The event could benefit from increased multi-disciplinary participation and additional philanthropic funding. Wellness retreats have enhanced patient care and are an innovative contribution to oncology nursing practice.

Oncology Nursing Forum. 2025 Mar 1;52(2):183–184.

P310. Establishing an Outpatient CAR-T Therapy Program in an Infusion Center

Judy Kauffman ¹, Indumathy Varadarajan ², Brooke Henry ³, Adrienne Banavage ⁴, Kathlene DeGregory ⁵, Herring Blake ⁶

Healthcare Delivery

Significance & Background

Chimeric Antigen Receptor T-cell (CAR-T) therapy has emerged as a transformative treatment for patients with relapsed or refractory hematologic cancers, offering new hope to those who have not responded to conventional therapies. Traditionally, CAR-T therapy has been administered in an inpatient setting due to the risk of severe side effects, such as cytokine release syndrome (CRS) and neurotoxicity. The inpatient model presents challenges, including extended hospital stays, high costs, and limited capacity. Recent advances in toxicity management, early intervention strategies, and real-time monitoring have opened the door to administering CAR-T therapy in outpatient settings, offering improvements in patient outcomes.

Purpose

The purpose was to establish an outpatient CAR-T therapy program within a dedicated infusion center, aiming to reduce inpatient admissions, enhance patient comfort, and optimize healthcare resource utilization. The program sought to demonstrate the feasibility and safety of outpatient CAR-T therapy, while maintaining Foundation for the Accreditation of Cellular Therapy (FACT) standards of care and improving patient access to this life-saving treatment.

Interventions

■ Patient Selection Criteria: Developed stringent inclusion and exclusion criteria to ensure only patients with low-risk for severe CAR-T-related toxicities are treated in the outpatient setting.
■ Staff Training: Provided comprehensive training for the infusion center staff.
■ Real-Time Monitoring: Implemented continuous monitoring systems for patients receiving outpatient CAR-T therapy.
■ Emergency Protocols: Established rapid-response protocols with the emergency department.
■ Patient Education: Developed educational materials for patients and caregivers.
■ Data Collection: Collected data on patient outcomes and overall program efficiency.

Results

Initial findings indicate that outpatient CAR-T therapy is feasible for selected low-risk patients when supported by a robust monitoring and emergency response framework. Early data show a reduction in hospital admissions, with the majority of patients completing therapy without severe complications. Patients report increased satisfaction due to the ability to recover at home, while healthcare institutions benefit from reduced strain on inpatient resources and lower costs associated with prolonged hospital stays.

Discussion

By leveraging existing infusion center infrastructure, this outpatient program aims to deliver high-quality CAR-T therapy while prioritizing patient safety and comfort. The shift to outpatient care not only supports better patient outcomes and experiences but also positions the institution at the forefront of innovative, value-based oncology care. Further research is needed to expand the inclusion criteria to a broader population, and ongoing data collection will inform continuous improvements.

Oncology Nursing Forum. 2025 Mar 1;52(2):184.

P311. Bathing with Chlorhexidine Gluconate: Should Patients use Foam or Wipes?

Kristine Kauflin ¹, Susan Smith ², Angeline Thomas ³

Quality and Safety

Significance & Background

Many oncology inpatients face the risk of central line-associated bloodstream infections (CLABSIs) during their hospital stay, leading to increased morbidity, mortality, and cost. Daily chlorhexidine gluconate (CHG) bathing is an evidence-based practice which has been adopted by many hospitals to prevent CLABSIs. However, inconsistent CHG bathing leads to decreased efficacy.

Purpose

Our facility has a large population of oncology and immunosuppressed patients, where our policy is to bathe all ICU patients and all inpatients with a central line daily with CHG wipes. Adherence varies across units despite nursing attempts to increase CHG use with education and patient engagement. Nurses identified patient complaints about the stickiness of CHG wipes as one barrier that led to patient refusal to participate. This quality improvement project was implemented to determine the impact of CHG foam as a method of application on patient adherence.

Interventions

Four inpatient units with a high central line utilization rate, including ICU, stem cell transplant, surgical oncology, and pediatrics piloted CHG foam for 8 weeks. Nurses completed a satisfaction survey before and after the pilot and received online and in-person education about the use of the foam. During the intervention period, CHG wipes were removed from the unit and all patients were bathed daily with CHG foam. Unit champions reinforced education, identified barriers, and provided support to nurses during the pilot. Bathing compliance was measured weekly and provided to the nurse leaders and champions along with recommendations for improvement.

Results

The outcome measures of the project include CLABSI incidence, CHG adherence, cost, and nursing satisfaction. During the pilot there was one CLABSI reported on the transplant unit, unrelated to CHG use. The rate of CHG adherence increased on all units, most significantly on the pediatric unit (35%). Nurse satisfaction surveys demonstrated that two thirds of nurses found CHG foam to be an acceptable product. Overall, CHG foam was more cost-effective than CHG wipes.

Discussion

In conclusion, additional time is needed to determine the impact of CHG foam on CLABSI incidence and patients demonstrated increased adherence to CHG bathing during the pilot. Nurses noted that the foam takes longer to apply than CHG wipes but reported that foam was more efficient for patients using it in the shower. Ongoing monitoring of adherence and satisfaction will provide additional information to determine hospital practice.

Oncology Nursing Forum. 2025 Mar 1;52(2):184–185.

P312. Quality Sleep Beings with U!

Jasleen Kaur ¹, Stephanie Susilo ², Grace Kim ³, Viridiana Chavez ⁴

Patient Education

Significance & Background

Sleep duration and sleep quality are significantly affected in hospitalized patients. Evidence shows that sleep plays an important role in the health and recovery of patients. Interrupted or limited sleep can lead to poorer or delayed patient outcomes. One promising non-pharmacological approach to improve sleep outcomes is the utilization of white-noise machines.

Purpose

Multiple studies have been conducted regarding the utilization of white noise and its impact on the physiological and psychological well-being of acutely ill patients. White noise machines improve the quality of sleep in hospitalized patients by masking unwanted sounds and decreasing the audibility of background sounds, inducing relaxation and reducing stress. This study aims to test the practicability of introducing white noise machines and its effect on sleep quality.

Interventions

White noise applications on iPad machines were introduced to the unit and a survey was developed based on the Richards-Campbell Sleep questionnaire in order to monitor their effectiveness. Questionnaire was used to measure sleep depth, latency, awakenings, return to sleep, sleep quality and noise. Nurses were instructed to encourage the use of the white noise applications at nighttime and then follow up during daytime with the questionnaire to evaluate the impact white noise applications had on their sleep quality.

Results

Over the course of two months, 17 patient responses were recorded. Based on survey results, the use of white noise iPad applications proved promising but require further implementation to solidify their effectiveness.

Discussion

Various barriers were identified throughout the implementation of the study impeding short-term data collection and requiring extension of study beyond confines of initial implementation timeline. iPad availability, activation, and patient set-up along with iPad devices malfunctioning or not charged made it difficult to implement the intervention in clinical setting. Going forward, creating a workflow utilizing volunteers, secretaries, and Certified Nursing Assistant to assist patient with iPad set-up, activation, and education can be introduced to encourage data collection.

Oncology Nursing Forum. 2025 Mar 1;52(2):185.

P313. Chemotherapy Unlocked: Cross-Training Intermediate Care Center Nurses for Enhanced Care

Sabrina Keheley ¹, Georgina Shannon ²

Coordination of Care and Navigation

Significance & Background

In 2023 a cancer center opened using a new care model that brings the care to the patient. With the new structure, the infusion center no longer exists and the infusion team is divided across five Disease-Specific Care Communities on five different floors. With infusions spread across the building, it is challenging for leaders to fill in and support staff when spread amongst the building. The new cancer center features an Immediate Care Center (ICC). Patient volumes fluctuate. While ICC nurses may be available to assist infusion nurses, none were initially trained to be chemotherapy competent.

Purpose

To train ICC nurses in administering chemotherapy so they are equipped to support infusion nurses, while also enhancing their knowledge of caring for cancer patients who have received chemotherapy.

Interventions

To ensure that nurses are deemed chemotherapy competent, ICC nurses were paired with infusion nurses for several weeks of hands-on training. Additionally, ICC nurses attended Chemotherapy Basics class, the Oncology Resident’s Program, and took the Chemotherapy Immunotherapy course offered through ONS to further their education.

Results

Staff completed a one-question survey before and after the training, using a 1–4 scale, where one indicates low understanding and four indicates high understanding of chemotherapy administration. Before training, 37% of nurses reported a high understanding, while 12% indicated a low understanding. After the training, 75% of staff reported a high understanding of the chemotherapy process.

Discussion

Although training was effective, we learned that we had to individualize each nurses training experience. Additional classes and orientation sessions were added to ensure full competency, which resulted in a longer training period for some nurses. To Maintain Competency, ICC nurses rotate within the Care Communities during their scheduled shifts 1–2 times per month. They are required to maintain their chemotherapy immunotherapy certification and are included in all infusion education. This endeavor has reduced the need for management to cover staffing gaps, has increased the ICC Nurses competence in caring for cancer patients and has provided additional support for the infusion team.

Oncology Nursing Forum. 2025 Mar 1;52(2):185–186.

P314. An Oncology-Specific Outpatient Perioperative Department – What an Extended Recovery Unit (ERU) can offer Post Surgery

Heather O’Neal ¹, Justin Kelly ², Megan Hunter ³, Jennifer Snyder ⁴

Coordination of Care and Navigation

Significance & Background

There is an increased need for access to surgical oncology treatments and procedures in growing cities. Same-day surgery is offered for procedures that do not require monitoring for more than twenty-four hours. To meet this need, a state-of-the-art center was built where comprehensive cancer care is offered in one location for all patients, including the latest surgical treatments. Additionally, the perioperative department offers an extended recovery unit (ERU) which has successfully increased access to care and decreased inpatient admissions after surgery.

Purpose

To provide oncology specific post-surgical care, greater than three hours and less than twenty-four hours of total post-operative surgical care, for patients requiring a hysterectomy, mastectomy, total or partial thyroidectomy, total or partial nephrectomy, prostatectomy, cystoscopy, and other procedures.

Interventions

The ERU operates Monday-Friday, twenty-four hours per day, and Saturday until 7pm, staffed by five advanced practice providers, seventeen registered nurses, and four patient care associates. Nurses are trained in post anesthesia and extended recovery care and attend oncology-specific classes in breast, gynecological, and urological surgical procedures. Nurses complete sixteen weeks of orientation and float between the PACU and ERU. The nurse admitting an ERU patient reviews the anesthesia summary, medical history, home medications, and performs a head-to-toe assessment, including surgical site assessment. Nurses coordinate and collaborate care with the surgeon’s clinic, pharmacy, social work, physical therapy, chaplaincy, and home health. Post-procedure patients must meet all ordered milestones in less than twenty-four hours before being discharged home. Nurses also complete all discharge teaching with the patient and caregiver prior to being released. Daily, charge nurses also collaborate between departments to ensure successful outcomes for all patients. This new access point in care has identified gaps in care that ERU nurses have expertly navigated to assist patients throughout the full continuum of their oncology care.

Results

The ERU has cared for 1,241 patients since opening, which has decreased the number of cases in the main operating room by approximately 100 cases per month. These patients would have required inpatient admission but instead were discharged home. This has directly impacted patient care by providing a quicker turnaround time from diagnosis to surgical intervention.

Discussion

This oncology specific surgical ERU allows cancer patients to have complex surgery, safely recover post administration of anesthesia, and be discharged to heal in their own home.

Oncology Nursing Forum. 2025 Mar 1;52(2):186–187.

P316. Prevent the worst, PPE First! Improving Personal Protective Equipment (PPE) Adherence with the use of Education and Simulation in the Ambulatory Cancer Center

Caitriona Keyes ¹, Yocheved Weinreb ², Toby Bressler ³

Quality and Safety

Significance & Background

Healthcare workers (HCW) and nurses in the ambulatory infusion center (AIC) are at risk for exposure to hazardous drugs (HD). Policy aligned with USP800/ONS HD administration safety standards, includes the use of personal protective equipment (PPE) to minimize exposure to HDs. Gaps in adherence to this policy was noted in the AIC. Known barriers to PPE compliance and safe practice include, insufficient knowledge on the risks of exposure, lack of instruction in donning and doffing techniques, perception that PPE is uncomfortable and too time-consuming, lack of accountability, and adopted culture/habit on the unit.

Purpose

The project’s purpose was to increase understanding, compliance, and adherence to PPE policy and safety standards in the AIC.

Interventions

An informal observation was used to note rate of compliance in the use of PPE in the AIC. Nurses were subsequently surveyed using a Likert scale tool to assess gaps in knowledge regarding the importance and use of PPE per policy and ONS safe handling. A comprehensive education plan including a power point presentation and simulation, was implemented. The education intervention addressed the potential health risks associated with handling and exposure to HDs, reviewed the current national standards and institutional policy on safe handling, discussed common barriers to PPE usage, and identified common routes of exposure from recent swab testing results, showing widespread contamination in an AIC setting. The nurses participated in a PPE donning and doffing simulation with a focus on correct sequencing and discussed barriers to PPE adherence and plans to address these barriers. Another Likert scale survey measured gains in knowledge and intent to change practice.

Results

The results showed an increase in all participants’ (n=12) knowledge and 100% of participants intend changes to their current practice and increased PPE adherence.

Discussion

Increased adherence to proper use and implementation of PPE by those who handle HDs is vital to safety in an AIC and any noted gaps must be assessed and addressed swiftly. In this AIC, prior assessment informed focused and comprehensive education addressing the identified gaps in practice and knowledge regarding use of PPE in the AIC. There is opportunity for continuing assessment and annual re-education to maintain standards and include new staff. The expected outcome is for every nurse in the AIC to utilize PPE consistent with hospital policy and national safety guidelines.

Oncology Nursing Forum. 2025 Mar 1;52(2):187.

P315. After-Hours Answering Service for Critical Results

Liana Keyes ¹, Brianna Flanagan ²

Coordination of Care and Navigation

Significance & Background

The Oncology Extended Care Clinic (OECC) provides urgent and supportive care to oncology patients. The goal is to triage and treat patients to avoid the Emergency Department and unnecessary admissions. The OECC operates from 7am to 11pm, 7 days a week. Patients frequently evaluated in the OECC are those with concern for infection and these clinical workups often include blood cultures.

Purpose

To create an after-hours workflow for reporting of critical laboratory results, specifically positive blood cultures, for patients evaluated in the OECC and subsequently discharged home to expedite admission and initiation of antibiotics.

Interventions

The microbiology department had a process to call the OECC main line to report critical results. This number wasn’t monitored when the OECC is closed nor was it routed to an answering service. If microbiology personnel were unable to reach a provider they attempted to call various providers, for example, medicine hospitalists, night charge nurses on the medical oncology unit, the patient’s Primary Care Provider. These patients didn’t have appropriate follow up for positive blood cultures and weren’t contacted until 8+ hours after results and therefore experienced a significant delay in care. The OECC was added to the hospital’s answering service account and an escalation algorithm was created to route these calls to the on-call hematology fellow. The fellow then determines if the patient requires immediate admission or if they can safely be evaluated during clinic operating hours.

Results

In 12 months there were 7 patients evaluated in the OECC, discharged home, and had positive blood cultures result when the OECC was closed. In one specific example, a critical positive blood culture result was called in to the on-call medicine hospitalist at 0419. The patient wasn’t contacted until 0830 at which point they were readmitted to inpatient oncology for IV antibiotics, resulting in a delay of 4 hours in treating bacteremia. Post-intervention results will be collected through the end of the calendar year.

Discussion

Creating an after-hours answering service and critical results escalation workflow minimizes the risk that patients will experience a delay in care after being discharged home from the OECC. Timely initiation of antibiotics in the event of positive blood cultures minimizes morbidity and mortality for oncology patients. This process identified and closed a significant gap in care for oncology patients at risk for infection.

Oncology Nursing Forum. 2025 Mar 1;52(2):187–188.

P317. Strengthening Oncology Leadership: Implementation of a Nurse Manager Transition to Practice Program

Elisabeth King ¹, Christine Tarver ², Rita D’Aoust ³, Deborah Baker ⁴

Management

Significance & Background

Oncology nurse manager (NM) turnover results in loss of clinical expertise and operations that impact workforce conditions, including nursing retention and satisfaction, patient outcomes, adverse events, and costs. Hospitals rarely provide formal onboarding for new NMs, leading to decreased competence and decreased psychological empowerment.

Purpose

This quality improvement project aimed to evaluate the effectiveness of an on-demand web-based transition to practice (TTP) program in improving NM competency and psychological empowerment among new oncology leaders. An asynchronous program was chosen to give autonomy and flexibility to the NM while accommodating the demanding schedules of oncology leaders with the ultimate goal of making leadership development more accessible and impacting retention.

Interventions

A pretest-posttest design was used, targeting oncology NMs with less than 12 months in their roles. The program included 25 hours of online education over 12 weeks, focusing on key areas such as leadership identity, strategic thinking, financial stewardship, communication, and staff management. Competency was assessed using the validated American Organization for Nurse Leaders (AONL) competency tool, and psychological empowerment was measured with Spreitzer’s empowerment tool. Six NMs enrolled (37.5% of eligible participants), and five completed the program.

Results

Participant (n=5) assessments demonstrated statistically significant improvements in both competency and psychological empowerment. The mean pre-test competency score increased from 240 (SD = 86.42) to 348.8 (SD = 91.8) post-test (p = .043), while empowerment scores rose from 55.2 (SD = 3.42) to 61.8 (SD = 4.32) (p = .042). In evaluating individual participant scores, self-assessment demonstrated improvement in both tools, demonstrating the program’s impact.

Discussion

The study’s diverse sample, including participants of various races, genders, ages, and experience levels, adds to the generalizability of its findings. Additionally, the oncology-specific focus of this study is crucial, addressing the unique challenges of cancer care. Oncology NMs face specific challenges, such as managing emotional and physical care complexities associated with cancer treatment. Improving psychological empowerment is crucial, as it better equips new leaders to thrive in the highly demanding field of oncology. The results demonstrate that an asynchronous TTP program effectively supports oncology NMs by improving both competency and empowerment. Eight months post-completion, 80% of the NMs were retained, highlighting ongoing challenges in leadership retention.

Oncology Nursing Forum. 2025 Mar 1;52(2):188.

P318. Keeping Infusion Centers Afloat with the Implementation of an Infusion RN Float Pool

Elizabeth Klatt ¹, Jennifer Zwink ², Jennifer Zaccone ³, Shauna Parrish ⁴

Management

Significance & Background

Innovative strategies are needed to address the ongoing nursing shortage (Peters, 2023). After reviewing timecard data for each outpatient infusion center within a Metro Regional area, which includes a large academic medical center, an average of 7–10 un-met Registered Nurse (RN) needs per day was identified. To maximize each infusion centers’ scheduling template, an infusion float pool (FP) was created with the goal of ensuring adequate staffing to enhance patient safety.

Purpose

The purpose of this project was to design and maintain a float pool of specialty trained RNs to address unmet needs in outpatient infusion spaces within a Metro Regional area.

Interventions

Staffing data for each infusion center was reviewed to assist with understanding and forecasting RN needs. The initial goal was for FP to cover unplanned time off (i.e. sick calls), planned leaves of absence, and approximately 50% of pre-approved time off. Orientation for the FP RNs was designed to familiarize them with the workflows and nuances of six different infusion clinics housed both in the academic hospital and across the surrounding metropolitan area. In collaboration with Nurse Leaders and Infusion Educator, scope expectations of the float RNs were discussed to provide consistency. Recruitment initially focused on travel RNs to expediate implementation of the program. Permanent positions were added and filled, often by travel RNs wanting to stay in the position.

Results

Prior to the creation of the Infusion Float Pool, there was 1 FP RN supporting 3 outpatient infusion centers located in an academic medical center. Since May of 2022, the Infusion FP team now supports 8 Infusion Centers across a Metro Regional area. 29 infusion FP RNs have been hired; 20 of which were internal Travelers. This has been a strong recruitment tool as 50% of internal travelers have now converted to a permanent position within the team, leading to a team size of 16 currently. This allows the team to provide about 45 shifts of infusion coverage weekly.

Discussion

The float RN role is satisfying to both the nurses in the role and the RNs at the sites they support. The float RNs have been a catalyst for standardization and implementation of best practices across the infusion sites.

References

Peters M. Time to solve persistent, pernicious and widespread nursing workforce shortages. International Nursing Review. 2023;70:247–253. doi: 10.1111/inr.12837. [DOI] [PubMed] [Google Scholar]

Oncology Nursing Forum. 2025 Mar 1;52(2):188–189.

P319. Knowledge is Power: The Impact of a Pre-Transplant Nurse Education visit for BMT Patients and Caregivers

Sarah Kleier ¹, Hannah Huebner-Cain ², Jennifer Lynch ³, Caterina MacDonald ⁴

Patient Education

Significance & Background

At a large Comprehensive Cancer Center performing bone marrow transplants (BMT) (n= 410 in 2020) BMT nurses reviewed oncology clinical care and identified a gap in post pandemic practices. This gap existed in consistent comprehensive pre BMT procedure teaches for all hospital patients and outpatients. Patients reported feedback of a feeling of being unprepared for the full process of transplant.

Purpose

To provide a detailed outline of programmatic changes and results of a new standardized nurse led chemo teaches for all pre BMT patients and families.

Interventions

BMT front line staff, LPC, patient and family advisory council, and patient and staff education collaborated to identify gaps, to create new educational handouts, and to implement a new standardized education program. Autologous and allogenic BMT nurse teams piloted standardizing all patients to have a 60-minute nurse education visit within a week of conditioning. Content created includes schedule, conditioning regimen, stem cell infusion, transplant timeline, common and high-risk side effects and management, supportive/preventative medications, and expectations of an inpatient stay.

Results

Evaluation of education visit effectiveness were collected from patients and family members. A baseline survey was given prior to education to self-evaluate knowledge and then after completion of the nurse teaching visit. Respondents reported an improvement in knowledge as good or higher (100%, n= 20) The second survey in the post-transplant setting, to determine how helpful this education was in retrospect after completed the treatment. 92% (n=12) of respondents rated the chemo teach as “very helpful”.

Discussion

Nurses in BMT targeting all patients with standardized education has decreased treatment related anxiety by providing knowledge on what to expect symptom management, and reportable symptoms reinforced for assurance of best long term BMT patient outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):189.

P320. Strength in Community: Building Confidence and Connection in Stem Cell Transplant Patients and Caregivers Through Education

April Klingensmith ¹, Judy Kauffman ², Brooke Henry ³, Carly Grubbs ⁴, Rebecca Clements ⁵

Patient Education

Significance & Background

A stem cell transplant presents significant physical, emotional, and logistical challenges for patients and their caregivers. Comprehensive education is critical to ensure they are well-prepared to navigate the transplant process, manage post-transplant care, and mitigate potential complications. Most patients and caregivers feel alone in this process.

Purpose

Provide a structured in person education program tailored specifically for stem cell transplant patients and their caregivers to improve patient outcomes, enhance caregiver confidence, promote a holistic understanding of the transplant journey, and provide a time to connect with others experiencing the same process. The goal is to empower patients and caregivers with the knowledge and resources needed to confidently manage the complexities of stem cell transplantation, ultimately improving both short- and long-term outcomes for patients and enhancing caregiver engagement and support while promoting a feeling of connections with other along the same journey.

Interventions

All patients and their caregivers attend an in-person class. Key topics covered include pre-transplant preparation, the transplant procedure, potential risks and complications, post-transplant recovery, and long-term follow-up care. The class is delivered in a supportive, interactive format and combines lectures, printed materials, and real-time question-and-answer sessions with multidisciplinary healthcare professionals. Participants hear from specialists in nutrition, apheresis, physical therapy, and social work, as well as inpatient and outpatient nurses. Participants are provided the opportunity to share their story and exchange contact information with other participants to stay connected and offer support to each other.

Results

Patients submit a post-class evaluation and have reported decreased feelings of isolation and increased understanding of the stem cell transplant process. Caregivers have reported feeling empowered to take care of the patient and decreased feelings of isolation.

Discussion

The standardization of an in-person education class pre-transplant for the patient and caregiver has increased the confidence of the patient and decreased the anxiety of the journey ahead of them. The class has provided a support structure with other patients going through the same journey. Future efforts will focus on further refining the class based on feedback.

Oncology Nursing Forum. 2025 Mar 1;52(2):189–190.

P321. Improving Communication Between Inpatient and Outpatient Nursing for Multidisciplinary Clinical Trials

Amanda Kluxen ¹, Jennifer Hull ², Rachel Kim ³, Wu J Kim ⁴, Zoe Swainson ⁵, Brittany Butler ⁶

Coordination of Care and Navigation

Significance & Background

Communication traces back to the earliest forms of life and continues to evolve into the mosaic of languages, symbols, and digital media we use today. However, effective and efficient communication is still a challenge. In 2023, our team opened a trial introducing a novel investigational treatment, Tarlatamab, for small cell lung cancer (SCLC) patients requiring treatment in both the in- and outpatient setting. As a result, a framework was created to bridge the gap between these two departments’ communication.

Purpose

Clinical trials require elevated communication between departments. The first two cycles of our trial required multiple inpatient admissions for safe drug administration. Therefore, a focus on communication between inpatient and outpatient departments became critical.

Interventions

Our team developed workflows to strengthen communication at multiple study time points. One specific in-patient floor was designated for our research admissions; however, each patient had a different treating RN due to the 1:1 care ratio. Prior to treatment, inpatient nurses were in-serviced on Tarlatamab. In response to staff turnover and protocol amendments, repeat in-services were uploaded to a live document within a shared drive for nursing staff to access in real time for reference. To aid in keeping communication consistent, one Epic chat was created with all involved team members. Clear expectations for drug administration, as well as a documentation format, were shared with the treating RN in the form of SmartPhrases. A unique email hashtag was created to ensure all pertinent in- and outpatient team members were included in treatment conversations. Further, a weekly email between the research team, research administration and in-patient nursing management was utilized to communicate upcoming research admissions.

Results

These workflows streamlined efficient communication and supported patient safety and optimal outcomes. There was increased protocol compliance and decreased protocol deviations. Nursing staff was more comfortable and confident treating our research patients and had the ability to reach out in real time.

Discussion

The exchange of information between members of a collaborative healthcare system need to be consistent, concise and adaptable. Our research team was able to adjust communication methods and tools with a multi-disciplinary approach to support quality treatment options for our SCLC patients. We are seeing more trials needing inpatient care so these frameworks of communication perpetuate future needs of clinical trials.

Oncology Nursing Forum. 2025 Mar 1;52(2):190–191.

P322. Oncology Preceptor Workshop: Continuing Education to Increase Knowledge and Engagement

Lisa Kohanski ¹, Savannah Ciacchi ²

Management

Significance & Background

Oncology preceptors are integral to the successful onboarding of nurses new to the specialty. Structured preceptor programs have proven benefits. Furthermore, ongoing education and enduring support are essential to foster engagement. An oncology focused preceptor continuing education program is one tool to meet this need.

Purpose

The purpose of this project was to develop and evaluate a new Oncology Preceptor Workshop. The workshop provides dedicated class time for specialized guidance to help oncology preceptors in orienting nurses new to their unit. Evaluation of the program will help identify adjustments that can be made to the program and will determine if preceptors found the class useful to their practice.

Interventions

The project consisted of 2 phases. During the first phase in September 2023, a learning needs assessment that consisted of a topic list and learning style preferences was sent to 74 current RN preceptors. Twenty nine RNs responded. The most highly rated topics, which were incorporated into the workshop curriculum, included oncology onboarding processes and education expectations, internal and external resources, precepting nurses with varying experience levels and from different generations, and managing conflict. Most often, lecture, hands on experience, and discussion were the preferred learning styles. The second phase of the project consisted of an in-person 4-hour workshop held 3 times in November and December 2023 and a follow-up 30-minute virtual meeting 2 months after the workshop. Fifteen preceptors completed the workshop. Nursing educators taught the class using lecture, a hands on activity, gamification, videos, and case scenarios. The program was evaluated with use of 3 surveys at different time points: pre workshop, immediate post workshop, and after the 2-month virtual meeting. The surveys included questions about preceptors’ knowledge, confidence, and attitudes about serving as an oncology preceptor and satisfaction with the workshop.

Results

Post survey results demonstrated an increase in participants’ knowledge of resources and communication skills. The 2 month survey showed 81.8% of respondents used skills learned during the workshop in practice.

Discussion

Despite positive feedback, barriers such as time away from unit limited participation. Refinement of the 2024 workshop included a reduction of class time to 3 hours. Continuing to engage preceptors with education on this role and skills will not only improve the orientation experience for the orientee, but also promote the preceptors’ own professional development.

Oncology Nursing Forum. 2025 Mar 1;52(2):191.

P323. Family Cancer Resource Center: A Crucial Community Resource Center for Information, Emotional Support, and Resources, Upholding the ‘No One Fights Cancer Alone’ Philosophy”

Renjitha Kolambel ¹

Survivorship

Significance & Background

Family Cancer Resource Center (FCRC) was established with the mission to provide comprehensive support to individuals and families affected by cancer, regardless of their financial status or insurance coverage. In a landscape where cancer care often lacks holistic support services, FCRC stands out by offering free, accessible resources and emotional support to anyone in need. This aligns with the ‘No One Fights Cancer Alone’ philosophy, emphasizing the importance of community-driven support in the cancer journey.

Purpose

The purpose of this abstract is to highlight the critical role of the Family Cancer Resource Center FCRC in addressing gaps in cancer care through its resource and support services. It aims to demonstrate how dedicated cancer resource centers can enhance patient and caregiver experiences, strengthen community engagement, and improve overall support in oncology care.

Interventions

FCRC offers a wide range of services designed to support individuals affected by cancer, including patients, survivors, caregivers, and family members, regardless of their treatment location. Services provided include informational resources, emotional and spiritual support groups, cancer transition classes, art classes, low-impact aerobics, nutritional classes, counseling sessions, and many more. The center is staffed by a team of skilled professionals and dedicated volunteers who deliver personalized care and support, ensuring that no individual faces their cancer journey alone.

Results

The effectiveness of FCRC’s services is evaluated through patient and caregiver feedback, service utilization rates, and community outreach metrics. Regular surveys and feedback mechanisms assess the impact of the center’s interventions on patients’ emotional well-being and access to necessary resources. Data is also collected on the number of individuals served and the types of support most frequently utilized.

Discussion

The FCRC plays a vital role in the cancer care continuum by providing essential support and resources that address the holistic needs of patients and their families. Its commitment to the ‘No One Fights Cancer Alone’ philosophy has not only enhanced the quality of life for individuals facing cancer but also strengthened community resilience. The center’s model offers a valuable framework for other organizations aiming to provide comprehensive, compassionate cancer support services.

Oncology Nursing Forum. 2025 Mar 1;52(2):191–192.

P327. Enhancing Oncology Staff Education And Standardizing Practices Through a Centralized Online Resource Community

Renjitha Kolambel ¹

Management

Significance & Background

In the dynamic field of oncology, consistent and up-to-date staff education is crucial for safe patient care. Across the organization, variations in chemotherapy and biotherapy practices have underscored the need for standardized, accessible educational resources. Traditional printed materials often result in outdated information, leading to inconsistencies in care. A centralized, online Oncology Nursing Resource Community page addresses these challenges by offering a unified platform for education and quick reference guides.

Purpose

The purpose of this community page is to streamline oncology staff education across the multiple campuses, providing access to chemotherapy classes, oncology-related training, and educational materials. The page aims to standardize chemotherapy and biotherapy practices by offering current guidelines, competencies, and skill validation resources, ensuring all staff adhere to the same high standards.

Interventions

The Oncology Nursing Resource Community page is an online hub accessible to all employees with their institutional login. It centralizes educational resources, including Power Points, course materials, and reference guides on chemotherapy and biotherapy. The page also provides information on required training, competencies, skill validation, PPE, and signage. Real-time updates ensure staff accesses the latest information, reducing the need for printed materials.

Results

The effectiveness of the page will be evaluated by monitoring staff engagement through metrics like page views downloads, and time spent on the site. Feedback will be collected to assess its impact on educational needs and practice standardization across campuses.

Discussion

The Oncology Nursing Resource Community page is a key initiative in enhancing and standardizing oncology education at the organization. By offering a centralized, up-to-date platform, it improves staff competencies, reduces reliance on printed materials, and supports higher quality patient care. This community page exemplifies the integration of technology into healthcare education, promoting continuous learning and professional development.

Oncology Nursing Forum. 2025 Mar 1;52(2):192.

P324. Revolutionizing Outpatient Cancer Care: 24/7 Symptom Management and Home-Based Support

Renjitha Kolambel ¹

Healthcare Delivery

Significance & Background

The growing complexity of cancer care necessitates innovative approaches to ensure patients receive timely, high-quality care. Unplanned clinic visits, avoidable emergency department (ED) visits, and hospital admissions contribute to increased healthcare costs and patient burden. The Virtual Symptom Management Project is a patient-centered, tech-enabled clinical service designed to extend the reach of traditional healthcare by offering coordinated, high-quality cancer care at home. This program collaborates closely with our health system to enhance outpatient care for cancer patients through proactive symptom management and continuous patient engagement, reducing the strain on healthcare providers and improving patient outcomes.

Purpose

The primary purpose of this initiative is to improve the outpatient quality of care for cancer patients by providing 24/7 access to symptom management through Virtual Care. This collaboration aims to reduce phone calls to providers, minimize unplanned clinic visits, and prevent avoidable ED visits and hospital admissions/readmissions. By integrating virtual care tech-enabled services, the project seeks to offer a seamless continuum of care that extends from virtual support to in-home care.

Interventions

Virtual care is staffed by experienced, certified oncology Advanced Practice Providers (APPs) and Registered Nurses (RNs) who use evidence-based clinical guidelines to provide supportive care. The intervention includes continuous patient engagement via two-way text messaging, phone calls, video visits, and coordinated in-home care. An AI-driven, oncology-specific chatbot offers patients additional support through text messaging. Patients can call virtual care to speak directly with a clinician about their symptoms, while virtual care clinicians can initiate video visits for clinical assessments and patient education. For more complex needs, virtual care partners with a mobile health service to deliver in-home care, ensuring a smooth transition from virtual to in-person care or directing patients to appropriate care based on their needs.

Results

The effectiveness of this collaborative approach will be evaluated by tracking reductions in phone calls to providers, unplanned clinic visits, avoidable ED visits, and hospital admissions/readmissions. Additionally, patient feedback, symptom management outcomes, and overall satisfaction will be continuously monitored to assess the intervention’s impact.

Discussion

Early results indicate that the virtual care model significantly enhances patient engagement and satisfaction while reducing the burden on healthcare facilities.

Oncology Nursing Forum. 2025 Mar 1;52(2):192–193.

P325. Expediting Breast Cancer Surgery within 60 Days to Improve Outcomes and Enhance Patient Experience for Stage I–III Without Neoadjuvant Therapy

Renjitha Kolambel ¹

Coordination of Care and Navigation

Significance & Background

Timely surgical intervention for patients with breast cancer is critical for improving patient outcomes and overall survival. Many contributing factors can often cause delays in care. According to the American College of Surgeons, as defined by the Quality-of-Care Measures, for patients with AJCC Clinical Stage I–III breast cancer in a non-neoadjuvant setting, expediting surgery in less than 60days from diagnosis is essential for optimizing care and also alleviating the emotional burden of waiting. This evidence-based measure is based on best practice, and identifying and addressing these delays is crucial for improving patient outcomes and experience and streamlining healthcare delivery.

Purpose

This initiative aims to reduce the time from a positive breast cancer biopsy to surgery within 60 days for Stage I–III patients without neoadjuvant treatment. The program focuses on identifying and overcoming scheduling limitations, diagnostic testing delays, and communication issues to ensure efficient, timely care.

Interventions

To achieve timely surgery for patients with breast cancer, several key strategies were implemented. These included streamlining imaging access by advocating for the prioritization of MRI imaging and biopsy turnaround times to ensure prompt diagnosis. Communication channels between physicians and specialists were improved, with timely result notifications to reduce delays in decision-making. Collaborations with ordering physicians expedited referrals and approvals, effectively addressing external obstacles. Resource allocation was optimized, and emotional support resources were provided to patients, ensuring they were well-informed and involved in decision-making. A critical factor in reducing the average time from breast biopsy to surgery was the collaboration between the navigation teams, imaging department, referring physician, and breast surgeons. Breast Nurse Navigators developed tracking methods and escalation pathways to remove barriers to care, providing patients with access to timely surgical intervention. Patient education was also developed and provided to empower patients to be active members of their care.

Results

By implementing these recommendations, our breast cancer centers across the healthcare system have significantly reduced days-to-surgery scheduling delays and improved care coordination, leading to faster diagnosis-to-surgery timelines.

Discussion

Expediting breast cancer surgery within 60 days offers multiple benefits, including improved overall survival, reduced anxiety, and better resource utilization

Oncology Nursing Forum. 2025 Mar 1;52(2):193–194.

P326. Optimizing Cancer Care: A Comprehensive Oncology Nurse Navigation Program To Streamline Patient Journeys and Remove Barriers to Deliver Exceptional Care

Renjitha Kolambel ¹

Management

Significance & Background

Background/Significance

Cancer care is complex and often fragmented, leading to delays in diagnosis, treatment, and overall care. Oncology nurse navigation programs play a critical role in guiding patients through the healthcare system, removing barriers to care, and ensuring timely access to treatment. The development of a centralized Oncology Nurse Navigation (ONN) team, with standardized training and resources, aims to optimize communication and collaboration between providers and the multidisciplinary team, ultimately enhancing patient outcomes and streamlining the patient journey.

Purpose

This initiative focuses on a centralized ONN team, well trained in oncology navigation. The team is tasked with eliminating care barriers through collaboration with providers and active participation in multidisciplinary tumor boards. Their role includes improving care coordination, patient advocacy, and contributing to quality improvement initiatives, ultimately aiming to enhance patient outcomes and the overall quality of care.

Interventions

The ONN team undergoes a comprehensive didactic orientation and training program tailored specifically to oncology navigation. They are equipped with tools and resources to identify and remove barriers to care, such as addressing gaps in communication, financial challenges, and social determinants of health. The ONN team works closely with providers, participates in tumor boards, and collaborates with the multidisciplinary team to ensure timely and efficient communication, patient-centered decision-making and seamless transitions of care. Additionally, they are involved in evidence-based practice (EBP) and quality improvement (QI) projects aimed at streamlining processes, improving care coordination, and enhancing patient satisfaction. The ONN team also participates in community outreach programs, raising awareness of cancer prevention, screening, and community health resources.

Results

The ONN team’s implementation has improved provider communication, reduced delays in care, and enhanced patient navigation. Their involvement in tumor boards has resulted in more personalized treatment plans, and community outreach efforts have increased cancer prevention awareness and screening participation. Our patient experience survey, specific to the ONN team, shows a Net Promoter Score (NPS) above 96%, indicating the team’s effectiveness in improving patient satisfaction and care delivery.

Discussion

Through multidisciplinary collaboration, quality improvement efforts, and community outreach, the ONN team enhances care coordination and plays a critical role in cancer prevention and early detection. Their high NPS score reflects the ONN team’s positive impact on patient experiences and their essential role in comprehensive cancer care.

Oncology Nursing Forum. 2025 Mar 1;52(2):194.

P328. Transforming the Culture of Hemodialysis Catheter Care among Oncology Nurses through Education within the Enterprise

Elizabeth Kong ¹, Mariea Casas ²

Treatment Modalities and Managing Administration

Significance & Background

Kidney failure is a common comorbidity afflicting our oncology patients requiring intermittent hemodialysis (HD) or continuous kidney replacement therapy (CKRT). Chronic HD patients often present with an arteriovenous fistula (AVF) or an arteriovenous graft (AVG), managed entirely by the HD registered nurses (RNs). However, in-patient HD catheter use as the primary vascular access was 59% in 2022 and 62% in 2023. The HD catheter is a dedicated large-bore central venous catheter (CVC) that all RNs can manage. Nevertheless, our novice to expert RNs expressed apprehension providing routine HD catheter care.

Purpose

Summarizing the multiprong educational approach implemented to address knowledge gaps for newly hired and existing RNs and Clinical Nurse Specialists (CNS) caring for patients with HD catheters. Didactic and hands-on instructions include dressing changes, exchanging the 4% sodium citrate locking solution, blood culture collection from a HD catheter, and utilizing the HD catheter for emergency resuscitation were reviewed.

Interventions

The HD RNs reviewed requests for help and developed a comprehensive HD catheter care module which is integrated into the monthly Department of Nursing Orientation (DNO) onboarding sessions via videoconferencing, reaching an average of 46 newly hired RNs In-person hands-on presentations were organized for the Nursing Professional Development (NPD), the CNS, and the Vascular Access Teams (VATS) cohorts to enhance education, support, and resources for the nursing staff on in-patient and outpatient wards. The HD catheter policy was updated with images and step-by-step instructions supported by our in-house video for real-time instruction.

Results

Evaluation of the educational and policy driven initiatives demonstrated significant improvements with routine HD catheter care. Outcomes indicated timely HD catheter dressing changes and locking solution exchanges by RNs maintaining the HD catheters when not used for HD or CKRT. Blood culture collection and appropriate use of the locking solution post culture collection was identified as a successful change. A notable decrease in calls for assistance from the HD RNs is attributed to greater support by the CNS and VATS cohort on the wards with enhanced utilization of the updated HD catheter policy to provide clinical guidance and reeducation to our nursing staff.

Discussion

Our educational initiatives resulted in changing the culture of past practice providing care for the HD catheter. Continued monthly DNO presentations and support from the CNS team on the individual wards, will standardize nursing practice.

Oncology Nursing Forum. 2025 Mar 1;52(2):194–195.

P329. Strides for Strength: Increasing Physical Activity During Hospitalization for Hematopoietic Cell Transplantation

Cassidy Kotobalavu ¹, Shannon Bethel ², Haley Midgley ³, Rachael Carlson ⁴, Brett Fechter ⁵, Jennifer Jones ⁶

Quality and Safety

Significance & Background

While hematopoietic cell transplantation (HCT) is a potentially curative treatment for many patients facing hematologic cancers, it is also a complex and challenging modality that can lead to declines in physical activity, mental state, and quality of life (Kolke, 2019). As time progresses throughout the acute post-transplant period, symptom severity only increases as quality of life decreases. A hallmark symptom of HCT is severe fatigue, which may last for years following treatment (Hacker, 2017), and the Oncology Nursing Society (ONS) has recognized physical exercise as its only evidence-based recommendation for cancer-related fatigue (Mitchell, 2014).

Purpose

The nursing staff on an inpatient unit that cares primarily for hematopoietic cell transplantation patients at an academic cancer institute recognized the need for an intervention to increase physical activity for their patients. The “Strides for Strength” program was created, in collaboration with physical therapy, to inspire patients to stay motivated to move and achieve their daily activities throughout their hospitalization. Strides for Strength features a self-tracking exercise program that aims to improve patient outcomes and decrease transplant complications associated with low physical activity, anxiety, depression and other HCT-associated side effects.

Interventions

All patients are given the option of participating in the Strides for Strength program upon admission. Education is provided on the physical and mental health benefits of exercise, including increased energy, improved sleep, strengthened immune system, and potentially reduced length of stay. By ambulating in the hallways, patients self-track their laps and mark off completed miles as they go. Patients can achieve either a Half Marathon or Marathon, and awards are given out for completion. Community members donated medals from local races that are given out to patients as a symbol of support. Staff gather at the finish line for every patient that completes the program to celebrate the accomplishment.

Results

The Strides for Strength program has been successfully adopted by the unit, and has been overwhelmingly popular among patients, with over 87% of new patients choosing to participate since implementation. Adaptations to the program have been made for patients with physical limitations to foster inclusion.

Discussion

The Strides for Strength program aims to encourage hematopoietic cell transplantation patients in increasing physical activity while improving patient outcomes. Patient participation continues to be evaluated, and clinical outcomes continue to be monitored and analyzed.

Oncology Nursing Forum. 2025 Mar 1;52(2):195.

P330. Boosting ICU Nurse Proficiency: Specialized Training for Rare High Acuity Procedures

Elzbieta Kowalski ¹, Jenna Booth ²

Management

Significance & Background

Competency maintenance for critical care nurses (CCNs) who deliver direct patient care in an eight-bed intensive care unit (ICU) within a comprehensive cancer center patients presents ongoing challenges. In addition to routinely performed procedures encountered by the nurses, the low frequency procedures can cause intense levels of discomfort associated with performing specialized procedures. In a small ICU, with less nurses working the same shift, it is difficult to obtain the necessary peer support that the nurses require. A lack of confidence pertaining to competency assessment can attribute to burnout and subsequent resignation from their nursing position. The clinical manager and clinical practice lead launched a survey for nurses to conduct a competency self-assessment in performing various specialized procedures.

Purpose

The goals of this initiative were to organize and implement annual hands-on ICU-specific skills sessions for all ICU nurses. This rationale for this strategy was to assist the nurses to attain acquisition and maintenance of high acuity and low frequency skills for certain procedures. By driving nurse confidence, related to clinical competence, there was a reduction in nurse turnover in the ICU.

Interventions

An ICU skills assessment survey afforded nurses an anonymous platform to self-assess their level of comfort performing ICU procedures. Using a 7-point Likert scale, the results of the survey identified twelve procedures that nurses determined to be their lowest comfort level to perform. A combination of didactic and hands-on instructional skills sessions, comprised of eight-hour classes, promoted skill reinforcement.

Results

Just one year prior to this initiative, the ICU nurse vacancy rate was 65%. After specialized skills implementation, the 2024 vacancy rate was reduced to 26%. Post-skills session evaluations were remarkably favorable. The nurse respondents shared that the hands-on training was valuable to their nursing practice and appreciated. They expressed a desire for ongoing annual training. Due to the success of this strategy, the classes are included in orientation for all newly hired critical care nurses.

Discussion

The ICU-specific skills session improved the comfort level among the nurses performing the high acuity and low frequency procedures. Although uncertainty related to those high acuity and low frequency procedures is not the sole reason for resulting in a reduction in the nursing turnover, the team understands it contributed to a higher level of nurse job satisfaction and, ultimately patient safety.

Oncology Nursing Forum. 2025 Mar 1;52(2):195–196.

P331. Assessing Oncology Nurses’ Perceived Difficulties in Providing Palliative Care to Adult Oncology Patients

Caroline Kozek ¹

Symptom Management and Palliative Care

Significance & Background

There will be more than 22.1 million cancer survivors in the United States by 2030. As the population of oncology patients increases, more healthcare personnel will be needed to provide palliative care. Palliative care nursing training varies widely in quality across the United States. Significant barriers oncology nurses experience while providing palliative care: lack of time, poor communication, and lack of knowledge.

Purpose

Oncology nurses provide palliative care to a large population of patients, but their role in providing palliative care is often uncertain. Researchers have shown that oncology nurses struggle with professional autonomy in their role. They have also identified several barriers oncology nurses experience while providing palliative care: lack of support, lack of time, and poor communication. The purpose of this quality improvement project was to assess and measure oncology nurses’ perceived difficulties in providing palliative care for adult oncology patients.

Interventions

A quality improvement study design was implemented, utilizing five informational palliative care sessions with in-patient oncology nurses. The sessions included the discussion of palliative care nursing practice, challenges in palliative care, as well as palliative care case studies. A demographic survey and The Nurses’ Difficulties Scale for Dying Patients and Their Families (NDD) scale were distributed to each participant via REDCap (an electronic survey software) at three separate time points to assess for a change in perceived difficulties.

Results

A total of 17 participants attended an informational session and completed the surveys from all three time points. The results of this project indicated that the informational session had a positive, long-term effect on oncology nurses’ perceived difficulties in providing palliative care to adult oncology patients. Specifically, it was shown that compared to the pre-informational session, oncology nurses reported a statistically significant improvement 4 to 6 weeks post-informational session in symptom management, communication with the healthcare team, communication with family, and grief management.

Discussion

A brief informational session about palliative care reduced oncology nurses’ perceived difficulties and improved their level of comfort in symptom management, communication with the healthcare team and family, and grief management. Potential implications of this project in nursing include the addition of palliative care training methods and skills courses for nurses. These efforts may also reflect an improvement in the quality of palliative care provided to oncology patients as well as patient/family satisfaction with communication.

Oncology Nursing Forum. 2025 Mar 1;52(2):196–197.

P332. Developing an Infusion Clinical Trials Unit Nurse Residency for a New Graduate

Makena Kraft ¹, Kimberly Ito ², Eileen An ³, Tate Weeks ⁴

Management

Significance & Background

The outpatient infusion oncology Clinical Trials Unit (CTU) at an NCI-designated comprehensive cancer center delivers cutting-edge care for patients enrolled in phase one trials. Traditionally, only experienced nurses staffed this specialty unit due to complexities in research. A challenge to this practice was identified when a motivated new-graduate nurse resident with a keen passion in clinical trials interviewed for a residency position.

Purpose

To develop and implement a pilot program for a CTU nurse residency program.

Interventions

Leadership reevaluated the exclusion of new graduate resident nurses from the CTU and in collaboration with the Education department, nurse preceptors, and charge nurses, a pilot program for a CTU Nursing Residency was developed. The nurse resident gained foundational skills by completing a shortened version of the standard infusion nurse residency. A seven-week CTU specialty training plan was initiated. CTU leadership and preceptors set weekly goals for the resident, which were documented in a detailed grid. This process aligned preceptors and the resident by setting a realistic trajectory for growth. Primary CTU residency goals focused on clinical tasks and skills acquisition. Understanding research, clinical trials, and unique investigational agents were later objectives. Cultivating a sense of consistent inquiry was achieved by daily focused explorations of oncology-related topics. Weekly check-ins were scheduled with leadership, preceptors, and the resident. These allowed for ongoing adjustments to meet the resident’s evolving needs.

Results

Weekly reflective journaling and meetings with preceptors aligned the transition to practices of research, clinical skills acquisition, and critical thinking. The resident’s evaluations reported high satisfaction with the training and by the completion, they transitioned successfully to manage a full patient assignment. Nurse preceptors noted the CTU residency training built confidence, competency, and critical thinking, as well as a comprehensive understanding of the nuances of clinical trials.

Discussion

Little is published on the success of new graduate nurse residency programs in research settings. This pilot demonstrates success in the transition of a resident in a CTU research setting. The intentional commitment and effort of all staff supported the success. Initial external skepticism of instituting the CTU nurse residency was mitigated through ongoing engagement and the resident’s successful transition. The resident’s practice of ongoing inquiry established in residency continues to contribute to their transition as an independent clinical trials oncology nurse.

Oncology Nursing Forum. 2025 Mar 1;52(2):197.

P333. A Unit-Based Initiative to Support New Graduate Oncology Nurses in the Acute Care Setting

Grace Kronenberg ¹, Lamonte Bullock ²

Management

Significance & Background With the ongoing nursing shortage, retaining nurses within the acute care setting is crucial. At this NCI-designated Cancer Center, the clinical coach role emerged as a response to the evolving demands of acute care nursing on a GI Medical Oncology Unit. The role provides individualized support, promotes professional growth, and fosters a culture of continuous learning. The role was designed to increase nurse retention/satisfaction, address the complexities of caring for patients in the oncology setting, bridge the gap between practice and theory, and improve patient safety and outcomes.

Purpose

This abstract discusses the effectiveness of a unit-based resource nurse dedicated to helping support the new graduate nurse in essential first-time nursing skill development and improve the new graduate nursing experience.

Interventions

This unit-based clinical coach role was created to mentor and support nurses within the first year of practice. This role is staffed on days/nights when there are 30% or more new graduate nurses scheduled for the shift. This role does not have a patient assignment to help assist nurses with critical thinking, multidisciplinary communication, first-time skills, and time management. When time allowed, this role conducted just-in-time education based on various topics to assist with education needs. The clinical coach role is not a preceptor role. Unlike a preceptor, who is responsible for teaching foundational skills and directly overseeing the transition of a new nurse during their orientation, a clinical coach focuses on supporting further skill development after the nurse has completed orientation.

Results

The role’s implementation was assessed using the Casey-Fink Graduate Nurse Experience Survey at various stages: pre-implementation, 3-months, and 6-months post-implementation, with these surveys successfully collected. The results indicated an increase in role confidence, managing patient care, support, role satisfaction, resilience, and skills in both 3-months and 6-months.

Discussion

Retaining new graduate nurses in the acute care setting remains crucial. There remains a need for additional support to the new graduate nurse in the oncology setting due to gaps in nursing school education and complexity of the oncology specialty. Interventions aimed to provide unit-based support to these new graduate nurses are targeted to increase retention, provide individualized support, promote professional growth, and foster a culture of continuous learning. Clinical coaches could be a necessary support strategy in ensuring the delivery of safe, effective, and compassionate patient care.

Oncology Nursing Forum. 2025 Mar 1;52(2):197–198.

P334. Escaping Classroom Learning: A Novel Approach for New Graduate Oncology Nurses and Preceptors

Anna Kuszaj ¹, Jordan Crompton ², Vanessa Jovellanos ³

Professional Development

Significance & Background

As healthcare evolves, innovative teaching methods are crucial for preparing new graduate oncology nurses to address complex patient needs. The COVID-19 pandemic has left many new nurses struggling with clinical transitions due to insufficient experience and decision-making skills. Concurrently, senior nurses are experiencing burnout, making traditional learning methods less effective. Most preceptors and new graduate nurses belong to the Millennial and Generation Z demographics, who value instant gratification, active engagement, and multimodal learning. Escape rooms offer an interactive approach that fosters critical thinking, teamwork, and effective communication under pressure. These engaging experiences enhance collaboration, strengthen relationships, and provide opportunities for debriefing and reflection, ultimately helping new nurses transition more smoothly into clinical practice.

Purpose

The goal is to develop an engaging escape room experience for new graduate nurses and their preceptors. This innovative activity will promote active learning, enhance teamwork under pressure, and strengthen the preceptor-nurse relationship. By fostering collaboration, boosting confidence, and encouraging reflection, this initiative will facilitate a smoother transition into clinical practice, ultimately improving patient care outcomes.

Interventions

Participants, comprising new graduate oncology nurses and their preceptors, will engage in scenarios that simulate real-life oncology challenges, such as patient care dilemmas, critical thinking skills, and interprofessional collaboration. Using various games and puzzles, each escape room will be tailored to address key competencies in oncology nursing, integrating evidence-based practices and ethical considerations.

Results

We anticipate that incorporating escape room learning into the new graduate nursing orientation will facilitate a smoother transition to clinical practice by enhancing critical thinking skills and effective communication. To measure success, we will analyze pre- and post-surveys to assess improvements in knowledge retention, skill competency, teamwork, and confidence in caring for our oncology population.

Discussion

Escape rooms not only stimulate a deeper understanding of oncology concepts but also strengthen the preceptor-nurse relationship, promoting mentorship and support. Through debriefing sessions, participants will reflect on their experiences, reinforcing lessons learned and enhancing their confidence in clinical practice. The anticipated outcomes include improved clinical readiness, enhanced communication skills, and a greater sense of community within oncology nursing teams. This innovative approach offers a compelling framework for preparing the next generation of oncology nurses, ultimately contributing to improved patient care and outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):198.

P335. Re-Imagining Chemotherapy Revalidation Utilizing Front Line Experts

Karla Lambson ¹, Cindy Bohlin ², Kerri Dalton ³

Management

Significance & Background

Annual nursing revalidation content should be value-added to the nurse and help to reinforce standardized practice and policies. In previous years, chemotherapy revalidation was not standardized across 6 outpatient sites within the organization. Content, format and requirements varied with each site. In addition, the oncology float pool (FP) infusion nurses completed chemotherapy revalidation independent of the primary oncology infusion team. This led to inconsistencies in nursing requirements and practice across the healthcare system.

Purpose

This project aimed to standardize the format and content of chemotherapy revalidation at 2 of the 6 sites and to incorporate the FP nurses in infusion revalidation to increase uniformity in nursing practice.

Interventions

The Clinical Nurse Specialist (CNS), educator, and program manager collaborated to write chemotherapy administration and safe handling objectives. An instructor-led competency station using a case study format was created, including a station guide for instructors and participants. A written test and policy guide were supplied. Participants completed this before attending the in-person station. A group of experienced infusion nurses were oriented to the role of instructor, the new format, and content. Instructors led participants in a 1:1 simulated setting starting from chart review to completion of chemotherapy administration. Collaboration occurred with FP leadership and FP nurses completed revalidation with the infusion revalidation instructors. The standardized revalidation content was shared with non-oncology infusion clinic leadership.

Results

Revalidation instructors and infusion nurses provided positive feedback on the new format. 2 out of 5 revalidation instructors were able to use this work as part of their career ladder advancement. Historically, at two of the infusion sites, the infusion CNS completed chemotherapy administration revalidation using direct observation during patient care. It is estimated that over 30 hours were saved by empowering the front-line nurses to revalidate their peers.

Discussion

Phase 1 of project was proof of concept and in phase 2, 5 of the 6 sites will participate in the standardized revalidation content. In collaboration with all sites, additional areas needing standardized work in every day practice were identified. Continued engagement with infusion nurses and their professional practice have been observed since making revalidation changes. Overall, standardizing the revalidation practice improved consistency and quality of chemotherapy administration from one nurse to another.

Oncology Nursing Forum. 2025 Mar 1;52(2):198–199.

P336. Looking Beyond the Unit Needs-Development of a Hybrid Staffing Model

Courtney Lamontagne ¹, Benjamin Blackburn ², Karla Lambson ³

Management

Significance & Background

Historically, oncology nurses work solely in ambulatory or inpatient settings. Little growth opportunities exist for nurses who, as they gain experience in a particular area of oncology nursing, shift competence from novice to expert. Most often, nurses transfer units, obtain advanced degrees, or go into leadership roles which create an experience complexity gap in patient care delivery. With increasing needs to provide complex care, reduce staff burn out, and support staff work-life balance, our facility identified the need to foster implementation of a unique staffing model.

Purpose

Pilot a newly created hybrid position shared between inpatient medical oncology and outpatient infusion center aiming to enhance the patient experience through facilitation of nurses’ professional experience opportunities. A secondary purpose was to reduce staff burnout and increase retention efforts to meet nurses’ work-life needs.

Interventions

The position was developed through listing to staff discussions regarding potential retention efforts, reflecting a split-funded full-time employee (FTE). Units with greatest demand were inpatient medical oncology and ambulatory infusion. As the infusion center had greater staffing needs, the position was allocated to 2, 10-hour shifts in infusion and 1, 12-hour shift in medical oncology per week. Further, the infusion center leadership would be the primary supervisor of this FTE. As a pilot, the first hire was required to have both inpatient medical oncology and ambulatory infusion experience. The first FTE was hired into the role with orientation providing competency-based needs over a 6-week timeframe.

Results

As many patients are seen in the ambulatory infusion area and inpatient setting for different needs throughout their treatment and disease, the new role has fostered ongoing relationships with patients which has improved continuity of care and prevention of complications. In addition, the nurse piloting the position has expressed tremendous professional growth, reduction in burnout, increased well-being, and their own intent to stay.

Discussion

This pilot position has been successful with many observed benefits to both patients and nursing. The expanded oncology nursing experience of caring for patients across different settings enhances their skillset, education, and knowledge of the patient experience. As promoting wellbeing and reducing nurse burnout has been shown to increase staff retention and improve patient outcomes, this position can be applied to other units and departments across the health system.

Oncology Nursing Forum. 2025 Mar 1;52(2):199–200.

P338. Mark Your Calendars: Empowering Nurses Through Protected Abstract Writing Time

Leslie Landon ¹

Professional Development

Significance & Background

At a National Cancer Institute-designated Comprehensive Cancer Center, nurses seldom presented at professional conferences, hindering the advancement of nursing science. Key barriers to dissemination include limited time, lack of mentorship, and insufficient leadership support. Recognizing this gap, the Director of Oncology Nursing Education sought to enhance dissemination support.

Purpose

To establish structured, protected time for nurses at a multi-site cancer center to draft, refine, and submit abstracts for the Oncology Nursing Society (ONS) Congress.

Interventions

The director organized a two-day abstract writing workshop prior to the ONS Congress abstract deadlines in both 2023 and 2024. Selected nurses, who had completed relevant projects, were allowed twelve hours of dedicated writing time. Pre-work materials included submission guidelines, a short video with tips from ONS, and exemplary abstracts from the ONS website. The workshop took place in a computer lab, where submission criteria, examples, and rubrics were collectively reviewed. Participants received writing time while the director circulated for feedback and queries. Drafts were peer-reviewed and subsequently sent to the director and clinical nurse specialist for final feedback.

Results

In 2023, all five participants submitted an abstract, with one person submitting two abstracts. Six abstracts were accepted, four for poster presentations and two for oral presentations. Notably, only one participant had previously submitted an abstract to a professional nursing organization. Post-workshop surveys indicated that all participants felt the protected time was instrumental in their success. The workshop was expanded in 2024, accommodating twelve nurses, and has resulted in nine submitted abstracts to date. Two more nurses intend to submit an abstract before the deadline and one decided to collect additional data.

Discussion

Nurses often implement impactful initiatives but struggle with disseminating information about their work. Key elements for empowering them include securing leadership support for protected writing time, prioritizing dissemination, providing mentorship, and fostering peer support. The initial workshop’s success sparked increased interest among nurses and garnered buy-in from leadership, highlighting the importance of such initiatives. To allow others to benefit from the structured support, the participants of the 2023 workshop did not participate in the second workshop; however, their previous experience enabled each to successfully submit an abstract in 2024. Additionally, there will be opportunities to partner with nurse scientists in the future to assist with statistical analysis and manuscript writing, further enhancing dissemination.

Oncology Nursing Forum. 2025 Mar 1;52(2):200.

P337. Igniting a Certification Movement Across Oncology Nursing Departments

Leslie Landon ¹, Erica Scott ², Nicole Sennebogen ³, Latesha Cook-Webb ⁴, Kate Burkhart ⁵, Rebeca Leon ⁶

Professional Development

Significance & Background

In a recent assessment conducted at a National Cancer Institute (NCI)-designated cancer center, it was found that only 29% of eligible nurses held an oncology nursing certification, with only six nurses attempting the exam in 2023. Given the organization’s designation as an NCI-designated cancer center and Magnet organization, promoting nursing certification is critical. Established barriers to certification include lack of time, financial constraints, test anxiety, and insufficient recognition for certified nurses. Oncology certification was not top of mind for most nurses.

Purpose

To begin a certification movement by increasing the number of oncology certified nurses by 25 before the end of the calendar year.

Interventions

Since the organization has programs to address certification costs and the need for recognition, the intervention focused on addressing time constraints for test preparation by providing a review course to which nurses were paid to attend. The Nursing Professional Development (NPD) specialist proposed offering a peer-led review course. After obtaining support from department leaders, the NPD team mapped out a curriculum of eight weekly one-hour sessions and identified peer presenters/mentor dyads. Sixty-seven nurses with varying levels of oncology experience enrolled. Participants worked in ambulatory and inpatient departments across six locations. Resource guides were developed linking participants to online resources, podcasts, and modules available through the learning management system. In-person facilitators were located at five sites and connected via Zoom.

Results

A post survey indicated 77% of participants intended to test within six months. So far, ten participants have taken the exam, achieving a 100% pass rate. Twenty additional participants have registered for the FreeTake® and will take the Oncology Certified Nurse (OCN) exam by year-end. Notably, forty nurses utilized the FreeTake® program this year, marking the highest utilization since starting the program in 2018. 85% of nurses using the FreeTake® program this year have passed their exam.

Discussion

The NPD team continues to monitor progress. Although the weekly format allowed a large number of nurses to participate, the team agreed that offering the content twice a week for eight weeks was not sustainable. Moving forward they will offer a two-day OCN review course semiannually. Participants will be required to commit to taking the exam within a specified timeframe. Encouragingly, forty nurses have already registered for the next review course. The movement is gaining momentum.

Oncology Nursing Forum. 2025 Mar 1;52(2):200–201.

P339. Development of Shared Governance Structure For Emergency Oncology Nurses to Enhance Practice Environment

Allison LaPetina ¹, Anne Longfritz ²

Healthcare Delivery

Significance & Background

In an oncology center, the Emergency Oncology Nursing (EON) Division was developed in September 2021. With the development of the EON division came the need to unify the departments, improve collaboration, enhance quality and safety, refine workflows and efficiency, and develop a community among the EON nursing staff. An EON council would achieve these goals and create a clear identity for EON nurses within the institution’s shared governance structure. A taskforce was established in October 2022, including clinical nurses from across the EON sites to ensure that their voices guided their work, and the council served their needs. This taskforce was key in building the council and membership structure. Council leadership was determined to consist entirely of clinical nurses. The EON council held its first meeting in February 2023.

Purpose

The purpose of the council was to bridge communication among the EON departments; promote nurse engagement, empowerment, satisfaction by creating opportunities for professional development; expand knowledge and develop expertise; advance and streamline practice and workflows; improve collaboration in healthcare delivery; enhance patient outcomes and experience.

Interventions

The council met monthly and included members from the 11 EON departments. Members focused on issues related to quality and safety, informatics, staff engagement, practice and education. Meeting agendas included leadership announcements, evaluation of divisional quality and safety trends and presentations on relevant EON topics.

Results

The EON council has had 19 meetings. Membership currently consists of 53 clinical nurses, 12 of which hold leadership positions on the council. Additionally, there are 13 nursing leadership members. The EON council has provided cohesion among the EON departments, improved teamwork and collaboration, dissemination of information, and enhanced efficiency. The council provided a forum for communication and decreased duplication of efforts across sites. Significant outcomes have been achieved including downtime instruction manuals across each site, re-education on bloodwork and lab draws, a scripting project for nurse-to-patient communication, and development of EON internal webpage.

Discussion

Developing the EON council has created a platform for unifying the EON division and enhancing nurse engagement and empowerment. It has allowed staff to improve communication and dissemination of work, while developing new quality improvement projects. It is recommended that shared governance structure be utilized in specialty oncology areas to develop expertise, advance practice improve collaboration and increase nursing satisfaction while improving patient outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):201.

P340. Oncology Nurse Well-Being and the Electronic Medical Record Generated Nurse-Patient Assignment

Sharon Le Roux ¹, Teresa Phan ²

Management

Significance & Background

As the complexity of patient care increases, nurses rely on appropriate staffing, skill mix, and equitable nurse-patient assignments to provide quality care. Results from an organizational nurse satisfaction survey noted oncology nurses were concerned about their well-being. With 43% of nurses leaving the oncology units due to staffing, acuity, work-related stress, and fatigue, implementing measures focused on equitable workload and nurse well-being were essential.

Purpose

To improve nurse well-being and satisfaction through the implementation of an electronic medical record (EMR) nurse-patient assignment tool.

Interventions

Prior to the launch of the EMR tool in February 2024, nurses on the surgical oncology unit were sent a satisfaction with patient assignment and nurse well-being pre-survey. After education was completed with unit nurses, the EMR tool was launched. Assignments were collected each shift to validate equitable workload distribution. At the end of the eight-week pilot period, a satisfaction with patient assignment and nurse well-being post survey was sent.

Results

During the implementation period, charge nurses created 855 individual nurse assignments for over 1,650 patients. Post survey findings noted 76.92% of respondents were satisfied with the EMR assignment tool compared with 48.78% satisfied with the manual tool. A significant decrease in the proportion of participants reporting their physical health interfered with their ability to work post-implementation was noted (OR: 0.3, 95% CI: 0.1–0.9, p = 0.0469). Additionally, a highly significant negative association with years of oncology experience (p = 0.0001) suggested that more years of oncology experience is associated with less depression and anxiety.

Discussion

Consistent with findings by Ivziku et al. (2022), this evidence-based practice project demonstrated that equitable nurse-patient assignments improve aspects of nurse well-being, such as anxiety, depression, and physical ability. During the intervention period, patient experience metrics showed improvement in ‘Response of hospital staff’ category from the 29^th percentile in 2023 Quarter One to 99^th percentile in 2024 Quarter One. This improvement could be attributed to equitable assignments allowing improved ability to respond quickly to patient needs. The use of the EMR nurse patient assignment tool is a critical component of a nurse well-being toolkit.

Oncology Nursing Forum. 2025 Mar 1;52(2):201–202.

P341. Effects of Self-Management on Quality of Life in Patients with Head and Neck Cancer: A Systematic Review

CHI Lee ¹

Symptom Management and Palliative Care

Significance & Background

Head and neck cancer is the seventh most common cancer in the world, and the survival rate is increasing and becoming a chronic disease. Head and neck cancer patients will undergo changes in appearance and function after treatment, which will affect the quality of life and cause psychological distress. Self-management has often been mentioned in recent years. Effective self-management can enhance patients’ self-confidence, promote the recovery of physical functions, and thereby improve the quality of life. However, the current empirical evidence of its effectiveness is still insufficient.

Purpose

This study evaluated the effects of self-management on quality of life in patients with head and neck cancer.

Interventions

This study used a systematic review to collect randomized controlled trials that used self-management as intervention measures to improve the quality of life of patients with head and neck cancer. A systematic literature search was conducted from PubMed, Web of Science, Embase and Airiti Library databases, and reference materials included in the literature were manually searched. Searching Chinese and English literature between 1999 and September 2024, including randomized controlled trials.

Results

We identified 524 articles, among which 2 full-text articles were assessed for eligibility. Literature data extraction and literature quality were read independently by two researchers, and literature review was conducted based on the Joanna Briggs Institute (JBI) randomized controlled trial checklist. Both documents show that the educational intervention based on building self-management skills favored quality of life and reduced anxiety and depression. The results show that self-management can effectively improve the quality of life of head and neck cancer patients.

Discussion

The results of this systematic review show that self-management can effectively improve the quality of life of patients with head and neck cancer. Although the existing evidence can provide suggestions for clinical care, more high-quality randomized controlled trials are still needed for further confirmation. Provide more empirical support for optimal self-management intervention models.

Oncology Nursing Forum. 2025 Mar 1;52(2):202.

P342. Abstract-Writing: See One, Do One, Teach One

Joyce Lee ¹

Professional Development

Significance & Background

Professional nursing practice relies upon a continual flow of new knowledge gained through experiences, quality/process-improvement projects, and research. Nurses learn in school how to apply research to evidence-based practice (EBP) and how to conduct literature searches and cite references for papers. At a certain point within their career, however, many nurses take more from the body of knowledge than they contribute. The American Nursing Credentialing Center (ANCC) Magnet Model Component “New Knowledge, Innovation, & Improvements” highlights the importance of contributing new evidence to the science of nursing. Healthcare organizations employ nurse scientists and researchers for this reason, but the American Nurses Association (ANA) Code of Ethics for Nurses Provision 7 states that all nurses are responsible for the development and dissemination of knowledge.

Purpose

To emphasize nurse leaders’ role in encouraging nurses to share best practices and guiding them through the abstract-writing process.

Interventions

Using a “see one, do one, teach one” approach, the nurse manager reflected upon past mentee experiences. Her first abstract-writing opportunity was identified by a colleague (research/EBP translationist), who observed the unit’s attainment of patient fall rates below the benchmark and suggested that best practices should be shared. That initial co-writing experience resulted in a national nursing conference poster presentation, which engaged the nurse manager’s interest to pursue other opportunities to disseminate new knowledge.

Results

Over 10 years, the nurse manager partnered with colleagues to write 5 abstracts that were accepted for national nursing conferences poster presentations. Recently, upon hearing that two of her nurses aspired to submit abstracts, she approached them with two relevant and timely topics. Together, they created a 6-week timeline and dedicated a few hours weekly toward writing. Both abstracts were accepted for podium presentations at national nursing conferences.

Discussion

The writing and presenting experience gave the nurses a sense of accomplishment and pride in their contributions to the profession. One nurse was eager to further develop her writing skills and attended a publication workshop sponsored by a local nursing organization. As directed by the ANCC Magnet Model and ANA Code of Ethics, nurses are obligated to promote improvements and share best practices so others can learn from their experiences. Nurse leaders should mentor nurses, as many of them desire to share new knowledge but need encouragement and guidance to develop their writing skills.

Oncology Nursing Forum. 2025 Mar 1;52(2):202–203.

P343. The Effects of a Horticultural Therapy Program on Anxiety, Depression, Stress, and Quality of Life in Female Cancer Survivors

Se-Na Lee ¹

Survivorship

Significance & Background

According to the 2021 Korea National Cancer Registry Statistics, there were 2.4 million cancer survivors in Korea. About 65% of cancer patients experience physical and psychological symptoms during diagnosis and treatment, and face challenges in rehabilitation and returning to daily life post-treatment. This underscores the need for comprehensive management to support their recovery, including self-esteem, social, and economic reintegration. Recently, studies have increasingly focused on the effects of horticultural therapy, a form of agro-healing, as a psychosocial intervention to improve the quality of life and overall health of cancer survivors. This study was conducted based on these emerging findings.

Purpose

This study aimed to examine the effects of a horticultural therapy program on state anxiety, depression, stress, and quality of life in female cancer survivors.

Interventions

The study utilized a quasi-experimental design with a pretest-posttest approach and a nonequivalent control group. Female cancer survivors who had completed active cancer treatment at the National Cancer Center were recruited, with 16 participants in the experimental group and 15 in the control group. The study was conducted from April to August 2024. The experimental group received a horticultural therapy program once a week for 120 minutes, over 12 sessions. No intervention was provided to the control group.

Results

The experimental group demonstrated statistically significant reductions in state anxiety (p = .042), depression (p = .032), and stress (p = .043) after the horticultural therapy program. However, cortisol levels, a physiological marker of stress, did not show significant differences. The experimental group also showed statistically significant improvements in the physical well-being subdomain of quality of life.

Discussion

These findings suggest that the horticultural therapy program was effective in reducing anxiety, depression, and stress among female cancer survivors and contributed positively to their overall mental health and physical well-being.

Oncology Nursing Forum. 2025 Mar 1;52(2):203–204.

P344. Leader Mentorship and the Effects it has on Bedside Leaders and CLABSI Prevention

Atiana Lee ¹, Allison Steen ², Stephanie Bradshaw ³, Kathleen Shuey ⁴, Kara Young ⁵

Quality and Safety

Significance & Background

CLABSI is a chief cause of healthcare infections, leading to prolonged hospital stays and increased cost of care. Although the number of infections has decreased nationally, an estimated 30,100 infections occur annually (NHSN). In oncology patients, mortality can range from 12–40%. Between July 2023 and May 2024, a hematology unit experienced 10 CLABSI events, historically marking the highest seen in years. In fiscal year 2023 the unit experienced 5 CLABSI events. Each CLABSI event cost the organization approximately $41,000.

Purpose

In a 24-bed hematology unit, will implementation of leader rounding reduce CLABSI events within a 6-week period.

Interventions

Prior to commencing the project, several interventions were implemented. Retreats were held for unit staff focusing on CLABSI prevention measures. The medication administration process was updated with staff utilizing the PosiFlush^TM SafeScrub Prefilled Saline Syringe to clean initially and between medications. The unit also implemented a two-person needleless connector change process. A planning team was formed consisting of oncology nursing leadership, epidemiology, and vascular access. Interventions implemented during the project included daily rounding on all central lines and peripheral IVs by leadership assessing for improvement opportunities. The first week, opportunities identified were addressed with bedside leaders and included management of central line dressings and peripheral IV maintenance. No significant opportunities were noted during subsequent weeks. After completion of 6-weeks of leader rounding, the planning team again met, evaluated results, and developed a plan to observe medication administration. Leaders shadowed bedside leaders daily for 4 weeks. During nurse shadowing, opportunities identified were addressed immediately with the bedside leader. Shadowing developed into mentorship at the bedside.

Results

Since the last CLABSI in April, no other events have been identified through the end of the fiscal year. The unit went 96 days CLABSI free. In addition to a decrease in CLABSI events, there was a noted improvement in unit morale. The leadership team took this opportunity to celebrate the hematology unit with cookies and balloons.

Discussion

Leadership rounding, and mentorship of bedside leaders brought about significant improvements in CLABSI interventions. Bedside leaders follow blood cultures more closely and identify early potential opportunities that could lead to an event. To verify results are unchanged, the planning team will continue mentorship rounds with bedside leaders and implement daily rounding on central lines and peripheral IVs should additional events occur.

Oncology Nursing Forum. 2025 Mar 1;52(2):204.

P345. From Chaos to Coordination: Elevating Education For Oncology Nursing Workflows

Rebeca Leon ¹, Erica Scott ², Tara Ridgeway ³, Erika Armstrong ⁴, Cheryl Billish ⁵, Shaniequa Green ⁶

Management

Significance & Background

A multi-site cancer institute faced challenges after implementing a new charting software due to a lack of standardized education across oncology specialties. Nurses reported inefficiencies in workflow, excessive time spent per patient, and inadequate knowledge on utilizing the technology, which led to low satisfaction. To address these issues, there was creation of a standardized education program that improves nurses’ ability to complete their workflows efficiently and increases nursing satisfaction.

Purpose

To share one multi-site cancer institute’s standardized education approach that would enhance nursing staff satisfaction and competency in completing a new oncology workflow. The focus was on improving workflow efficiency and increasing the effective utilization of charting software.

Interventions

Several interventions were implemented, including initial office hours & dissemination which provided real-time support and troubleshooting to introduce the new workflow, along with educational videos and handouts. Oncology ambulatory clinic class for new hires, a comprehensive class for new hires to familiarize them with the oncology workflow and software. Oncology ambulatory clinic office hours for established staff, which provides ongoing support for established staff to address specific workflow challenges.

Results

Success of the educational plan was measured with utilization metrics; this data collection tracked the effective use of the charting software among staff and nursing perception surveys: surveys to assess nurse perceptions of their preparedness and ease of use after training. Utilization doubled over the educational intervention period. Before initial training there was 40% utilization of the new workflow. During the initial office hours training utilization increased to 51.96%. Immediately post initial training utilization reached 75.55%. Since the implementation of the new hire class utilization rose to 82.72%. With additional support for established staff with office hours, utilization peaked at 84.65%. Nursing satisfaction increased significantly due to education with time spent on the workflow decreasing by half, nursing perception of educational interventions is favorable and provides support to complete workflow on their own.

Discussion

The standardized education approach led to improved nurse satisfaction and proficiency in completing the oncology workflow. Tailoring the program to different disease groups and care settings contributed to its success. However, gaining buy-in from established staff was a challenge. As this program evolves, continuous improvements will be made to address ongoing educational needs and maintain elevated levels of satisfaction and efficiency across the oncology nursing team.

Oncology Nursing Forum. 2025 Mar 1;52(2):204–205.

P346. End the Flaws with Order of Draw

Savannah Lethco ¹

Quality and Safety

Significance & Background

On the BMT unit, all lab draws are performed by the nurse as the majority of our patients have central lines. The main cause of skewed lab results is due to potassium ethylene-diamine-tetra-acetic acid (K-EDTA) contamination. K-EDTA is an anticoagulant used in the tubes that assess hematology and blood typing labs. Due to the potassium component, K-EDTA can cause pseudohyperkalemia, pseudohypocalcemia, and pseudohypomagnesemia if those tubes are drawn prior to lithium heparin tubes that assess various chemistries (Asif et al., 2019). By treating these potentially inaccurate levels with electrolyte replacement medications, unnecessary treatment could result. For example, lowering falsely high levels of potassium could disrupt the cardiovascular system.

Purpose

If intervention is taken to correct false electrolyte levels, patient safety is threatened as well as unnecessary use or wasting of resources (Debnath et al., 2020). Effective strategies focused on proper blood collection practices should be put into place to prevent incorrect lab results (Debnath et al., 2020). It is further recommended that order of draw should be followed to minimize contamination (Asif et al., 2019).

Interventions

Participants were given a badge bead tool and an educational handout. The badge bead tool was developed as a visual representation of the draw order sequencing. The handout outlines the correct order of draw according to both color and tube name.

Results

A lack of competency regarding basic phlebotomy terminology and lab testing was revealed by the results of a pre- and post-test Kahoot quiz. Even with the educational handout and badge resource, nurses still answered questions incorrectly which could be attributed to differing learning styles. Overall, nurse confidence surrounding lab draws increased from 82% to 100%. The pre-test revealed a significant need for phlebotomy training that extends beyond the hospital-issued annual competency module. The post-test reveals an overall improvement in nursing phlebotomy competencies.

Discussion

The intervention is recommended for those certified in venipuncture including patient care technicians and nurses. The education and associated tools should be provided to all current nurses and become part of the nursing services orientation. Even when experienced nurses enter the system, they must adapt to the organization’s specific lab tubes and order of draw.

Oncology Nursing Forum. 2025 Mar 1;52(2):205.

P347. Patient Education and the Role of the Nurse Visit

Lisa Levinson ¹

Patient Education

Significance & Background

Patient education contributes to greater patient understanding, adherence and outcomes. Nurse visits provide a 1:1 opportunity for patients and their loved ones/caregivers to review, ask questions and explore problem solving strategies with a member of their care team. Cancer diagnoses, treatment and survivorship present the need for reevaluation, multiple service lines/providers, coping capacity and resilience on behalf of the patient which can be further complicated by complexity of care as well as adverse symptoms. The Registered Nurse, as a member of the care team can function as an adjunct and support for the patient and family members/caregivers as they navigate their cancer related care.

Purpose

To optimize patient understanding of their treatment plan. In understanding the why of a suggestion or intervention the patient may be more likely to be an active participant in their care and exhibit greater adherence to their care plan. As a result of nurse visits the patient will experience greater autonomy, satisfaction with their care.

Interventions

Nurse visit phone call to be scheduled 1–2 weeks after GI Consult visit to follow up on symptom management, medication adherence and questions. In the event a treatment has not provided resolution or improvement of symptoms communication with the provider to identify alternate options for the patient may occur. Identification of nonadherence in regard to timing of medication. Reviewing the goals for patient plan of care and address concerns/questions patient may have as to possible side effects.

Results

Patient reported improved satisfaction with care and increased communication with care team. Nurse visits identified patients had not started treatment suggestions due to outstanding questions/concerns thus allowing patient to discuss and/or presented opportunity for provider to suggest alternate treatment.

Discussion

Nurse visits provided in follow up to a GI Consult appointment as per patient reporting allowed for greater opportunity for patients to ask questions and contributed to a greater understanding of the patient as to their plan of care. Patients reported when presented with further context as to the “why” of interventions suggested by the GI Consult team they were more likely to adhere to their plan of care. Patients reporting nurse visits allowed for improved and more timely communication with their care team helping to lessen possible delay of care and resulting in improved quality of life and management of symptom burden.

Oncology Nursing Forum. 2025 Mar 1;52(2):205–206.

P348. A Biotene a Day Keeps Oral Mucositis Away

Cindy Li ¹, Bridgette Ramirez ², Maria Becerra ³

Patient Education

Significance & Background

Non-adherence to Biotene among patients is a significant concern in an inpatient hematology/oncology unit at Santa Monica UCLA Medical Center. Observations revealed a troubling trend: many patients lacked an understanding of why they were prescribed Biotene, or they were not following the prescribed regimen properly. On this unit, Biotene is routinely prescribed to treat oral mucositis (OM) and as a preventative measure. The prescribed schedule is designed to effectively manage and prevent the onset or progression of oral mucositis. This research aims to improve adherence to Biotene treatment among patients during hospitalization.

Purpose

This project aimed to increase motivation and adherence to Biotene treatment among patients on the unit.

Interventions

A nurse-led Biotene educational intervention was implemented over 8 weeks from July 2024 through August 2024 using the Plan, Do, Study, Act Model. Nurses used an evidence-based Biotene educational handout that included the following information:

■ Information about oral mucositis and its associated complications.
■ Insights into the effectiveness of Biotene when used correctly.
■ Guidance on supplemental dental hygiene practices.
■ The education based on the handout was done by nurses at bedside using the teach-back method. Use of teach-back has been proven to improve knowledge, skills, and self-care abilities in patients with chronic disease (Talevski et al., 2020).

Results

To evaluate patient adherence to Biotene following education, we utilized the MARS-5 adherence scale, a five-statement survey allowing the patient to evaluate their adherence from one (Always) to five (Never) (Chan et al., 2020). The five statements included: (1) I forgot to take them, (2) I alter the dose, (3) I stop taking them for a while, (4) I decide to miss out on a dose, (5) I take less than instructed. We collected a total of 14 pre- and post-education patient responses. Taking the average results of each statement, the overall response showed a remarkable 40.6% increase post-intervention stating that after patients were educated, they were more likely to adhere to their Biotene regimen.

Discussion

A key issue identified on the unit was the lack of adequate patient education regarding oral mucositis, which contributed to poor adherence to Biotene. The implementation of educational handouts has demonstrated a positive effect on understanding and adherence, as indicated by post-survey data. Continued efforts are necessary to evaluate the long-term impact of these educational initiatives.

Oncology Nursing Forum. 2025 Mar 1;52(2):206.

P349. Assessing the Quality of Life of Brazilian Patients with Multiple Myeloma

Maria Theresa Lima ¹, Edvane De Domenico ²

Symptom Management and Palliative Care

Significance & Background

Multiple Myeloma (MM) is an incurable disease, relapsing and symptomatic in 93% of cases. Early diagnosis, management of the disease’s aggressiveness and high rates of treatment abandonment are the biggest challenges for healthcare teams.

Purpose

To assess the impact of the disease and treatments on the quality of life of patients with Multiple Myeloma.

Interventions

This is a cross-sectional, descriptive study with a quantitative approach, carried out in the hematology outpatient clinics of two Brazilian hospitals linked to the Sistema Único de Saúde (SUS), located in the city of São Paulo, São Paulo, Brazil. Data collection, after approval by the research ethics committees, took place between December 2022 and April 2023, including participants over the age of 18, with a proven diagnosis of MM, at any stage of treatment. Those with comprehension difficulties and mental disorders were excluded. Patients answered a form with social and clinical variables. The Myeloma Patient Outcome Scale (MyPOS), adapted and validated for the Brazilian population, was used to measure quality of life (QoL). The data was analyzed descriptively, using absolute numbers and percentages, using the Statistical Package for the Social Sciences, version 28.0.

Results

The study included 145 patients, predominantly female (57.93%), brown and black (62.07%), with a mean age of 66.1 years (SD: 10.40) and a mean diagnosis time of 41.1 months (SD: 43.34). The most frequent myeloma subtype related to monoclonal immunoglobulin was IgG (53.79%). The most commonly applied type of staging was ISS (78.62%) and, of these, 33.10% of patients were classified with ISS 2. Around 69.66% of the participants had comorbidities, and 100% were taking medication for some clinical condition at the time of the interview. Pain was the most reported symptom, with 56.56% considering it ‘moderate’ to ‘unbearable’. Movement difficulties and weakness, ‘moderate’ to ‘strong’, were mentioned by 41.38% and 36.55%, respectively. The fear of the disease getting worse was mentioned by 42.07%. The QoL continuum assessed by MyPOS was worse in the “Symptoms and Functionality” subscale compared to the “Emotional Response” factor.

Discussion

The study showed that, despite advances in therapies, treatment-related symptoms and the chronic profile of MM, along with comorbidities, negatively affect patients’ QoL. Although challenging, multi-professional and personalized interventions are necessary to promote self-management in order to optimize QoL and reduce the burden of symptoms.

Oncology Nursing Forum. 2025 Mar 1;52(2):207.

P350. Hospital Risk Stratification Dashboard/High Risk Patients

Victoria Lindahl ¹, Jane Porter ², Danielle Brown ³, Colleen Lewis ⁴, Norma Jean Carlile ⁵, Aya Alajrash ⁶

Coordination of Care and Navigation

Significance & Background

Patients are living longer, and the incidence of cancer diagnoses continues to rise. Following the end of the CMS Oncology Care Model, there were limited tools available to identify and provide at-risk patients with navigation services. Identifying patients at high risk of ED/IP utilization to ensure available nursing resources are appropriately assigned is critically important. The high-risk category of patients has factors that may impact their health and oncology treatment outcome.

Purpose

To identify patients most in need of nurse navigation services based on their risk for ED visits and (IP)hospitalizations.

Interventions

Hospital Risk Stratification Dashboard provides the following information and categories for patients in follow-up at Florida Cancer Specialists. Patients identified in the High and Moderate-High Risk dashboard categories are assigned to a Remote RN Navigator with initial call to patient completed within 24 hours. The assigned RN Navigator proactively reaches out to the patient at defined time points (pre/post-surgery, pre/post-radiation, pre/post-first chemotherapy or oral therapy/hormonal, post-ED/IP visit, routine follow-up minimum q4 weeks).

Results

2024 Patients Enrolled

■ January 523 patients
■ February 105 patients
■ March 75 patients
■ April 87 patients
■ May 314 patients
■ June 239 patients
■ July 373 patients
■ August 237 patients

Discussion

1,953 patients that were identified as high to moderate risk of hospitalizations were enrolled/managed by the Remote RN Navigator team between January 2024 to August 2024. The navigators proactively managed disease/treatment-related side effects and overall wellbeing on an ongoing basis. Upon identification of patient risk level, the navigator was able to proactively the manage and promptly address symptom treatment and disease-related concerns to help reduce the risk for ED/hospitalization, functional decline, or acute exacerbation or decompensation. Future focus includes ongoing monitoring of ED/IP utilization of patients post implementation of navigation services.

Oncology Nursing Forum. 2025 Mar 1;52(2):207–208.

P351. No Pressure: Empowering Staff to Combat Device-Related Skin Injuries via the Donna Wright Competency Model

Virginia Lindsey ¹, Dena Shore ², Ryan Minnix ³, Makia Cade ⁴

Quality and Safety

Significance & Background

Oncology patients who must undergo surgical procedures are at increased risk for pressure injuries due to multiple factors. On a surgical oncology unit, pressure injuries related to medical devices were occurring, particularly in patients undergoing ear, nose, and throat (ENT) surgeries. These patients are at higher risk for pressure injury due to oncologic processes, poor nutritional status, decreased mobility, and co-morbid conditions. As pressure injuries can result in increased morbidity and mortality, intervention was deemed imperative.

Purpose

The purpose of this quality improvement project was to evaluate the effectiveness of the Donna Wright Competency Model to decrease medical device associated hospital acquired pressure injuries for oncology patients on a surgical unit.

Interventions

Nurses (RNs) and nursing assistants (NAs) self-identified tube securement as an area to improve in their competency assessment. The Donna Wright Competency Model provides a consistent, successful competency assessment process. The three main components of this model are ownership, empowerment, and accountability. Staff attended education related to proper tube securement and confirmed competency of the skill via demonstration during patient care. In addition to learning how to secure tubes properly, new RNs attended a pressure injury prevention and identification course. Chart audits were performed to monitor documentation, along with event reporting data of pressure injury occurrence.

Results

Staff RNs and NAs were participative in the competency assessment and completion; 100% of staff members completed both the education and confirmation of competency. While tube securement documentation compliance initially dropped, tube securement was noted to be trending upward post intervention, with an average of 61% during the month of August 2024. Since project introduction there have been zero device related pressure injuries, and staff have increased pressure injuries found and charted upon admission by 20%.

Discussion

Implementing a tube securement intervention may increase staff awareness and decrease device related pressure injuries. Utilizing the Donna Wright Competency Model allowed staff members to self-identify opportunities for improvement. As the competency they chose aligned with a potential causative factor of pressure injury in surgical oncology patients, nursing staff were directly involved in the intervention planning and implementation. This project demonstrates the potential for the Donna Wright Competency Model to effect change in nurse sensitive indicators.

Oncology Nursing Forum. 2025 Mar 1;52(2):208.

P352. Implementation of Surgical Nurse Coordinators Across Multiple Cancer Center Locations

Jana Linsenmeyer ¹, Katie Smith ², Paul Baareman ³

Coordination of Care and Navigation

Significance & Background

Surgical Oncologists manage patients in multiple clinic locations within this health system. Historically, each clinic staffed their departments independently, leading to inconsistent nursing support for the surgeon and patient. Gaps in care coordination were noted from patient dissatisfaction and confusion with non-standardized patient education documents and conflicting information. Clinicians expressed a need for a better staffing plan to manage their complex patient population.

Purpose

To implement surgical nursing coordinators (SNC) for care coordination across multiple practice sites.

Interventions

Nursing leadership developed a staffing model using existing FTEs that paired 2 SNCs to 1–2 providers each. These nurses became responsible for all patient education for pre- and post-operative care at clinic encounters, nurse-only clinic visits, or nurse-only telehealth visits. Visits are scheduled by evaluating the patient’s preferred learning style and complexity of the education. Education materials are available electronically or on paper. Telephone triage duties for clinical sites were combined to simplify and standardize the patient experience. Triage calls are documented and routed to the SNC. This permitted the SNC availability for patients regardless of physical location and provided the opportunity for patients to talk with a familiar person.

Results

The SNC model was successfully implemented across 2 clinical sites identified with a high need for multidisciplinary care. Management from both sites collaborated to maintain standardized expectations for staff performance. Patients are scheduled for telehealth or clinic nurse visits in the time between consultation and surgery, which affords the opportunity to gather questions about their upcoming surgery after the surgical consultation. Telehealth teaching allows for more individualized care that involves patients and their caregivers in the location of their choice. During the 3-month period from implementation to evaluation, the SNCs supported 202 patients that underwent surgery. Absorbing the surgeon’s second clinic location increased SNC’s patient load by 40% each. The SNC’s report increased intrinsic job satisfaction and ownership of their work.

Discussion

The SNC role has enhanced continuity of care for patients who are seen in multiple care sites. Nurses and Providers report high satisfaction with this implementation. This innovative role serves as a model for primary nursing care in a multi-faceted and complex health care system. With many patients also seeing medical and radiation oncology at the same time, this staffing model allows for ease of communication and a seamless patient experience.

Oncology Nursing Forum. 2025 Mar 1;52(2):208–209.

P353. Effects of Utilizing a Retired Nurse in an Oncology Clinic With Specific and Creative ways to Reduce Burnout and Retain Nurses

Josephine Lisowski ¹, Abigail Dillon ²

Management

Significance & Background

A retired nurse from an ambulatory oncology clinic identified burnout among younger nurses. To avoid burnout a strong culture rooted in quality, patient safety, and excellence in nursing needs to be nurtured. The retired nurse felt a pull to return. She contacted human resources and the nurse manager to identify a new role utilizing her strengths to help with burnout and retention. The retired nurse gained a new perspective of nursing while identifying variables. One constant in healthcare is change: technology, management styles, mergers. New oncology drugs with different mechanisms of actions and side effects are ever changing. These changes are magnified with a global pandemic. One constant observed: nurses are resilient regardless of generation. Utilizing Benner’s Novice to Expert Theory a retired nurse reentered the workforce to prove positive outcomes of utilizing a retired nurse to mentor and reduce burnout with the goal of nurse retention.

Purpose

Encourage clinics to keep retired nurses on a per diem basis. The goal from the nurse manager and retired nurse was to lift the burden on the main work force by utilizing a retired nurse. Utilizing a retired nurse to mentor, nurture and support will prove nurse satisfaction and retention.

Interventions

■ Encourage HR and oncology manager to create a per diem position that offers flexibility for the retired nurse.
■ The leader pulled reports to identify staffing needs.
■ The nurse manager and the retired nurse met monthly to review the purpose with specific tasks.
1. Mentoring
2. Education
3. Support the primary preceptor in onboarding.
4. Lunch Coverage
5. Clinical Skills
  - Phone Triage
  - Injection clinics
  - Starting IV’s, accessing ports.
6. Quality Improvement Projects
7. QOPI Regulatory Readiness Project
8. Onboarding new patients to environment

Results

■ This clinic has an increase in employee satisfaction scores.
■ One example of a nurse interviewed “The day before and the day after a holiday is historically very busy, having retired nurse support even for a few hours was so helpful.”
■ Nurse retention obtained.

Discussion

This project had amazing outcomes. The project tapped into different generations, different management styles while utilizing creative interventions and specific goals to produce positive outcomes for all stakeholders.

Oncology Nursing Forum. 2025 Mar 1;52(2):209–210.

P354. Don’t Let it Bite You

Megan Loney ¹, Denice Gibson ², Rachel Naftulin ³, Nina Dimitrova ⁴, Abraham Kanate ⁵, Stuart Scherger ⁶

Coordination of Care and Navigation

Significance & Background

Bispecific T-cell Engager (BiTE) Therapies are a new and growing classification of treatment options that come with a significant risk of cytokine release syndrome (CRS) and immune effector cell neurotoxicity syndrome (ICANS) during the initial treatment phase. These risks make it inappropriate to initiate treatment in most community oncology settings.

Purpose

In 2023, it was identified by the transplant and cellular therapy team at a community-based hospital in a large metropolitan area that the community oncology patients needed a center to provide timely access to bispecific therapies. Because of the CRS and ICANS risk during treatment initiation, patients need to be treated in a setting that has a process to identify and manage risks with with nurses and providers that have CRS/ICANS management experience, including specialty-trained 24/7 nurse triage, outpatient care and a dedicated inpatient unit. Patients and their caregivers need adequate and standardized education about symptom monitoring and reporting.

Interventions

The nurse navigators and clinical nurse specialist worked together with the medical director and clinical pharmacists to develop standard operating procedures as well as patient/caregiver and staff education materials. For every new patient, the nurse navigator meets with the patient at initial consultation to review side effects in detail and assess readiness to start treatment including adequate caregiver plan. The nurse navigator speaks with the caregiver(s) personally either in person or over the phone to ensure their understanding of the role and commitment. The nurse navigator then meets with caregivers during the first treatment visit to go over the daily expectations, how to perform CRS and ICANS assessment at home, and how to report symptoms. When appropriate, these patients are transitioned back to their referring oncologist for continued long-term management. The nurse navigator confirms with the oncology office/infusion center that they are prepared to give the needed therapy, are REMS certified (as appropriate), and the patient has appointments scheduled within the appropriate time frame.

Results

Patients have been able to safely initiate treatment in the appropriate setting and then return back to their referring oncologist for ongoing treatment closer to home.

Discussion

Coordination of care for patients receiving bispecific therapies is critical to ensure timely access to treatment initiation at an appropriate center and safe transition back to the referring oncologist.

Oncology Nursing Forum. 2025 Mar 1;52(2):210.

P355. Enhancing Clinical Competence: A Specialized Central Venous Access Device Class for Oncology Nurses

Melanie Longo ¹, Amanda Sarafin ², Andrea Wagner ³

Management

Significance & Background

Due to prolonged treatments, including systemic hazardous drugs, blood product administration, and other supportive therapies, central venous access devices (CVADs) are a lifeline for many oncology patients. Novice oncology nurses often lack the knowledge, exposure, and experience necessary to adequately care for these devices. Within the past year, our large academic medical center experienced a significant nurse turnover within the inpatient oncology service. As a result, a need was identified to develop a specialized training class focused on the care and maintenance of CVADs.

Purpose

This project aimed to develop and implement a class that comprehensively reviewed central venous access devices (CVADs) for novice oncology nurses to enhance their clinical competence, confidence, and adherence to best practices.

Interventions

Three oncology nurse specialists developed the 2-hour CVAD class, which included a didactic lecture and hands-on skills. The didactic lecture reviewed key terminology, common CVAD types and locations, various supplies and equipment, occlusions, central line-associated bloodstream infections, essential documentation, and maintenance as outlined in organizational policy. The skills portion included CVAD dressing and needleless connector changes, implanted port accessing, blood culture collection, and occlusion management. The first session was held in June 2023 and has been held periodically based on need. All new oncology nurses were required to attend one of the sessions.

Results

Three CVAD classes have been held since June 2023. The average number of nurse attendees per session was 8. Although still ongoing, nurses provided feedback via an evaluation, and 100% of respondents indicated that the class improved their knowledge and confidence in managing CVADs. Additionally, all nurses indicated that the class enhanced their orientation/onboarding. Limitations to this project include offering it to only new oncology nurses and a limited number of sessions.

Discussion

Novice oncology nurses require a strong foundation in managing CVADs. Offering this class improved their knowledge and significantly strengthened their confidence. This reassurance is crucial in ensuring novice oncology nurses provide care that adheres to organizational and national standards. In the future, we plan to offer more classes open to nurses at any level looking to expand their knowledge of CVADs. Additionally, we aim to offer continuing nursing education hours.

Oncology Nursing Forum. 2025 Mar 1;52(2):210–211.

P356. Optimizing Central Line Blood Culture Collection Techniques: A Practice Change Evaluation in Adult Oncology Care

Melanie Longo ¹, Andrea Wagner ², Amanda Sarafin ³

Quality and Safety

Significance & Background

Neutropenia, which may be caused by the cytotoxic effects of medication or disease state, is commonly observed in inpatient oncology patients. As a result, this population is at high risk for developing fevers due to their reduced immunity. Blood cultures are an essential diagnostic tool to identify if the fever is caused by an infectious microorganism that could lead to a bloodstream infection. In our large academic medical center, blood cultures are often collected from central lines when present in oncology patients to rule them out as the source of infection. However, the existing oncology practice deviated from generally accepted performance standards and did not align with organizational policy or Infusion Nursing Society (INS) guidelines.

Purpose

This study aimed to evaluate the impact of implementing a practice change in collecting central line blood cultures among adult oncology patients and whether the updated protocol reduced the number of blood cultures ordered and contamination rates.

Interventions

Our practice change involved collaboration with the oncology interdisciplinary team, including leadership, nurses, providers, clinical educators, infection prevention, and infectious disease experts. An extensive literature search was performed to validate current evidence. The new process involved sterile needleless connector change and blood culture collection from the central venous access device (CVAD) hub. In addition, an algorithm was developed to standardize criteria for repeat blood cultures in this population to limit the frequency of needleless connector changes. A new skills checklist and video demonstration were developed and disseminated for staff education before mandatory in-person competency sessions.

Results

Data was reviewed among patients admitted across six inpatient oncology units. Pre-implementation data was analyzed from January 2023 through January 2024. In that timeframe, 4,925 blood cultures were drawn from 1,090 patients; 228 were positive, and 54 (1.10%) were contaminants. Post-implementation data was analyzed from February 2024 through June 2024. A total of 2,125 blood cultures were drawn from 492 patients; 301 were positive, and 35 (1.65%) were contaminants. Limitations include the brief evaluation period for the practice change, the learning curve involved, and obstacles to monitoring compliance effectively.

Discussion

While preliminary data displays increased contamination and collection rates on par with previous practices, established evidence and standards must be applied to practice. Additional data is needed to validate the overall improvement with this practice change.

Oncology Nursing Forum. 2025 Mar 1;52(2):211.

P357. Huddle up: Uniting Ambulatory Leaders for Improved Teamwork, Patient Care, & Experience

Erin Longstreth-Papsun ¹, Tara DelGrippo ², Jennie Gilliland ³

Management

Significance & Background

Effective collaboration among multidisciplinary ambulatory nurse leaders is crucial for enhancing patient care and improving departmental efficiency. An appreciable gap in communication and synergy among ambulatory leaders at an NCI designated cancer center was identified due to working silos, location distance, and lack of connection during onboarding. This impeded the ability to address issues collectively and leverage each other’s strengths.

Purpose

The goal of this project was to build a more cohesive environment among 15 ambulatory nurse leaders through a structured virtual huddle. This initiative sought to improve interdepartmental understanding, address each department’s specific needs, and strengthen teamwork to enhance patient care, staff engagement and overall coordination.

Interventions

A daily 15 minute virtual huddle held at 9:15 AM, Monday through Thursday was used as the intervention. During these sessions, leaders discussed key topics including patient volumes, staffing issues, patient safety concerns, workplace incivility, and highlighted exceptional staff members through an “Ambulatory Star of the Month” initiative. Additionally, the huddle provided a platform for brief updates on ongoing projects and collaborative efforts. This regular interaction was designed to create a unified approach to problem-solving and resource sharing. This included leaders from distant network clinics, as well as a home-based nursing phone triage team leader.

Results

The effectiveness of the huddle was evaluated through both qualitative and quantitative measures. Collaborative projects initiated as a result of the huddle included the Bee Caring initiative, ACE: Ambulatory Care Excellence redesign work, medical assistant upskilling, chemo/radiation patient coordination, and enhanced staff onboarding and orientation. Patient experience and employee engagement surveys were monitored to assess the impact of these interventions on staff and patient satisfaction and care quality.

Discussion

The huddle up intervention significantly improved interdepartmental collaboration and led to several successful projects that addressed key operational and patient care issues. The 2020 Employee Engagement survey showed that ambulatory nursing staff scored RN-RN teamwork at 3.97, and with the 2024 survey, this score increased to 4.22. Most notably, the Likelihood to recommend score on the Outpatient Oncology patient experience surveys increased from 85.5% before the intervention to 95.43% after one year, positioning the institution in the 92nd percentile compared to peers. This improvement reflects a positive impact on patient care coordination and experience, demonstrating the efficacy of structured, regular communication and collaborative problem-solving among ambulatory nurse leaders.

Oncology Nursing Forum. 2025 Mar 1;52(2):211–212.

P358. Increasing Hospice And Palliative Care Utilization in the Hispanic Community

Jackeline Lopez ¹

Symptom Management and Palliative Care

Significance & Background

Increasing research highlights the benefits of early hospice and palliative care for terminally ill individuals. Despite these benefits, Hispanic populations in the United States underutilize these services compared to non-Hispanic whites. As the Hispanic population grows and ages, the need for culturally appropriate palliative and end-of-life care intensifies.

Purpose

This systematic review aimed to identify barriers to palliative and hospice care utilization among Hispanics in the United States and explore potential interventions to improve access and use of these services within Hispanic communities.

Interventions

A comprehensive literature review was conducted using nursing databases such as CINAHL and Medline, with search terms related to hospice, palliative care, and Hispanic/Latino populations. The search yielded 15,982 peer-reviewed articles. After screening, 16 articles—both quantitative and qualitative—met the inclusion criteria for the final review.

Results

The majority of articles reviewed included participants with oncology diagnoses, making these findings particularly significant for addressing gaps in care for Hispanics with cancer. Key barriers identified include cultural influences, religious beliefs, family involvement, knowledge gaps, physician discomfort, communication barriers, prognostic awareness, and language concordance. Many Hispanic patients lack an understanding of palliative care, often confusing it with end-of-life care services. Inaccurate prognostic awareness suggests a need for improved culturally sensitive communication about prognosis. Physician discomfort and ineffective communication strategies further hinder care, highlighting the need for cultural competence and language support services. Family involvement and religious beliefs play key roles in decision-making, making culturally relevant education and family-centered approaches essential. The main interventions identified include palliative care consults, lay patient navigators, and educational videos. Further research is needed to validate these results and explore the effectiveness of different formats.

Discussion

To address palliative care needs and enhance hospice service utilization among Hispanic populations, a multifaceted approach is required, considering cultural, linguistic, and religious factors. The findings are particularly significant for improving care among Hispanic cancer patients. Recommendations include coordinating early Spanish-speaking palliative care consults with a multidisciplinary team; developing culturally relevant educational materials to increase awareness and understanding of palliative and hospice care; encouraging family involvement in advance care planning and decision-making; implementing educational programs for nurses and healthcare providers focused on cultural sensitivity and humility; and expanding access to language support services and bilingual healthcare providers. The next steps involve implementing these strategies in clinical settings and evaluating their impact.

Oncology Nursing Forum. 2025 Mar 1;52(2):212–213.

P359. “Race to Transplant: Rapid Implementation of Alternative Vascular access for Healthy Allogeneic Donors”

Kaddie Lopez ¹, Maria Theresa Dizon Fabros ², Sarina Torres ³

Treatment Modalities and Managing Administration

Significance & Background

More than 8,000 people in the United States received allogeneic stem cell transplantations in 2020 (Cleveland Clinic, 2024). 70% of people who need transplantation won’t find a matching donor in their family (Cleveland Clinic, 2024). In these instances patients rely on registries & wait for months for a match. When a match is found time is of the ultimate essence & the race to stem cell collection & transplantation is on. This is the story of how a comprehensive cancer center worked to decrease the time to transplant through rapid implementation of an alternative means of collection.

Purpose

Stem cell collection from healthy donors has historically been through peripheral veins or through central venous catheters (CVC) placed by Interventional Radiology (IR) when venous access is poor. The risk of placing a CVC in a healthy donor include: infection, thrombus, air embolus, & pneumothorax. The CVC is immediately removed after sufficient stem cells are collected due to the risks donors are required to stay a minimum of 2 hours for monitoring; leading to donors being transferred to the Evaluation & Treatment Center (ETC) from the Apheresis department after business hours. In 2023, patient volume began to exceed capacity in all areas of the Cancer Center resulting in delays of CVC insertion by days, decreased efficiency of Apheresis, impaction of ETC, all resulting in the pushing out lifesaving transplant. A solution was needed in order to help our patients.

Interventions

Alternative methods of stem cell collection were explored & literature showed, Midline catheters were effective & safe for HPC collection either in donors (Caime, et al, 2020). The PICC leadership team was able to secure product, create & vet policy & patient consent, create competency validation, educate the staff, operationalize scheduling & billing; & see first patient within 80 days of problem identification.

Results

Since implementation in December 2023; 31 healthy donors have used a midline as a means of stem cell collection, 77% requiring 1 day collection (24); 23% requiring 2 day collection. 0 patients required transfer to ETC for observation. The midline has contributed to the decompression of the iR & ETC departments while increasing throughput & efficiency of the Apheresis department & decreasing time to transplant.

Discussion

Rapid implementation of new processes is possible through collaboration & persistence of operational leaders.

Oncology Nursing Forum. 2025 Mar 1;52(2):213.

P360. A Cancer Programs Approach to Addressing Food Insecurities, Transportation, and Lodging among Cancer Patients in a Financially Distressed Area

Deborah Lorick ¹, Cynthia Dasaad ², Christy Monteith ³

Coordination of Care and Navigation

Significance & Background

Antelope Valley Medical Center (AVMC) is a 420-bed district-community acute care hospital located in Lancaster, CA. AVMC is a disproportionate hospital with 41% inpatient stays with Medi-Cal coverage and 37% with Medicare. Supportive care barriers for our patient population such as food insecurity, transportation and lodging during treatment were identified by utilizing the NCCN Psychosocial Distress Thermometer and Oncology Navigator Intake assessment. Research has indicated that cancer patients living in rural areas receive poorer quality of treatment and care than their urban counterparts (Journal of Multidisciplinary Healthcare).

Purpose

To address the needs and provide assistance to patients meeting a criterion of receiving oncology related treatment, financial necessity, and distance barriers. To reduce stress related to financial, travel and food insecurities.

Interventions

American Cancer Society Grants, Antelope Valley Medical Center Foundation Grants and Community Engagement/Support through food donations were received. Created an application for patients to provide information needed for vetting those with the greatest need of assistance. Navigator received applications, reviews and allocates funds for transportation, lodging, and food distribution. Patients chosen due to their need receive a gas card for transportation. Travel a long distance or have treatment daily patients may receive a lodging benefit. Food distribution patients in need receive 2 x per month fresh vegetables and dry food products.

Results

Lodging

$25,000 received October 2022 from ACS-assisted 18 patients with lodging. $10,000 received May 2024 from ACS-assisted 8 patients with lodging.

Transportation

(2023–2024) $5,000 received from ACS-98 gas cards for $50 were distributed. $3,500 received from AVMC Foundation-68 gas cards for $50 were distributed. $3,000 received from ACS-59 gas cards for $50 were distributed.

Food

Goal set to distribute food to 50% of patients receiving treatment with identified needs. During the month of August 68% of patients identified received the food rescue kits.

Discussion

Patients receiving the diagnosis of cancer have feelings of fear and confusion, they feel overwhelmed with the thought of how they will deal with this new diagnosis and then having to worry about supporting their family’s needs and how they will get to treatment should be the last thing they need to think about. Our aim is to decrease these worries by financially assisting with transportation/lodging and/or distribution of food to those most in need.

Oncology Nursing Forum. 2025 Mar 1;52(2):213–214.

P361. Smells Like Stress Relief: The use of Aromatherapy to Decreases Nurse Stress Levels in an Outpatient Infusion Center

Jeri Lowman ¹, Jennifer Zaccone ², Amiee La Touche ³

Management

Significance & Background

The stress and burnout experienced by Registered Nurses (RN), particularly those caring for oncology patients, are significant (Wazqar, 2019). On a recent survey almost 50% of RNs working in an outpatient infusion clinic at a large academic medical center responded ‘neutral’ or ‘unfavorable’ to a statement indicating the organization cares about their health and well-being. Elevated stress can lead to burnout and have negative impacts on RN health and quality patient care. Innovative strategies are needed to address stress and feelings of dissatisfaction among oncology RNs.

Purpose

This project’s purpose was to determine if wearing an aromatherapy delivery system during work is effective in reducing RN’s perceived stress levels working in outpatient oncology infusion.

Interventions

For one-week RNs self-reported their stress levels before and after each shift using a Likert scale ranging from 0 (indicating no stress) to 10 (indicating extreme stress). The following week nurses were invited to wear a lavender Elequil Aromatabs® aromatherapy patch on their uniform top throughout the shift. During the intervention week RNs continued to report pre and post shift stress levels.

Results

Before the aromatherapy intervention pre-shift surveys showed an average reported stress level of 3.08 (N=46). Post shift RNs reported an average stress level of 4.2 (N=18). Throughout the week utilizing aromatherapy, pre-shift stress levels averaged 3.10 (N=46) with post-shift stress levels averaging 2.54 (N=11).

Discussion

It appears the use of lavender Elequil Aromatab® aromatherapy decreased RNs perceived post-shift stress level from 4.2/10 to 2.54/10. It was challenging to get RNs to remember to complete the post-shift survey. Due to the smaller than desired participation rates, the project will be replicated in another patient care area in the outpatient oncology setting in the coming weeks. Additional data will be collected from the RNs that chose to utilize aromatherapy.

References

Li H, Zhao M, Shi Y, et al. The effectiveness of aromatherapy and massage on stress management in nurses: A systematic review. Journal of Clinical Nursing. 2019;28:372–385. doi: 10.1111/jocn.14596. [DOI] [PubMed] [Google Scholar]
Wazqar DY. Oncology nurses’ perceptions of work stress and its sources in a university-teaching hospital: A qualitative study. Nursing Open. 2019;6:100–108. doi: 10.1002/nop2.192. [DOI] [PMC free article] [PubMed] [Google Scholar]

Oncology Nursing Forum. 2025 Mar 1;52(2):214.

P362. The Effectiveness of Psychological Interventions in Reducing Stigma in Cancer Patients: A Systematic Review

Yen-Yi Lu ¹, Yen-Yi Lu ²

Symptom Management and Palliative Care

Significance & Background

Cancer-related stigma can affect patients’ healthcare-seeking behavior, sleep quality, and overall quality of life. While psychological interventions seem to improve or prevent the feelings of stigma in cancer patients, the effectiveness of these measures remains inconsistent. Furthermore, there is a lack of systematic literature reviews in Taiwan that specifically examine the effectiveness of psychological interventions on reducing stigma in cancer patients.

Purpose

This study aims to explore whether psychological health interventions can reduce feelings of stigma in cancer patients.

Interventions

A systematic literature review was conducted by searching PubMed, Embase, Cochrane Library, CINAHL, MEDLINE, and two Chinese electronic databases for eligible studies on cancer-related stigma published between January 2013 and April 2024. The included studies were assessed for quality using the modified Jadad scale.

Results

Three randomized controlled trials involving 304 patients were included. The results indicated that cognitive behavioral therapy (CBT) or psychological support interventions, such as ReBIC (Restoring Body Image After Cancer) or BRIGHT treatment manuals, significantly reduced stigma scores in cancer patients. While the interventions showed short-term effectiveness, some studies did not demonstrate long-lasting effects across all time points. The impact of interventions might vary due to differences in countries, ethnic groups, and cultural factors, suggesting the need for further research.

Discussion

CBT and psychological support interventions have some effectiveness in reducing stigma in cancer patients. Various demographic, disease-related, and psychosocial variables are associated with cancer-related stigma, especially in breast cancer. Over time, additional intervention care may be required to further alleviate these feelings. Our findings can serve as a foundation for healthcare professionals to develop health promotion and prevention strategies for cancer patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):214–215.

P363. Chill Out: Preparing Nurses to Cool Down Chemotherapy-Induced Hair Loss

Raquel Luague ¹, Connie Masters ², Suzie Allen ³, Ma Cheryl Maico ⁴, Annabelle Duve ⁵

Treatment Modalities and Managing Administration

Significance & Background

Chemotherapy-induced alopecia is one of the most distressing side effects of cancer treatment, making patients feel vulnerable, self-conscious, and exposed as cancer patients. Scalp cooling is an effective supportive therapy to minimize chemotherapy-induced alopecia. Nurses’ readiness to provide scalp cooling during chemotherapy treatments is vital to the success of the incorporation of this supportive therapy.

Purpose

We aim to evaluate the specific education needs and effectiveness of in-person training sessions on infusion nurses’ level of preparedness for implementing scalp cooling therapy.

Interventions

A pre-survey was used to identify specific education needs and assess infusion nurses’ readiness to administer scalp cooling therapy. Nurses watched on-demand videos about the machine and patient preparation. The vendor did in-person training using a demonstration/return demonstration. Dedicated stations were set up in the infusion center for practice sessions. The vendor’s educator validated the nurses’ scalp cooling therapy administration competencies. A post-training survey evaluated the nurses’ level of readiness and general knowledge after the training sessions and competency validation. Eleven staff members attended training, and nine completed the post-training survey.

Results

Before staff education and implementation, a survey of 27 infusion nurses revealed that only 6 (29%) were ready to care for patients receiving scalp cooling therapy, indicating limited knowledge. The identified educational needs included machine operation, costs, side effects, efficacy, safety, and patient tolerability. After training, 9 of the 11 nurses that underwent training responded to the post-survey. Of these, 100% believed they were ready to take care of patients on scalp cooling therapy, 62.5% felt all educational needs were met, and 87.5% recognized the importance of scalp cooling as a supportive care intervention.

Discussion

The post-survey indicated that the education needs and improved staff readiness were addressed during training for scalp cooling therapy. The infusion center integrated scalp cooling into supportive care treatments to better address alopecia challenges. As the patient population utilizing scalp cooling therapy expands and new nurses are onboarded, the unit nurse educator should provide independent training and education to reduce reliance on the vendor’s branded materials. Prior to launch, the nursing journal club reviewed studies on scalp cooling, identifying opportunities that could guide further study of our institution’s program.

Oncology Nursing Forum. 2025 Mar 1;52(2):215–216.

P364. Using a Simulator Versus Traditional Education for Subcutaneous Drug Administration in Cancer Patients

Laura Luengas ¹, Beatriz Andrea Prada Alvarez ², Adriana Carolina Aya Porto ³, Karen Rodriguez ⁴, Andres Felipe Cardona Zorrila ⁵

Patient Education

Significance & Background

Safe drug administration is a fundamental aspect of cancer patient care, particularly home-based therapies, where the self-care and training of patients and their families are crucial. In this sense, therapeutic education is critical to establishing a therapeutic alliance between health professionals and patients, promoting treatment adherence.

Purpose

To evaluate traditional education and simulation as strategies to optimize the use of the subcutaneous route for drug administration in cancer patients, intending to facilitate and amplify the adoption of this strategy at institutional, local, and regional levels.

Interventions

Preliminary result of a cohort study to evaluate using a simulator and a traditional education program for subcutaneous drug administration in cancer patients. A structured survey was conducted to define the capabilities for device placement, complications, and confidence in the procedure. The impact of simulator use was evaluated by comparing the results with the two methods. A training device for intradermal/subcutaneous injection with an arm from the shoulder to the elbow was used as a simulator (product number ul0184, Manufacturer Ultrassist, Reference B0BJV8J1M4). In all cases, an AUTOGUARDTM device (BD® Medical, Sandy, UT, USA) protected with BD INSTAFLASHTM technology was used, which reduces damage to the subcutaneous cellular tissue by tunneling the path in a similar way to when it is used to channel a blood vessel. All patients knew the study’s objective and voluntarily agreed to participate.

Results

Simulation-based training is superior in overcoming difficulties in placing subcutaneous devices in cancer patients, both in terms of speed (41 minutes), safety (60%), and efficiency of learning curves 80%).

Discussion

Preliminarily, the usefulness of simulation in facilitating the placement of catheters for subcutaneous drug administration in cancer patients has been demonstrated.

Oncology Nursing Forum. 2025 Mar 1;52(2):216.

P365. Evidence Based Approach: Utilizing Normal Saline as an Alternative to Heparin for Central Venous Access

Guadalupe Luna ¹, Cynthia Ramirez ²

Treatment Modalities and Managing Administration

Significance & Background

Many researchers have studied replacing the use of heparin for the patency of Central Venous Access Devices (CVAD) with 0.9% normal saline (NS) and the practice of the pulsatile technique. The potential side-effects associated with heparin can include heparin-induced thrombocytopenia, heparin overdose, and hypersensitivity reactions (Goossens, 2015). Changing to the use of 0.9% NS with a pulsatile technique has been shown to be noninferior to heparin in the avoidance of intraluminal occlusions (Egnatios & Gloria, 2021). In 2023, 8 patients from our clinic required interventional radiology (IR) for occluded port-a-caths (PACs). Additionally, tissue plasminogen activator (tPA) was used nine times.

Purpose

To evaluate the efficacy of flushing the CVAD with 10 – 20 ml of 0.9% NS with pulsatile technique versus the standard use of heparin. Another goal of utilizing this technique is to possibly reduce costs.

Exclusion Criteria

Patients with functional PACs with zero blood return post IR testing prior to the initiation of the project.

Interventions

Clinic Registered Nurses were trained and determined competent to perform the procedure. Data was collected on the number of PACs accessed which met inclusion criteria. The use of tPA and the need for IR support in the treatment of CVAD was reported. Also, the rates of central line-associated bloodstream infections (CLABSI) were tracked.

Results

Pre implementation (01 October 2023 to 30 March 2024) 889 PACs were accessed/flushed in the outpatient oncology clinic; tPA was used 9 times. 8 patients required IR. Post implementation (01 April 2024 to 13 Sep. 2024) 579 PACs were accessed/flushed. tPA was utilized on 3 PACs and zero PACs required the use of IR for access support and there were no reported cases of CLABSI. This interim data reflects a reduction in tPA use by approximately 33.3% as well as a 100% reduction in the requirement for IR. There were no adverse events noted with heparin administration or with the only 0.9% NS pulsatile technique.

Discussion

The use of 0.9% NS has resulted in direct and indirect cost savings of approximately $11,000. During this identified period, the use of normal saline with a pulsatile technique has been shown to be noninferior to heparin in the avoidance of intraluminal occlusions.

Oncology Nursing Forum. 2025 Mar 1;52(2):216–217.

P366. “Ouch, that Hurts! is there a better way to Administer this Chemotherapy?”. Improving Nurse Satisfaction and Hand Strain with Subcutaneous Administration of Daratumumab-Hyaluronidase

Mary Mackrell ¹, Debra Lewis ², Claudine Tomlinson ³

Treatment Modalities and Managing Administration

Significance & Background

Novel approaches to administering subcutaneous oncolytic drugs with the aid of hyaluronidase has substantially reduced chair time and improved administration efficiency. However, at our cancer center this has led to ergonomic complaints of nurses’ hand strain and fatigue, as well as challenges in nurse assignments to mitigate exacerbating further hand strain associated with administering daratumumab-hyaluronidase at a 45-degree angle, using a 25-gauge subcutaneous needle. To determine the scope of the problem, a survey of forty-one ambulatory infusion nurses was conducted to understand the extent and severity of hand strain, and level of satisfaction with the current technique. Results revealed 95% of nurses experienced hand strain and fatigue, and 90% of nurses required a pause or change in hand position to administer the drug over the recommended time frame of 3–5 minutes. Eighty-eight percent of nurses experienced moderate to severe pain.

Purpose

To address nurse hand strain and dissatisfaction with administering subcutaneous daratumumab-hyaluronidase by implementing a change in technique. Objectives included evaluation of infusion nurses perceived degree of hand strain and fatigue, and overall satisfaction post-implementation.

Interventions

A team of infusion nurses, nurse leaders, and pharmacists reviewed alternative options with the pharmaceutical manufacturer educator. The team chose to trial use of a larger 23-gauge subcutaneous needle. To evaluate the impact of the change, twenty-three nurses responded to the post-survey 30-days after the trial.

Results

The post-survey revealed a decrease of 63.2% in hand strain and fatigue. Seventy-four percent of nurses experienced a reduction in the need to pause or change hand position during drug administration. Twenty-six percent of nurses still experienced moderate to severe pain. Overall, nurse satisfaction increased by 74% in administering daratumumab-hyaluronidase according to product information.

Discussion

A team approach to improving and measuring the impact of a practice change is central to sustaining a healthy workforce. Use of a larger 23-gauge needle to safely administer subcutaneous daratumumab-hyaluronidase has resulted in a significant reduction in hand strain and improved overall nurse satisfaction. Addressing prime occupational concerns identified by our infusion nurses led to a dramatic improvement in practice.

Oncology Nursing Forum. 2025 Mar 1;52(2):217.

P367. New Nurse Roundtable – An Investment in the Future of Nursing

LeAdelle Maez ¹, Emily Hilding ²

Management

Significance & Background

Due to local demand for specialized oncology treatment and the strain on the system of being above capacity for the past few years, Huntsman Cancer Hospital expanded by constructing a new building with space for outpatient clinics and two new inpatient units. This created the opportunity to split the combined Bone Marrow Transplant/Hematology unit into two separate units, with Hematology being a newly created unit within the system. This change made it challenging to hire 60% of the nursing staff as new nurses for the team. With so many new nurses on the unit, we wanted to give them specific time dedicated to their concerns, a friendly learning environment, and time with management.

Purpose

For newly graduated nurses, the transition to a specialized unit involves not only learning the ropes of nursing but also understanding complex disease processes, medications like chemotherapy, and procedures not covered in their academic curriculum. The steep learning curve underscores the need for enhanced management support during their first year.

Interventions

We created a New Nurse Roundtable where we gave dedicated time every quarter to the new nurses for the first year. The topics discussed included line crunches, resiliency, and time management, which were either suggested by the new nurses or identified as areas of need. This allowed them time to talk about topics that were important to them and open time to chat with each other and see if their experiences were like the other new nurses on the unit.

Results

The post-survey results were overwhelmingly positive, with the nurses expressing that the program was time well spent. They felt supported by the management team and appreciated the opportunity to integrate into the unit, fostering a sense of team spirit. Nurses opened up to each other about their struggles, helped find solutions, and felt a new investment in everyone’s success.

Discussion

We found our new nurse roundtable discussions were very well attended. We want to expand the program to include all the nurses to help continue the sense of belonging, a feeling of being involved, a safe place to bring up questions and frustrations, and time with management. In turn, we hope this will help with less staff turnover, increase confidence in their bedside nursing skill, and bring a sense of belonging to all staff.

Oncology Nursing Forum. 2025 Mar 1;52(2):217–218.

P368. Enhancing Patient Care: A Nursing Initiative for Pre-Screening Diabetic Oncology Patients Prior to Pet Imaging

Christina Maggiulli ¹, Ann Martin ², Jaclyn Andronico ³, Piera Robson ⁴

Coordination of Care and Navigation

Significance & Background

Positron Emission Tomography (PET) is utilized for staging and monitoring cancer treatment in patients. Diabetic patients often have a challenging time meeting the criteria needed to proceed. The test requires 6 hours of fasting and a fingerstick blood glucose (BG) greater than 70 and less than 200mg/dl. Not meeting these requirements leads to cancellations and the rescheduling of patients, increasing the stress and dissatisfaction within the patient population. Negative impacts regarding scheduling, resource use, and radioisotope loss present a financial burden for the institution. At one National Cancer Institute (NCI) designated cancer center, they assembled a nursing task force to address this issue, with the goal of reducing the cancellation rates for diabetic patients needing PET scans.

Purpose

The basis of this initiative was to decrease same-day PET cancellations, improve both workflow and patient experience within the nuclear medicine department and decrease financial impact.

Interventions

The task force consisted of 7 nurse champions representing nuclear medicine sites across the center. With approval from physician and nursing leadership stakeholders, interventions and education for nurses were developed. The champions trained the nuclear medicine nurses using a “train-the-trainer” model, providing them with didactic lectures. An IT data report was used to identify diabetic and hyperglycemic patients scheduled for PET scans four days in advance. Nuclear medicine nurses contacted these patients, reviewed the PET scan requirements, and ensured that the patients were aware of how to manage their hyperglycemia and diabetes medications according to the policy. In cases where the requirements were not addressed, the radiology nurses contacted the ordering team to ensure that patients were properly advised.

Results

Pre-data collected from July to September 2021 showed a 19% cancellation rate of patients with BG fingerstick outside 70–200mg/dl. The intervention went live center-wide in July 2022. One year post intervention data, July to September 2023, indicated a decrease in PET cancellations to 15%. The presentation will further detail the cancellation rate data and details related to the nursing interventions supporting this initiative.

Discussion

Oncology patients with diabetes, hypoglycemia, and hyperglycemia may encounter difficulties in meeting the requirements for PET exams. Nursing plays a crucial role in addressing institution-wide challenges and enhancing the patient experience. This project can be readily replicated in other institutions to enhance the PET exam experience for patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):218.

P369. Confidence and Competence: The Power of a Transition to Practice Program for New Oncology Nurses

Michelle Maiers ¹, Jocelyn Faro ²

Management

Significance & Background

Transition to practice programs are notable for improving retention, confidence and role competence across specialties. In 2021, our multi-site cancer center recognized a gap in support as new to oncology nurses did not have access to a specialty transition to practice program. Accordingly, these nurses attributed their lack of oncology knowledge as impacting their perceived confidence and ultimately influenced their decision to remain in their role.

Purpose

In September 2021, the Oncology Specialty Onboarding Program was created to address cancer-specific knowledge gaps for new to oncology nurses. This program aimed to support successful transition to oncology nursing with the goal of improving confidence and competence.

Interventions

A review of the literature and stakeholder feedback guided curriculum development for the onboarding program, which consisted of seven 4-hour didactic classes. The program was inclusive of novice to experienced nurses in all oncology care settings, including acute care, infusion, radiation oncology, and ambulatory clinics, which promoted a shared learning environment. Learner-centered, multimodal learning strategies included a didactic introduction to principles of cancer care, a simulation day specific to the nurses’ care setting, and completion of the online Oncology Nursing Society’s Oncology Nurse Orientation Program. Interprofessional partners collaborated to offer insightful sessions regarding patient support in navigating critical stages in the cancer care continuum. Professional development opportunities, including certification, were reviewed to inspire commitment to the specialty.

Results

Evaluations were collected for 82 program participants across seven cohorts. Upon program completion, 100% of participants reported the information was relevant to their role. A follow-up survey to assess attendees’ level of confidence was provided with 32 respondents to date. Of these nurses, 84% agreed or strongly agreed their confidence in caring for oncology patients had increased since attending the program. Competence was achieved by 100% of participants as demonstrated by patient case presentations evaluated by nurse educators. A positive indicator of the program is the 86% retention rate of all attendees to date.

Discussion

This innovative multi-modal onboarding program for new-to-specialty nurses provided a comprehensive framework for standardized education across care settings and positively impacted overall retention and perceived role confidence. As new nurses are increasingly entering the oncology specialty, this program could be implemented in any cancer care area and may benefit organizations in achieving positive patient outcomes through improving nurse confidence, competence, and retention.

Oncology Nursing Forum. 2025 Mar 1;52(2):218–219.

P370. Analysis of Rapid Response Team Encounters on an Inpatient Medical-Surgical Oncology Unit

Anna Maio ¹, Mary Kate Reilly ², Jane Sallustro ³

Quality and Safety

Significance & Background

The Rapid Response Team (RRT) was created to intervene when hospitalized patients are clinically declining to improve patient outcomes. There are several factors that may affect the utilization and success of such resources, including nurse to patient ratios, time of shift (day vs night), and staff experience level. There is a shortage of published data regarding actual utilization of Rapid Response Teams in the United States, and even more so in the Oncology setting. Further, it can be challenging to communicate RRT occurrences amongst staff who are not present during the event.

Purpose

The purpose of this project was to compile, analyze, and communicate data regarding one hospital unit’s rapid response occurrences.

Interventions

Data was collected retrospectively from the hospital’s RRT Tableau dashboard for a medical-surgical oncology unit. Behavioral rapid responses were excluded. Chart reviews were conducted for each patient. The data was presented to staff on a quarterly basis during an in-person meeting, as well as distributed via email for those who could not attend.

Results

During a 3-month period (April 1– June 30, 2024), 28 rapid responses were called. Of those, 93% were medical patients, while 7% were surgical. The median age of patients was 72 years old, with an even distribution of males and females. The most frequent reasons for RRT encounters were tachycardia, change in mental status, hypotension, and bleeding, respectively. 43% of RRT encounters resulted in an escalation of care to either a telemetry unit or the intensive care unit. 68% of RRT encounters occurred during the day shift, while 32% of RRT encounters occurred at night. The most common interventions during RRT encounters included intravenous bolus, a non-rebreather mask, STAT imaging, antihypertensive agents, and vasopressors.

Discussion

Rapid Responses are an important part of nursing care, however they have not been well documented in literature. Further, information regarding RRT encounters on a unit is often shared by word of mouth amongst nursing staff, rather than formal presentations. By analyzing this data, we were able to evaluate the utilization of the RRT. Analyzing this data also allowed us to identify common characteristics of RRT patients, frequently used interventions, and what proportion of RRT encounters resulted in an escalation of care. Ultimately, this information was used to provide education to nursing staff.

Oncology Nursing Forum. 2025 Mar 1;52(2):219–220.

P371. Tumor Infiltrating Lymphocyte Therapy Education: Bridging the Gap Between Solid Tumor and Cellular Therapy

Thea Malile ¹, Melissa Gutknecht ², Alexandra Dormal ³

Management

Significance & Background

Tumor Infiltrating Lymphocyte (TIL) therapy was approved by the Food and Drug Administration (FDA) in February of 2024 for treatment of Metastatic Melanoma. All nurses caring for this patient population must receive cellular therapy training to align with standards from the Foundation for the Accreditation of Cellular Therapy (FACT). Cellular therapy training was historically required for only hematopoietic stem cell transplant nurses since previous cell therapy treatments were directed toward malignant hematology. With FDA approval of TIL therapy, this posed a large knowledge gap for inpatient and ambulatory medical oncology nurses, hematology nurses, and intensive care unit (ICU) nurses. TIL specific education was created to bridge the knowledge gap as this is the first FDA approved cellular therapy for solid tumor patients.

Purpose

A TIL therapy in-service was developed based upon product specific requirements to ensure our cancer institution’s alignment with FACT standards, to provide quality care for patients, and to increase nursing knowledge of TIL therapy. The objective of this education is to understand administration of TIL cells, identify expected adverse events, and determine treatment specific nursing interventions.

Interventions

Since nurses work in varying clinical settings, a 13-minute video recording was developed based upon the FDA approved product to ensure convenience of viewing for staff and for tracking of education completion. To assess increased knowledge of TIL therapy following the education, participating staff were required to complete a post education assessment.

Results

A total of 115 staff members across ambulatory oncology, inpatient oncology, and the ICU have completed the TIL training. 100% of staff received a passing grade of 80% or greater on the post education assessment. While video education was utilized to bridge the initial gap for timely FACT compliance, TIL therapy has been incorporated into an existing cellular therapy class that newly hired staff will be required to attend. By December of 2024, an additional 49 nurses will receive TIL therapy education.

Discussion

The first FDA approved TIL therapy was administered in September following the product specific education. Nursing staff vocalized increased understanding of TIL therapy, ability to escalate adverse events to providers, and confidence to advocate for transfer to higher level of care when necessary. TIL education has not only helped ensure alignment with FACT standards, but also in providing treatment specific care to this patient population.

Oncology Nursing Forum. 2025 Mar 1;52(2):220.

P372. Empowering Precision Medicine: Leveraging Redcap for Efficient Family History Collection in Hereditary Cancer Clinics

Patricia Mallaber ¹, Kristina Streb ²

Healthcare Delivery

Significance & Background

A comprehensive family history is essential to identifying those at risk for hereditary cancer syndromes. National guidelines base genetic testing recommendations on personal and family history. In an academic medical center Hereditary Cancer Program, historically, family history forms were mailed to patients to complete prior to their visit. Many forms were incomplete or not returned, requiring staff to gather history during the visit leading to increased patient and provider burden.

Purpose

An online tool was developed to allow patients to enter family history before appointments via an electronic device. The long-term goal of this project is to improve efficiency, reduce costs, and free up time for more meaningful discussions during the clinical visit.

Interventions

A multidisciplinary team created a REDCap survey to collect detailed family and personal cancer histories. The survey was shared with patients via the electronic patient portal before appointments, enabling clinical staff to review and document the information in advance. During a three-month evaluation period, a total of 728 visits were scheduled in the program and a total of 267 surveys were initiated by patients on REDCap (37%). The mean age for patients who completed the survey was 48 years old (range 18–97, median 46). A majority (80%) of respondents were female and a total of 19.5% of patients had a personal history of at least one type of cancer (see chart). Although some surveys were incomplete (<1%), and family history knowledge was occasionally inaccurate, patients reported no issues with the process. The team aims to harness the electronic health record to collect this data in the future. Results and

Discussion

Overall, the intervention was a success. Administrative staff found it easier to send electronic messages rather than mail paper forms. Follow-up messages with secure links helped increase survey completion rates. The intervention resulted in more accurate and relevant data during the assessment period, improving appointment flow and allowing for more focused discussions. Providers reflected on the enhanced communication with patients and the ability to address cancer risks more thoroughly. Having the family history in advance allowed staff to quickly identify genetic red flags as well as being able to provide quality counseling and guidance on genetic testing. Our process can serve as a model to other institutions looking to streamline and improve family history assessment for genetic testing.

Oncology Nursing Forum. 2025 Mar 1;52(2):220–221.

P373. A Comparative Analysis of Patient Perceptions of unit Based Sound

Christopher Mangels ¹, Stephanie Jahner ², Kathleen Casey ³, Susan Ayers ⁴

Quality and Safety

Significance & Background

Oncology patients enter the hospital seeking a healing environment. Unfortunately, loud noise levels associated with modern medical care may impact sleep quality. Studies have shown an association between lack of sleep and negative health outcomes such as: increased infection rates, worsening pain, increased readmission rates, poor memory recall, prolonged wound healing, decreased strength, and mood disturbances. To highlight the importance of sleep on health and provide incentive for reduction of noise, the Center for Medicare and Medicaid Services (CMS) includes a question regarding ambient noise in the Hospital Consumer Assessment of Healthcare Providers and Services (HCAHPS) survey. Historically, the Dana Farber Cancer Institute’s Inpatient Hospital (DFCI IPH), a 30-bed oncology hospital, has utilized HCAHPS scores to better understand patient experience but low response rates and lack of direct feedback have made improvements difficult. Decreasing noise levels is a priority nursing goal for the DFCI IPH. A literature review showed noise levels to be a struggle at numerous institutions with no solid intervention. In addition, it was discovered that patients frequently associate “quietness” with sleep quality. A survey was created to provide more comprehensive assessment as well as patient suggestions.

Purpose

We sought to better understand patient perception of ambient sound and its impact on sleep quality within a 30-bed inpatient oncology hospital.

Interventions

Upon discharge patients were provided a voluntary 13-question survey regarding their perception of noise and sleep quality while inpatient. After discharge, patients were sent a voluntary 59 question, one of which concerns unit-based noise, survey 2 weeks after discharge from Press Gainey.

Results

Completion rate of the in-person discharge survey were higher than mailed HCHAPS survey. Scores obtained through in-person discharge survey did not mirror the scores obtained by mailed HCHAPS survey. In-person discharge survey data provided free response questions allowing for patient driven suggestions on improvement of noise levels.

Discussion

The use of a voluntary discharge survey in conjunction with HCAHPS surveys provided a more comprehensive understanding of patient perception of unit-based noise and suggestions for improvement than HCAHPS surveys alone. Implementation of suggestions may result in improvement in perception of noise without significant impacts to the built environment. Additionally, the quick response time of the discharge survey permits for a faster understanding of the impact of interventions.

Oncology Nursing Forum. 2025 Mar 1;52(2):221.

P374. Establishing a Standardized Handoff Tool: A Continuous Quality Improvement Experience at the DFCI IPH

Christopher Mangels ¹, Joan Deary ², Kathryn France ³, Emma Hanley ⁴, Patricia McHoul ⁵

Healthcare Delivery

Significance & Background

Quality clinical hand-off is an essential part of safe, high-quality patient care. Poor communication due to incomplete hand-off resulted in negative financial impact and increased mortality. Novice nurses are frequently overwhelmed, making comprehensive handoff a concern. Standardized handoff tools can serve as a learning tool to assist in developing this skill. The change in the nursing workforce as a result of the COVID-19 pandemic has resulted in an influx of novice nurses and a decrease in experienced mentors. The Dana Farber Inpatient Hospital (DFCI IPH), a 30-bed oncology facility, has experienced this shift. DFCI IPH admits patients for acute illness, hospice care, chemotherapy, bone marrow transplant, and research protocols. The population is difficult for new nurses to provide care and give a comprehensive report.

Purpose

To share the impact peer education and support can have on practice change and improvement.

Interventions

Unit Based Practice Council (UBPC) members provided education and individualized training sessions on the usage and benefits of the standardized hand off tool. They also provided educational resources and reminders. Staff members were asked to complete confidential surveys regarding their knowledge and usage of the hand-off tool as well as their perception of thoroughness of report.

Results

Analysis of survey results showed significant increase in the usage of the standardized hand-off tool, at all experience levels, after the intervention. Nurses with less than three years of experience also reported increased levels of confidence with report, post intervention.

Discussion

The UBPC’s efforts to foster change through individualized education and support of a standardized hand-off tool resulted in a significant increased usage of the tool. The use of the tool increased new to practice nurses’ confidence in their report giving capabilities. Developing and promoting standardized communication tools may help to reduce anxiety associated with transition to practice and increase patient safety.

Oncology Nursing Forum. 2025 Mar 1;52(2):221–222.

P375. Tea for the Soul: Healing the Hearts of Oncology Nurses

Meghan Manthorpe ¹, Jacqueline Anorga ², Maria Weinstein ³

Psychosocial Dimensions of Care

Significance & Background

Oncology nursing is often described as a gift that takes a special kind of nurse. Consistently walking with patients through each step of their oncologic journey, from diagnosis, treatment, and even death, can take an intense toll on the passionate oncology nurse. The impact of this compassion fatigue has always correlated to high turnover, lower patient satisfaction scores, and increased complaints (Garcia et al., 2019). Thus, in 2022, phase one of our “Tea for the Soul” nurse-led peer group initiative was created, seeking to equip the staff of an inpatient malignant hematology unit with the tools to combat burnout. There was noted opportunity to assess baseline burnout on the unit, leading to phase two: the distribution of the Maslach Burnout Inventory (MBI) for Medical Professionals.

Purpose

To assess levels of burnout on inpatient oncology nurses using the MBI, assisting in the creation of validated wellness interventions.

Interventions

In April of 2024, 35 Registered Nurses (47% of unit) were surveyed using the MBI, a survey endorsed by the World Health Organization (WHO) and has been used across various professions to assess burnout. The survey includes 22 questions, addressing three areas that signify burnout when found in conjunction. Survey was advertised via a table set up with tea and snacks, allowing staff time to fill out survey and anonymously submit.

Results

The survey resulted in negative scores regarding emotional exhaustion compared to the average population, which is described as feelings of stress and weariness, where aspects of the job demand more than one can give. Results indicate 31% of staff scored as “Overextended”, indicating they have passion for the job but find they do not have the means to recover from the workload. Another 31% were categorized as “Ineffective”, indicating low confidence and lack of recognition (Maslach & Jackson, 2018).

Discussion

Based on results, the team recommends to the organization they implement wellness programs, such as healthier food options and gym memberships. We plan to promote team building amongst nurses and leaders by performing a BIRD Communication event with organizational development. We also found opportunity to explore leadership styles, and thus will be pursuing a DISC assessment for all leaders. Tea for the Soul will develop a unit-based council to assist with these opportunities and keep frontline staff at the heart of any interventions.

Oncology Nursing Forum. 2025 Mar 1;52(2):222.

P376. Just Keep Scanning, Just Keep Scanning! An Approach to Enhancing Patient Identification and Nursing Communication for Radiopharmaceuticals

Nicole Marcelino ¹, Brianna Lynes ²

Radiation

Significance & Background

New innovative cancer research uses radioactive isotopes to bind to targeted cancer cells for specific prostate and neuroendocrine cancers. This treatment will make the patient radioactive for seven days post administration. Hartford Healthcare has experienced challenges with easy identification of these patients. Additionally, patients receiving these radiopharmaceuticals have difficulty recalling the proper precautions for safe handling thus, putting others at risk of accidental exposure and improper handling.

Purpose

The aim of this change is to better identify patients who are radioactive in order to decrease patient safety events, improve patient care, and better protect those who care for these patients.

Interventions

Patients receiving radiopharmaceuticals will be given a patient wristband with a specific quick response (QR) code imprinted on it. The QR code will link to information on special handling instructions including a resource number for questions. The patient will be instructed to wear this bracelet for 7 days post treatment and encourage their healthcare team to scan the QR code. The design of this study is PDSA that will use a post intervention survey to collect qualitative data. Lastly, we will record the amount of triage calls, specifically pertaining to safe handling, pre and post intervention for quantitative data.

Results

Current data collection has been tracking information on triage calls pre-intervention. Currently, more than half of the calls have been related to safe handling. Furthermore, there was a reported safety event where a patient received inappropriate care at an HHC Emergency Department due to improper understanding and awareness of their radioactive status. Future evaluation will consist of a patient survey to evaluate if the bracelet was used, the QR code was scanned, and if the patient found the intervention useful.

Discussion

The current stage of this project is obtaining the appropriate bracelet. Once this is procured the QR code will be printed onto the bracelet. We expect this intervention to decrease triage calls, decrease reported safety events, and conclude positive patient remarks within the survey. This can lead to new methods of patient identification using QR codes to communicate necessary information for improved safety among staff and patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):222–223.

P378. Implementing the D.R.E.A.M. Nurse: Reducing Burnout and Driving Quality Care on an Inpatient Oncology Unit

Hallie Marino ¹, Erica Alexander ², Robin Butler ³

Screening, Early Detection, Genomics

Significance & Background

Staffing challenges secondary to pandemic impacted nurses on a thirty bed acute care hematology/oncology unit. This was evidenced by a decrease in published nurse satisfaction scores for the unit. Knowing that nurse burnout and moral distress can be prevalent amongst oncology nurses unit nurse leaders reached out to the CNO (Chief Nursing Officer) to serve as the executive sponsor for a project to improve nurse satisfaction and reduce burnout. The team had a townhall meeting with frontline nurses to determined the the root cause of the problem, which was an increase in workload without additional supportive resources being in place. In 2023 the D.R.E.A.M. (Discharge (D), Resource (R), Education (E), Admission (A), Medication (M)) nurse pilot was implemented into the care model for the unit.

Purpose

The goal of the D.R.E.A.M. nurse pilot was to address the care needs of the patient population and serve as a resource to the nursing staff. Impact of the D.R.E.A.M nurse was measured by nurse satisfaction, quality of care and the level of burnout on the unit.

Interventions

Unit leaders performed GEMBA rounding to identify areas where resources were needed. They identified areas included witnessing bedside procedures, admission/discharge/transfer activities, administration/monitoring of antineoplastic therapies and supportive care as well as providing education to patient and families. Meeting with the unit practice council and leadership the roles and responsibilities of the D.R.E.A.M. nurse were created and qualified individuals completed training/competency assessments. Nurses voluntarily completed the burden assessment survey (Burden Assessment Tool BAT-12) pre and post-intervention. The pilot lasted three months during which time multiple PDSA cycles were used to optimize the role.

Results

The results showed an improvement in the average nurse burden score from 3.4 (Very High Burnout) pre-intervention, to 2.5 (High Burnout) post implementation. Additionally, through the increase in quality audits, CLABSI numbers decreased with the unit achieving two quarter with zero CLABSI. Both quantitatively, through the hospital based survey scores for nurse satisfaction, and through qualitative feedback gathered post-intervention, nurses were more satisfied with the work environment.

Discussion

Through this pilot staff and unit leaders crafted a model of care to meet the needs of the patient population while focusing on staff wellbeing. Identifying the root cause and performing small cycles of change helped to achieve successful outcomes with the D.R.E.A.M. role.

Oncology Nursing Forum. 2025 Mar 1;52(2):223–224.

P379. Utilizing High Fidelity Simulation to Improve Novice Oncology Nurses Competency and Confidence in Managing Oncologic Emergencies: A Program Evaluation Project

Hallie Marino ¹

Management

Significance & Background

Oncology nurses are integral in delivering quality care to achieve positive patient outcomes. Comprehensive knowledge and skills in the management of oncologic emergencies are foundational for competent oncology nursing practice. Emory University Hospital (EUH) is a comprehensive cancer center providing care to complex oncology patients. In recent years EUH oncology units saw an influx of novice nurses new to the specialty. A review of practices revealed that education on oncologic emergencies occurred primarily through didactic learning. Despite participation in didactic learning, the interdisciplinary team expressed concerns for nursing competency with recognizing/managing oncologic emergencies, highlighting the need to enhance the onboarding experience.

Purpose

Formal undergraduate education prepares nurses for general practice, but requires the core competencies for oncology nursing to be obtained in the clinical practice setting. Structured orientation programs contribute to novice nurses’ achievement of competency, but must be adapted to meet the evolving needs of the learners and the organization. This program evaluation project assisted with the development of a simulation based educational program to promote competency of novice oncology nursing staff in foundational skills for managing oncologic emergencies.

Interventions

The 2017 CDC framework for program evaluation guided the design and implementation of a simulation-based learning intervention to improve clinical competency, self-confidence, and anxiety with clinical decision making for novice oncology nurses managing oncologic emergencies. Simulation scenarios were designed by an interdisciplinary team of clinical experts and simulation participants recruited from the oncology nurse residency program (ONRP). Electronic surveys containing validated tools were distributed pre-simulation, post-simulation, and 30 days post-simulation to measure self-competence, self-confidence and anxiety.

Results

Eighteen novice nurses participated in the simulation with 94% demonstrating objective competency. The pre-intervention (M= 52, SD = 7.45) and post-intervention (M= 67, SD = 5.84) participants experienced improvement in self-perceived competency (t(17) = 9.27, p = <.001). In addition, self-confidence (t(17)=3.72, p = 0.0017), and anxiety (t(17)=3.48), p = 0.003) improved with a sustained impact in participants self-confidence in the ability to utilize information to see the bigger picture (t(13)= 2.15, p= 0.025).

Discussion

The recognition of oncologic emergencies requires knowledge and skills with complex decision making. This project demonstrated that incorporating a simulation-based intervention, in addition to traditional didactic learning, significantly improved the novice nurse’s self-perceived competency and self-confidence while lowering anxiety with complex decision making.

Oncology Nursing Forum. 2025 Mar 1;52(2):224.

P380. Oncology Care Initiation Unit Criteria and Flow

Pacifico Marquez ¹, Maura Abbott ², Angelica Martinez ³, Alma Carter ⁴, Lorie Ann Magno ⁵

Healthcare Delivery

Significance & Background

Oncology patients receiving treatment for their diagnosis are increasingly medical complex and ill. Patients often access care via the Emergency Department (ED) unnecessarily for complaints related to disease and side effects of treatment. The Oncology Care Initiation Unit (OCIU) at Columbia University Irving Medical Center/New York Presbyterian Hospital (CUIMC/NYPH) was founded to treat and manage non-life-threatening oncology and hematologic symptoms while avoiding unnecessary ED visits. The OCIU patients receive treatment for their symptoms in the NYPH Oncology Adult Infusion Center. The patient flow in an infusion center is critical in preventing delays to treatment for these acutely ill patients This project focused on the workflow to mitigate delays to treatment to improve clinical outcomes.

Purpose

The workflow criteria were created to be able to treat OCIU patients safely and in a timely manner. This Unit is used solely for specific Columbia Adult Oncology and Hematology Patients who meet defined clinical criteria and excludes all patients experiencing a true medical emergency. Clinical inclusion criteria were developed to determine when it was safe to allow a patient to be treated in the Infusion Center.

Interventions

There is a designated clinical team comprised of the OCIU Nurse Practitioner (NP) and the Infusion Center Registered Nurse (RN), and a designated treatment space in the Infusion Center. The OCIU Infusion RN provides care for one OCIU patient at a given time. Designation of these resources in combination with the clinical criteria allow for immediate individual assessment and treatment without delay, leading to improved clinical outcomes. There will be a total of 5 patients per day/chair/RN.

Results

The criteria and resource allocation helped those patients who needs urgent care and treatment to be seen on time and safely. There was a significant reduction in unnecessary Emergency Room visits that were prevented with >85% of patients being discharged home from the OCIU. This also improves the flow of these patients in the Infusion Center.

Discussion

There will be a communication between Nurses and Nurse Practitioner everyday regarding the expected patient of the day. The patients will be prioritize based on their needs and hope to expand the service to additional patients and complaints based on the success of the current unit.

Oncology Nursing Forum. 2025 Mar 1;52(2):224–225.

P381. Enhancing Administration Efficiency of Chemotherapy and Biotherapy with Certified Oncology Registered Nurses in Non-Oncology Units

Gina Martinez ¹, Julio Garcia ², Anely Campo ³, Jill Lykon ⁴, Elizabeth Smith ⁵, Javier Abreu Amador ⁶

Treatment Modalities and Managing Administration

Significance & Background

The University of Miami Hospital’s 11 North Unit, the sole hospital unit specializing in Chemotherapy, Immunotherapy, and Biotherapy (CIB), faces critical challenges due to its limited 30-bed capacity, which frequently exceeds demand. This overcapacity leads to the placement of oncology patients in non-oncology units, resulting in delays in chemotherapy administration due to a shortage of Registered Nurses (RN) trained in chemotherapy administration. To address these challenges, it is essential to improve treatment efficiency while adhering to Oncology Nursing Society (ONS) guidelines and our established CIB administration time of 60 minutes from a physician’s order. By exploring the integration of a resource certified chemotherapy administration RN in non-oncology units, we aim to enhance the timeliness and safety of treatment delivery, ensuring optimal patient outcomes.

Purpose

To address these workflow challenges, we launched a six-month pilot program featuring a dedicated chemotherapy RN tasked with administering all CIB for patients on active treatment located in other units. The primary objective was to ensure that CIB administration occurs within 60 minutes, in accordance with ONS guidelines.

Interventions

The pilot program involved a resource RN working Monday through Friday to coordinate CIB administration, provide staff education, and ensure compliance with protocols. Key metrics were tracked to evaluate the impact of this intervention on patient care and operational efficiency.

Results

Data from the pilot program indicated significant improvements in adherence to established CIB administration times, with Resource RN hours averaging 225 per month. Furthermore, a comparative analysis of antineoplastic medication administration revealed the percentage of non-oral antineoplastics administered within 60 minutes of the scheduled start time rose from 72.0% of all administrations (n = 5,183) during February to July 2023 to 79.0% (n = 8,625) during February to July 2024 as seen on Figure 1.

Discussion

The positive results from the pilot program indicate that dedicated resource RNs significantly improve both operational efficiency and patient care. Considering these findings, a proposal has been submitted to the finance department to secure funding for two full-time resource RN positions. By adding these dedicated resource RNs, we aim to provide consistent, high-quality care that addresses the unique needs of oncology patients, ultimately improving their treatment experience and outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):225–226.

P382. Improving Compliance in Blood Transfusion Documentation at an Ambulatory Treatment Center (ATC)

Ensaf Mather ¹, Michelle Lawrence ², Raquel C Herrera ³, Jeraldine Paco ⁴, Jocelyn De La Pena ⁵, Jomy Tony ⁶

Quality and Safety

Significance & Background

Blood transfusions are closely regulated for safety, aligning with state and federal health standards. Our institution maintains strict protocols to prevent and monitor transfusion complications utilizing a quality metric dashboard in the Hemovigilance Unit (HVU) staffed with advanced practice nurses. The outpatient ATC infusion team administers 50–100 units of blood components daily, with a current documentation compliance score of 73%.

Purpose

In March 2023, the ATC leadership initiated a quality improvement project aimed to address the gaps in documentation. Our goal was to increase the compliance score from 73 % to at least 90%.

Interventions

The initiative started by reviewing the current documentation practices. Provider/HVU notifications were the areas of noncompliance identified in the documentation of patients with adverse reactions. This area has been consistently pulling our score down and averaging 67%. To address the problem, the team collaborated with educators, business analysts, and frontline staff to create a checklist that would assist the clinical staff in accurately documenting these reactions and provider/HVU notifications. Other strategies and implementation planning included:

■ Patient care assistant workflow changes with focused blood vital signs assignment.
■ Vital sign machine placement in every patient room.
■ Re-education regarding the transfusion process with emphasis on provider and HVU notification procedures. Collaboration with the business analysts to formulate weekly transfusion compliance reports.
■ Consistent constructive feedback on non-compliance and development of a plan to meet the expected performance and behaviors.
■ Assigned a resource nurse to provide real-time blood auditing.
■ Developed a blood vital signs clock visual cue on our census board.

Results

After 6 months of implementation, the documentation compliance scores increased to >90%, with the greater impact of the provider notification rate increasing from 67% to 88% and continuing to improve. Moreover, the increase positively impacted the overall institutional compliance rate by 10%. The post-survey analysis revealed that 51% of staff agreed and 29% strongly agreed with the intervention. This project shows that involving front-line staff to make practice decisions yields better outcomes.

Discussion

This project demonstrates that staff training and continuous education initiatives cultivate a culture of improved documentation. A strong commitment to patient safety and improving our practices can positively impact the quality of care and patient experience.

Oncology Nursing Forum. 2025 Mar 1;52(2):226.

P383. Designing an Electronic Portal for Oncology Nurses: Empowering Care Through Technology

Christina Matousek ¹

Management

Significance & Background

Within the rapidly evolving healthcare environment, the utilization of technology is an essential component as it has been linked to improved efficiencies and enhanced patient care. Nurses are constantly being asked to adapt and respond to the fluctuations in healthcare delivery and policy, but struggle to locate resources to align care with these changes, leading to frustration and burnout. At our comprehensive cancer center, nurses consistently identified this gap, calling for nursing leaders to provide staff with a creative solution to address their needs.

Purpose

The purpose of this project was to create an oncology-specific website to provide staff with a meaningful resource for patient care and professional development.

Interventions

Feedback from staff was collected systematically to identify gaps and needs. Trends included lack of knowledge of standard operating procedures (SOPs), resources for nursing/patient education, and resources for obtaining professional certifications. Leadership feedback included lack of centralized area to store relevant resources for staff including continuing education opportunities, oncology class content, unit-specific resources, and staff recognition. Individual pages were developed to provide staff and leaders with a meaningful resource, including pages dedicated to our RN ambulatory fellowship program, oncology classes, continuing education/nursing educational resources, rewards and recognition, certification center, patient education, and SOPs. Electronic evaluation forms and storage capabilities were created within the website to enhance the orientation check-in process. Links to institutional policies and professional organizations were included for ease of access for staff. Unit specific pages are being developed to allow leaders a dedicated space for resources.

Results

Staff and leaders were surveyed for feedback and has been overwhelmingly positive. 71% of respondents report knowing how to locate this platform, with 62% accessing this site on a regular basis. Per feedback, the top three elements that are most useful include one area to locate resources, ease of use, and resource center for both classroom and SOPs. Efforts continue to be made to promote the website to staff. Enhancements were created based on feedback; for example, a section was established for monthly continuing education sessions featuring an on-demand. The website is updated monthly and as needed to ensure resources remain current.

Discussion

The development of an oncology website within our institution has provided staff and leaders with a centralized center for resources to enhance both patient care and professional development.

Oncology Nursing Forum. 2025 Mar 1;52(2):226–227.

P384. Reinvigoration of a Shared Decision-Making Avenue Across a Large, Multi-Site Healthcare System

Jennifer Matoush ¹, Margaret Wagnerowski ²

Management

Significance & Background

Across a large multi-site, multi-state healthcare system, including three academic medical centers and eleven community practices, collaboration among cancer nursing teams is critical. The healthcare system uses the same Electronic Health Record (EHR), including shared cancer treatment plans, policies, procedures, and guidelines. Nursing leaders identified the need for a consistent, practice focused, system wide decision-making committee, with representation from each unique site and practice.

Purpose

To reinvigorate an enterprise-wide practice committee, providing an avenue for shared decision making and implementation of evidence-based practice across a large multi-site medical center.

Interventions

An existing committee, which was previously focused on information sharing and inconsistently met, was reworked with nursing representatives from each unique geographic area and practice. Two Clinical Nurse Specialists from different geographic sites were chosen to co-chair the committee. The committee’s purpose and function were reviewed and updated and a structure for developing agendas, minute taking and follow up of agenda items was established. The committee instituted a consistent virtual meeting cadence, meeting two hours every month. To provide consistent messaging and share important information with clinical staff, as well as give non-members an opportunity to provide feedback on issues, highlights from each meeting are shared with all key stakeholders for dissemination.

Results

The success of the committee was determined through increased member attendance and high level of engagement, as well as project outcomes. Topics brought to the committee generated many small work groups, engaging non-members and members, which developed solutions that were vetted through the larger committee. Project work completed in the two years since the committee was re-invigorated include review and updating of all cancer focused nursing policies, procedures, and guidelines, implementation of standardized patient education videos and documents, implementation of site wide home spill kits, implementation and updating of several nurse-initiated protocols, and several enhancements of the EHR.

Discussion

An enterprise-wide nursing practice committee is essential to strengthening cancer practice and problem solving in a large multi-site healthcare system. Working together to solve issues and streamline processes maximizes resources and prevents duplication of work. The collaborative problem solving and diversity of ideas from the wide array of members has led to a strong, outcomes focused committee, where nurses feel safe to freely share ideas, concerns, and tackle problems together.

Oncology Nursing Forum. 2025 Mar 1;52(2):227.

P385. Education is the Key to Compliance Success

Dina Mattei ¹

Management

Significance & Background

In Spring 2021, a large academic medical institution expanded Bar Code Medication Administration (BCMA) and Interoperability to its outpatient infusion areas. This decision stemmed from persistent medication administration errors in the infusion departments and to align with successful implementations elsewhere in the institution. The initial target for compliance in infusion was set at 80%, lower than the system-wide goal of 95%. After a six-month introductory period, no significant improvement in compliance scores was observed. This highlighted a critical need for an educational program to enhance understanding and adherence to the new workflows and safety features.

Purpose

Ensuring patient safety through a regulated medication administration is paramount. Integrating BCMA and Interoperability into infusion workflows with standardized compliance goals is a crucial step in achieving this goal. The education implementation aimed to reduce the number of medication errors, improve accountability, and align with the Health System’s compliance standards.

Interventions

To enhance compliance with BCMA and Interoperability in the infusion areas, a structured educational program focused on interactive and bidirectional learning was executed. This initiative aimed to improve understanding of scanning methods and emphasize the importance of individual actions on compliance scores. Feedback sessions allowed staff to share challenges they face with the system and encourage open dialogue to identify common issues and areas for improvement. Data transparency shared compliance scores and trends with staff, making the data accessible and understandable. Incremental goals produced achievable compliance targets (e.g., moving from 80% to 90% and then 95%). Performance tracking used dashboards to track individual and team performance, allowing staff to see their contributions to the overall compliance scores. Accountability measures included check-ins for assessments to discuss progress and challenges. This kept the staff focused on improvement.

Results

Since its implementation, the compliance education has led to remarkable outcomes. Our compliance scores not only reached but exceeded the Health System’s goal of 95%. This achievement reflects a significant transformation in both the processes and the culture surrounding medication administration.

Discussion

By implementing this structured educational program, a culture of safety and accountability in medication administration within the infusion departments was fostered. Through interactive learning and continuous support, compliance scores improve and ultimately enhance patient safety across the institution.

Oncology Nursing Forum. 2025 Mar 1;52(2):227–228.

P386. Febrile Neutropenia: Beat the Clock with Code Heat

Nell Mayendia Blanco ¹, Jennifer Juarez ², Alexis Ondarza ³, Giomara Giron ⁴, Carolina Alonso ⁵, Aileen Barcelo ⁶

Quality and Safety

Significance & Background

Febrile neutropenia represents an oncologic emergency necessitating immediate intervention to reduce risk of sepsis and mortality. According to NIH guidelines, identification of neutropenic fever mandates prompt notification of providers, comprehensive testing, and the administration of antibiotics—all of which should occur within one hour. An analysis of cases where antibiotics were delayed revealed a significant opportunity for process improvement. It became evident that nurses required a streamlined mechanism to swiftly obtain assistance and necessary supplies, enabling them to complete all essential tasks as rapidly as possible.

Purpose

By creating educational materials and targeted interventions to improve the timeliness of care, we aim to enhance patient safety, optimize clinical outcomes, and streamline the management of febrile neutropenia in oncology settings. Implementation of a ‘Code Heat’ rapid response system and a ‘Code Heat Cart’ stocked with essential diagnostic supplies was designed to eliminate delays in treatment.

Interventions

Our nursing Shared Governance Council identified key barriers to obtaining timely assistance and necessary supplies. We developed and distributed a quick-reference guide to educate the nursing staff on protocols and expectations. We also instituted a “Code Heat” protocol at the unit level, allowing any available clinical staff to assist the primary nurse with critical tasks, such as order verification, diagnostics, laboratory work, and antibiotic delivery. Additionally, we implemented a “Code Heat Cart,” stocked with supplies for diagnostics, to eliminate delays in care. When “Code Heat” is called, clinical staff promptly retrieve the cart and collaborate with the primary RN to complete all required tasks efficiently.

Results

Chart audits were conducted to assess the time between the onset of fever and the administration of antibiotics, enabling us to evaluate improvements in compliance. The data indicates that since the implementation of the “Code Heat” protocol, instances of timely antibiotic administration have nearly doubled. Additionally, a survey administered to nursing staff revealed improvements in their perception of teamwork and their ability to complete tasks punctually.

Discussion

Guidelines state that timely antibiotic administration following the identification of a neutropenic fever reduces the incidence of sepsis and decreases mortality in oncology patients. The “Code Heat” initiative combined these concepts and profoundly impacted our ability to receive timely resources and assistance, ultimately improving compliance and patient outcomes. Nurses now receive the help they need quickly, allowing them to focus on providing optimal patient care.

Oncology Nursing Forum. 2025 Mar 1;52(2):228–229.

P387. Enhancing Clinical Trial Decision Making for Breast Cancer Patients: Insights from a Clinical Trial Navigation Program

Sabrina Mayhew ¹, Susan Colen ², Leeza Patel ³, Alexandra Burd ⁴, Sara Horton ⁵, Laura Esserman ⁶

Coordination of Care and Navigation

Significance & Background

BreastCancerTrials.org (BCT) is a user-friendly website that helps breast cancer patients find clinical trials. The platform empowers patients to explore potential trial options to determine if participation is a good fit for their treatment plan. A Clinical Trial Navigation Program was developed to further support BCT users. By addressing barriers and providing personalized support, education, and guidance, the navigator can support informed decision making about clinical trial participation.

Purpose

The objective of this study was to identify the primary concerns that prompted patients to seek assistance from the BCT clinical trial navigator.

Interventions

The program provided patients direct access to a certified nurse navigator specializing in clinical trials. Navigation services were advertised through the BreastCancerTrials.org website, social media, and an email campaign. The navigator provided personalized education on trials, answered questions and empowered patients in their clinical trial decision making process.

Results

We analyzed interactions and common questions of patients who contacted the Clinical Trial Navigation Program between May 1, 2024, and September 1, 2024. Patients were able to contact the navigator through various channels, including phone calls, emails, scheduled navigation appointments, and open Zoom office hours. Navigation inquires came from patients, caregivers, family members, friends and lay patient navigators who wanted to discuss trials for both metastatic and early-stage disease. A total of 109 interactions were conducted; 10 navigation phone calls, 21 emails, 34 through scheduled navigation appointments and 44 who registered for an open Zoom office hour session. The most common request was assistance in finding trials that matched their cancer characteristics, with key concerns around understanding trials, determining eligibility, and deciding if participation was right for them.

Discussion

Clinical trials not only provide access to innovative therapies but also offer patients the opportunity to contribute to advancing breast cancer research, yet many patients lack awareness and/or struggle with decision-making and enrollment. The Clinical Trial Navigation Program was developed to provide personalized support and education to address patients’ needs. BreastCancerTrials.org, combined with one-on-one navigation, equips patients with the tools needed for informed decision-making about clinical trial participation – which creates an improved patient experience and ultimately may lead to better outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):229.

P388. Promoting Practice Knowledge and Engagement for Research Staff in a Clinical Trials Unit: The Impact of a Standardized Shadowing Curriculum

Luningning Mayor-Talmadge ¹, Kimberly Ito ², Ariam Zeresennai ³

Management

Significance & Background

Early phase clinical trials (EPT) at an NCI-designated comprehensive cancer center Clinical Trials Unit (CTU) are substantive components in oncology care. Implementing EPTs mandates collaboration between infusion nurses and non-clinical research staff. Misalignments in the staff’s understanding of roles and workflow can lead to patient delays, protocol deviations, and decreased patient and staff satisfaction. Communication between the teams typically occurs via phone or in brief unit visits and is often sporadic, creating a gap in the development of camaraderie and mutual understanding between clinical and research teams.

Purpose

To design a program that enhances research staff practice knowledge and engagement within the context of the patient care workflows within a CTU.

Interventions

Unit leadership and staff initiated a structured CTU shadowing curriculum to establish a collaborative model of engagement. Representatives outlined primary goals for the shadowing curriculum: 1) expand research staff’s knowledge and experience of CTU clinical workflow intersections, 2) cultivate awareness of the patient’s experiences and expectations, and 3) mentor collaboration and camaraderie between CTU nursing and research staff. The curriculum integrated these goals with educational content and concurrent experiential research staff shadowing. Research staff shadowed both the CTU charge nurse and bedside nurses to comprehend patient care and experiences while participating in clinical trials.

Results

Post-program survey results (n=11) revealed key themes, including increased willingness among research staff to engage with nursing staff in the future, better research staff understanding of patient care workflows in clinical trials, and the research staff’s increased confidence in comprehending patient experiences during visits. CTU nurses also reported a deepened appreciation for the complexities of research patient care and the roles of research staff.

Discussion

Effective teamwork and collaboration in healthcare are not guaranteed by co-location or parallel patient care. This structured shadowing curriculum proved pivotal in creating a collaborative educational environment, enhancing role comprehension and setting the stage for improved teamwork and best patient outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):229–230.

P389. Reading Between the Lines: A Nurse-Led Review of Automated Reports and Documentation Compliance of Johns Hopkins Fall Risk Assessment Tool

Melinda Mayorga ¹, Thelma Ramos ², Ann Farley ³, Naomi Hyland ⁴, Ruben Singzon ⁵, Janice Kim ⁶

Quality and Safety

Significance & Background

The Johns Hopkins Fall Risk Assessment Tool (JHFRAT) is a validated tool to assess fall risk in both inpatient and ambulatory settings. Nursing documentation of the JHFRAT is imperative to determine compliance with patient safety initiatives and institutional policy standards. An automated compliance report showed ambulatory oncology nursing documentation was 40% compliant with JHFRAT documentation. This result was incongruent with observed documentation, fall prevention strategies and below benchmark fall rates across ambulatory infusion centers. The ambulatory fall prevention committee conducted chart reviews to challenge the institutional report of JHFRAT documentation.

Purpose

Accurate capture of JHFRAT documentation in ambulatory oncology infusion centers.

Interventions

■ JHFRAT data report generated to capture nursing JHFRAT documentation compliance
■ Chart review (n=170) was compared with automated report that identified discrepancy in data capture in 5 of 8 infusion centers
■ Review of internal data metric capture of JHFRAT
■ Data analysis metrics corrected, and new automated report generated

Results

Of the 170 charts reviewed within 5 of 8 ambulatory oncology infusion centers, 162 charts contained a completed JHFRAT (95% compliance). These results were shared with the data management team who reviewed internal computer algorithms and applied corrective measures to programming/logic computations. New automated results revealed a 70% compliance with JHFRAT documentation.

Discussion

While automated reports provide valuable data to measure compliance and records of care given, they must be interpreted with caution if data does not align with observed fall metrics, patient safety interventions and nursing documentation. When the original JHFRAT documentation report was presented in the ambulatory fall prevention committee, nurses did not agree with the report because it did not align with their reported individual practice of JHFRAT documentation. To validate this, the committee reviewed 160 charts from 5 of 8 infusion centers. This revealed 94% JHFRAT documentation compliance. This data was shared with the oncology informatics team who performed another real time 10 chart review. This additional review showed 98% compliance. At this point, the team analyzed and repaired faulty programming revealing 70% JHFRAT documentation compliance in 5 of 8 infusion centers. Current JHFRAT documentation compliance is now 92%. Nursing must partner with informatics to monitor documentation compliance validated with concurrent chart review. When actual practice is documented and captured, accurate data is obtained that can correlate with high standards of patient care and outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):230–231.

P390. Nurse-Led Fall Prevention Interventions to Reduce Falls From Wheeled Exam Stools in Oncology and Medical Ambulatory Clinics

Melinda Mayorga ¹, Mary Reed ², Jana Evenhouse ³, Kelly Vecchiarelli ⁴, Christina Tam ⁵, Lena Orlovsky ⁶

Quality and Safety

Significance & Background

Wheeled exam stools (WES) are a well-used seating option for clinical staff to perform examinations and assessments in the oncology and medical clinic setting. Patients and visitors often use WES as a seating option during appointments without regard to safety and potential fall risk. Ambulatory staff may not have considered fall risk when offering WES as a seating option. Analysis of institutional fall metrics revealed a trend of falls experienced by patients, visitors and staff related to WES.

Purpose

■ Disseminate fall trend related to WES to clinic personnel.
■ Develop a nurse-led education and action plan for oncology and medicine clinics across enterprise.
■ Reduce number of falls related to WES.

Interventions:

■ Analysis of Falls over three years related to WES
■ Disseminate fall trend related to WES to clinic staff
■ Nurse-led action plan developed/activated throughout oncology/medicine clinics and delivered during staff meetings. This included:
- * Falls/falls with injury related to WES
- * Education on proper body alignment when entering/exit from WES provided to staff.
- * Removal of WES from nonessential areas, including dressing and waiting rooms.
- * Initiation of WES safety rounds by nursing leadership, fall champions and unit nurses.
- * Discussion in unit huddles, fall prevention committee meetings
■ Clinic fall prevention champions supported and reinforced action plan.
■ Highlighting staff when “caught in the act” of removing WES from patient areas.

Results

Six falls from WES in a 13-month period. Patient falls were 67% while 37% of falls were visitor or staff related. Since action plan implementation, an 11-month period of 0 falls from WES. In months 12–14, 3 falls (33% patient, 67% visitor/staff) from WES occurred necessitating a review of all interventions. Months 15–22, zero falls from WES reported.

Discussion

A nurse-led fall prevention action plan and education can be socialized to oncology and medicine clinics. Nurses are well positioned to respond to fall trends that enhance patient safety. Post intervention, there was a reduction of falls from WESs for 11 months. Three falls (one with level 2 injury) occurred after this period which necessitated a review of the action plan, staff education and renewed implementation of safety rounds to verify elimination of WES in reach of patients. Fall prevention practices related to WES was added to onboarding and annual staff competency assessments to level set expectations that WES are not a safe seating option for non-clinicians.

Oncology Nursing Forum. 2025 Mar 1;52(2):231.

P391. Pediatric Post-Anesthesia Care Unit (PACU) in an Adult Radiation Oncology Setting

Marri McAndrews ¹, Erika Burkhart ², Nicole Melchiorre ³

Healthcare Delivery

Significance & Background

Proton therapy offers highly targeted radiation with minimal impact on surrounding healthy tissues, presenting significant benefits over traditional photon therapy. To facilitate access to this advanced treatment and ensure comprehensive care, a new Proton Therapy Center opened in July 2023, including a specialized Pediatric PACU designed to manage the recovery of pediatric patients from anesthesia. The introduction of a Pediatric PACU within a predominantly adult outpatient Radiation Oncology facility addresses the needs of pediatric oncology patients undergoing photon or proton therapy requiring anesthesia.

Purpose

The Pediatric PACU was established in response to the increasing demand for proton therapy among pediatric patients. This unit aims to deliver tailored care that aligns with the developmental needs of children undergoing cancer treatment.

Interventions

Nursing staff underwent four weeks of training at a local pediatric hospital, focusing on pediatric airway management and emergency protocols. This training included observation of pediatric anesthesiologists, respiratory therapists, and child life specialists, as well as hands-on experience in airway management. Key developments include the creation of a pediatric emergency airway cart and a medication binder for emergency situations, both developed in collaboration with pediatric anesthesia teams. The PACU also features child-friendly design elements such as interactive ceiling tiles and age-appropriate toys to enhance the environment for young patients.

Results

Since its inception, the Pediatric PACU has managed 338 cases, with ongoing expansion in patient volume.

Discussion

To address the challenges of long-distance travel for proton therapy, the Pediatric PACU fosters a supportive and reassuring environment for patients and families. The continuity of care provided by dedicated primary nurses has strengthened patient and family relationships, facilitating smoother transitions through extended treatment regimens.

Oncology Nursing Forum. 2025 Mar 1;52(2):231–232.

P392. The World of Oncology: An Introduction for Graduate Nurses

Maira McBride ¹, Molly Mattay ², Maryann Maramba ³, Laura Johnson ⁴

Management

Significance & Background

The world of oncology can be complex and daunting for graduate nurses whose initial knowledge of oncology is often minimal. We cover a wide range of specialties across our 3 inpatient units. This can lead to low levels of confidence and increased anxiety when caring for oncology patients. Enhancing graduate nurses’ confidence by equipping them with unit specific knowledge and skills can facilitate a smoother transition into the inpatient oncology units.

Purpose

The purpose of this “World of Oncology” program is to instill the basics of oncology nursing with the goal of increasing confidence in graduate nurses at the start of their oncology nurse journey.

Interventions

This educator led program focuses on the basics of oncology though a two-day curriculum of didactic content and hands-on skills. The program is held during week 4 and week 8 of precepted orientation to first expose the graduate nurses to the unit workflow and the world of oncology. This timeframe allows for the concept of flipped learning, where participants come prepared with questions based on their hands-on experiences, creating a more dynamic, interactive program. The morning lectures cover a broad range of topics from our various specialties including surgical oncology, medical oncology, and bone marrow transplant. Presenters consist of oncology educators, advanced practice providers, a pharmacist and other clinical program coordinators. The afternoon consists of an instructor-led hands-on practice session, allowing participants to develop and refine essential skills for our oncology units.

Results

To validate the effectiveness of the program, participants are asked to complete a confidence survey before and after the two-day training. Using a Likert scale the survey addresses the graduates’ opinions, attitudes and motivations on the topics covered in the program. These oncology-focused didactic and skills days have led to a noticeable increase, averaging around 20%, in their confidence levels related to the basics of oncology nursing.

Discussion

Graduate nurses often experience low confidence. The program content provides the nurses with the opportunity to secure a foundation in oncology basics. Instructor led skills are also an effective plan to minimize anxiety and increase confidence for when these same skills are performed on the unit. Overall, following the implementation of this curriculum, there is a marked increase in the confidence levels of oncology graduate nurses.

Oncology Nursing Forum. 2025 Mar 1;52(2):232.

P393. Avoiding Silos: Sharing Knowledge to Improve Patient Outcomes Across Care Settings

Anna McClenny ¹, Trisha Harmon ², Katie Ortner-Henry ³, Phuong Huynh ⁴, Sarah Kimbrough ⁵

Management, e.g. staffing, onboarding, competency, nursing education

Significance & Background

While cancer care has predominantly shifted to ambulatory settings, the care continuum may still include hospital encounters. Many community hospitals do not have dedicated oncology units, which challenges the development of expertise due to sporadic exposure to oncology patients. Oncology patients often present with high acuity, making oncology specific knowledge critical for supporting optimal patient outcomes. Nurse educators from ambulatory cancer centers are well situated to collaborate with these hospitals and enhance the provision of impactful oncology nursing education.

Purpose

To develop a curriculum with relevant and priority topics for inpatient nurses, ultimately improving oncology patient outcomes throughout the care continuum.

Interventions

A dedicated nurse education team from a large NCI-designated ambulatory cancer center performed a gap analysis to determine priority topics relevant to inpatient oncology practice at a community hospital. This analysis included a site assessment to understand workflows and equipment. The facility’s most experienced front-line oncology nurse was consulted to aid in identification of facility supplies, knowledge gaps, and oncology topic concerns on the unit. Additionally, the hospital’s education manager and pharmacists were interviewed to identify applicable oncology treatments, workflows, and policies. Using this analysis, a tailored curriculum was developed and delivered. An overview of cancer regimens was taught, focusing on priority assessments and symptom management. Key topics included medication-related toxicities, vesicants, and principles of supportive care. Further didactic content included oncologic emergencies, ASCO/ONS guidelines, and diagnosis-based considerations. Incorporations of hands-on components allowed for simulation of hazardous drug administration and port management practice, including initial skills validation for port access and de-access.

Results

Post-course survey results demonstrated that the course effectively provided foundational oncology nursing knowledge and equipped participants to confidently provide safe, specialized care. Feedback from the facility’s education manager at a follow-up meeting echoed this sentiment. During this meeting, the education team also shared pertinent resources and provided recommendations for further nursing development. Positive reviews led to a request for this training from a second community hospital.

Discussion

The oncology patient population continues to grow, increasing the demand for nurses with specialized knowledge. The expertise of nurses at specialized oncology facilities should be shared with community hospitals. This practice of knowledge sharing and fostering relationships can equip nurses to positively influence patient outcomes across the care continuum.

Oncology Nursing Forum. 2025 Mar 1;52(2):232–233.

P394. Acting F.A.S.T.: Identifying and Managing Strokes in an Outpatient Oncology Setting

Andrea McDermott ¹

Symptom Management and Palliative Care

Significance & Background

Cerebrovascular diseases (CVDs) are common in oncology patients, and can significantly aggravate their condition and prognosis, with approximately 15% of patients having a concomitant CVD. Outpatient settings are experiencing increased patient volume; therefore, establishing protocols for patient emergencies fosters improvement in staff confidence and patient safety. The confidence to identify and manage strokes is paramount when caring for oncology patients, as they are at higher risk and require swift treatment. At one National Cancer Institute designated cancer center, an algorithm for nurses to identify stroke patients and provide important interventions in the outpatient ambulatory setting was created.

Purpose

This initiative was to provide a standardized response to patients with potential strokes in an ambulatory setting and escalate their care.

Interventions

A multidisciplinary approach to creating an outpatient stroke algorithm included meeting with Quality and Safety, Evidence-Based Practice, nursing directors, and Advance Practice Providers/Physicians. Approximately 10 meetings were held to finalize the algorithm by utilizing an established inpatient workflow and translating the feasible practices into an outpatient system. Vital workflows were outlined such as using the F.A.S.T. acronym to identify symptoms, contacting 911, activating a Medical Emergency Response, and instituting interventions while waiting for emergency room transfer. The algorithm was presented to nursing shared governance committees, clinical councils, and medical board. Once approved, 6 virtual didactic lectures were held over a one-week period to educate nursing staff. The algorithm can now be found on the main hospital webpage.

Results

A standard clinical guideline was developed and implemented, and is currently being used in all outpatient regional sites. Over 250 nurses attended the virtual education sessions. Pre- and post-testing was completed to evaluate nursing confidence and comfort with learning the new algorithm and putting it into practice. Results showed average increases of: 4.97% in confidence recognizing stroke symptoms, 8.14% in confidence performing interventions for stroke symptoms, 4.47% in comfort calling a Medical Emergency Response, and 10.69% in knowledge on documentation in the medical record.

Discussion

The algorithm achieved the goal of developing a standardized workflow to guide the management of patients with stroke symptoms in the outpatient setting. This employs an evidence-based approach to provide important interventions and improve care coordination. Similar workflows could be implemented at other institutions to increase staff confidence and improve patient safety through an established standard of care.

Oncology Nursing Forum. 2025 Mar 1;52(2):233–234.

P395. Ring, Ring... Are you ok?: Simulation Training to Enhance Newly-Hired Oncology Nurse Navigator Confidence in Telephone Symptom Assessments

Lauren McGovern ¹, Ann Furey ²

Professional Development

Significance & Background

Oncology nurse navigators (ONN) play a crucial role in enhancing patient care by improving symptom management and education. ONNs often conduct assessments over the phone without the ability to visually assess a patient. They must effectively utilize resources, review patient charts, and ask open-ended questions to develop a full assessment. This approach is essential for collaborating with the cancer care team and improving patient outcomes.

Purpose

To enhance self-rated confidence of newly hired ONNs in conducting telephone symptom assessments, identifying priority interventions, and completing appropriate documentation through simulated patient scenarios.

Interventions

Following a staff learning needs assessment, two telephone assessment simulation scenarios were developed by clinical nurse educators to enhance nursing practice. Nurse leaders identified staff ONNs who were hired within the past six months to participate in these virtual simulations. Prior to the simulation, participants were provided detailed information about the simulation, including learning objectives. Simulations occurred over Zoom and lasted approximately 45 minutes. A staff member, acting as a patient, with a blocked camera was on the zoom and a nurse educator facilitated the scenario and post-debriefing. Participants reviewed a mock patient chart and then conducted the patient phone call. During the simulations, participants collaborated to conduct symptom assessments, identify interventions, and describe best practices for documentation and follow-up care.

Results

To date, three simulations have been completed with a total of eight participants. Half of the participants completed the program evaluation. All respondents rated the simulation as a valuable use of time and expressed willingness to participate in future simulation scenarios. Additionally, all respondents either agreed or strongly agreed that they felt confident, as a result of the simulation, in conducting telephone symptom assessments, identifying priority interventions, and completing appropriate documentation. Free text comments highlighted the most valuable aspects of the scenario, including the comprehensive chart review before the patient call, the review of the standardized telephone documentation template, and the methods for assessing the patient’s self-rated symptom severity.

Discussion

Training ONNs to conduct comprehensive telephone symptom assessments has the potential to enhance the quality of nurse-patient interactions and improved patient symptom management. Additional ONN training programs could be developed to include not only newly hired ONNs but more experienced ONN staff members, thereby broadening the scope and impact of the training initiative.

Oncology Nursing Forum. 2025 Mar 1;52(2):234.

P396. Supporting Emerging Nurse Leaders: Piloting A Structured Mentorship Program

Lauren McGovern ¹, Indy Robles ², Esmerelda Ciano ³, Colleen McLaughlin ⁴, Jeanine Rundquist ⁵

Professional Development

Significance & Background

Effective leadership is critical in healthcare and has been shown to have a positive impact on patient safety and satisfaction, staff job satisfaction and retention, and reduced staff incivility. In order to continue to support workforce development, it is essential to train and retain skilled leaders. Mentorship programs offer a structured approach to leadership development and retention.

Purpose

Evaluate the feasibility and outcomes of a formalized mentorship program between new nurse and clinic assistant (CA) managers and experienced nurse leaders and assess if it impacts the professional development and retention of nursing department leaders.

Interventions

A structured mentorship program was developed and is currently being piloted in an ambulatory oncology setting. New hire CA and nurse managers and those hired within 18 months of the pilot were included in the mentee recruitment. Mentees were paired with experienced nurse leaders based on professional goals, personal interests, and identified areas of concerns. Mentors were not direct supervisors of their mentees. Participation was voluntary. Participants received a Mentorship Toolkit and other online resources. Participants were expected to meet for 45–60 minutes monthly, over a twelve-month period, with the choice of virtual or in-person meetings.

Results

Participants complete anonymous surveys at 3, 6, and 12-months. To date, nine pairings have enrolled in the pilot with four pairs completing the 3 and 6-month surveys. Preliminary data shows an improvement in the mentee’s professional growth, problem-solving abilities, and handling of human resource issues. Mentors reported gains in their professional growth and personal satisfaction. All participants felt well-supported and satisfied with monthly meetings. The main challenge identified was coordinating schedules for monthly meetings between participants.

Discussion

Mentorship programs have the potential to improve new manager transition into practice. Ongoing data collection will further evaluate the impact of the mentorship program on leadership retention.

Oncology Nursing Forum. 2025 Mar 1;52(2):234–235.

P397. Cancer Survivorship: It’s not just an Endpoint

Meaghan McGuire ¹, Kathleen Halasz ²

Survivorship

Significance & Background

According to the National Cancer Institute (NCI), survivorship starts the day someone receives a cancer diagnosis (2024). The National Comprehensive Cancer Network (NCCN) lists cancer pre-habilitation as appropriate for many newly diagnosed survivors prior to initiating treatment (2024); therefore, survivorship care should start at diagnosis (Zebrack, 2024).

Purpose

Survivorship clinics usually follow patients after treatment when side effect management might not be as beneficial, and many are time sensitive such as cardiac rehab prior to initiation of certain treatments. Having a survivorship visit in the beginning of treatment could impact the health and well-being of the patient before, during and after treatment.

Interventions

Doylestown Cancer Institute has Nurse Navigators (NN) and a Survivorship Nurse Practitioner (SNP) available to assist patients before, during and after treatment. All newly diagnosed solid tumor cancer patients that have an associated NN are offered a visit with the SNP in person or via telehealth per patient convenience. During the survivorship appointment patients undergo an evaluation and introduction to the program that includes education specific to diagnosis, pre-habilitation, resources available, and referrals made as appropriate. After an evaluation patients are encouraged to reach out as needed to discuss ongoing concerns in addition to routine oncologic care. The NN continues to remain available.

Results

Initially, concerns were raised that individuals would be overwhelmed and a SNP appointment before treatment, would be futile; however, patients reported they were satisfied with the intervention and felt more prepared. Patients reported a better understanding of their diagnosis and treatment, how to care for themselves during treatment, ways to decrease long term side effects of treatment, and resources available to them throughout treatment.

Discussion

Survivorship starts at diagnosis and several resources exist that can improve the outcomes of patients before, during, and after their cancer journey. With a better understanding of the value of survivorship care that starts at diagnosis additional research focusing on this type of intervention is necessary to continue to improve the lives of cancer survivors.

Oncology Nursing Forum. 2025 Mar 1;52(2):235.

P398. Increasing Nurse Comfortability Providing Sex Education to the Chemotherapy Patient

Amanda McKaig ¹, Elliana Souza ²

Patient Education

Significance & Background

Physical intimacy greatly contributes to a person’s well-being and quality of life (Kelvin et al., 2014; Maree & Fitch, 2019). In most cases, patients can continue to be sexually active while undergoing cancer treatment if they are following safe sex practices (Kelvin et al., 2014). Unfortunately, safe sex practices are rarely discussed between oncology providers and their patients (Kelvin et al., 2014). Some barriers to these discussions include sexual health being perceived as a lower priority, lack of education, personal comfort level, and waiting for patients to initiate the conversation (Maree & Fitch, 2019). When it comes to discussing sexual health with oncology patients, younger and less experienced nurses report the greatest level of discomfort (Julien et al., 2010). Purpose; The purpose of this project is to increase nurse comfortability providing sex education to chemotherapy patients. This will be achieved by implementing a standardized patient education pamphlet to help guide conversations regarding sexual health and intimacy.

Interventions

A pre-survey was sent to staff nurses on an inpatient solid-tumor oncology unit, measuring their attitudes and comfortability regarding sex education. Preliminary results show that 70% of respondents never provide sex education to their chemotherapy patients. When asked how comfortable they felt providing sex education on a scale of one to five (one being not comfortable at all and 5 being extremely comfortable), 66% of respondents selected two or three, indicating a moderately low level of comfortability. This demonstrates a practice gap and suggests patients are not receiving adequate education. To address this, a standardized patient education pamphlet will be created to outline key points regarding safe sex during chemotherapy treatment. This will be reviewed with patients as part of their initial chemotherapy education and can be used by nurses to standardize education and facilitate conversations.

Results

A post-survey will be sent to nurses to measure their attitudes and comfort regarding sex education after implementing the pamphlet. Our goal is to see an increase in both the frequency with which nurses provide sex education and their self-rated comfort level.

Discussion

Our project aims to address gaps in patient education and help nurses feel comfortable discussing sexual health and intimacy with their oncology patients. We hope to emphasize the importance of sexual health as part of a holistic approach to cancer care.

Oncology Nursing Forum. 2025 Mar 1;52(2):235–236.

P399. Ensuring Safe and Effective HAI Pump Refills: The Impact of a Standardized Flow Sheet

Katherine McLaughlin ¹, Faith Regn ²

Healthcare Delivery

Significance & Background

An HAI (Hepatic Artery Infusion) pump delivers high doses of chemotherapy directly into the liver through the hepatic artery, targeting liver metastases with concentrations approximately 400 times higher than those achieved by intravenous administration. This method uses the liver’s unique anatomy to significantly reduce systemic toxicity and improve treatment effectiveness by concentrating the drug specifically where it’s needed. However, precise refilling procedures are crucial, as incorrect administration can lead to ineffective treatment, or the pump could deplete its reservoir and become unusable later. At our infusion center, many nurses lacked the knowledge and skills needed to verify orders and administer treatments correctly. To address this, we developed an HAI pump refill flowsheet to support staff and ensure correct treatment administration.

Purpose

This initiative’s main objective was to develop a standardized flow sheet for HAI pump management that could be used by nursing staff to enhance the accuracy and timeliness of refills and treatment administration. This tool was designed to minimize variability in care, reduce missed treatments, and ensure consistent patient management.

Interventions

A detailed flow sheet was created, outlining each step required for the proper administration of HAI pump refills. This included protocols for glycerin, heparin, and FUDR (floxuridine) administration, and procedures for managing abnormal situations. The document was structured to be user-friendly, offering clear guidance on accessing the pump, instilling solutions, and ensuring proper flow rates based on the patient’s individual pump. The flow sheet also includes decision-making protocols for when to contact providers in cases of abnormal findings.

Results

Data collection is ongoing; however, preliminary trends indicate a reduction in missed or improperly administered doses. Anecdotal evidence from nursing staff suggests that the implementation of the flow sheet has reduced errors in HAI pump management. Nurses report ease in using the flowsheet and feeling more confident in their ability to manage these complex treatments.

Discussion

The HAI flow sheet has been a successful addition to standard nursing chemotherapy education. The flow sheet has become a critical tool in ensuring safe and effective chemotherapy administration at our center.

Oncology Nursing Forum. 2025 Mar 1;52(2):236.

P400. Battling Falls with injury One Bed Alarm at a Time

Margaret McManus ¹, Christopher Calderone ²

Quality and Safety

Significance & Background

Nurses are an integral part of the change process in the healthcare setting. The patient population cared for primarily have an oncology diagnosis and are seeking treatments for both their disease and symptom management. Due to the side effects of the cancer treatment, pain management, and often the cancer diagnosis itself, these patients pose high safety risks. One safety risk highlighted is the risk of falls. On average, up to 50% of inpatients can be categorized as “at risk for falls”. In 2023, falls were up trending. This same year, the hospital received medical beds which included the ability to initiate a bed alarm.

Purpose

Our team implemented a 3-month pilot involving the expansion of bed alarm usage in relation to patients with a BMAT score of 3 in the hopes of reducing falls with injury.

Interventions

Having not used bed alarms before, staff were educated on the Bringham Women’s Falls TIPS board. If a patient were to “forget or choose not to call” a bed alarm would be initiated, and in return alarm notifying staff when a patient left the bed without assistance. Response times remained prompt, but this intervention did not prevent falls for patients at risk based on lower extremity weakness, which account for 60% of our patient falls per data. Taking this into account interventions were put into place to include the Bedside Mobility Assessment Tool (BMAT), an algorithm applied by nursing staff to determine a patient’s highest functional mobility, and bed alarm activation. Additionally, to maintain best practices, leaders conducted regular rounds to educate patients and verify safety measures were followed.

Results

The pilot outcomes were promising: a 21% drop in falls overall and a 56% reduction in falls with injury. Better patient outcomes can be achieved with proper organization, communication, and the inclusion of nursing staff in the change process. With the initial success of the pilot, the remaining inpatient units adopted the process of placing patients scoring a BMAT level 3 on bed alarms.

Discussion

Upon completion of the presentation, attendees will walk away with pearls of wisdom about how to successfully care for a patient at risk for falls. They will also identify the mobility challenges and fall risks oncology patients present with and how to apply BMAT with bed alarm utilization.

Oncology Nursing Forum. 2025 Mar 1;52(2):236–237.

P401. Reducing Cervical Cancer Stigma

Gretchen McNally ¹, Electra Paskett ²

Psychosocial Dimensions of Care

Significance & Background

Cervical cancer is highly stigmatized, mainly due to its association with sexual activity and the Human Papilloma Virus (HPV). Stigma is a barrier to help-seeking and presenting for care, contributing to treatment delays, and negatively impacting the quality of care received.

Purpose

To develop a white paper reviewing cervical cancer stigma and to inform innovative solutions for the American Cancer Society National Roundtable on Cervical Cancer (NRTCC) stigma workgroup.

Interventions

N/A.

Results

The Health Stigma and Discrimination Framework (HDSF) (2019) guided the organization of cervical cancer stigma studies into the time-based categories of past and present, with future recommendations. Identified articles classified as “past” (n=2) focused on the connection of cervical cancer to HPV, considered a sexually transmitted infection. The media highlighted this association, which generated unfavorable perceptions. Most of the “present” studies (n = 7) were descriptive in nature. One study evaluated an online intervention.

Discussion

In 2010, the National Comprehensive Cancer Network (NCCN)recognized cancer-related stigma as “the elephant in the room,” a significant barrier to delaying, receiving, or terminating care for treatable conditions. The HSDF recognizes the complexity of stigma, with co-occurring and bidirectional intersectional factors existing on multiple levels. This framework recognizes that more similarities than differences exist with stigma between distinct conditions. Recent studies have comprised higher risk, diverse populations, such as low-income, different races and ethnicities, and sexual and gender minorities, among others. Future studies need to incorporate standardized measurement tools to compare across studies and inform the development of effective cervical cancer and HPV-related stigma reduction interventions. One proposed solution uses a universal precautions approach to stigma reduction, utilizing the socioecological model HSDF. Integrating universal precautions into every situation versus select circumstances reduces the assumptions that give rise to stigma. The first step is to focus on communication, as terminology may increase stigmatizing attitudes and influence the care delivered. Several professional organizations have released sensitive and inclusive guidelines recognizing the power of language.

Oncology Nursing Forum. 2025 Mar 1;52(2):237.

P402. Enhancing Nursing Orientation Through Peer Mentorship

Meagan McQuade ¹, Jennifer Oakvik ², Kathryn Hanley ³

Professional Development

Significance & Background

Despite over 60 years of nursing orientation practices, there has been limited innovation in approaches to support new graduate nurses. Recent surveys indicate that 21.2% of newly licensed registered nurses (RNs) leave their positions within the first year, underscoring the urgent need for effective retention strategies. New graduates often face significant psychosocial challenges, including stress and negative thinking, particularly during their initial months of practice. Studies reveal that many experience heightened stress levels and low job satisfaction for up to nine months post-hire, highlighting the necessity for ongoing support during this critical transition period.

Purpose

This study aims to enhance nurse retention, reduce turnover, and improve job satisfaction through the implementation of a peer mentorship program within the nursing orientation framework at MSK.

Interventions

The intervention involves pairing each new graduate nurse with a designated peer mentor, fostering a supportive environment for professional development. An organized initial meeting will establish clear goals and expectations for the mentorship process. Subsequent connections will be determined collaboratively by the mentor and mentee to ensure flexibility and relevance to the new nurse’s needs.

Results

By integrating peer mentorship into the existing orientation structure, we anticipate a reduction in turnover rates within the first 12–24 months of practice at MSK. We will evaluate the program’s impact on job satisfaction, stress management, and overall retention through qualitative and quantitative assessments.

Discussion

This study posits that the introduction of peer mentorship during nursing orientation can significantly alleviate the psychosocial challenges faced by new graduate nurses. By providing tailored support and fostering a sense of belonging, this initiative aims to create a more resilient nursing workforce, ultimately enhancing retention and job satisfaction in a demanding healthcare environment. Further research will be essential to assess long-term outcomes and establish best practices for mentorship integration in nursing orientation programs.

Oncology Nursing Forum. 2025 Mar 1;52(2):237–238.

P403. Empowering, Educating, and Supporting Oncology Nurses in Interdisciplinary Evidence-Based Practice with Early Identification and Treatment for the Oncology Sepsis Patient

Sydne Mead-Smith ¹

Quality and Safety

Significance & Background

At a large academic National Comprehensive Cancer Network (NCCN) designated hospital that provides world-class oncology treatment and research we have nurse driven policies and protocols around sepsis. This center is committed to involving and empowering nurses in interdisciplinary decision-making around the practice of early identification and treatment for oncology sepsis patients. Sepsis continues to be a threat to our very vulnerable oncology patient population.

Purpose

To increase awareness and elevate sustainable tools that educate and empower nurses in the delivery of evidence-based practice nursing sepsis interventions to improve oncology patient outcomes.

Interventions

In recent years, the medical community has appreciated the importance of early identification and treatment as best practice for patients with suspected sepsis. At this institution, nursing-activated bedside sepsis huddle and implementing nursing-initiated orders were implemented to improve oncology patient outcomes and decrease mortality. The successful methods and interventions of the practice change involved identifying all key stakeholders, designing a mindful action plan, and creating an impactful timeline. Interventions included targeted oncology staff education with multidisciplinary team involvement, increase enterprise-wide sepsis awareness, provide real-time case feedback, and distributing transparent monthly quality metrics regarding Centers for Medicare and Medicaid Services SEP-1 core measure. A unit specific needs assessment was also completed to evaluate knowledge, attitudes, and beliefs around the topic of sepsis in the oncology patient population.

Results

Empowering the bedside nurse to actively implement evidence-based nursing interventions improves oncology patients’ outcomes with sepsis. These practice changes support autonomous nursing practice, increase initiation of the sepsis huddles, strengthen multidisciplinary team communication and relationships. Quality analytics will be regularly monitored with the goal of decreasing septic shock mortality for our patients. These value-added practice changes around sepsis are well supported by leadership and continue to produce optimistic outcomes. Following our pilot study we already appreciated an increase of twenty-eight percent in the utilization of the evidenced-based practice nursing-activated bedside sepsis huddle. Further education enterprise-wide is needed to increase sepsis awareness and the importance of interdisciplinary collaboration when caring for the septic patient.

Discussion

Nurses are instrumental in delivery of evidence-based strategies that directly improve oncology patients’ outcomes impacted with sepsis. The ongoing support and creation of tools that support autonomous nursing practice exemplifies our hospital’s values and mission.

Oncology Nursing Forum. 2025 Mar 1;52(2):238–239.

P404. Expanding Cellular Therapy Weekend Capacity: A Training Program for Non-Cellular Therapy Infusion Nurses

Jessica Meeker ¹, Jennifer Hotchkiss ², Lauren Sullivan ³, Margie Guillory ⁴, Teresa Mazeika ⁵, Janet Bagley ⁶

Healthcare Delivery

Significance & Background

With the rapid growth of the ambulatory cellular therapy program, care is required seven days a week to meet the needs of this population. A shortage in the number of trained cellular therapy nurses on the weekends, a time when nurses from all disease centers come together on one unit, became apparent. To address this critical shortage, a targeted training initiative was developed to train non-cellular therapy infusion nurses with the expertise required to meet the complex needs of patients receiving cellular therapies during the weekend.

Purpose

To design a training program to enhance nurse competency in the care of patients receiving cellular therapies to address the growing demand for specialized cellular therapy nursing care on the weekends.

Interventions

Cellular therapy educational material was created by the clinical nurse specialist and nursing leadership for the cellular therapy training program. This material was reviewed for feedback by cellular therapy infusion nurses prior to it going live as an online educational module in HealthStream. This material provided a general overview of cellular therapy, conditioning therapy, and the nurse’s role caring for this patient population. Time was spent shadowing a cellular therapy nurse, as well as a cellular therapy pharmacist and advanced practice provider while they performed their patient teaches. To enhance this training program, the patient teaches by pharmacy and the advanced practice provider were recorded and added to the online HealthStream module. Following the completion of this mandatory online training and shadowing, the nurse is assigned to take care of cellular therapy patients on the weekend.

Results

Nurses completed pre- and post-training surveys to evaluate the effectiveness of the training program. A total of 19 nurses were trained. Most nurses were unfamiliar or somewhat familiar with types of stem cell transplants prior to the training program (63%), conditioning therapy (73%), and the nurse’s role in ambulatory transplant (84%). Following the training, most nurses were familiar or very familiar with types of stem cell transplants (66%), conditioning therapy (83%), and the nurses’ role in ambulatory transplant (83.4%).

Discussion

The training program effectively addressed the shortage of weekend cellular therapy-trained nurses, ensuring consistent, high-quality care for this complex patient population. This initiative can serve as a model for other institutions facing similar staffing challenges in specialized care settings.

Oncology Nursing Forum. 2025 Mar 1;52(2):239.

P405. Clinical Trials in the Community-Building Patient Trust and Improving Access

Eileen Meisler ¹, Kaitlin Brenner ², Alyssa Frank ³, Wendy Hildebrandt ⁴, Emilie Slonoc ⁵, Lisa Mirossay ⁶

Healthcare Delivery

Significance & Background

Multiple barriers exist to enrolling patients on clinical trials. A common obstacle is the ability to easily access major academic centers due to logistical challenges such as travel distance, parking, and navigating a complex system. Continuity of care and established rapport are of high importance to oncology patients and influential factors in trial consideration.

Purpose

Our purpose is to empower patients within the community by providing additional options for treatment and creating a greater understanding of clinical trials.

Interventions

Eight regional sites of varying distance from a large academic medical center offer clinical trials which closely align with the community’s unique oncology treatment needs. Each site offers care across a variety of oncologic malignancies with specialized research personnel. The regional team also participates in community outreach screening trials to enhance our minority population’s access to care. This promotes an atmosphere of trust and decreases misconceptions about research. To combat transportation challenges, regional sites coordinate van and uber services for patients in need.

Results

Since implementing regional clinical trials, enrollment has increased from a total of 380 in 2011 (5 sites) to 601 in 2023 (8 sites). These totals include interventional and non-interventional trials. Interventional trial enrollment increased from 43 in 2011 to 214 in 2023, an astounding 400% increase. As more regional sites were added, transfers to the main campus decreased by 73% during those same years. Current challenges at regional sites include lab processing limitations, lack of inpatient units, unwillingness of sponsors to ship medications to locations other than the main hub and limited staffing/resources.

Discussion

Offering clinical trials in our neighborhoods is a positive action for the community. Access to healthcare is a human right. As our data suggests, by eliminating transportation, financial and trust barriers, availability of oncology research at regional sites can, and should, be the wave of the future.

Oncology Nursing Forum. 2025 Mar 1;52(2):239–240.

P406. Timely Insulin Delivery on Inpatient Oncology Unit

Erin Meixner ¹, Kathleen Ricciuti ²

Quality and Safety

Significance & Background

New CMS standards state that sliding scale insulin must be given within 30 minutes of point of care (POCT) glucose testing. Insulin administered after 30 minutes is a medication error. 3AB Inpatient Oncology Unit was not meeting the goal of 90% compliance with scores as low as 69.17%.

Purpose

This discrepancy not only poses a risk to patient safety but also highlights the need for a concerted effort to enhance nursing practices and ensure that all staff members are well-informed about the importance of timely insulin administration. Addressing this issue is vital not only for compliance with CMS standards but also for the overall quality of care provided to patients, particularly those in vulnerable populations such as oncology patients who may have complex medical needs and at an increased risk for infection from delayed healing associated with uncontrolled diabetes.

Interventions

Baseline assessment was sent to all nurses and patient care technicians. 5 question quiz given to get an idea of barriers to timely insulin administration. Barriers identified were that the team was confusing prandial and correctional insulin. Unit based council discussion on responsibilities and teamwork to improve compliance and decided on new workflow to ensure buy in from participants along with detailed re-education to all team members. PCTs to collect first POCT prior to meal delivery and verbally notify nurse of result. Nurses who are not able to medicate within the half hour are responsible for re-testing POCT glucose.

Results

Immediate 3-month post-intervention period results were 88.7%, 91.9%, and 93.0%. Workflow changes have continued to ensure compliance and the unit has met the goal of 90% monthly since this time.

Discussion

By focusing on these strategies, the 3AB Inpatient Oncology Unit was able to elevate its compliance rates and ensure that all patients receive the timely care they require, ultimately enhancing patient outcomes and safety in alignment with CMS standards.

Oncology Nursing Forum. 2025 Mar 1;52(2):240.

P407. Optimizing Existing Resources to Improve New Chemotherapy Patient Experience

Cassandra Mendez ¹, Heather Harris ², Nicole Coates ³, Jordan Carrera ⁴, Jana Linsenmeyer ⁵

Coordination of Care and Navigation

Significance & Background

This growing community-based outpatient chemotherapy infusion unit (OCIU) has seen 15.5% volume increase in the last year. Despite rising new patient volumes, staffing numbers have remained consistent since opening in 2017. To meet this increasing demand, the need to standardize the intake process for new chemotherapy patients was identified.

Purpose

The purpose was to find opportunities to enhance the new patient experience by optimizing existing resources.

Interventions

A workgroup was created between OCIU and clinic nursing to identify areas for improvement in the process for new chemotherapy patients. We observed gaps in knowledge and inconsistencies in venous evaluation practices among providers. Specifically, only 55% of patients received vein assessments before starting chemotherapy. Among those assessed, 50% were found to need a central venous access device (CVAD). Of those who required a CVAD, 31% experienced delays, with CVAD placement occurring after the initiation of chemotherapy. Additionally, fewer than 50% of patients received chemotherapy education from the pharmacist. Lastly, infusion team members were frequently unaware of new patients scheduled to start chemotherapy until the day of first infusion. To improve workload and patient experiences, the intervention focused on: 1) Clinic provider education on the importance of venous assessment prior to first treatment; 2) Development of a new communication group within the electronic health record (EHR) which included the infusion team in new patient notifications; 3) OCIU nurses implemented proactive chart reviews for the upcoming week to allow time to schedule needed interventions; and 4) Financial authorization checks were integrated into daily interprofessional huddles, which alerted team members to upcoming new patients to improve coordination of care.

Results

The data pool consisted of patients newly starting chemotherapy, with those beginning oral chemotherapy agents excluded from the analysis. Since implementing these interventions, the percentage of new patients receiving pharmacist led education increased from 48% to 74%. Additionally, the rate of patients undergoing venous assessments has improved dramatically, from 55% to 100%.

Discussion

The collaborative effort among staff members within the Cancer Center has enhanced teamwork and improved patient care, as evidenced by increased patient education and preparedness. Although we have seen improvements, we recognize that challenges remain due to staffing limitations. A future goal is to implement an EHR new patient checklist to enhance ease of use and streamline the process for team members.

Oncology Nursing Forum. 2025 Mar 1;52(2):240–241.

P409. Improve Blood Product Administration Compliance Score in the Ambulatory Treatment Center

Gina Mendoza ¹, Sheila Castro ², Lita Soria ³, Saly Jacob ⁴, Bibina Thomas ⁵, Melinda Eliff ⁶

Quality and Safety

Significance & Background

Administration of blood products (either platelets or red blood cells) occurs frequently in the oncology ambulatory treatment center. Administration of blood products consists of several steps including time of product received, completing dual nurse checks, and pre and post transfusion administration. These steps help ensure patient safety as well as compliance with nursing documentation. Maintaining documentation compliance is a crucial part of the administration process as it monitors all levels of safety checks completed by the nursing staff.

Purpose

The objective of this quality improvement project was to increase blood product administration compliance score by identifying barriers in the blood administration process through collaboration with nursing staff and nursing leadership. The goal was to increase and maintain blood product administration compliance from 70% to 100% (February 2024 through April 2024) and sustain compliance of 100%.

Interventions

A series of assessment questions were created to identify barriers in the blood administration process. Results were analyzed and interventions were created. 39% of nursing staff expressed that the blood product administration process was not clear and concise and 78% were in support of using a tip sheet to help guide the administration process. From the results obtained, a slide show presentation was created and presented to the nursing staff in staff meetings and small group huddles. The presentation outlined the step-by-step process of blood product administration with focus on audited documentation, and an institutional tip sheet was also reviewed with the nurses. The team monitored monthly audits and analyzed results from the post-survey.

Results

From February 2024 through April 2024, blood product administration compliance increased from 78% to 100%. A post survey was administered to nursing staff after the interventions were implemented. 94% of the nurses felt that the PowerPoint presentation was helpful in clarifying the blood product administration process. Nursing staff have been able to sustain compliance of 100% since April 2024 through present (July 2024). Team members continue to monitor compliance scores and potential barriers monthly or more frequently if needed.

Discussion

Blood product administration compliance is critical in maintaining proper documentation, hence ensuring safe patient care as well as upholding institutional standards of care.

Oncology Nursing Forum. 2025 Mar 1;52(2):241.

P408. Medication Administration for Apheresis Procedures in a Hospital-Based Setting

Maricel Mendoza ¹, Sara Patterson ²

Quality and Safety

Significance & Background

Medication administration during apheresis procedures requires strict adherence to Standard Operating Procedure protocols to prevent complication and ensure patient safety. Adherence with medication protocols in a hospital-based setting can be challenging due to the complexity of the Apheresis procedural treatments. Non-adherence can lead to medication errors, adverse events, and poor patient outcomes. Thus, highlighting the need for standard of care to enhance adherence. Addressing these gaps requires targeted solutions such as enhanced training, standardized workflows, and ongoing support to ensure consistent practice to Apheresis procedures.

Purpose

This quality improvement project’s primary goal was to develop strategies to incorporate medication administration protocols during apheresis according to hospital-based requirements, as they may differ from free-standing centers. It aims to identify common barriers to meeting these requirements and implement effective interventions to address these barriers.

Interventions

Interventions focused on enhancing medication administration workflow included several key components. RNs were educated on apheresis-specific medication protocols, and the electronic Medication Administration Record (MAR) was utilized for real-time documentation. Real-time audits were conducted to monitor adherence to the workflow, and feedback sessions to address any identified gaps in practice. Medication administration workflows were developed for therapeutic procedures and cellular therapy collections, ensuring a standardized practice. The workflow incorporated medication administration standards, barcode scanning, and sequencing of medication preparation according to hospital-based operating procedures, which may differ from apheresis procedural workflow. Documentation of pre-procedure patient assessments, procedural Timeouts, venous access (peripheral/central), medication administration, and post-cannulation were incorporated into this workflow. To ensure a comprehensive assessment and effective implementation, the team included the two Apheresis RN project leads, Safety and Quality, and the Cellular Therapy Manager.

Results

Real-time adherence and the effectiveness of the implemented workflow were assessed through regular audits of eMAR, and direct observation of procedures. Pre- and post-intervention data were collected to evaluate improvements. The audits confirmed that all workflow steps were consistently followed, with staff reporting greater confidence in adhering to the updated process.

Discussion

The findings suggest that structured education, standardized processes, and real-time feedback can significantly improve apheresis procedure workflow with medication protocols. A collaborative, interdisciplinary approach was essential in addressing knowledge gaps and promoting accountability. Future efforts should focus on sustaining these interventions within the scheduled patient appointment time, continuing regular audits, and exploring additional strategies to enhance medication workflow in apheresis procedures.

Oncology Nursing Forum. 2025 Mar 1;52(2):241–242.

P410. Enhancing Patient Outcomes: Evaluating the Impact of the MMRF Patient Navigation Center

Veronica Bohorquez ¹, Erin Mensching ², Brittany Hartmann ³, Grace Allison ⁴, Anne Quinn Young ⁵

Patient Education

Significance & Background

Multiple myeloma is an uncommon and complicated blood cancer. Advances in research over the last 20 years have created numerous treatment options.

Purpose

However, this abundance can make it difficult for patients to stay updated with the latest therapies, especially in community settings. It is essential for patients to be aware of these developments and actively participate in their care to optimize outcomes.

Interventions

The Patient Navigation Center (PNC) at the Multiple Myeloma Research Foundation (MMRF) is a free resource for multiple myeloma patients and caregivers. Staffed by three experienced oncology professionals, the PNC offers personalized information, emotional support, and guidance on clinical trials, empowering patients to make informed decisions. Patients can reach the PNC by phone, email, or web form, and each interaction is tracked as a case. PNC nurses work with patients until their needs are addressed, and insights are shared with the education team. Monthly reviews help identify trends, ensuring key themes are integrated into education programs.

Results

To assess impact, two surveys are conducted: a satisfaction survey post-interaction and a longitudinal survey 90 days after initial contact. In 2023, 7,160 patients and caregivers contacted the PNC. From December 2023 to June 2024, 1,127 patients received the longitudinal survey, with a 15% response rate. Among respondents, 86% reported taking positive steps after speaking with a Navigator. Key actions included communicating treatment goals with their care team (55%), discussing lab results (34%), and seeking a second opinion (23%). The survey included optional LIKERT scale questions to assess respondents’ confidence and empowerment with 75% (n=131) answering. Of this subgroup, 79% agreed or strongly agreed that speaking with a patient navigator helped reduce anxiety or distress about their diagnosis, and 74% agreed or strongly agreed that they understood their condition better after communicating with an MMRF Patient Navigator.

Discussion

Our data reveals communication with Patient Navigators positively impacts patients and caregivers navigating multiple myeloma. However, 14% of respondents did not take positive steps. Future efforts will focus on conducting a gap analysis to explore barriers and the patterns influencing behavior changes. Key factors will include disease stage, frequency of communication with the PNC, and geographic location. By investigating these variables, we aim to develop more targeted strategies to address unmet needs and improve outcomes for multiple myeloma patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):242–243.

P411. Navigating the Challenges of Return to Work: Factors Affecting Employment Among Breast Cancer Survivors

Leni Merdawati ¹, Hui-Chuan Huang ²

Survivorship

Significance & Background

Returning to work (RTW) is a vital aspect of recovery for breast cancer (BC) patients, symbolizing restored normalcy, financial stability, functional capability, and improved quality of life. Despite its importance, the factors contributing to the lack of RTW among these patients are poorly understood.

Purpose

This study aimed to identify and analyze the factors associated with non-RTW among breast cancer patients.

Interventions

A cross-sectional study was conducted in two hospitals in Indonesia, utilizing convenience sampling to recruit eligible participants. A total of 250 breast cancer patients were included in the study. Data were collected on various factors potentially related to non-RTW, including symptoms of distress, loneliness, anxiety, depression, perceived social support, and frailty. Logistic regression analysis explored the relationships between these factors and the likelihood of not returning to work.

Results

Out of the 250 patients, 148 had not returned to work. The analysis revealed that higher levels of anxiety (odds ratio [OR]: 5.30; 95% confidence interval [CI]: 2.16, 12.98), significant loneliness (OR: 3.15; 95% CI: 1.29, 7.67), and frailty (OR: 2.53; 95% CI: 1.07, 5.98) were significantly associated with non-RTW. Additionally, patients with lower perceived social support were at a higher risk of not returning to work (OR: 5.65; CI: 1.81, 17.63).

Discussion

The findings indicate that psychological distress, loneliness, frailty, and insufficient social support are critical factors influencing the likelihood of breast cancer patients not returning to work. To enhance RTW outcomes, healthcare professionals should implement early counseling, health education, and support groups, assisting patients in both physical and psychological preparations for re-entering the workforce.

Oncology Nursing Forum. 2025 Mar 1;52(2):243.

P412. The Biosimilar Journey: Oncology Nurse Leadership Taking the Lead

Sarah Merkle ¹

Healthcare Delivery

Significance & Background

Following the approval of the Biologics Price Competition and Innovation Act of 2009, biosimilars have gradually entered the market in the United States. As of August 2024, the FDA has approved 59 biosimilars. Nearly half of which are utilized in the cancer care setting. Over the last decade, biosimilars have failed to achieve more than a fraction of the $54 billion in savings predicted by the 2017 Rand report on their market potential. This is believed to have been hindered by regulatory constraints, competitive obstacles, and operational challenges. The hope is for biosimilar drugs to continue to drive down drug prices used to treat illnesses such as cancer. Ultimately providing opportunities to improve healthcare access and outcomes and reducing overall healthcare costs for patients with cancer. All oncology healthcare providers should be familiar with the clinical efficacy and FDA approval and evaluation process of Biosimilars. Biosimilars are comparable to already approved “reference” biologics in terms of potency, safety, and efficacy. Due to a perceived lack of knowledge, many of our healthcare providers expressed uncertainty about their willingness to utilize Biosimilars. Compared to other organizations, we identified that our community hospital infusion center utilization rate of biosimilars was well below the benchmark.

Purpose

The purpose of this abstract is to describe an Oncology Nursing led initiative to increase biosimilar utilization in a community hospital infusion center.

Interventions

■ Formed a multidisciplinary Oncology Formulary Committee. This committee streamlines biosimilar formulary approvals and ensures that order sets are built to support operations.
■ Hired an employee dedicated to build order sets for biosimilars.
■ Developed a tool for oncology office staff to identify the patient’s insurance company’s preferred drug before infusion orders are sent for authorization.
■ Criteria for biosimilar usage developed in partnership with the Oncology Medical Director.

Results

■ Biosimilar utilization improved for Bevacizumab from 18% to 51%
■ Biosimilar utilization improved for Trastuzumab from 0% to 17%
■ Biosimilar utilization improved for Rituximab from 12% to 62%
■ Overall, our organization saw 4 million savings in 340b drug spend in the last fiscal year

Discussion

Financial prudence is the responsibility of the entire Healthcare Team. Oncology Nurse Leaders are in an ideal position to identify opportunities to optimize systems and workflows to ensure timely, cost-effective, evidence-based treatment of oncology patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):243–244.

P413. A Quality Improvement Initiative to Improve Health Literacy

Lois Merrick ¹, Barbara Lubejko ²

Patient Education

Significance & Background

Our organization is committed to health equity and improving access to cancer care for everyone. More than 80% of people in the U.S. don’t have the level of health literacy needed to understand and act upon information they’re given about their health. Our team creates content and material designed to help people understand their disease process and navigate care. A review of our content and materials revealed that the average reading level was higher than the 8th grade recommendations. Also, images didn’t reflect audience diversity. To further understand deficits in our materials, a consultant was hired to recommend improvements.

Purpose

The purpose of our quality improvement (QI) project was to improve our process for creating understandable and actionable patient education materials for our diverse audience using health literacy best practices.

Interventions

Our team of nurse medical editors (NME) reviewed patient-facing content for relevance and reading levels. A need for revisions to lower reading levels was identified. The NMEs took the IHA Health Literacy course to establish a baseline understanding of health literacy principles and best practices as a guide to revise content and eliminate health equity language barriers. Health literacy modules were then developed for other employees in the organization. Materials for patient and caregiver education were revised in print and on the organization’s website to meet core elements of health literacy such as reading level and accessibility. QR codes were added to printed material for easier technological accessibility and some materials were translated into Spanish and 12 other languages.

Results

Our initial evaluations were focused on assessing the reading level and overall accessibility of the revised educational materials as compared to pre-QI. We developed a digital tracking system that is now incorporated into our metrics. We were able to obtain early feedback from native speakers working in healthcare. This allowed us to make additional improvements in tone and relevancy.

Discussion

Our nurse-led QI initiative to increase access to relatable, relevant, and actionable patient education has been a major focus of work. We plan to continue to partner with clinicians and communities to create new materials based on gaps or needs. We are also partnering with a major EMR company to ensure the materials are readily available to nurses and other oncology professionals.

Oncology Nursing Forum. 2025 Mar 1;52(2):244.

P414. Oncology Clinical Trials 101: The Development of Education for the Care of Oncology Clinical Research Patients Across all Settings

Sarah Middlekauff ¹, Ruth Knecht ², Nichelle Ogiste ³

Management

Significance & Background

While working to standardize the role of the oncology nurse in the care of oncology clinical trial patients at a large cancer hospital in New York, gaps in the knowledge of the new and incumbent staff emerged, prompting the development of education.

Purpose

The nursing leadership team tasked the outpatient oncology nurse educator with developing content to enhance the foundational knowledge of both incumbent and new oncology nurses regarding the basics of oncology clinical trials and their role in caring for these patients. This education lays the groundwork for all nursing staff, with the ability to be built upon if additional knowledge deficits are identified.

Interventions

The outpatient oncology nurse educator worked closely with the outpatient oncology research nurse clinician and the inpatient oncology research clinical coordinator to develop a course that can be accessed and completed by all oncology nursing staff. The course reviews the differences between standard of care and clinical research, the purpose of clinical research in cancer care, the phases of clinical trials, the application of data retrieved from clinical trials into practice, and a review of important policies and procedures at the institution as they relate to clinical research.

Results

The educational course is assigned to all new staff during onboarding and will be assigned to all incumbent staff as a part of their annual required education. Feedback received from those who have completed the course has been positive and has expressed that it has been a good overview of the clinical research process in oncology, and clearly speaks to the role of the oncology nurse when caring for patients on clinical trials.

Discussion

This education is the first step to bridging the knowledge gap for oncology nurses as they care for clinical research patients. This education is designed to be a framework that can be built upon if additional gaps or learning needs are identified.

Oncology Nursing Forum. 2025 Mar 1;52(2):244–245.

P415. Navigating a Pilot Program for CMS Principal Illness Navigation (PIN) Reimbursement

Jacqueline Miller ¹, Valerie Csik ²

Coordination of Care and Navigation

Significance & Background

In 2023, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updated payment policies and rates for services provided by clinicians in calendar year 2024. The final rule included new codes and payments for Principal Illness Navigation (PIN) services, HCPCS codes G0023, G0024, G0140, and G0146, which use auxiliary personnel such as patient navigators to provide care coordination in the treatment of a serious, high-risk illness. These codes represent the first reimbursement opportunity for navigation services, a historically under-funded service that is highly valued for patients with illnesses, such as cancer, that require care coordination and support to enhance patient outcomes.

Purpose

This pilot aims to develop a process to bill for PIN services and support navigation program sustainability.

Interventions

A multifaceted approach was adopted, beginning with a thorough review of CMS guidelines to understand the billing requirements. Stakeholders from Navigation, Quality, Compliance, Technology, Population Health, and Billing were engaged to outline the workflow for billing navigation services. Our focus was limited to codes G0023 & G0024. Providers were educated to obtain consent for each patient referred for navigation services. Comprehensive reporting mechanisms reflecting documentation to support billing requirements were created and testing was performed in collaboration with billing. Claims were systematically prepared and submitted to CMS, with ongoing tracking of reimbursement status to evaluate the effectiveness of these efforts.

Results

In the first month following the implementation of this PIN billing pilot (July 2024)), we successfully submitted ten claims to CMS, marking a significant step toward utilizing the navigation services reimbursement framework effectively. Each claim was carefully tracked to ensure compliance and facilitate necessary follow-ups with the navigation team.

Discussion

The implications of PIN billing for nursing practice are profound, as successful reimbursement for navigation services can lead to enhanced care coordination, ultimately improving patient engagement and adherence to treatment plans. CMS’ attention to funding for navigation programs underscores the essential role that navigators play in managing complex patient conditions and highlights the need for ongoing education about reimbursement processes and coding. By advocating for effective navigation services, nursing can lead the way toward improved healthcare delivery models that prioritize patient-centered approaches and improved patient outcomes.

References

Centers for Medicare & Medicaid Services. Medicare Physician Fee Schedule Final Rule Summary: CY 2024. MM13452.pdf (cms.gov) 2023. Nov 22, [Google Scholar]

Oncology Nursing Forum. 2025 Mar 1;52(2):245.

P416. Blast Off: A Unit’s Educational Journey to Induction Therapy for Acute Leukemia Patients

Kelsey Miller ¹, Beverly Sloan ²

Management

Significance & Background

Patients with acute leukemia (AL) were diagnosed at our 697-bed level 1 trauma suburban hospital and transferred to tertiary referral hospitals for induction chemotherapy. Our unit experienced nursing turnover with 7 nurses (6 FTE) in 2022 and 11 nurses (9 FTE) in 2023 resigning. The inpatient oncology unit had to onboard new staff, which included 5 new graduates in 2023. In January 2023, our unit had 3 FTE on dayshift and 6.9 FTE on nightshift that were chemotherapy trained. Our goal was to have 8.4 FTE chemotherapy trained on both shifts by July 1st, 2024 to treat AL patients needing induction.

Purpose

To review the educational approach and process improvement strategies implemented to onboard and provide safe, quality care to AL population at our hospital by July 1st, 2024.

Interventions

Multidisciplinary team assembled mid-December 2023 to identify and fill program needs and collaborate on improving existing workflows. New protocols were developed. In addition to general nursing orientation, staff received oncology specific orientation, including obtaining the ONS® Chemotherapy Immunotherapy Certificate Course. Following successful completion of the course, staff went to the outpatient infusion center and performed hands-on scenarios. For AL training, the unit utilized resources from specialty organizations and internal fellow lectures. Staff were enrolled in an internal 2-hour class in a case study format with workbook. The clinical nurse specialist (CNS) developed the content, partnering with the nurse educator who designed the class into an escape room. Objectives were stated at the beginning of the course and an experienced AL nurse assisted with facilitating the classes.

Results

Overall, 25 of 27 staff members completed their survey. 72% of nurses stated they were prepared to safely manage this patient population after the course through enhanced assessment and early interventions. 68% of nurses rated the presentation overall as outstanding and 32% good. The inpatient unit successfully treated their first AL patient with induction chemotherapy in July.

Discussion

Nurses new to oncology can successfully treat the AL population with a structured educational plan and hands-on interactive case studies. The course served as an introductory class, and staff members with prior experience may benefit from more focused education. It is important to have a multidisciplinary team approach with key stakeholders to identify system-level operational opportunities and resources needed.

Oncology Nursing Forum. 2025 Mar 1;52(2):245–246.

P417. SWAT Rounding to Reduce Injury Falls on an Inpatient Oncology Unit

Kelsey Miller ¹, Beverly Sloan ²

Quality and Safety

Significance & Background

Hospitalized patients with cancer have an increased risk of falling due to many associated factors. Risk factors include high risk medications used for symptom management, low blood counts, fatigue leading to activity intolerance, and side effects of cancer or cancer treatment. An inpatient medical surgical oncology unit experienced an increase in falls with injury Quarter one of 2024 with a 1.73 quarterly injury fall rate per 1,000 patient days. This rate exceeded the national benchmark and internal targets. Trends of the 4 injury falls were all toileting related, with 75% of patients left unsupervised. Family assisting instead of staff contributed to two of these falls. Nursing turnover and experience may have contributed to unfamiliarity with high reliability principles.

Purpose

To identify and escalate patient safety and quality of care concerns related to falls in the oncology population and identify potential near miss events by implementation of Safety Warning Action Team (SWAT) rounding. The unit goal was to have zero injury falls.

Interventions

The unit director (UD) and clinical nurse specialist (CNS) engaged their fall resource nurse to post a communication flyer a week before go-live on March 28th, 2024. To create momentum, drinks and snacks were provided starting on nightshift by nurse leaders. The process of SWAT rounding starts with the nurses on each shift identifying the highest risk patient from their assignment who is going to fall and why. This is announced at change of shift huddle. The UD, CNS, and nurse facilitator perform proactive safety rounding on these patients at 0800 and 1400 to provide loop closure, ensuring patient safety and issue resolution.

Results

Our oncology unit went 5 months injury fall free after implementation of SWAT rounding.

Discussion

It may take up to six weeks to engrain in a unit’s culture. Our SWAT rounds are now led by the unit facilitator. Our staff have adopted high reliability principle of proactive thinking, with majority of fall prevention interventions already in place. SWAT rounding can be implemented for any high-risk patient criteria or nursing sensitive indicators (i.e., restraints, behavioral health patients, telemetry, central line associated bloodstream infections). It can also be operationalized at the unit level or system-wide depending on resources.

Oncology Nursing Forum. 2025 Mar 1;52(2):246.

P418. The Freedom to Disconnect From Your Continuos Ambulatory Delivery Device at Home: A Win-Win Opportunity!

Ricahrd Miller ¹, Ruth Cocirteu ², Regina Carlisle ³, Anne Kolenic ⁴

Patient Education

Significance & Background

Requiring patients to return to the ambulatory center to disconnect from their continuous ambulatory delivery devices (CADD pumps) has implications for patients and infusion centers. Patients travel great distances for treatment, desire to spend less time in cancer centers, and want to maintain regular routines. Infusion centers face scheduling challenges, staff shortages, an increasing number of outpatient treatment protocols, and lost revenue as appointments for pump disconnections are not billable to insurance companies. One way to address these concerns is to carefully identify specific patients or family caregivers to self-disconnect their CADD pumps at home.

Purpose

To develop a formal process and education tools to train nurses, patients, and family caregivers on the practice change to self-disconnect from CADD pumps at home.

Interventions

A literature search and communication with cancer centers identified best practices and details on how institutions implemented similar programs. An interdisciplinary team from nursing, medication safety, pharmacy, patient education office, and senior leadership worked over a year to create a process, and develop resources, and guidelines. Nursing formulated a teaching checklist, instructional video and booklet, and standard operating procedures. Discussion s happened with CADD supplier to ensure an infrastructure was in place for a twenty-four hour hot-line for patients to trouble shoot issues. Input and evaluation of project’s educational material and roll out plan occurred at monthly Clinical Practice Meetings. The instructional booklet and video were designed using health literacy best practices and reviewed by staff and Patient Advisory Council members. Unit champions were given formal training in the process, which included discussion and an opportunity to review materials and provide input.

Results

This practice change is slated to go-live during the fourth quarter of 2024. Evaluation metrics will include the percentage of patients participating, adverse events, and patient and nursing feedback.

Discussion

The complexity of planning for this procedural change required frequent meetings with an interdisciplinary team led by nurses. Input from oncology nurses was essential for the update of guidelines and the development of teaching materials. The implementation of the CADD self-disconnect procedure can be a win-win scenario for patients and centers.

Oncology Nursing Forum. 2025 Mar 1;52(2):246–247.

P419. Empowering Oncology Nurses: Strategies for Reducing Burnout and Improving Retention

Pamela Minasian ¹, Ruth Alvarez Gaspar ², Rebecca Choi ³, Philip Tu ⁴, Faith Buziecki ⁵

Management

Significance & Background

High turnover rates among oncology nurses are a growing concern due to the emotional and physical demands of caring for cancer patients. Retention strategies that address work-related stress, burnout, and professional development are essential for maintaining high-quality patient care.

Purpose

This project aims to evaluate and discover areas of improvement in order to support the nurses, the impact of a multifaceted nurse retention program designed to support oncology nurses through career development, mental health resources, and mentorship. The goal of the project is to implement and assess the effectiveness of a targeted nurse retention program aimed at improving job satisfaction, reducing burnout, and increasing nurse retention rates in an oncology setting.

Interventions

A survey was sent out to all oncology nurses evaluating job satisfaction, management involvement, availability of resources, and most importantly, reasons for leaving the oncology department. A retention initiative was introduced at a comprehensive cancer center, involving three key components: (1) Regular access to mental health services, including counseling and support groups tailored to oncology nurses; (2) Professional development opportunities, including specialty certification and continuing education support; (3) A peer mentorship program for new and mid-career nurses. Pre- and post-implementation surveys were administered to measure job satisfaction, perceived stress levels, and intent to stay in the profession.

Results

Preliminary results indicate a significant improvement in job satisfaction and a reduction in burnout symptoms after four months of program implementation. Retention rates improved over the same period, and qualitative feedback highlighted the value of the mentorship program and mental health resources as key components of the intervention’s success.

Discussion

This initiative demonstrates the potential of structured support programs to improve job satisfaction and retention among oncology nurses. By addressing both professional growth and emotional well-being, healthcare organizations can create a more sustainable work environment, ultimately enhancing patient care and reducing staff turnover. The findings suggest that oncology nursing leaders should prioritize comprehensive retention strategies that include mental health support, career development, and mentorship to foster long-term retention and improve nurse well-being.

Oncology Nursing Forum. 2025 Mar 1;52(2):247–248.

P420. Building Chemotherapy Competency: A Preceptor-Led Didactic Day

BriAnn Minnig ¹, Linda Reuber ², Sarah Schultz ³, Sacha Kelly ⁴, Cate Gilbertson ⁵

Management

Significance & Background

Following the merger of two hospital systems, inconsistencies were identified in the training protocols for oncology nurses regarding chemotherapy administration. To address these discrepancies, a combination of elements from both systems’ training programs were utilized. As a result, the organization adopted the completion of the ONS online chemotherapy courses and the issuance of a provider card as the primary method for training new chemotherapy nurses across the five sites with adult inpatient oncology units.

Purpose

A gap analysis demonstrated that newly chemotherapy-trained nurses were receiving a comprehensive introduction to chemotherapy administration through the online ONS course but were missing hands-on experience and were unfamiliar with chemotherapy policies and procedures of the organization.

Interventions

A preceptor-led chemotherapy didactic day was developed and incorporated into initial chemotherapy training with an emphasis on safety protocols and handling procedures. Leadership selected chemotherapy-competent nurses on each of the five oncology units to become designated preceptors for chemotherapy didactic day training. Topics covered during the didactic day included an overview of common chemotherapy agents and their mechanisms, administration techniques, protocols, managing side effects, and patient education. An additional key component of the learning was a simulation requiring the learner to double-check a chemotherapy protocol, release the protocol, and administer a drug with the support and oversight of a chemotherapy-competent preceptor.

Results

Since the implementation of the chemotherapy didactic day, twenty-six nurses have participated, with 77% rating the training as “very beneficial” on a 5-point Likert scale, while 23% rated it as “somewhat beneficial.” Participants noted the value of hands-on practice and the expertise of their preceptors. Additionally, 92% found their preceptor to be knowledgeable and approachable, creating a supportive environment for asking questions.

Discussion

A preceptor-led chemotherapy didactic day is an effective teaching method to supplement online chemotherapy training such as the ONS chemotherapy administration courses. A didactic day focused on an organization’s protocols and policies for chemotherapy administration provides new chemotherapy nurses the opportunity to receive more specialized training within the unit they will be practicing.

Oncology Nursing Forum. 2025 Mar 1;52(2):248.

P421. Recipe for Success: Standardizing Hazardous Drug Carts to Promote Safe Handling

BriAnn Minnig ¹, Linda Reuber ², Brittany Hermes ³, Melissa Eddy ⁴

Treatment Modalities and Managing Administration

Significance & Background

Historical practice for obtaining necessary personal protective equipment utilized in hazardous drug or chemotherapy administration in patient rooms was obtaining a “chemotherapy caddy”. This caddy was unable to be adequately disinfected and new USP 800 regulations were instituted regarding PPE for hazardous medications. Therefore, a new process was required to provide PPE for bedside care for patients receiving hazardous medications.

Purpose

Patients receiving hazardous medications are hospitalized on all clinical units and care areas. A method for housing and delivering PPE to patient rooms was required for safe and efficient care of patients receiving hazardous medications.

Interventions

A small group of supply chain leaders, staff, and nursing practice and education met to determine the required PPE components and type of cart needed for hazardous drug delivery. Nurse Unit Practice Councils were queried on current hazardous drug cart components, ordering process as well as desired additional administration supplies for convenient access. A “recipe” or list was developed to assist supply chain staff in stocking necessary PPE and hazardous drug cart items.

Results

The hazardous drug cart “recipe” was updated to include all PPE and required supplies for hazardous medication administration. PPE stocked in the cart included chemotherapy gowns, eye and face protection, chemotherapy rated gloves, hazardous drug room sign that outlines precautions for 48 hours, closed system transfer devices (CSTD), and a custom assembled chemotherapy spill kit. Yellow chemotherapy waste bags and receptacle for chemo trace waste came with the cart to assist with proper trace waste disposal. Unit Practice Councils as well as other nursing staff will receive follow-up questionnaires as check-ins to determine effectiveness of new hazardous drug cart and its recipe of contents.

Discussion

All nurses who administer hazardous drugs received online training on identification, procedures, and spill management before handling a hazardous drug. Assistive personnel also received an online learning on care requirements including PPE usage. While the electronic medical record included hazardous drug administration precautions, these details were often not prominently displayed outside the patient’s room or care area, unless a sign was posted on the door. The hazardous drug cart, along with the door sign and necessary supplies became readily available, thereby enhancing safety for both staff and patients during hazardous medication administration and for the 48 hours following administration.

Oncology Nursing Forum. 2025 Mar 1;52(2):248–249.

P422. Transforming Oncology Care through Gemba Walks: Driving Collaboration and Continuous Improvement in Cancer Care

BriAnn Minnig ¹, Linda Reuber ², Sacha Kelly ³, Sarah Schultz ⁴, Cate Gilbertson ⁵

Healthcare Delivery

Significance & Background

The concept of a Gemba walk underscores the importance of leaders immersing themselves where patient care is delivered. This hands-on approach enables leaders to observe workflows in real time and engage directly with staff, fostering a deeper understanding of daily challenges and successes. By adopting the Gemba methodology within oncology settings, organizations can significantly enhance collaboration among team members and drive improvements in patient care outcomes.

Purpose

To strengthen collaboration among oncology operational leaders and the nursing practice and education team across inpatient oncology units within a large metro hospital system.

Interventions

A quarterly Gemba was established involving oncology practice and education and operational leadership from five inpatient oncology units. The location of each Gemba rotated among the sites to allow for visualizing unique site layouts and an opportunity for collaboration with the nursing leadership at each site. Standing topics included hospital, oncology unit, and ambulatory chemotherapy infusion clinic tour, chemotherapy safety events reviews, and process improvement.

Results

The implementation of an oncology Gemba significantly promoted open communication, effective problem-solving, and strengthened teamwork among healthcare professionals. It encouraged meaningful discussions and engagement with team members to demonstrate a commitment to addressing their needs and suggestions. As a result, the oncology Gemba has led to several impactful outcomes, including the creation of a systemwide oncology newsletter for bedside staff, the endorsement and implementation of a comprehensive didactic and hands on chemotherapy training process across the oncology care continuum, the standardization of patient education materials for chemotherapy patients throughout the system, and the establishment of a forum for reviewing and providing feedback on chemotherapy policies.

Discussion

Observations made during Gemba walks can reveal successful practices and processes that can be shared across teams and departments, ultimately enhancing overall performance. Regular Gemba walks foster a culture of continuous improvement, where collaboration plays a vital role in achieving better outcomes. By touring each oncology site, team members gained insights into the challenges and workflows from diverse perspectives, promoting a more unified approach to problem-solving and care enhancement. Leaders who were present in the care environment engaged with staff to brainstorm effective solutions, resulting in more practical and impactful strategies. The success of the oncology Gemba process has been so noteworthy that it has become a model for replication in other service lines, such as cardiology.

Oncology Nursing Forum. 2025 Mar 1;52(2):249–250.

P423. Streamlining Chemotherapy Initiation: Reducing Admission-to-Treatment Time

BriAnn Minnig ¹, Linda Reuber ², Brittany Hermes ³, Jb Breeding ⁴, Christine Hall ⁵

Healthcare Delivery

Significance & Background

A 329-bed urban hospital with an inpatient oncology unit identified several barriers affecting the safety and efficiency of oncology care. Key issues included a lack of pre-task completion before patient arrival and insufficient time for independent chemotherapy double checks, which led to delays in starting chemotherapy administration. In response, a multidisciplinary team of oncologists, pharmacists, oncology nurses, and informaticists developed an inpatient chemotherapy care map with a goal to reduce the admission to chemotherapy start time to five hours.

Purpose

The inpatient oncology unit recorded an average admission to chemotherapy start time of 9.2 hours, indicating that the system goal of under 5 hours was not being met. The aim was to reduce hospitalization time and costs associated with delays in chemotherapy initiation while enhancing patient satisfaction. Specific objectives included streamlining the process for outside oncology clinics admitting patients for chemotherapy treatment and improving communication between oncology nursing staff and pharmacists.

Interventions

To enhance the chemotherapy admission process, collaborative meetings were established among oncology clinics, inpatient pharmacy, and nursing staff to identify and address gaps. The oncology unit transitioned from tracking chemotherapy admissions on paper to a virtual spreadsheet, allowing inpatient nursing and pharmacy staff to access and modify the tracker easily, facilitating better visualization and coordination. Additionally, the charge nurse of the oncology unit used the virtual tracker to conduct a pre-screening of chemotherapy admission tasks—including central line checks, lab results, and signed chemotherapy orders—one day prior to patient admission.

Results

During the four months of implementation, the admission to chemotherapy start time decreased to 5.2 hours. Patients who received chemotherapy during their hospitalization but were not initially admitted for treatment were excluded from these results.

Discussion

Although the system admission to chemotherapy start time goal was not met, initial results indicated a significant improvement in reducing chemotherapy wait time on the oncology unit of focus. Considering the limited number of chemotherapy admissions over the past four months, it would be advantageous to continue monitoring progress of implementing a virtual tracker and pre-screen of admission tasks. Although the virtual tracker was determined to be more functional and user-friendly for oncology pharmacists and charge nurses, increased use of the virtual tracker may demonstrate additional nursing or pharmacy opportunities for optimizing the chemotherapy start time for direct admissions.

Oncology Nursing Forum. 2025 Mar 1;52(2):250.

P424. We Have that Effect on People: Multimodal Immune Effector Cell Education for the Interdisciplinary Team

Jennifer Mitchell ¹, Jennifer Mitchell ², Dena Shore ³, Dena Shore ⁴

Management

Significance & Background

Inpatient and outpatient treatment centers are widely expanding the use of immune effector cell (IEC) therapies. IEC therapy is a rapidly evolving, high-alert therapy that can result in serious adverse effects for the patient. As IEC therapy may have unique toxicities that are unlike other oncology treatments, early recognition of adverse effects, appropriate grading of presenting symptoms, and the promotion of appropriate treatment and escalation of care are key to successful patient outcomes.

Purpose

The purpose of this project was to create education for the interdisciplinary team that would standardize the recognition of common adverse effects of IEC therapies, including how to grade, score and treat toxicities, and escalate care.

Interventions

Two oncology nurse educators created multimodal learning opportunities for the interdisciplinary team to increase knowledge of IEC treatments, the use of standardized screening tools to detect toxicities, and appropriate treatment options. Educational offerings included live and on-demand didactic education and simulation exercises. New employees were educated during the onboarding process and existing employees were supported with continuing education opportunities. Team members were engaged in multiple versions of the education. Standardized patient scenarios were presented to provide opportunities to apply knowledge, use the screening tools and discuss treatment options. Anonymous post-surveys were collected after each event to assess learner satisfaction with meeting educational objectives.

Results

From July 2023 to August 2024 IEC education efforts included 303 members of the interdisciplinary team in the inpatient and outpatient care areas. Interdisciplinary team members (RNs, LPNs, APPs, PharmDs, nutritionists, speech/language pathologists) engaged in the learning events. Post course evaluations showed 97% of participants were overall “very satisfied” with the training experience and positive open-ended feedback categorized the training as being “great,” “concise,” and that the practice scenarios were particularly helpful.

Discussion

IEC therapy utilization in oncology is expanding rapidly. Consistent, correct use of standardized assessment tools can lead to early detection in patient changes, rapid intervention, and decreased severity of toxicities. Utilizing a multimodal approach is an effective way to educate the interdisciplinary team regarding IEC therapy, screening for associated toxicities and treatment options. Educational updates and “at the elbow” support are needed when assessment and treatment protocols change or as the therapy evolves, and a multimodal approach may be considered as best practice.

Oncology Nursing Forum. 2025 Mar 1;52(2):250–251.

P425. Traveling Over the Service Gap: Strategically Preparing and Incorporating Travel Rns on the Stem Cell Transplant and Cellular Therapy Unit

Jennifer Mitchell ¹, Jennifer Mitchell ², Cory Kassen ³

Management

Significance & Background

Stem cell transplant and cellular therapy (SCTCT) nursing is considered a niche market, making it difficult to find travel RN staff that readily possess the necessary background and training to care for this patient population. Inadequate availability, preparation and assignment of nurses on the SCTCT unit can result in suboptimal patient care. Global nursing shortages have proven problematic for the SCTCT unit attempting to increase bed availability and services while providing nurses that are trained per the Foundation of Accreditation for Cellular Therapy (FACT) guidelines. General hospital orientation is insufficient to prepare travel RNs to work with SCTCT patients. SCTCT RN staff needed guidance in creating appropriate travel nurse patient care assignments for patients receiving cellular therapy.

Purpose

The purpose of this project was to create tools that would allow for the safe onboarding and expanded use of travel RNs on the SCTCT unit, thereby increasing SCTCT bed availability and services.

Interventions

Educational materials and a flowchart for appropriate pairing of active SCTCT patients with travel RN staff were created. Educational materials introduced the travel RN to foundational concepts, common peri-transplant supportive care medications, common complications and management, and resources. Materials conformed to the FACT-JACIE accreditation manual (v8.2). The travel RN assignment flowchart described common patient scenarios with “yes/no” guidance to assist staff with creating appropriate assignments that aligned with SCTCT related education provided during orientation.

Results

Travel RNs (100%) completed the required SCTCT specific education and began assuming care of patients receiving cellular therapy starting in June 2022. With the increased number of travel RNs, the unit’s inpatient average daily census of SCTCT patients rose from 5.59 (2021) to 8.57 (2024), representing a 53.3% increase. The outpatient average daily census of SCTCT patients rose from 1.46 (2021) to 4.12 (2024), representing a 182.2% increase.

Discussion

While travel nurses are not a permanent solution to increase nurse staffing concerns, it is a necessary intervention to provide continuity of care to SCTCT patients. To ensure safe care is provided to patients undergoing cellular therapy treatment, proper onboarding and methods to create appropriate travel RN patient care assignments are essential. The processes established in this project will continue to be utilized and evaluated for effectiveness as the SCTCT program continues to expand.

Oncology Nursing Forum. 2025 Mar 1;52(2):251.

P426. Leveling up Clinical Competence in an Inpatient Oncology Unit: Utilizing Competitive Gaming through Nursing Olympics to Master Clinical Skills

Joy Mitts ¹, Tamera Smith ², Nell Mayendia Blanco ³, Jan Roy ⁴, Eduardo Martin Ross ⁵, Annette Caravia ⁶

Management

Significance & Background

Traditional teaching methods, such as lectures, webinars, and Zoom classes, often fall short in engaging nursing staff and promoting long-term retention. Integrating competitive gaming into clinical nursing education presents an innovative approach to enhance critical thinking, clinical skills, teamwork, and communication. Our unit’s annual competency program emphasizes high-risk, low-volume skills and essential nursing quality measures, equipping staff to effectively manage rare and critical scenarios, thereby improving patient safety and overall care.

Purpose

The introduction of “Nursing Olympics” aims to transform the review of essential educational topics into a dynamic and interactive experience for nursing staff. By incorporating games, competitions, and incentives into the annual competency training, we enhance information retention and foster a more engaging learning environment.

Interventions

A learning needs assessment was conducted at the beginning of the year identifying key areas for learning opportunities and performance improvement among the nursing staff. The four selected topics to review included central line maintenance and care, blood product administration, bladder irrigation, and parenteral nutrition. The “Olympics” theme was chosen as the competitive games were occurring the same year and created a spirited environment. An educational presentation was done at the beginning of the session to review standard policies and procedures, updates in protocols, and nursing expectations. Staff were divided into three different groups and participated in relay races, scenario based challenges, and interactive simulations covering these critical educational topics utilizing hands on skills.

Results

We analyzed pre and post competency skills assessments to evaluate the effectiveness of our interventions. Initial surveys completed prior to the “Nursing Olympics” indicated that many nurses felt “somewhat uncomfortable” or “uncomfortable” with the skills that would be discussed; however, following the “Nursing Olympics”, there was a notable increase in confidence levels with most nurses reporting feeling ”somewhat comfortable” or “comfortable” with the skills presented. Additionally, staff expressed high satisfaction with the gaming approach and requested further similar educational events for other competencies.

Discussion

Interactive education is vital in nursing as it cultivates critical thinking and enhances clinical competencies through experiential learning. By incorporating competitive gaming into the annual competency training on our inpatient oncology unit, we not only made the educational experience enjoyable but also better prepared our nurses to address real-world patient care challenges, ultimately leading to improved health outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):252.

P427. Transformative Learning in Oncology Nursing: a Flexible, Comprehensive, and Interactive Orientation

Jocelyn Mitts ¹, Annette Caravia ², Yaribey Lopez ³

Management

Significance & Background

Oncology nursing has become increasingly complex in an environment where there are increased expectations on the provision of quality care resulting in improved patient outcomes. Although there has been a rise in the recommendation to incorporate interactive learning techniques, the time allotted to orient new staff has not changed. In fact, there has been a push to shorten orientation to allow for these new nurses to enter the workforce earlier. The need for a transformative, flexible approach to oncology nurse orientation has become essential.

Purpose

To empower new nurses to become compassionate and competent oncology caregivers, a transformative orientation program was developed for new graduate nurses in an inpatient acute oncology unit.

Interventions

Learning needs assessments were completed that demonstrated new nurses desired to learn oncology basics, oncologic emergencies, oncologic toxicities, chemotherapy, and immunotherapy, as well as be educated on palliative care, end of life, conflict resolution and stress management. An orientation program was created to incorporate nursing competencies, critical thinking, communication skills and knowledge of oncology and palliative care. The curriculum incorporated interactive classes employing a variety of learning techniques as well as the addition of supportive debriefing sessions. Classes were two, four or eight hours. Clinical shifts were modified to either eight-, ten- or twelve-hour shifts. By modifying the clinical shifts, classes were able to be added to the orientation program without adding to the orientation’s length of time. The nurses had to re-think a pre-conceived notion that oncology nursing was composed of twelve-hour shifts administering chemotherapy.

Results

Addressing the multidimensional aspects of oncology nursing in this manner enhanced the learning of clinical skills, while allowing the new nurses to discuss their experiences fostered a deeper understanding of the nursing and patient experience. Enforcing a variable schedule emphasized the importance of flexibility and promoted resilience. Additionally, since the inception of the modified shift schedule, more than seventy percent of the new graduate residents completed residency earlier than the allotted time frame.

Discussion

Post-surveys have included concerns that adding extra days and classes for the nurses to come into the hospital, while helpful, were also physically and emotionally exhausting. Further evaluation of the program will continue to be made and nurse feedback will be reviewed as changes are made.

Oncology Nursing Forum. 2025 Mar 1;52(2):252–253.

P428. Bridging the Gap: Chemotherapy Administration in Non-Oncology Settings

Nicole Mizzoni ¹, Ana Fernandez ²

Treatment Modalities and Managing Administration

Significance & Background

Chemotherapies and biotherapies are increasingly being administered in non-oncology settings and/or for non-oncology purposes. This presents a challenge as these settings do not have chemotherapy trained nurses. In a large academic center, the lymphoma, multiple myeloma unit is responsible for off unit chemotherapy (OUC). The unit noticed an increase in the number of OUC and lack of care coordination and safe handling. With the growing concerns, the lymphoma, multiple myeloma unit recognized the need to start an OUC education inservice.

Purpose

The purpose of this study was to create a chemotherapy education for non-oncology nursing units focusing on coordination, communication and safe handling of chemotherapy drugs.

Interventions

Starting in November 2023, the lymphoma, multiple myeloma unit started to administer OUC and collect data including unit and number of chemotherapies ordered. Education sessions were coordinated with management to start in March 2024. Based on the data, the units with the most OUC were prioritized for education. Oncology nurses provided in-service training on the OUC process, communication, patient monitoring, and safe handling. The education also addressed frequently asked questions including best practices for care coordination and drug reaction protocols. Instructions on how to order chemotherapy disposal bins and spill kits were also provided.

Results

From March 2024 to present, 12 units were educated. Eight of these units were non-oncology units, representing 68% of OUC. The other four units were oncology units. The focus for these units was newer staff who were not familiar with the OUC process. Currently, 132 chemotherapy patients have been treated with a total of 163 chemotherapy drugs administered across 26 units. No safety events have been reported. Feedback has been positive from nurses and management. Limitations include units with low OUC have not been educated.

Discussion

Providing OUC education to units with non-chemotherapy trained nurses is essential to ensure proper care coordination and safe handling. Oncology nurses play an important role in OUC and bridging the gaps in non-oncology settings. In the future, we plan to provide education to the remaining units and reeducation where needed to ultimately increase OUC confidence and improve outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):253.

P429. Oncology Admission Bundle: a Comprehensive Approach to Categorizing Disease Specific Patient Education Materials at Admission

Daria Mlynarski ¹, Kaitlyn Izzo ², Jessica Peters ³, Tracey Slaven ⁴, Nancy Hopkins ⁵, Deborah Capodilupo ⁶

Patient Education

Significance & Background

During the pandemic, the chaos of an influx of acutely sick patients, short staffing, and an inherent need for providing safe, condensed care in the setting of an emergency crisis caused a shift in the cadence of the education we provided at the bedside. As a result of the changes we adopted during the pandemic and onboarding of many new staff members, we inadvertently steered away from some of our unit norms, the use of educational brochures we currently had in practice, and standard forms required at admission. In turn, this caused gaps in the information delivered to our patients at admission. Our units comprise of oncology patients with specialties in stem cell transplant and Car T cell therapy, and standardized patient education is critical for these patient populations during their admissions.

Purpose

Our project was designed to standardize the patient education materials and forms received at admission and encourage use throughout a patient’s stay. The goal had two purposes: to provide new staff members with guidance on what the teaching expectations were throughout a patient’s admission and to provide patients with disease-specific education and learning objectives to streamline information received during their admission.

Interventions

We identified the three most common patient populations on our units and categorized admissions into general oncology, stem cell transplant, and Car T cell therapy, with supplemental inserts for stem cell transplant discharge education and palliative care comfort measures when applicable. We assembled bundles with specific education materials, standard forms, and a welcome letter. We disseminated and reviewed bundles at admission and throughout our patients stay.

Results

After a year of project implication, we surveyed the nurses to gather information on the project and its goals. We surveyed for nursing compliance with packet use, enhancement of their own education, helpfulness of the packets, thoughts on improvement of patient stay and readiness for discharge, and if it improved patient education during their stay. We are still analyzing data from the nursing survey and will complete data analysis this fall.

Discussion

Patient education is a critical component of nursing care. Providing patients with disease-specific education at admission helps to set the expectations for admission and streamline the information received with the goal of contributing to patient compliance during their stay.

Oncology Nursing Forum. 2025 Mar 1;52(2):253–254.

P430. Transitioning a Medical-Surgical Unit into a Dedicated Oncology Unit

Michael Mocoski ¹

Healthcare Delivery

Significance & Background

As oncology care continues to grow as a critical focus in health care, institutions often face the challenge of expanding their own oncology service line despite limited space and resources.

Purpose

Transforming an existing medical-surgical unit into a specialized oncology unit may offer a practical solution to meeting the increase demand for oncology services, maximizing space and resources while improving care delivery.

Interventions

A four-phase strategic plan for such a transition focusing on vision, education, compensation, and certification facilitate this transition.

Vision

Effective leadership communication is essential to ensure transparency and address staff concerns regarding the unit’s transformation. Leadership and management should convey the vision at daily huddles with formal discussions about the transition occurring at staff meetings. Management would provide sufficient opportunity for staff to decide whether they would remain in the unit or seek transferring to another unit more in alignment with their career aspirations.

Education / Certification

A comprehensive educational plan, developed in collaboration with oncology nurse educators, will introduce staff to oncology care. Once the nurses meet the Oncology Nursing Society’s certification requirements, they will achieve their chemotherapy / immunotherapy provider status and eligibility to commence preceptorship training. Reimbursement for certification fees will serve as an incentive for change. Preceptorship training and tailored educational programs will enhance competency across a variety of roles, from bedside nurses, charge nurses, nurse residents and certified nursing assistants.

Compensation

Human Resources would conduct a comparative market salary analysis to reflect the specialized nature of the unit, while the finance department would support higher wage adjustments and lowering nurse-patient ratios. The finance department would approve additional full-time positions to meet the unit’s new staffing demands.

Results

Chemotherapy administration should increase, as the new oncology unit becomes more autonomous in oncology care. There would be less reliance on other oncology staff in the institution to provide nursing oncology support.

Discussion

Leadership must anticipate staff hesitation to change, maintain transparency, and ensure a gradual transition to safeguard both patient care and staff development. Leadership would highlight professional development, compensation, and lowered nurse-patient ratios as benefits to change. Management would provide oversight to staff training to prevent overwhelming preceptors from supporting units. A slow, deliberate transition is essential to ensure staff success while maintaining quality patient outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):254.

P431. Lab Orders in the Hands of Nurses: Driving Efficiency & Care in Hematology

Katelyn Momberg ¹

Coordination of Care and Navigation

Significance & Background

Nurse-driven protocols have demonstrated efficacy in enhancing patient care and operational efficiency across healthcare settings. The Hematology Clinic lacked specific lab-focused protocols, driven by registered nurses. Lacking such, the clinic noticed delays in lab order entries, lengthy patient appointments while waiting for providers to enter lab orders, and overall decreased patient satisfaction. Implementing a nurse-driven lab ordering protocol could replicate the success seen in other settings by improving treatment timeliness, standardizing care, and empowering nurses with greater autonomy. This initiative aimed to address the need for expedited care in an outpatient setting. Previous studies have highlighted the benefits of nurse-driven protocols. For example, a protocol to expedite diagnostic processes in behavioral health led to reduced wait times and improved patient satisfaction. Standardized orders for managing anemia in oncology also demonstrated improved patient outcomes. These findings suggest that similar protocols could enhance efficiency in other clinics.

Purpose

In the outpatient hematology clinic, how does the implementation of a nurse-driven lab ordering protocol affect treatment timeliness, standardization of care practices, and nurse autonomy compared to traditional methods within a two-week period?

Interventions

The intervention selected was a nurse-driven lab ordering protocol, where the nurse could utilize a pre-written standardized set of labs based on patient diagnosis as well as if the patient is established within the clinic. The protocol was developed with input from the Hematologist physicians and received approval from the ASPCC. Implementation involved training nursing staff and measuring outcomes such as order modality, time to enter orders, and adherence to protocols. Barriers such as staff resistance were addressed through ongoing communication.

Results

Pre-implementation data revealed that 47% of lab orders were entered on the same day as appointments, with 5% of late entries by providers causing delays. Post-implementation, 100% of lab orders were entered before appointments. Notably, 69% of orders were initiated through the nurse-driven protocol, with 0% causing care delays, demonstrating adherence and reduced delays.

Discussion

The implementation of the nurse-driven lab ordering protocol led to enhanced standardization of care and increased nurse autonomy, with all orders entered timely and a significant portion processed through the new protocol. Continued education and feedback will support the protocol’s sustainability. The results highlight the benefits of integrating nurse-driven initiatives in outpatient settings and suggest avenues for further application and research.

Oncology Nursing Forum. 2025 Mar 1;52(2):254–255.

P432. Making Metrics Matter - Measuring the Impact of Patient Advocacy

Ashley Moncrief ¹

Management

Significance & Background

To determine the impact of advocacy efforts, a global non-profit patient advocacy organization initiated the collection of interaction metrics; this provided concrete data which had not been reported since the organization’s inception in 1994.

Purpose

Develop a system to collect metrics from patient/caregiver interactions and to use the data to evaluate organizational effectiveness. Secondary uses include strategic planning and grant submissions.

Interventions

Identify pertinent information to be obtained from patient/caregiver interactions. Develop a process for data collection. Analyze metrics; distribute to key stakeholders. Utilize data in program planning, financial needs assessments, and organization level evaluations.

Results

The Director of Patient Care collected the first interaction metrics from July 24, 2023 to October 21, 2023. Priority information included: Number of unique patient/caregiver encounters; method of outreach; geographical location; number of referrals made to Centers of Excellence; nature of inquiries The initial Patient & Caregiver Interaction Report was sent to Centers of Excellence, staff, pharmaceutical partners, and the International Nurse Leadership Board starting on October 23, 2023. The report was distributed to patients, caregivers, and supporters via the Fall/Winter 2023 newsletter (Volume 29, Issue 2). Per leadership consensus, collection of quarterly metrics was made the responsibility of the Director of Patient Care. Metrics were distributed again in April and July 2024. Twelve months of organizational metrics revealed: The Director of Patient Care assisted 376 unique patients/caregivers who contacted the patient advocacy organization; 60 referrals were made to Centers of Excellence that specialize in the care of a rare malignancy; impact extended to thirty-one states in the United States and sixteen countries; the top two categories of inquiries were disease related questions (20.45%–2.3%) and requests for educational material (13.54%–29%).

Discussion

Prior to the intervention, this patient advocacy organization had no systematic way to evaluate impact. Information on the volume and nature of patient/caregiver inquiries is now being collected. Data is analyzed and distributed to stakeholders via the Quarterly Patient & Caregiver Interaction Reports.

Innovation

Patient advocacy organizations work selflessly on behalf of the patients and caregivers they serve. It is important for such organizations to find a way to mathematically quantify the impact of outreach efforts. Metrics matter when it comes to determining the health of the organization over time.

Oncology Nursing Forum. 2025 Mar 1;52(2):255–256.

P433. Getting to Know You: Early Education on Lifestyle Modifications in Stem Cell Transplant Patients

LaTarvia Moore ¹, Julia Collins ²

Patient Education

Significance & Background

Bone marrow transplant (BMT) patients can face significant challenges in maintaining their lifestyle due to treatment effects such as the increased risk of infection and bleeding following a stem cell transplant. Effective management of lifestyle habits is crucial for these patients to prevent unanticipated complications and ensure optimal outcomes and quality of life. Understanding a patient’s daily routine and challenges allows nurses to provide relevant education about managing their health and necessary lifestyle changes in a way that resonates with the patient. This quality improvement initiative addresses the need to assess patient’s lifestyle early in the transplant process to help nurses identify potential barriers to patient safety precautions post discharge and provide tailored education to prevent unanticipated complications after discharge and decrease patient anxiety at discharge.

Purpose

The primary aim of this quality improvement initiative was to determine if early identification and education on necessary lifestyle modifications would enhance patient’s understanding and compliance of safety precautions after discharge and decrease patient anxiety regarding restrictions at discharge.

Interventions

We used the PDCA cycle to implement this quality improvement project. To achieve our objectives, we first designed a survey to gather detailed information on patients’ lifestyle habits, including activities such as personal hygiene practices, pets, hobbies, dietary choices, and social interactions. In-services from the unit educator and professional practice leader were conducted at shift huddles to educate staff on the purpose of the patient survey form and its use. The forms were then placed into the admission folders to become a part of admission tasks so early identification of educational needs surrounding patient safety and lifestyle modifications could be addressed.

Results

This project was implemented September 2024. Patient surveys to evaluate effectiveness of the tool in prompting early discussion on required lifestyle modifications, anxiety surrounding discharge instructions, and patient satisfaction with receiving this education early in the transplant process vs at discharge will be distributed to transplant patients.

Discussion

Early discussions about lifestyle modifications are crucial for stem cell transplant patients, enabling them to proactively manage their health and prevent unanticipated complications after discharge. By providing education and support, healthcare providers can empower patients to take an active role in their recovery, ultimately leading to better outcomes and quality of life.

Oncology Nursing Forum. 2025 Mar 1;52(2):256.

P434. when Your Oncology Patient Has Kids: Tips and Resources for Nurses

Kelsey Mora ¹

Psychosocial Dimensions of Care

Significance & Background

One-third of cancer patients are diagnosed at an age when they may be parenting children, and the rate of diagnoses for this population has increased almost 30% since the 1970s. Based on these rates, in 2020, it was estimated that between 2.85–3.5 million American parents had cancer. Parents with cancer report that one of their biggest concerns is the well-being of their children, yet staff feel unprepared to support their patients’ children. As a result, families with young children have traditionally lacked access to the social-emotional support they need during their cancer treatment. A new national non-profit is aiming to solve that issue.

Purpose

Research shows that children and adolescents have improved mental health outcomes when they receive open communication about their parent’s cancer. However, adult oncology care providers often do not feel equipped to have these difficult conversations. Nurses are frequently asked by their patients how to best communicate with their children about cancer, yet rarely have received specific training on how to talk with children. Improving communication with children starts with arming nurses with language and tools to support their parenting patients requesting this guidance.

Interventions

A national non-profit organization has taught more than 800 oncology care providers to better support their parenting patients through training and on-demand resources focused on how to talk to kids about cancer. This presentation gives nurses actionable, evidence-based guidance to help their patients “share information, expectations, and feelings” with their children and adolescents throughout their cancer diagnosis and treatment. Attendees will practice supporting parenting patients of different age children through guided scenarios and role play. Attending nurses will also learn about external support and resources for continuing education in this area.

Results

Survey feedback was overwhelmingly positive. 100% of oncology care providers said they are likely to recommend the training to other health care providers. Nurses who attend the training report feeling more prepared to guide their parenting patients through difficult conversations about cancer with their children as a result of the content and guidance in the featured presentation.

Discussion

Oncology nurses spend extensive time with their patients and are often the person being asked by their patients “what about my kids?” With increased training and access to resources, nurses can improve the psychosocial outcomes not only for their patient but also their children.

Oncology Nursing Forum. 2025 Mar 1;52(2):256–257.

P435. Expanding Our Knowledge and the Unit for Cellular Therapy and Stem Cell Transplant

Christine Morales ¹, Laura Martin ², Kristin Ferguson ³, Elizabeth Earle ⁴, Harella Wilson ⁵, Mikerlyne Castor ⁶

Management

Significance & Background

The Stem Cell Transplant and Cellular Immunotherapy Program (SCTCIP) at our large academic medical center has increased in volume creating a need to expand the infusion center that supports the program. At baseline, we had 1 permanent and 2 contract nurses that were proficient in caring for this patient population. Our goal was twofold, to move the patients to the same space as the SCTCIP clinic in 4 dedicated infusion chairs, and cross-train our standard of care nurses to support and supplement the current SCTCIP nurses and program growth.

Purpose

Standard of Care infusion (SOC) nurses did not feel confident caring for stem cell transplant and cellular therapy patients and we were at capacity in our main infusion center.

Interventions

To address the gap in knowledge, we devised a 3-step training program that each SOC RN would go through to become competent in the care of stem cell transplant and cellular therapy patient population. We utilized the Oncology Nursing Society’s line course “ONS Hematopoietic Stem Cell Transplantation” to establish a baseline of knowledge for the nurses. Step two we partnered with the inpatient SCTCIP unit created a 6 hour in person classroom day that incorporated speakers from the Blood and Marrow Collection Department, the inpatient nursing team, The SCTCIP Physicians, and the SCTCIP Quality Coordinator. The content traced a patient journey from referral to transplant to discharge. The third step included self-learning modules and hands on competencies to ensure nurses caring for the (SCTCIP) patients were confident in their skills. The self-learning modules included information on conditioning regimens, HLA Labs, cytokine release syndrome, Post transplant vaccination schedules and policy review. The hands-on skills included Central line care and CLABSI prevention, emergency response and code readiness.

Results

Over the course of 6 months, we successfully trained 20 infusion nurses or 90% of the staff to care for stem cell transplant and cellular therapy patients. In June we successfully opened four infusion chairs in the SCTCIP clinic. This allowed us to offload volume from our main infusion center.

Discussion

The 3-step training program can pave the way for innovative RN care approaches to autologous and CAR T-cell patients, and improved RN coordination in oncology and hematology clinical settings.

Oncology Nursing Forum. 2025 Mar 1;52(2):257.

P436. Establishing Roles and Responsibilities for Clinical Oncology Navigation at UNC Healthcare

Patricia Morfeld ¹, Deanna Harris ²

Coordination of Care and Navigation

Significance & Background

Oncology nurse navigation began at our organization 16 years ago for leukemia and breast patients. While these patients follow different treatment pathways due to their complex nature and high census it was logical to supplement their teams with additional staff. Navigators began by carving out a new professional path that within our program.

Purpose

Within two years additional providers were clamoring for navigators and in the next decade navigators were added annually. As positions were added there was no job description or path for orientation and evaluation. At the beginning of the pandemic the role underwent dynamic change from being 100% in person to 100% remote. With the end of the pandemic administration faced the dilemma of who to bring back in person and how often. The disruption in nurse hiring and retention placed pressure on leaders to maintain the navigation workforce. Hybrid work agreements were negotiated but in order to provide these roles effectively it became more important to provide structure for all members of the team.

Interventions

Beginning in spring 2023 we assembled an interdisciplinary group of to identify the essential components of clinical navigation, including current state and preferred state.

■ One-on-one meetings with current oncology navigators to identify points of pride and areas for improvement.
■ Reviewed national organization documents from the American Cancer Society (ACS), Oncology Nursing Society (ONS), and the Academy of Oncology Nurse & Patient Navigators (AONN).
■ Sorted responsibilities between: clinic staff, navigation staff, and triage staff then further divided them into three categories: Clinical, Psychosocial, and Administrative.
■ Began creating standard practices between disease groups for documentation and delegation.

Results

Feedback is good and focused on the positive impact on patient care, appreciation for the professional role of navigation, teammates feeling empowered to speak directly to providers and their leadership team about concerns, and staff reporting an increase in job satisfaction.

Discussion

With research continuing to identify the benefits of navigation the investment in this professional nursing role is essential. CMS billing and reimbursement, patient reported outcomes, and the development of new and better treatments make funding and recognition for clinical navigation a financial and ethical responsibility. By continuing to broaden the scope and availability of oncology navigation our organization can fully address the equity issues for oncology patients across North Carolina.

Oncology Nursing Forum. 2025 Mar 1;52(2):257–258.

P437. Cultivating Critical Thinking in Oncology Nurses

Madolyn Moritz ¹, Katie Ortner-Henry ², Phuong Huynh ³

Management

Significance & Background

Knowledge of oncology treatment-related side effects requires critical thinking to determine priority nursing interventions. There is a need for innovative strategies to develop this oncology nursing clinical judgement. At a large NCI designated ambulatory cancer center, nurse educators identified a need to effectively cultivate this expertise across broad treatment modalities, as this gap has been identified as a critical element for promoting best patient outcomes.

Purpose

To describe an interactive oncology nursing assessment class developed for new and experienced nurses to enhance critical thinking and clinical judgement skills.

Interventions

A team of nurse educators developed a three-hour oncology assessment curriculum and simulation learning experience. Priority topics were identified based on key oncology content and education strategies to support critical thinking. Content included assessment skills, chemotherapy and biotherapy treatments, and use of SBAR communication. To provide a comprehensive review of side effects, nurses from different specialties were divided into small groups to compare symptoms between chemotherapy and biotherapy. The distinction between pathophysiology of chemotherapy versus biotherapy was articulated to ensure understanding of the determination of appropriate nursing interventions. Low-fidelity simulations and the use of SBAR communication were used to hone critical thinking skills. Integration of educator-led time outs and debriefs was utilized to assure learner understanding and engagement.

Results

The class has been well received with nurses reporting increased confidence in their oncology nursing assessments, use of SBAR communication, and critical thinking skills after the class. In a post-class online survey, 94% of attendees responded that the class improved their critical thinking skills for patient assessments.

Discussion

Oncology is a rapidly evolving specialty involving cutting-edge science and new innovations in treatments. Nurses require constant knowledge updates to maintain clinical judgement and expertise. In the class, gaps were identified, including the mechanism of action of biotherapies, pathophysiology of oncology treatment side effects, and the rationale for appropriate interventions. Dedicated opportunities for nurses to gain confidence and competence in oncology treatment knowledge and assessment skills are essential. An engaging classroom space creates a culture of continued learning. The use of an evidence based SBAR tool was effective in guiding nurses to think critically through the patient assessment and practice clinical reasoning skills. Institutional support of ongoing oncology nursing knowledge and confidence is paramount and ultimately results in improved patient outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):258–259.

P438. Reducing Falls in Outpatient Infusion Centers: Implementation of the Morse Fall Scale

Kelly Morris ¹, Jessica Harlow ², Amanda Clements ³, Katie Lassiter ⁴, Adrienne Banavage ⁵, Yara Mahmoud ⁶

Quality and Safety

Significance & Background

In September 2023, a fall at an outpatient infusion center highlighted significant variability in the fall risk assessment tools used across different sites. The inconsistency in identifying high-risk patients and implementing fall precautions necessitated a standardized, evidence-based approach to reduce fall incidents.

Purpose

The purpose of this evidence-based practice (EBP) project was to find and implement a validated fall risk assessment tool for use across our outpatient infusion centers to accurately identify patients at high risk of falling and decrease fall incidents. The IOWA model was used.

Interventions

Using a PICO format, we conducted a systematic review of the literature to find the best-suited validated fall risk assessment tool for routine use in outpatient infusion centers. The initial search identified eight different tools, each with varying degrees of evidence and complexity. We excluded tools that were inpatient-focused, required specialized equipment, or were complex to administer. After a rigorous evaluation, three articles remained. Additional insights were gathered through the Oncology Nursing Society Community Forum. The Morse Fall Scale emerged as the optimal choice due to its validation by the Agency for Healthcare Research & Quality, ease of use, and relevance to outpatient care. Following approval from the infusion nursing leadership team, we identified fall champions comprised of leaders and front-line nurses from each infusion site. Fall champions educated nurses on how to use the Morse Fall Scale, and the tool was integrated into the hospital’s electronic health record for ease of documentation.

Results

After the implementation of the Morse Fall Scale in our outpatient infusion centers on January 8, 2024, the fall rate dropped from 0.19% to 0.09%–0.10% in the first month and reached 0.0% within six months, with no falls reported to date. Completion of the Morse Fall Scale by nurses increased from 71.7% in the first quarter to 76.9% in the third quarter of 2024.

Discussion

This EBP project successfully reduced fall rates in our outpatient infusion centers and has standardized how we identify patients at high risk of falling across multiple sites. The rigorous evaluation process ensured that the Morse Fall Scale was chosen based on strong evidence and practical applicability. Future efforts will focus on additional education, adherence to using the scale, and tracking fall rates.

Oncology Nursing Forum. 2025 Mar 1;52(2):259.

P439. Streamlining Pre-Screening for Phase I Oncology Trials: Utilizing a Patient Database to Improve Referral Efficiency and Outcomes

Julia Morrissey ¹, Laura Hurley ², Fatima Darwiche ³, Catharine Frost ⁴, Yasmin Baig ⁵, Yan Wang ⁶

Healthcare Delivery

Significance & Background

Pre-screening patients for Phase I oncology clinical trials is an extensive and time-sensitive process that impacts patient outcomes. The University of Michigan O-CTSU Multi-Tumor Experimental Therapeutics (MET) program receives referrals from various sources and aims to efficiently complete the pre-screening process through administrative strategies, including a shared referral email, a patient tracking database, and a comprehensive active study guide.

Purpose

Our objective is to assess the baseline referral intake data in the patient database, with the long-term goal of enhancing referral outcomes and reducing time from referral to trial recommendation and treatment initiation.

Interventions

We conducted an analysis of patients referred for pre-screening, manually input into a HIPAA-compliant REDCap database by the study team. We also utilized a clinical research nurse to screen eligibility and match potential clinical trials. Data reviewed include patients referred between May 2023 and June 2024.

Results

The MET program received 367 referrals from May 2023 to June 30, 2024. Referrals came from nine different disease programs. Of the referrals, 65.4% were matched to at least one trial option. 32.43% patients referred consented to a clinical research trial, and 24.80% patients were confirmed eligible and enrolled. The primary reason for referral failure was ineligibility due to health status. Additionally, 11.3% of referred patients declined the trial option, 5.8% initiated other treatment options while waiting for a trial slot, and 4.9% had no available trial. The median turnaround time from referral to initial response to the referral providers was 4 days. For subjects who consented and enrolled in the trial, the median turnaround time from referral to consent was 17 days, and the median turnaround time from referral to enrollment was 27 days.

Discussion

The analysis of referral data from the MET program demonstrates the effectiveness of strategies in streamlining the pre-screening process for Phase I oncology trials. With 65.4% of referred patients matched to at least one trial option and a median turnaround time of 4 days for initial responses, the program has exhibited promising efficiency in managing referrals. However, approximately 5% of referrals encountered a lack of available trials, and treatment delays while waiting for trial slots indicate areas for improvement. These findings serve as a baseline for future opportunity to further reduce time to initial response/treatment initiation and improve patient access to experimental therapeutic trials.

Oncology Nursing Forum. 2025 Mar 1;52(2):259–260.

P440. Kicking Heparin to the Curb? Saline Shows Promise for Implanted Port Locks

Anna Mueller ¹, Erin Smith ², Erin Smith ³, Caroline Apter ⁴, Jennifer Mitchell ⁵, Tracy Shelmire ⁶, Bridget Coleman ⁷

Treatment Modalities and Managing Administration

Significance & Background

Implanted ports are crucial for long-term vascular access, and it is essential to keep them open to ensure optimal patient care. Blockages can cause significant problems for oncology patients, such as delays in treatment, higher utilization of healthcare services, and reduced quality of life. While heparin has been the standard choice for preventing port blockages, emerging evidence show saline may be just as effective.

Purpose

To determine if saline is as effective as heparin in maintaining port patency in oncology patients in order to identify a safer option for port management.

Interventions

This was a five-month cohort study of 476 oncology patients with single-lumen implantable ports and 1843 unique encounters between November 2023 and March 2024. While heparin was the predominant flushing solution for patients’ implantable ports in November 2023 (198 heparin-lock versus 25 saline-lock), we made the gradual shift to saline being the predominant flushing solution by January 2024 (34 heparin-lock; 436 saline-lock), February 2024 (0 heparin-lock; 462 saline-lock), March 2024 (1 heparin-lock; 465 saline-lock). We examined data on patients’ characteristics, including heparin versus saline as a port-flush solution, and alteplase utilization to restore function in occluded implanted chest ports. We analyzed participants’ data using descriptive statistics and a Chi-Square test to examine the association between the two port flush solutions and the utilization of alteplase during patient encounters.

Results

The study included 317 female and 159 male patients, with most identifying as White (83%) and having a right chest single-lumen implantable power port (61.3%). Patients’ median age was 68 years. Out of 476 oncology patients and 1843 encounters, alteplase was used to restore occluded implanted chest port function in only 14 patients (2.94%) and 15 encounters (0.8%) across all five months. The Chi-Square test suggested no statistically significant differences in occlusion rates, measured by alteplase overall utilization, when saline became the predominant port-flush solution versus heparin (p>.05).

Discussion

The findings of this study suggest no statistically significant difference in maintaining port patency between heparin and saline port-flushes. By advocating for the use of saline, especially in settings with limited heparin access or high costs, nurses can contribute to improved patient outcomes. However, regular monitoring for signs of occlusion remains crucial, even with saline. Early detection and intervention can help prevent complications and minimize the need for alteplase treatment.

Oncology Nursing Forum. 2025 Mar 1;52(2):260.

P441. Development and Implementation of a High Dose Rate Brachytherapy Program for Prostate Cancer: A Multidisciplinary Approach

Kelly Muldoon ¹, Ella-Mae Shupe ², Roberta Anderson ³

Radiation

Significance & Background

A new High Dose Rate (HDR) brachytherapy program was developed at a single site, representing a complex multidisciplinary initiative. The successful implementation of this program required ongoing communication and collaboration between the Radiation Oncology department and key stakeholders in other departments, including Anesthesia, Infection Control, Facilities, Patient Quality and Safety, and the electronic medical record (EMR) analysts. These partnerships were critical to ensuring a safe and effective implementation of a new treatment option for both newly diagnosed prostate cancer patients, and those experiencing recurrence after previous radiation therapy.

Purpose

This abstract aims to present the approach taken by a Radiation Oncology center in the development and implementation of an HDR brachytherapy program for prostate cancer patients.

Interventions

The team first traveled to observe an established HDR brachytherapy program, which informed the subsequent development of standards of practice (SOP) and orientation for nursing staff within Radiation Oncology. Multiple dry runs were conducted with all involved departments including Radiation Oncology (nursing, physicians, radiation therapists, physicists, and dosimetrists), Anesthesia, Infection Control, Facilities, Patient Quality and Safety, and the EMR analysts. Collaborations with EMR analysts was essential to creating proper workflows for documentation in preoperative (pre-op), intraoperative (intra-op), and post-anesthesia care unit (PACU) settings. Pre-op and PACU nurses received targeted education to effectively prepare and recover patients undergoing brachytherapy. Additionally, guidelines were developed for primary care providers regarding pre-op evaluations, including necessary bloodwork, chest X-rays, EKG, and medication management. Radiation Oncology nurses were trained in skin preparation, gowning, draping, urinary catheter insertion, EMR documentation, interventions for urinary retention post-procedure, and voiding trials.

Results

To date, the program has successfully completed 32 cases, treating a total of 19 patients. Additionally, five radiation therapy nurses have been trained in the HDR brachytherapy procedure.

Discussion

The evaluation of this program highlights the effectiveness of the multidisciplinary collaboration, which was instrumental in the seamless implementation of the HDR brachytherapy program. This collaborative approach has led to strengthened interdisciplinary efforts within the institution. The program’s success underscores the importance of thorough preparation, including education, workflow integration, and interdepartmental coordination, in developing new therapeutic interventions.

Oncology Nursing Forum. 2025 Mar 1;52(2):260–261.

P442. The Patient Related Outcomes Survey (PRO) Discloses Persistent Symptoms in Lymphoma Cancer Survivors

Ellen Mullen ¹, Haleigh Mistry ², Asiya Siddiqui ³, Katherine Gilmore ⁴, Ying Qiao ⁵, Maria Rodriguez ⁶

Survivorship

Significance & Background

Patient-reported outcomes (PROs) are measures of a patient’s health status as reported directly from the patient without added interpretation by a healthcare worker or anyone else (FDA). At MD Anderson Cancer Center, the PROs are recorded using the validated tool, MD Anderson Assessment Symptom Inventory (MDASI). The MDASI is a cancer specific symptom burden questionnaire composed of 13 core symptoms and 6 interference items (Table 1). It has been used in the lymphoma survivorship clinic since 2021. Lymphoma survivors are transitioned to survivorship clinic upon completion of treatment with curative intent, achieved remission and based on lymphoma subtypes: Hodgkin’s lymphoma-2 years of no evidence of disease (NED), Diffuse Large Cell Lymphoma-5 years NED, Peripheral T-cell lymphoma-5 years NED, and Follicular Lymphoma, Grade I & II-10 years NED.

Purpose

The MDASI is used to measure lymphoma survivors’ symptoms and incorporate symptoms review into the clinical encounter. Electronic distribution provides real-time alerts to providers on key high alert symptoms

Interventions

The MDASI is integrated in the Electronic Health Records and sent via the patient portal 7 days prior to their clinic visit. A follow-up reminder message is sent out to patients 3 days prior to their visit if not completed. Four key symptoms (pain, distress, sadness, and shortness of breath) are set to trigger alerts to providers.

Results

Since its’ launch in 2021, the response rate is averaging about 55% (total 659 responses). Table 2 summarizes the frequency of the four key symptoms from moderate (score 5–7) to high alert level (score >7) responses for FY21 to FY24. Long term survivors still experience symptoms that warrant intervention. For FY21–FY24, 11% of patients reported mod/high alert values for distress, while 14% reported mod/high alert values for pain. In 2021, the numbers for distress and sadness rates were high but are lower after that year. Two possible explanations: the sample size was smaller in 2021 and the ongoing pandemic, hence more stress and sadness.

Discussion

The MDASI demonstrates that lymphoma cancer survivors experience moderate to high level symptoms beyond completion of treatment and achieving remission. The MDASI helps clinician understand patient needs and provide opportunities to intervene proactively and improve quality of life. Currently, the clinic is improving the response rate by enhancing patient education and by sending out reminders through patient portals.

Oncology Nursing Forum. 2025 Mar 1;52(2):261–262.

P443. Leveraging Digital Patient Outreach to Increase Lung Cancer Screening

Andrew Munchel ¹, Elizabeth Younger ²

Screening, Early Detection, Genomics

Significance & Background

According to the American Cancer Society, lung cancer is the second most diagnosed cancer in both men and women and the most common cause of cancer deaths. Lung cancer screening (LCS) with low-dose computed tomography (LDCT) has been shown to reduce mortality among those at highest risk. Despite being recommended by the United States Preventive Services Task Force (USPSTF) for over a decade, overall LCS uptake remains low nationally.

Purpose

The purpose of this quality improvement project was to demonstrate the feasibility of passive electronic patient outreach to facilitate LDCT screening among active smokers.

Interventions

In collaboration with multidisciplinary system stakeholders, a digital patient outreach campaign was developed as part of an oncology nurse-led initiative. Patient eligibility was aligned to commercially insured current smokers meeting USPSTF age and pack year eligibility criteria with a recent visit to a health system primary care provider (PCP) within the preceding 12 months. Using brief introductory language outlining potential LDCT screening eligibility and overall benefit, patients were offered the opportunity to confirm their smoking status, pack years and insurance coverage via the patient portal. Upon patient confirmation of smoking status and pack year history as previously reported in the EHR, an electronic order for testing was offered for self-scheduling. Testing recommendations and the electronic order for initial LDCT was enabled as a protocol-delegated function on behalf of the patient’s PCP.

Results

Across 2120 patient outreach attempts, the digital outreach intervention resulted in 3.02% of patients completing their recommended LDCT screening via self-scheduling. Among 64 patients confirming their LDCT eligibility digitally, the average time from initial outreach to scan completion was 39 days. An additional 4.20% of digital outreach recipients completed their recommended LDCT screenings, scheduled and coordinated through traditional workflows in the months following digital prompting.

Discussion

Digital patient outreach, paired with self-scheduling upon eligibility confirmation, is a low resource intensive strategy towards annual LDCT completion. Offering LDCT to eligible patients beyond the exam room walls may be an effective strategy for increasing lung cancer screenings.

Oncology Nursing Forum. 2025 Mar 1;52(2):262.

P444. Cultivating a Shared Purpose to Reduce Avoidable Cancer-Related Ed Utilization

Andrew Munchel ¹, Lindsay Ebling ²

Healthcare Delivery

Significance & Background

Emergency department (ED) utilization by cancer patients strains limited resources and places this vulnerable population at risk. Research by Tabriz et al. (2023) suggests that over 50% of ED visits among patients with cancer are potentially preventable. Factors contributing to avoidable visits often include inadequate patient education regarding symptom management, gaps in continuity of care, and insufficient access to outpatient resources. As cancer patients frequently experience complex health needs and comorbidities, addressing these issues is crucial to improving the overall quality of care.

Purpose

This quality improvement project aimed to implement a comprehensive strategy towards reducing unnecessary visits to the emergency department (ED) among ambulatory oncology patients across six regional cancer centers.

Interventions

Guided by the principles of Nemawashi, initial project interventions focused on fostering shared purpose and a collective commitment to enhanced patient care. Utilizing a Plan-Do-Study-Act (PDSA) framework, a series of countermeasures were implemented which included the development of eleven nurse triage protocols designed to improve symptom management at the first point of contact. In tandem with enhanced nurse triage, advanced practice provider schedule slots were reserved to facilitate same-day patient access as appropriate. Additional project countermeasures included standardized patient education materials with enhanced language regarding urgent symptoms and guidance on when and how to contact the ambulatory cancer centers. To screen for unmet patient needs, a post-chemotherapy check-in call process was implemented for all new lines of therapy, with nurse contact occurring 48–72 hours following initial treatment.

Results

The percentage of chemotherapy treatment patients with an ED encounter categorized as potentially avoidable decreased from 4.10% to 3.73% compared to the preceding 12-month baseline period; this 9.02% reduction was observed despite a 10.79% increase in overall chemotherapy treatment volumes.

Discussion

Supporting nurses through change management and fostering a shared purpose were essential for success. Recognizing the time needed for implementation and respecting staff’s gradual engagement with new processes were critical factors. A phased rollout using the PDSA approach ensured staff commitment and contributed to achieving positive outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):262–263.

P445. Implementing and Sustaining a Successful Ambulatory Radiation Oncology Unit Council

Amanda Munter ¹

Radiation

Significance & Background

The shared governance structure allows nurses to actively participate in improving patient outcomes and nurse satisfaction. Nursing shared governance involves collaborative decision-making between clinical nurses and nurse leaders. However, historically, the radiation oncology unit council included only a few nurses from one site, which limited representation of the entire nursing team. This emphasizes the need for change and better inclusion.

Purpose

Creating an engaging and purposeful nursing shared governance structure that empowers and drives decisions to improve the professional oncology nursing practice and patient care for ambulatory radiation oncology nursing.

Interventions

The reorganization of the unit council has led to the appointment of one clinical nurse representative at each of the eight network locations, backed by two clinical practice leads, an assistant nurse manager, nurse manager and a clinical director. The reorganization facilitates the participation of nurses from co-located hospitals in their entity specific core councils, practice councils, and professional development councils. Unit councils play a crucial role in setting annual SMART goals, essential for driving changes in nursing practices within the department. This structure fosters inclusion, engagement, and a sense of value for our nursing staff while aligning with the mission, vision and values of the health system. The radiation oncology nursing department, a complex and dynamic entity, consists of three sub-councils, each with its own focus. These sub-councils, each playing a crucial role in our department’s activities, report to the unit council to provide updates on their respective areas, seek approvals for new initiatives, and request support and suggestions from the unit council members. This structure allows for effective communication and collaboration among the sub-councils and the unit council, ensuring that the department’s activities are aligned with its overarching goals.

Results

In spite of operating across eight network locations, our nursing team functions as a unified whole. The inclusive restructuring of the unit council has not only boosted nursing engagement and professional certification but has also fostered teamwork and significantly enhanced clinical efficiencies and workflows.

Discussion

Designing a shared governance framework model that suits our department’s unique needs and complexity was crucial in encouraging nurse participation. A shared governance model in the ambulatory setting requires a strong and influential nurse leader who can identify and remove obstacles that impede progress and success, provide necessary resources along with promoting autonomy, ownership and accountability.

Oncology Nursing Forum. 2025 Mar 1;52(2):263.

P446. Transforming Preceptor Education in an Ambulatory Cancer Clinic

Keri Nace Mercer ¹, Michele Wagner ², Geralyn Quinn ³, Laura Cullen ⁴

Management

Significance & Background

Historically oncology nurses entered practice in an inpatient setting, gained skills and then transitioned to ambulatory care. Now nurses are entering ambulatory clinics as new graduates. As a result, new evidence-based preceptor training and resources are needed. Three main facts often contribute to the gaps in oncology clinics. First, preceptor training and tools are often geared to inpatient settings. Second, oncology clinics are often organized by specialties (e.g., medical, surgical) and further by cancer types (e.g., breast, lung). Thus, cross training for staff coverage is needed. Third, busy clinic preceptors often lack training, are unaware of evidence-based precepting resources and need tools specific to new graduates. Lack of an evidenced-based preceptor training and resources has resulted in staff dissatisfaction, turnover, inexperienced staff, and an increase of poor patient outcomes (Piccinini et al 2018).

Purpose

Our aim is to implement an evidence-based preceptor program for nurses in the ambulatory cancer clinic. The Iowa Model (Iowa Model Collaborative, 2017) guides this practice change, and we received support from an Evidence-Based Practice (EBP) internship (Cullen & Titler, 2004). Expected outcomes include an increase in preceptor understanding of roles across specialties, staff satisfaction, and retention in this comprehensive cancer clinic

Interventions

Practice changes included staff participating in existing departmental Preceptor Workshops, creating an oncology specific workshop and orientation tools.

Results

Two on-line questionnaires were distributed, the first measured knowledge, attitudes, and behaviors about preceptor orientation. The second investigated nurses’ perceptions of barriers and facilitators to precepting, willingness to serve as a preceptor, and specialty clinics they felt comfortable serving as a preceptor. Staff agreed having a primary preceptor was important for a quality orientation (91.3%) and felt they had valuable information to share with preceptees (95.7%). Balancing priorities managing a clinic, while precepting was an identified challenge. Three focus areas for improvement were identified for more training (e.g., pre op teaching, policies and procedures, and nurse-driven protocols for each specialty). Consensus existed for prioritizing completion of the Preceptor Workshop and annual compliance and adding clinic-specific orientation support and tools.

Discussion

Using an EBP process to support preceptors offers a foundation for staff engagement and retention. The refresher course will be evaluated for revision and sustained use. Staff engagement, retention, and patient outcomes will be monitored. Results will be shared during the ONS Congress.

Oncology Nursing Forum. 2025 Mar 1;52(2):263–264.

P447. Comparing Heparin versus Normal Saline for Maintaining Implanted Port Patency

Alexandra Naik ¹, Mia Niwa ², Alexandra Volko ³, Bridget Deveney ⁴

Treatment Modalities and Managing Administration

Significance & Background

ecent nursing evidence-based practice studies have suggested that normal saline flushes are as effective as heparin in maintaining patency for implanted port catheters at time of deaccess.

Purpose

The purpose of this study is to determine if there is a significant increase in implanted port occlusion when switching from heparin instillation to normal saline flushes at time of deaccess at the Honickman outpatient infusion center.

Interventions

For this study, the number of alteplase doses administered during the pre-implementation phase (April/May 2024) was compared to the doses administered post-implementation (June/July 2024).

Results

There was no increase in the number of times the declotting medication alteplase was administered when comparing the pre-implementation phase (April/May 2024) to the post-implementation phase (June/July 2024).

Discussion

Use of heparin for instillation in maintaining port patency can lead to increased risk of heparin induced thrombocytopenia, allergic reactions, and increased hospital costs. Using normal saline does not carry any increased risks of adverse reactions. The implementation of this practice increases patient safety while decreasing hospital costs.

Oncology Nursing Forum. 2025 Mar 1;52(2):264.

P449. Overcoming Barriers to Cancer Care for Vulnerable Populations Though a Collaborative Initiative

Lauren Nangle ¹, Megan Roy ²

Coordination of Care and Navigation

Significance & Background

A collaboration between Unite Here Health (UHH) and Penn Medicine has been established to address the unique challenges faced by UHH’s eleven thousand members. These members often encounter significant barriers such as language difficulties, food insecurity, transportation issues, poverty, and health illiteracy. Additionally, they tend to prioritize work over their health concerns, further complicating their access to timely cancer care.

Purpose

The initiative aims to provide oncology nurse navigation (ONN) interventions that facilitate timely cancer care while addressing the various barriers these members face. The goal is to achieve better outcomes, reduce cancer care costs, and improve the patient experience.

Interventions

To facilitate this initiative, five new positions have been created: Coordinator, ONN, Social Worker (SW), and two Advanced Practice Providers (APP). Referrals are made from UHH health promoters (HP) and Mount Sinai Health Center (MSHC) physicians directly to the Penn Medicine team. ONN triages patients’ symptoms and medical records to determine the appropriate provider and facilitate appointments. ONN identifies barriers to care and intervenes by arranging necessary services, providing education, coordinating transportation, and ensuring overall care coordination. Weekly huddles with a multidisciplinary team, including UHH, MSHC, and Penn Medicine, are conducted to identify and anticipate patient needs during treatment. Penn Medicine waives copays for treatments, including labs, radiology, and home infusions. UHH arranges all medication and transportation to appointments at no cost to the patient. A UHH SW and APP meet with all oncology patients at the health center close to home to enhance quality of life and provide oncology support.

Results

Within the first six months of the collaboration, 130 patients have enrolled in the program. Metrics are tracked on the cost of care, referral times, and the time to the first appointment. Notably, there is an increased understanding of the care plan, resulting in better compliance and reducing the risk of patients being lost to follow-up.

Discussion

The success of this initiative is attributed to the collaboration among UHH, MSHC, and Penn Medicine. Effective communication has been crucial in supporting this population through their cancer journey. Future goals include increasing cancer screening programs for this population and reducing transportation costs by coordinating more visits, utilizing telemedicine when appropriate, and decoupling labs and radiology to the health center.

Oncology Nursing Forum. 2025 Mar 1;52(2):264–265.

P450. Transforming Cancer Care through Nursing Excellence: The Launch of an Oncology Nurse Academy

Robin Neider ¹, Ashley Orlowske ²

Professional Development

Significance & Background

In 2022 our practice CCO and CNYONS President met to discuss potential educational opportunities for our new oncology nurses. As we emerged from the COVID pandemic we identified the need for education in the area of oncology as many of the new nurses did not have oncology experience and others were new graduates. We also identified the need for a program that allowed nurses to gather, share a meal and network with each other, and while serving as support and learning partners.

Purpose

In early 2023 the chapter board reviewed the needs and started formulating the idea behind the Oncology Nurse Academy. The purpose of the academy was to educate and inform new oncology nurses of the basics of cancer care, including diagnosis, pathology and treatment. During development it was found that the topics were relevant and helpful for even experienced nurses and advanced practice. The initial intention was to focus on the most common cancers. However, our topics evolved over time after we considered the input from the attendees.

Interventions

Our first academy was a four week program. Each week included a 45 minute presentation and a 15 minute question and answer session. Our speakers were medical oncologists who covered the diagnosis, pathology and treatment of lung, breast, GI cancer and multiple myeloma. We provided dinner and allowed time for networking and discussion. It was also important to us to offer CEUs, which were applied for through Montana Nursing Association, and supported by evidence from ONS publications and podcasts. We gave each attendee a CNYONS notebook.

Results

At the conclusion of each program, the attendees were asked to complete an evaluation which identified areas of learning, as well as additional topics for future academy topics.

Discussion

Each set of evaluations were reviewed to determine what new needs could be addressed and it was determined that the Academy could reach more nurses and serve a larger purpose by expanding the topics presented. As a result, additional sessions were scheduled. As of this writing, a session on next generation sequencing and research has been presented and a session on bi-specifics is planned. Additional future topics include oncological emergencies and radiation therapy.

Oncology Nursing Forum. 2025 Mar 1;52(2):265.

P451. A Unit Based Governance Approach to Nurse-Patient Assignments

Peyton Neilson ¹, Jamie Adams ², Lisa Booth ³, Kimberly Hamel ⁴

Management

Significance & Background

A suburban NCI Designated Infusion Center Unit Based Governance (UBG) council brought forward concerns related to current nursing patient assignments and infusion therapy intensity leading to nursing acuity. Nurse-patient assignments were viewed as being inconsistent, unbalanced, and potentially unsafe. Therefore, UBG leadership requested that the UBG council review, revise, and re-implement a new assignment sheet and acuity scale.

Purpose

The purpose of this project was to ensure that infusion nurse-patient assignments are consistent, safe, and appropriately based on infusion therapy acuity.

Interventions

A review of literature was conducted and staff survey was created to determine the best evidence based acuity scale in infusion. The existing 5-point Likert patient acuity scale was re-defined and integrated into a re-designed infusion assignment sheet. An acuity number was assigned from a 5 point acuity scale to all regimens that are administered at the Infusion Center. Regimens ranged from 1 to 5 with 1 being the least and 5 being the most reaction risk/time intensive/complicated regimen. Nursing and scheduling staff were given the opportunity to review the proposed acuity scale. If a disagreement was noted, a recommendation and explanation was asked for. In some instances, the acuity scale was revised, the treatment regimen was assigned a higher or lower number based on staff consensus. The daily patient assignment sheet includes all nurses working for the day and their assigned patients with their regimen acuity number. The nurses’ total acuity for the day is calculated by adding assigned patient acuity numbers together. The goal acuity for assigned patients is 16–22 which usually averages to 6–8 patients per shift.

Results

A satisfaction survey related to the proposed acuity scale will be sent to staff in October 2024. The staff will be re-surveyed in early 2025. At that time, survey results and requested acuity modifications will be reviewed and presented through the UBG council for approval. Results will be measured by nurse satisfaction, less scheduling errors, and the ability to fall within the goal acuity range.

Discussion

UBG empowers nurses to use their clinical knowledge to revise a unit specific concern. A unit specific nurse-patient assignment sheet and acuity scale have implications for making nursing assignments better and increasing the nursing satisfaction within the unit.

Oncology Nursing Forum. 2025 Mar 1;52(2):265–266.

P452. Engagement of Oncology Advanced Practice Provider through a Professional Advancement Program

Jaclyn Newfield ¹, Shila Pandey ², Naomi Cazeau ³, Stella Nwogogu ⁴, Sofia Romero ⁵, Kelly Haviland ⁶

Professional Development

Significance & Background

Advanced practice providers (APPs), including Nurse Practitioners (NPs) and Physician Assistants (PAs), are integral providers of oncology clinical care. Professional advancement programs (PAPs) promote APPs based on demonstrated leadership in areas of education, research, technological innovation, and/or clinical expertise, while serving to recognize and reward contributions. Existing PAPs have significant variability and there is limited evidence regarding the level of engagement these programs generate.

Purpose

This project aimed to determine the frequency of APP promotions and the level of participation in professional activities after the implementation of a PAP. Professional activities with the greatest and least participation were identified.

Interventions

In 2022, a PAP for APPs called Ascend (Advanced Practice Provider Clinical Excellence and Development Program) was instituted at a National Cancer Institute (NCI)-designated metropolitan cancer center. Ascend is a four-tiered PAP with six domains (direct comprehensive care, research, drivers of change, education, professional development and leadership, and technology and innovation) containing over 70 enrichment steps (professional activities) to accrue eligible points for promotion. A descriptive analysis of data generated from 2022 and 2023 applications was performed to determine frequency of each enrichment step. Data on promotion rates were collected from APP leadership.

Results

In 2022, 21% (216/1051) of staff applied for promotion, of which 55% (118) were promoted to APP III and 28% (60) to APP IV. In 2023, 6% (59/1067) of APPs applied for promotion and 61% (36) were promoted to APP III and 17% (10) to APP IV. Over the two years, applicants reported engagement in each domain as follows: 1519 (143, 332) in direct comprehensive care, 170 (11,51) in research, 621 (0,166) in drivers of change, 190 (0,50) in education, 796 (0,101) in professional development and leadership, and 94 (7,27) in technology and innovation.

Discussion

Oncology APPs exhibited a desire for professional growth by engagement in a PAP. While the initial application cycle exhibited the greatest participation, applications for advancement remained consistent in subsequent cycles. PAPs should allow for ongoing modifications of the application including expansion of criteria for advancement and approaches to evaluation. Engaging organization leadership is critical to continue program growth and sustainability. Further research is needed to evaluate the impact of the PAP on APP satisfaction and retention.

Oncology Nursing Forum. 2025 Mar 1;52(2):266.

P453. Development of a Research Curriculum for Advanced Oncology Practitioners

Kimberly Noonan ¹, Caitlin Murphy ², Samantha Morrison-Ma ³

Management

Significance & Background

The role of the advanced oncology practitioner (AOP) in delivering cancer care is integral to the oncology workforce in providing safe, quality care that extends healthcare access to individuals nationwide. Recent policy changes from the Center for Therapy Evaluation Program (CTEP) grants AOPs authority to write chemotherapy orders without physician co-signatures. This change in clinical practice enhances the autonomy for AOPs and enables them to provide more efficient care. However, with this expansion in privileges there is recognition of a significant educational need to provide comprehensive training for AOPs caring for patients on clinical trials and the responsibilities of signing clinical trial cancer therapy orders. Limited evidence exists that describes the role and educational needs of AOPs in caring for patients on clinical trials.

Purpose

The aim of this initiative is to prepare AOPs with the necessary skills and knowledge to provide comprehensive care to patients on clinical trials.

Interventions

Recognizing this need for AOP training in the area, DFCI developed and launched an AOP Research Curriculum that includes both didactic and electronic health record (EHR) system demonstration training to write cancer therapy orders. The initiative launched in August 2024 and continue through March 2025. Approximately 280 AOPs that care for patients on clinical trials will complete the training. Results and

Discussion

The evaluation of the AOP Research Curriculum will involve pre- and post-surveys to assess changes in the AOPs knowledge and clinical practice when caring for patients on clinical trials. This approach not only supports the professional development of AOPs but also aligns with the broader goal of ensuring high-quality, evidence-based cancer care.

Oncology Nursing Forum. 2025 Mar 1;52(2):266–267.

P454. Evaluating Oncology Medication Patient Education Materials Using Health Literacy Guidelines

Nina Noskowiak ¹, Regina Carlisle ², Steven Folk ³, Nicholas Bitz ⁴, Jeffrey Pasucal ⁵, Sharon Zhong ⁶

Patient Education

Significance & Background

Patients and families often face information overload and finding materials that are comprehensive and reader friendly is challenging. Oncology medication patient education content from websites and vendors can be cumbersome to read and may lack guidance about common side effect management. Furthermore, some sources may offer information that differs from the provider’s instructions, potentially leading to confusion or harm. Oncology nurses and pharmacists play a vital role in identifying and providing education materials that are useful and aligned with health literacy guidelines.

Purpose

To review medication patient education handouts from various sources for consistency and health literacy best practices and make a recommendations for updating the cancer center’s medication patient education policy.

Interventions

An interdisciplinary team of oncology nurses and clinical pharmacists reviewed oncology medication content from online and vendor sources. Each team member examined patient education content for an IV chemotherapy regimen and oral chemotherapy medication in their area of expertise, looking for alignment with the hospital’s patient education standards for fever, safe handling of body fluids and oral treatment safety guidelines. The group also evaluated each resource for health literacy components such as plain language and the reading ease of printed materials. Following the review, a recommendation for amending the cancer center’s education policy was presented to the medication safety committee for discussion and endorsement.

Results

Evaluation of this project includes a summary of the team’s findings for each source, noting pros and cons, differences in content and use of health literacy guidelines for reading ease. In addition, feedback from team members about the use of the newly approved resource in their daily practice will be shared.

Discussion

While there are many different sources of oncology medication patient education available, they may not always align with health literacy best practices or an institution’s guidelines. The cancer care team is responsible for offering useful, accurate and thorough information that is easy-to-read. Doing so can help patients and families become active partners in their care, identifying and addressing side effects, if and when they arise.

Oncology Nursing Forum. 2025 Mar 1;52(2):267–268.

P455. Perceived Spousal Support and Quality of Life for Women with Breast and Gynecological Cancers in Nigeria

Chinomso Nwozichi ¹, Elizabeth Maciejewski ²

Psychosocial Dimensions of Care

Significance & Background

A cancer diagnosis can be challenging for both patients and their spouses, as partners often struggle to find effective ways to offer support. In Nigeria and many parts of Africa, the family unit is traditionally an essential source of support, which can be leveraged to aid cancer patients (Olagundoye & Alugo, 2018). However, evidence suggests that some Nigerian women with breast and gynecological cancers face rejection and a lack of support from their spouses, often due to perceived loss of sexual attraction and the financial burden associated with treatment (Nwozichi et al., 2024). This lack of support is exacerbated by treatment-related changes, such as mastectomy, hysterectomy, and reconstructive surgeries. In some cases, partners may react negatively, leaving women to navigate the illness on their own.

Purpose

This study aimed to explore the relationship between perceived spousal support and the quality of life among Nigerian women with breast and gynecologic cancers.

Interventions

An online survey was administered to Nigerian women with breast and gynecologic cancers, and responses were collected using Google Forms. The data was coded and analyzed using Python software.

Results

The majority of participants (50.4%) reported moderate levels of spousal support, while 46.1% had a high quality of life. A weak positive correlation was found between spousal support and quality of life (r = 0.227). Spousal support was significantly associated with age (p = 0.000), religion (p = 0.000), stage at diagnosis (p = 0.0086), and employment status (p = 0.0013). However, no significant relationship was found between spousal support and the current stage of cancer (p = 0.1483). Regarding quality of life, significant relationships were observed with age (p = 0.0000), diagnostic stage (p = 0.0086), current cancer stage (p = 0.0000), employment status (p = 0.0013), and religion (p = 0.0000).

Discussion

The findings of this study align with those of Csuka et al. (2023), who reported a strong correlation between spousal support and improved quality of life in women with breast and gynecologic cancers. Emotional, practical, and social support from a spouse plays a key role in helping women cope with their illness. A supportive spouse offers emotional stability, reducing anxiety, depression, and feelings of isolation. This emotional support contributes to a more positive outlook, directly enhancing overall quality of life.

Oncology Nursing Forum. 2025 Mar 1;52(2):268.

P457. Time Toxicity Among Cancer Patients: a Concept Analysis Using Walker and Avant’s Method

Chinomso Nwozichi ¹

Psychosocial Dimensions of Care

Significance & Background

Cancer treatment has traditionally been assessed in terms of its physical, financial, and emotional burdens on patients. However, an underexplored dimension is the impact of treatment on patients’ time—a factor increasingly referred to as time toxicity. In recent years, as cancer treatments have become more complex and prolonged, time toxicity has emerged as a critical dimension oncology professionals must consider as it influences the quality of life, adherence to therapy, and treatment outcomes.

Purpose

The purpose of this concept analysis is to examine the concept of time toxicity using Walker and Avant’s method. The goal is to clarify its attributes, antecedents, and consequences, develop a formal definition, and explore its implications for cancer care.

Interventions

Walker and Avant’s method of concept analysis was used to analyze time toxicity. A comprehensive literature search was conducted across multiple databases, including PubMed, CINAHL, and Scopus. Related concepts, contextual factors, and model cases were examined to illuminate the evolution and application of time toxicity in oncology. Throughout the concept analysis, data were managed using NVivo software (Version 12) for qualitative data analysis. Themes and sub-themes related to attributes, antecedents, and consequences were identified and refined through multiple coding iterations.

Results

Time toxicity is defined by five core attributes: temporal burden, disruption of daily life, cumulative impact, opportunity cost, and emotional strain. Key antecedents include a cancer diagnosis and complex treatment regimens, while consequences include reduced quality of life, treatment non-adherence, economic burden, and caregiver strain. Contextual factors, such as healthcare infrastructure and socioeconomic status, shape the manifestation of time toxicity in different patient populations. Time toxicity is the cumulative temporal burden experienced by cancer patients due to frequent and prolonged treatment regimens. It disrupts daily life, imposes opportunity costs, and contributes to emotional and psychological strain. Time toxicity impacts patients and caregivers, with consequences that extend to quality of life, economic stability, and treatment adherence.

Discussion

The concept of time toxicity highlights the need for healthcare systems to consider the time burden placed on cancer patients. Interventions aimed at reducing time toxicity, such as streamlined care coordination, telemedicine, and flexible scheduling, may improve patient outcomes and quality of life. Oncology nurses, as frontline care providers, are uniquely positioned to identify and address time toxicity through patient advocacy, education, and care management strategies.

Oncology Nursing Forum. 2025 Mar 1;52(2):268–269.

P458. Empowering New Infusion Nurses: Strengthening the Outpatient Oncology Infusion Preceptor Program and the Onboarding of New Infusion Nurses to Enhance Their Preparedness for Independent Practice

Lesleigh O’Dell ¹

Management

Goal

To enhance the outpatient oncology infusion nurse preceptor program, thereby improving the onboarding and orientation experience for new infusion nurses and preparing them for independent practice.

Significance & Background

In recent years, oncology, both inpatient and outpatient, has experienced a significant increase in staff turnover. Many new hires enter the field with limited or no oncology experience, creating a growing demand for specialized knowledge in cancer types, treatment regimens, and symptom management. This knowledge gap poses challenges for preceptors, particularly in addressing the orientee’s limited oncology background, prior experiences with preceptorship, the time available to foster critical thinking, and the need for robust preceptor development.

Purpose

This project aims to standardize and enhance the preceptor program across multiple infusion sites, addressing the difficulties new infusion nurses face when transitioning from orientation to independent practice. By doing so, the program seeks to equip preceptors better to effectively onboard new nurses and support their journey toward becoming confident, independent infusion staff nurses.

Interventions

An assessment of preceptor roles across seven outpatient infusion centers was conducted to evaluate their involvement in the onboarding process for new infusion nurses. Based on these findings, nurse educators developed a structured preceptor program tailored to the needs of new oncology infusion nurses. This program included weekly objectives for preceptors and orientees, tools for providing effective feedback, strategies for adapting to various learning styles, and weekly surveys to monitor progress throughout the orientation period.

Results

Eleven preceptors completed the enhanced preceptor course and its evaluation. Since the program’s implementation, six new oncology nurses have completed their orientation. Notably, two of these nurses required an additional two weeks of orientation to support their transition into independent practice.

Discussion

Feedback from team members regarding the preceptor and orientation process provided valuable insights into improving new hires’ confidence and satisfaction in their roles as oncology infusion nurses. The initiation of the standardized preceptor program, informed by this feedback, demonstrated measurable improvements in preceptor self-confidence, orientees confidence in their preceptors, and the readiness of orientees to transition to independent practice as infusion nurses.

Oncology Nursing Forum. 2025 Mar 1;52(2):269.

P459. Engaging Staff in Assessment and Solutions for Burnout on an Outpatient Oncology Floor

Hannah O’Flanagan ¹

Quality and Safety

Significance & Background

A comprehensive cancer center in a head, neck, and lung ambulatory unit treating ~80 patients daily, identified a need to assess for nurse burnout. As care is fast paced with an acute patient population, requiring complex clinical expertise from the nurse’s, burnout is a possible outcome which can lead to decreased job satisfaction, potential mistakes, staffing shortages, and reduction of best quality-of-care.

Purpose

To address nursing burnout proactively by evaluating stressors and providing solutions in an ambulatory oncology infusion center.

Interventions

A staff nurse leader researched burnout assessment tools, reviewing the literature and methodology for implementation of a survey for oncology care. A survey was created with an existing tool and the addition 5 open-ended questions for nurses to report stressors at work, stuck points, symptoms of burnout, ideas to mitigate the stressors discussed and an opportunity for further feedback. Data was analyzed for trends and reviewed with nursing leadership and proposed solutions were implemented with follow up survey evaluating effectiveness of changes.

Results

Respondents (85%) reported communication and delays in care as contributing stressors at work. Staffing, (71% ), timing of lunches and breaks( 43%), work culture (14%) also were identified as stressor contributors. Gaps in timely communication between nurses and providers orders, being signed, and access to supplies in the patient rooms also significantly contributed to perceived burnout. Implemented solutions: Hiring to full FTE accomplished. Additional infusion rooms added were allocated to the department and appropriate supplies designated for each room. Lines of workflow communication were standardized with emails, clinical updates, and one-on-one recaps. Dedicated attention to scheduling of late in the day infusions assured correct infusion times and fewer overtime hours. Organizationally new regulatory guidance has been initiated addressing a culture shift in lunches and breaks. Staff report decrease in stressors and ongoing evaluation will be key to assure efforts sustain best clinical care can be delivered.

Discussion

Burnout must be assessed by those experiencing it so that the mitigation truly addresses root causes. This process operationalizes assessments of burnout with a new tool and system for acknowledging nursing burnout and potential causes. The ongoing survey and reflection engages leadership and staff nurses as a team to continually adapt and improve cancer outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):269–270.

P460. The Impact of Nurses’ Voices in Healthcare Advocacy

Colleen O’Leary ¹

Professional Development

Significance & Background

The ANA code of ethics states that nurses must “participate as advocates in civic activities related to healthcare through local, regional, state, or national initiatives”. Advocacy is also one of ONS’s core values. When a nurse addresses public policy, legislators listen. Nurses have the power to advocate for practices that will lead to the best outcomes for patients, families and clinicians. Ohio Oncology Nurses at the Statehouse (OONS) is an initiative to meet this objective.

Purpose

To gather oncology nurses from around Ohio to teach them about advocacy and afford an opportunity to address their legislators regarding selected healthcare policies.

Interventions

Each local chapter in Ohio was contacted about an opportunity to be involved in the first OONS event. A planning committee with nurses from 4 chapters was formed. Working with ONS’s Director of government affairs and advocacy, as well as the Assistant VP of state government affairs at one institution, a list of current healthcare bills was developed. Experts on each of the bills were contacted for background and input. Three bills, biomarker testing, prior authorization and white bagging were selected. A two-day event included education about advocacy in general and the bills that would be discussed on day 1. Visits to legislators occurred on day 2. Sessions included a state representative that was a nurse, a state senator, a lobbyist, a representative from the board of nursing and a staff nurse involved in advocacy as well as the experts on each of the bills.

Results

Seventeen nurses participated. Visits were made to 11 Senate offices and 12 House offices. All three of the bills were supported by the legislative offices. Shortly after the event we received word that the biomarker that we advocated for bill had passed in the House after being stalled there for several months. It is now in the Senate. All aspects of the program received high marks from participants. Comments included feeling empowered to advocate, excellent program and all the speakers were excellent.

Discussion

Nurses are in a unique position to have their voices heard and listened to in healthcare policy. When we speak up on behalf of our patients, families and colleagues change can be made. We have to teach more nurses how they can advocate and give them opportunities to do so.

Oncology Nursing Forum. 2025 Mar 1;52(2):270.

P461. Creation and Implementation of a Hazardous Drug Spill Competency

Samantha O’Neil ¹

Management

Significance & Background

Hazardous spills is an area of concern and fear for many staff members working with oncology patients. In a long-term acute care setting, patients are often working with therapy during infusions or treatment. It was identified that nurses on the oncology unit were not confident or competent in using a spill kit appropriately. In response, it was identified additional training and education was needed.

Purpose

To provide staff with an opportunity to use a hazardous spill kit to practice how to properly use equipment to effectively clean a spill in a simulation or practice setting. The goal was to promote safety, improve staff’s knowledge about the procedure, and increase their confidence.

Interventions

Nurses were presented a short PowerPoint with information regarding facility resources, contacts, and the procedure used in the event of a spill. The ONS “Safe Handling Basics” spill video was then used to explain the steps involved in a spill. Lastly, staff then participated in a mock spill in the infusion room with the spill kit equipment and assessed using a competency checklist. A pre and post survey was used to assess their confidence regarding different aspects of a spill cleanup and after-action steps. In total, training took about 30 min on average for each session.

Results

Staff were overall very receptive and enjoyed the training. A total of 17 nurses participated. This included 15 oncology nurses, a nurse manager, and a resource nurse. Confidence regarding spill management was assessed using a 7 question pre and post survey. All questions had an increased in confidence level in the post test compared to the pre-test.

Discussion

Hazardous drug safety continues to be a hot topic and a concern for staff. Conducting this training was beneficial and proved to be an area staff want more education on. With the success of this pilot, the goal is to train the rest of the nurses on the oncology unit and expand the training to include both therapist and housekeeping.

Oncology Nursing Forum. 2025 Mar 1;52(2):270–271.

P462. Clabsi Reduction on a Solid Tumor Unit

Irene Odonkor ¹, Earl McKenzie ²

Coordination of Care and Navigation

Significance & Background

Central line-associated bloodstream infections ( CLABSI) are a critical concern in healthcare, our surgical oncology unit where port associated infections were noted as significantly high by the state depart in 2022( 5) with no major difference sighted in 2023 ( 4).

Purpose

This project aimed to implement a comprehensive strategy to reduce port associated CLABSI’s by enhancing collaboration among healthcare teams and standardizing protocols within the unit.

Interventions

Key intervention included engaging the nursing staff in the improvement process and fostering an interdisciplinary approach. We partnered with the radiology team to prioritize midline insertion for patients on our unit, ensuring timely and appropriate access. Additionally, we discussed line necessity during during interdisciplinary rounds to promote judicious use of central lines. Education sessions for the emergency department (ED) team were conducted to minimize unnecessary access of ports upon patient arrival.

Results

Following the implementation of these implementation and at the time of authoring this abstract, we have reduced CLABSI rates to zero. Staff engagement and adherence to new protocols significantly improved, as demonstrated by compliance audits. The collaborative efforts with radiology and the ED also contributed to a more streamlined process for line insertions and access management.

Discussion

The results indicate that an interdisciplinary approach, combined with active staff engagement and targeted education, can effectively reduce CLABSI rates. This project highlights the importance of collaboration across teams in enhancing patient safety. Future initiatives will focus on sustaining these improvements and exploring further interdisciplinary strategies to optimize patient care across the health continuum.

Oncology Nursing Forum. 2025 Mar 1;52(2):271.

P463. The Role of Oncology Nurses in Artificial Intelligence Integration for Enhanced Patient Care and Operational Efficiency

Roselyn Ogunkunle ¹, Samina Asfandiyar ²

Healthcare Delivery

Significance & Background

Artificial intelligence (AI) is rapidly transforming healthcare, offering significant potential to improve patient care and streamline operations. Oncology nurses, at the forefront of patient interactions, are uniquely positioned to leverage and contribute to AI-driven tools. However, their role in AI adoption, application, and optimization is often underemphasized. Integrating AI into nursing practice can enhance patient outcomes, reduce administrative burdens, and improve workflow efficiency. Understanding the implications of AI for oncology nurses is essential for maximizing AI’s benefits in both patient care and job satisfaction.

Purpose

The project seeks to examine the role of oncology nurses in AI integration, with a focus on how AI can enhance patient care, improve workflow efficiency, and support data-driven decision-making. Additionally, it aims to explore how AI tools can be applied while maintaining ethical standards and preserving compassionate, patient-centered care.

Interventions

A comprehensive literature review was performed to identify key areas where AI influences nursing practice. The review focused on AI’s role in enhancing patient monitoring, personalizing care plans, reducing administrative workloads, and providing decision-making support. Studies, articles, and reports from peer-reviewed journals were analyzed to assess AI’s current applications and impact on oncology nursing. Key themes were identified to understand AI’s potential to improve patient outcomes, optimize workflows, and support nurses in clinical decision-making processes.

Results

The analysis demonstrated that AI significantly enhances oncology nurses’ ability to provide timely, personalized care, with predictive analytics playing a key role in the early detection of patient deterioration. Automation of administrative tasks, such as documentation and scheduling, has reduced workloads, allowing nurses to focus more on direct patient care. Additionally, ethical considerations related to AI, particularly in maintaining compassionate, patient-centered care, are evolving as AI becomes more widespread in healthcare. The ongoing need for a balanced integration of AI remains critical to addressing these ethical challenges effectively.

Discussion

Oncology nurses are crucial to the successful integration of AI in healthcare. Their active involvement ensures that AI technologies remain patient-centered, ethical, and seamlessly incorporated into clinical workflows. AI has the potential to enhance personalized care, streamline workflows, and support ethical decision-making, making it a valuable tool for improving patient outcomes and increasing nurse job satisfaction. Fostering AI literacy among nurses is essential for advancing healthcare and maximizing the benefits of AI-driven innovations in clinical practice.

Oncology Nursing Forum. 2025 Mar 1;52(2):271–272.

P464. Helping Patients Help Themselves: Effectiveness of Digital Application in Patient Education

Songhee Oh ¹, Felicia Melo ²

Patient Education

Significance & Background

The World Health Organization has identified a lack of treatment adherence as a major global problem leading to increased healthcare costs and re-hospitalizations for oncology patients. Evidence indicated that utilizing digital methods for patient education effectively increases patient understanding, motivation in self-care, and treatment adherence.

Purpose

To provide patients with a digital application to improve patient motivation to participate in self-care, understanding and treatment adherence.

Interventions

Patients admitted to inpatient hematology/oncology unit were offered digital application that provides video-based patient education on several topics including stem cell transplant and chemotherapy. The survey from Schooley, et al. (2020) was used to evaluate self-reported understanding and motivation to participate in care.

Results

Comparisons of pre- and post-intervention survey results showed that patient’s understanding and motivation to participate in care increased from 93% to 100%.

Discussion

Use of digital application for patient education enhanced patient motivation and adherence to treatment. Using digital education in addition to conventional education methods can positively impact patient participation and treatment adherence.

Oncology Nursing Forum. 2025 Mar 1;52(2):272.

P465. Prevalence and Risk Factors of Depressive Symptoms and Stress in Patients with Head and Neck Cancer Before Undergoing Intensity-Modulated Radiotherapy

Jieun Oh ¹, Wenhui Zhang ², Canhua Xiao ³, Yufen Lin ⁴

Psychosocial Dimensions of Care

Significance & Background

Depressive symptoms and stress are common psychological issues in head and neck cancer (HNC) patients before undergoing intensity-modulated radiotherapy (IMRT). Recognizing and understanding the risk factors of these psychological issues in this population is crucial for identifying patients at highest risk for these symptoms and developing interventions to improve patient outcomes.

Purpose

This study assessed the prevalence of depressive symptoms and stress in HNC patients before undergoing IMRT and determined the associated risk factors.

Interventions

A cross-sectional secondary data analysis was conducted using a dataset from a prospective longitudinal study of patients with HNC who underwent IMRT. Depressive symptoms and stress were evaluated by the Patient Health Questionnaire (PHQ-8) and Perceived Stress Scale (PSS). Forward selection multivariable logistic regression analyses with blocks of demographic, clinical, and symptom characteristics were conducted to explore their associations with depressive symptoms and stress.

Results

Participants included 197 patients with HNC (mean age 59.7 ±10.2, 75.6% male, 81.7% white). Prevalence of depressive symptoms (PHQ-8 ≥ 5) and moderate to severe stress (PSS ≥ 14) were 43.7% and 49.5%, respectively. Fatigue [p < 0.001; AOR = 7.729; 95% CI (2.552 – 23.406)]; pain [p = 0.011; AOR = 3.164; 95% CI (1.305 – 7.671)]; stress [p = 0.004; AOR = 3.861; 95% CI (1.537 – 9.698)]; and sleep disturbances [p = 0.006; AOR = 7.544; 95% CI (1.782 – 31.937)] were associated with depressive symptoms. Patients experiencing fatigue [p = 0.023; AOR = 1.041; 95% CI (1.006 – 1.077)]; pain [p = 0.046; AOR = 0.647; 95% CI (0.423 – 0.992)]; depressive symptoms [p = 0.008; AOR = 1.252; 95% CI (1.059 – 1.480)]; and sleep disturbances [p = 0.046; AOR = 1.127; 95% CI (1.002 – 1.268)] experienced significant stress. Marital status and smoking were linked to depressive symptoms and stress before entering these symptoms but were not significant predictors after controlling for these symptoms.

Discussion

Depressive symptoms and stress were considerably high among HNC patients before undergoing IMRT. Fatigue, pain, stress, and sleep disturbances were significant risk factors. Our study highlights the contributing risk factors in this population, benefitting the development of targeted interventions for those at greatest risk. Future research should validate our findings and employ longitudinal studies to examine how demographic, clinical, and symptom characteristics influence patient depression and stress throughout and following IMRT.

Oncology Nursing Forum. 2025 Mar 1;52(2):272–273.

P466. Incorporating Standardized Nursing Language in Electronic Nursing Care Plans to Address Symptom Management in Patients with Cancer

Nancy Ohanian Gerhard ¹, Kimberly Sanchez ²

Symptom Management and Palliative Care

Significance & Background

Symptom management is an important care plan component. Patients with cancer may experience reduced quality of life and functional well-being from unaddressed psychosocial needs and uncontrolled symptoms. Standardized nursing language can be used in care plans for psychosocial and physical symptoms in this patient population as a result of cancer diagnosis and treatment. Internal data revealed electronic workflow limitations and outdated content as contributors to low compliance with nursing care plan and patient education regulatory requirements. Specifically for patients with cancer, very few symptom management-related care plans and education topics were available for documentation.

Purpose

This project aimed to improve nursing workflows for care plan and patient education documentation and increase electronic care plans and education topics for use with patients with cancer.

Interventions

Two clinical nurse specialists, as part of a larger optimization team, reduced a cumbersome, multi-location documentation workflow to a simple, one-location workflow for either care plans or patient education. Forty-six nursing care plans were created with three components: problem, anticipated outcomes, and planned interventions. All care plans aligned with standardized nursing language, including North American Nursing Diagnosis Association-International, Nursing Interventions Classification, and Nursing Outcomes Classification. Twenty-six new documentation options were added for patient education. More care plans and education topics focused on symptom management. Nursing education included a one-time interactive eLearning module, monthly staff meeting presentations, and one-on-one teaching during project implementation. An electronic report was built to monitor documentation compliance.

Results

Since implementation, approximately 400 staff interactions occurred to review the new workflows and care plan compliance has increased. Nurses verbally reported satisfaction with the new workflows, naming ease of use as a facilitator to meeting regulatory requirements. During previous regulatory visits, many cited opportunities were identified. At a recent regulatory visit, the new workflows were commended and 29 of 30 (96%) patients met regulatory requirements. Overall compliance, looking at all appropriate care plan documentation for all admitted patients in one day, is 41% (127 of 310 patients), with most missing one or two problems for a complete care plan.

Discussion

Streamlined workflows and standardized nursing language in electronic nursing care plans support oncology nurses in identifying and implementing symptom management interventions. Reducing psychosocial and physical symptom burden experienced by patients with cancer is essential in extending oncology nursing impact in symptom management and high-quality cancer care.

Oncology Nursing Forum. 2025 Mar 1;52(2):273–274.

P467. Percutaneous Transesophageal Gastrostomy Tube Abstract

Erica Oldenburg ¹

Patient Education

Significance & Background

At our facility, clinical case reviews are utilized to review patient’s care, treatment, and outcomes to identify areas of improvement. During a clinical case review for a gynecologic oncology patient, issues were addressed regarding complex discharge needs related to care for percutaneous esophageal gastrostomy tubes (PTEG). A PTEG is a drain that is used when a traditional venting G tube is not feasible due to tumor burden or ascites. The case review identified gaps in the PTEG process regarding discharge education instructions, access for proper home supplies, staff education, and patient education teaching materials.

Purpose

The purpose of this project was to collaborate with multiple services to improve the care of this population by developing appropriate nursing education regarding care, patient education/ discharge instructions, and continuing proper care of the PTEG across the inpatient and outpatient locations.

Interventions

Prior to the intervention, a pre-survey was used to assess RN knowledge of diet, site care, flushing, supply needs, drain care order, and post discharge follow up for the PTEG: Survey results indicated staff needed more PTEG education. The next step included collaborating with interventional radiology to review standard of care for PTEG and create educational materials. Collaboration also took place between the medical oncology unit and central supply to obtain the appropriate supplies needed to care for PTEG drains. This information was disseminated per Microsoft SWAY content during staff meetings. This content was shared with the medical oncology, surgical oncology, and outpatient cancer center nursing staff.

Results

Pre and post surveys included the questions, “How comfortable do you feel taking care of PTEGSs and how comfortable are you providing discharge education to patients about PTEG management at home?” (Pre-survey N= 23. Post-survey N=13). Comfortability in caring for PTEG drains increased by 26% and comfortability providing discharge education increased by 22%.

Discussion

This project not only improved communication across multiple disciplines/departments including interventional radiology, gynecologic oncology, central supply, case management, discharge nursing council, and the bedside staff to improve the overall knowledge and care for PTEG drains. This enhances patient experience along the care continuum for this specific, vulnerable population.

Oncology Nursing Forum. 2025 Mar 1;52(2):274.

P468. Tailoring Fall Prevention for Oncology Patients: an Interprofessional Approach to Reducing Falls with Injury in an Inpatient Environment

Julia Olsen ¹

Quality and Safety

Significance & Background

Patient falls, especially those resulting in injury, are sentinel events and all care team members play a role in their prevention. Oncology treatment adds a unique level of complexity to fall prevention tactics; some of the treatments have attributed side effects that may increase a patient’s risk of falling (i.e. neutropenic fevers, neurotoxicity, orthostasis, etc). Although universal fall precautions exist to address risks of falls, there is opportunity to identify additional fall prevention tactics unique to oncology patients that truly individualize these efforts.

Purpose

The purpose of this workgroup is to focus on oncology-specific risk factors that can lead to falls, identify fall prevention interventions to address these risk factors, and ultimately reduce the rate of falls with injury on the three hematology/oncology/blood and marrow transplant & cellular therapy (BMTCT) inpatient units, while also empowering all members of the care team to participate in fall prevention.

Interventions

A clinical nurse leader at a large academic medical center created an oncology service line workgroup to address fall prevention in the hematology/oncology and BMTCT patient populations for the inpatient units. Team members include bedside nurses, certified nursing assistants, medical providers, nursing leadership, a clinical nurse educator, therapy representatives, and a designated pharmacist that care for these patient populations. The team meets monthly to review fall data for the service line, complete peer reviews on fall events, discuss additional resources needed to enhance fall prevention efforts in oncology, and participate in hospital-wide fall prevention opportunities.

Results

Since the inception of this workgroup in June 2023, we have seen a reduction in falls with injury for the service line; fiscal year 2023 had a fall with injury rate per 1000 patient days of 0.94 while fiscal year 2024 decreased to 0.68. Another outcome of the workgroup was creation of mobility guidelines for oncology patients, including specific guidelines for patients at risk for neurotoxicity. Increased and continued engagement by all members of the team has been evident since the workgroup began.

Discussion

Fall prevention is a team effort. Increasing awareness and including bedside care members in fall prevention specific to the oncology patient population can help reduce falls with injury and improve collaboration among the interprofessional team. Other institutions may wish to adopt this process to reduce falls and increase patient safety related to falls.

Oncology Nursing Forum. 2025 Mar 1;52(2):274–275.

P469. Implementing Oncology Nursing Society (ONS) Courses for Orientation

Mary Olson ¹, Elizabeth Loach ²

Management

Significance & Background

Comprehensive nursing orientation is crucial for quality patient care. A detailed orientation boosts job satisfaction, aids in retaining nurses, and promotes ongoing professional growth, paving the way for certification. Orientation programs for oncology nurses were inconsistent across a large health organization.

Purpose

Launch online orientation courses developed by the Oncology Nursing Society (ONS) for newly hired oncology RNs in both inpatient and outpatient environments.

Interventions

A team of frontline nurses developed criteria recommendations for courses based on experience, practice area, and Oncology Certified Nurse (OCN®) status. Oncology leaders approved the recommendations, and a business case was developed to purchase courses through ONS’ bulk purchasing option, ONS All Access. A component of the plan was to evaluate the utilization of the courses after six months. The business case was shared with the Nursing Professional Development and Learning and Development teams. After review and funding approval at the system level, courses were purchased, and a go-live date was set.

Results

Evaluation included a survey to learners and leaders in addition to nurse retention rate. Learner respondents confirmed the courses were effective in improving their fundamental oncology nursing knowledge. All leaders who participated in the survey concurred that the courses prepared new oncology RNs “very well” for their professional success. The retention rate for the 28 learners registered during the trial period was 89% (25/28) post go-live. Six months after the course completion, a second survey was conducted to evaluate the impact on nursing practice, professional growth, suggestions for orientation enhancement, and retention intent. Learner responses confirmed course material was applicable and useful in their practice.

Discussion

Based on results, leaders support the continued use of ONS courses during orientation. Additionally, retention data from the trial period suggests a positive impact on nurse retention. The goal is long term improved retention rates. Also, the expectation is strong foundational knowledge will lay the groundwork for continuing professional development including OCN® certification. Future steps may include offering new courses and development of oncology scenarios to enhance the orientation program.

Oncology Nursing Forum. 2025 Mar 1;52(2):275.

P470. Enhancing Patient Experience through a Culture of Safety, Engagement, and Compassion

Yvette Ong ¹

Quality and Safety

Significance & Background

Psychological safety is crucial in oncology nursing, influencing nurse satisfaction and patient outcomes. A supportive environment fosters engaged staff who feel secure and motivated to provide compassionate and safe care. Key factors such as work-life balance, wellness, and joy in work contribute to engagement and empowerment. Cultivating a shared culture and vision is essential for delivering quality care and enhancing patient experience.

Purpose

Provide insights on sustaining a culture of safety and implementing targeted interventions to enhance nurse satisfaction and patient experience in the inpatient oncology setting.

Interventions

Leaders focused on building trusting relationships, promoting teamwork and recognition, and personalizing care. To sustain a culture of safety, strategies included a Just Culture approach to encourage open communication; role-modeling behaviors for consistency in practice; and leader rounds and quality debriefs to enhance communication and ensure that nurses feel valued and empowered. Effective teamwork was facilitated through team briefs and recognizing each team member’s role in patient care. Building strong connections between leaders and nurses fostered a collaborative environment, encouraging ownership and shared responsibility. Recognition, appreciation, and acknowledgment were crucial for team engagement, reinforcing positive behaviors, boosting morale, and strengthening commitment, which enhanced nurse satisfaction and retention. Strategies included nominating individuals for recognition awards, acknowledging the complexity of oncology nursing work, ensuring adequate resources and leadership support, offering flexible scheduling, and sustaining professional governance. Engaging with patients beyond their medical condition and empowering them by involving them in their care and addressing their preferences promoted a personalized approach that enhanced the patient experience. Incorporating patient stories in team briefs strengthened connections between care providers and patients.

Results

Overall Safe Care Assessment was rated at 99% (5/2024) with an increased perception that staff suggestions are incorporated in decisions about safety from 84% (5/2022) to 91% in (5/2024); and teamwork from 87 (5/2022) to 89% (5/2024). Overall patient experience scores improved with Rate the Hospital at 98% (FY2024) and Nurse Communication increasing from 75% in FY2023 to 99% FY2024. These improvements are attributed to increased staff engagement and a strengthened culture of safety.

Discussion

The interventions effectively cultivated a supportive environment, consequently enhancing patient experience. Ongoing commitment is essential for sustaining improvements and fostering a culture of excellence. Future initiatives will focus on refining these strategies and addressing emerging challenges to further enhance patient experience.

Oncology Nursing Forum. 2025 Mar 1;52(2):275–276.

P471. Cancer Service Line Competencies: A Multi-Modal and Roll Specific Evaluation of Oncology Nursing Competency

Buerkley Opalecky ¹, Desiree West ²

Management

Significance & Background

With the evolving landscape of treatments in oncology, it is imperative that oncology nursing education and competency also evolve with the growing learning needs of oncology nurses. Learning style preferences exist among practicing nurses, and education in various formats is essential to the success of nurses in the ever-changing health care environment. Organizations must be innovative in preparing professional development opportunities related to education and competency in order to engage and retain nursing staff (Mangold et al., 2018). The terms competence and competency are often used interchangeably, however competency is generally defined as the oncology nurses’ ability to perform or demonstrate a task or skill at the established standard of an institution (Beaver et al., 2019). This established standard is based on policy, best-practice guidelines, and professional standards of practice.

Purpose

At an NCI designated comprehensive cancer center, annual competency validation has historically been completed by clinical nurse educators (CNE) observing skills for competency and remediating deviations from standard operating procedure or policy. Nursing feedback reflected lack of perceived necessity for competency validation and poor engagement.

Interventions

An innovative and engaging format for annual competency was developed by an ambulatory and inpatient CNE to not only promote and validate competency, but also increase engagement and positive feedback. Validation for competency was observed through implementation of multiple activities via clinic escape room, chemotherapy verification and administration escape room low-fidelity simulation of hazard drug spill clean-up, and high-fidelity simulation for recognition and treatment of severe hypersensitivity reaction.

Results

Engagement was evaluated through post-competency survey, specifically asking, “the teaching methods used were helpful and effective,” and “I enjoyed how this year’s competency assessment was designed.” A 5-point Likert scale for responses was utilized for responses, and an opportunity to provide free text feedback. In response to “teaching methods were helpful and effective,” 79% of RNs reported “strongly agree with the statement.” In response to “I enjoyed how this year’s competency assessment was designed,” 79% of RNs reported “strongly agree with the statement.”

Discussion

Implementation of creative methods for competency validation has allowed nurses to demonstrate skill competency in a fun and engaging environment. These changes validate use of creative teaching and learning methods for oncology nurses to increase engagement. Changes to future annual competency curriculum will be made based on nurse feedback and outcomes data.

Oncology Nursing Forum. 2025 Mar 1;52(2):276–277.

P472. Realize, Recognize & Respond: Incorporating Trauma-Informed Care into Breast and Gynecologic Radiation Therapy

Wandaris Ortiz ¹, Lisa Nelson ²

Radiation

Significance & Background

Patients undergoing radiation therapy are often impacted by past trauma or abuse. Various aspects of the treatment process can trigger re-traumatization. Abuse survivors with new diagnoses of breast or gynecologic cancer may experience repeated trauma in the same area of their body where past abuse once took place. For these patients, the loss of control over their bodies, combined with the perceived power shift to providers performing invasive exams and procedures, causes difficulty in establishing safety, trust, and compliance with treatment.

Purpose

Nurses at an NCI-designated cancer center used the framework of Trauma-Informed Care to educate radiation staff on how to realize the prevalence of trauma, recognize the signs and symptoms, and learn how to meaningfully respond to create safe environments that reduce the likelihood of re-traumatization during radiation treatment.

Interventions

Radiation nurses developed a training program for all radiation staff on how to incorporate the pillars of trauma informed care into treating breast and GYN radiation patients. These pillars include providing a safe environment, establishing trust and transparency, peer support and self care, patient-provider collaboration, and empowering survivors. Through this training, health care providers gained knowledge of how adverse events in childhood and throughout life can impact a patient’s attitude towards medical care and attitudes towards health overall. Staff interventions included preparing patients pre-arrival for the possibility of a breast or pelvic exam, giving patients options for exams and preserving dignity wherever possible, introducing all providers involved and explaining their roles, minimizing observers, asking permission before performing invasive procedures, and conducting distress screenings and providing appropriate resources to patients who suffer from past trauma.

Results

Trauma informed care training has given radiation staff tools to minimize patient triggers, identify patient fears or anxieties,promote a culture of safety and trust, and increase compliance with medical care. Conversations with patients throughout their treatment have shown a positive qualitative response to the initiatives. Data collection about patient treatment complianceand distress levels during treatment is ongoing.

Discussion

It is important for radiation nurses, providers, and therapists to be trauma-informed to ensure best patient experience and provide optimal outcomes for radiation therapy. Trauma informed care provides a paradigm to decrease avoidance of medical care, increase compliance with treatment, and positivelyimpact the overall outcome of cancer care.

Oncology Nursing Forum. 2025 Mar 1;52(2):277.

P473. Let’s Talk! Engaging Nurse Learning through an Educational Newsletter

Katie Ortner-Henry ¹, Trisha Harmon ², Anna McClenny ³, Phuong Huynh ⁴

Management

Significance & Background

At a large NCI-designated ambulatory oncology center that supports 13 individual infusion departments over 6 locations, education delivery for practice and policy changes has often faced challenges and inefficiencies. Historically, dissemination of updates was not standardized, leading to inconsistent practice, misinterpretation, missed content, and dilution of high priority information. In addition, the ambulatory oncology setting requires nurses to learn and adapt to high volumes of evolving evidence-based practice. Nurse educators are well positioned to support this need, as they are responsible for identifying knowledge gaps, curating and delivering pertinent content, and evaluating comprehension.

Purpose

To promote consistent access to nursing practice changes and support continued oncology learning through a dedicated education newsletter.

Interventions

A team of educators who specialize in Oncology Infusion practice determined an electronic newsletter would support large-scale delivery of education and would ensure standardization, nurse accessibility, and quality of content. The approach of the newsletter was to capture and reinforce a month’s review of information, excluding operational content. Topics included policy updates, evidence-based practice changes, reinforcement of best practice, and continuing education opportunities. Inclusion of pathophysiology and research evidence provided rationale and better understanding of topics. A “Learn Something New” section was included to promote engagement and deepening of oncology learning; examples of topics included bispecific antibodies, tumor-infiltrating lymphocytes, and innovations in symptom management. Contributors to the newsletter included nurses from multiple campuses to validate applicability to all sites.

Results

Feedback has been gathered from frontline nurses and leaders. Nurses have appreciated the ability to easily refer to the newsletter when practice questions arise as well as the opportunity to further their oncology expertise at their own pace. Nurse leaders have welcomed a consistent forum to address knowledge gaps and practice drift. Overall, the newsletter has stimulated communication among educators, leaders, and frontline nurses.

Discussion

In the fast-paced world of oncology, where topics are vast and innovations frequently emerge, engagement of nurse learning is critical. A dedicated education newsletter provides a format where information is consistently accessible, single-sourced from educators, and prioritizes relevant topics. Formatting, sequence of topics, and a predictable structure support nurse interest and capacity for engagement. Prioritizing nurse education through a monthly newsletter has resulted in the overall empowerment of knowledge and best practice across the organization.

Oncology Nursing Forum. 2025 Mar 1;52(2):277–278.

P474. Revitalization of New Hire Training During Rapid Recruitment

David Ortwein ¹, Rachael Coyle ², Francis Panebianco ³, Kayla Boegly ⁴, Lauren Cullen ⁵, Christine Usher ⁶

Management

Significance & Background

With the advancements in cancer care and the migration of cancer treatment out of the traditional hospital setting and into the ambulatory setting, the infusion department at a large academic medical center has expanded significantly. Since the start of 2023, over 60 nurses have been hired to the department. The rapid pace of hiring, preexisting training structure, and the added complexity of a multi floor department revealed gaps in consistent support for new staff members during orientation. As a result, orientation periods were prolonged, causing delays in opening additional space to meet the increasing patient volume demands.

Purpose

To address the gaps identified for new hires, the leadership team convened to explore potential solutions. The goal was to enhance and standardize the dissemination of education to new staff and develop a streamlined mechanism to track their progress. Improving communication between new hires and the leadership team was essential to identify issues and proactively resolve practice deficiencies.

Interventions

Two areas of opportunity were identified. First was hosting a skills day off the unit to allow nurses the opportunity to have hands-on practice during their first week of orientation. This skills day focuses on the practices and procedures essential for infusion nurses to safely care for patients. The second intervention involved implementation of orientation coordinators to support the single clinical practice lead of the department. The coordinators are experienced clinical nurses who serve as a reliable resource for bidirectional feedback regarding any challenges or concerns that the new nurses experience.

Results

The skills day occurs on the first Friday of the new hires’ orientation. The orientation coordinators meet weekly with new hires for check-ins, ensuring ongoing support and guidance and assistance with training continuity across floors and preceptors. This feedback is then communicated to the leadership team for resolution when needed.

Discussion

The revitalized onboarding process has empowered infusion leadership to offer enhanced support during nurse orientation. The role of the orientation coordinators has proven instrumental in integrating education training within existing practices, fostering collaboration between clinical leaders and staff. This initiative aims to ensure successful onboarding and ultimately improve the quality of patient care within the infusion department.

Oncology Nursing Forum. 2025 Mar 1;52(2):278.

P475. Essentials of Oncology Course: a Nursing Education Initiative to Increase Confidence Among Novice Oncology Nurses

Christina Osorio ¹, Susan Sakalian ², Carolyn Fairclough-Ellis ³, Arlene Simpson ⁴

Professional Development

Significance & Background

Oncology nursing is a specialized field requiring deep knowledge of cancer pathophysiology, treatments, and symptom management. Novice nurses often struggle with knowledge gaps, emotional stress, and unfamiliarity with advanced therapies. With the global rise in cancer cases and increasing complexity of care, the need for skilled oncology nurses is growing. The Oncology Nursing Society (ONS) Nurse Generalist Competencies provide a framework for developing essential skills in oncology. An “Essentials of Oncology” course based on these competencies ensures novice nurses gain the necessary knowledge and skills to deliver high-quality care and support their professional growth.

Purpose

The course aims to equip novice oncology nurses with the foundational knowledge, skills, and confidence to navigate oncology’s complexities. By covering cancer biology, treatment protocols, patient management, and emotional support strategies, the course enhances nurses’ readiness to contribute effectively to oncology care teams and improve patient outcomes.

Interventions

The course covers cancer pathophysiology, screening, immunotherapy, cellular therapy, patient education, and symptom management. Interactive learning methods include rapid response simulations, a myelosuppression escape room, and port access competency skills validation to build critical thinking and practical skills.

Results

The course’s effectiveness will be measured through post-course surveys assessing oncology knowledge, practical skills, and confidence levels. Participant feedback will determine the relevance and applicability of course content. Long-term evaluation will focus on nurse performance in clinical settings, including patient outcomes, error reduction, and nurse retention.

Discussion

This course addresses an essential need by offering novice oncology nurses a solid educational foundation. By building confidence and competence, the course prepares nurses to deliver high-quality cancer care while promoting professional growth. The course positively impacts patient outcomes, nurse satisfaction, and retention, making it essential for addressing the growing demand for skilled oncology professionals amidst the evolving cancer care landscape.

References

Oncology Nurse Generalist Competencies. n.d.. Retrieved from https://www.ons.org/sites/default/files/OncologyNurseGeneralistCompetencies2016.pdf.

Oncology Nursing Forum. 2025 Mar 1;52(2):278–279.

P476. Development of a Complexity Grading Tool for Research Studies to Properly Assess App Effort Within Clinical Research Studies

Christopher Otero ¹, Jessica MacIntyre ², Evelyn Wempe ³

Quality and Safety

Significance & Background

To meet the need to accrue more patients to clinical trials, a complexity grading tool for assessing Advanced Practice Provider (APP) workload in clinical research protocols is essential. Because there is no standardization in practice, scope creep with other research personnel may occur and task allocation may not be balanced. By quantifying APP research workload, APPs can work at scope of practice and cancer care in clinical research can be optimized with current resources.

Purpose

The purpose of a Complexity Grading Tool for research studies is to standardize a method to assess clinical research protocols specific to APP involvement and effort. This tool could help mitigate current issues we are facing such as study deviations, scope creep, potential burnouts from inappropriate workload distribution, and other potential patient care issues.

Interventions

Based on current clinical practice at an academic medical center, a grading tool was developed to assist in providing role delineation and work efforts metrics for APPs supporting clinical research. Key study elements were determined using ten criteria specific to the support and function of an APP. Tasks were given a rating of low, moderate and high complexity based on difficulty of the task. APP time and resource consumption were validated as part of the workflow. In order to improve the tool and make sure it appropriately depicts the workload, feedback was gathered by members of the study team.

Results

The evaluation of a grading complexity tool for determining APP effort in clinical research protocols revealed that the tool effectively categorized protocols based on complexity, leading to a more accurate estimation of effort required from the APP). The tool demonstrated reliability in distinguishing between low, moderate and high complex protocols based on the criteria, allowing for better resource allocation and workload management. It also facilitated clearer communication between research teams and APPs, optimizing workflow efficiency and contributing to improved protocol adherence and patient care.

Discussion

The complexity grading methodology provides a systematic way to balance the APP effort in clinical research, which has important implications for nursing and clinical research team support. Both patient care and resource management can be enhanced by use of tool in practice. Future directions, include implementing a time study with APPs to validate this tool further.

Oncology Nursing Forum. 2025 Mar 1;52(2):279.

P477. A Weekly Check-In During Orientation to Improve Oncology Clinic Nurse’s Competence and Satisfaction

Sophie Ou ¹

Professional Development

Significance & Background

The demanding and complex nature of oncology clinic nursing necessitates a well-structured orientation to ensure nurses remain both competent and satisfied. At our department, 15% of new hires left within six months of onboarding in 2022–2023. A review revealed that many nurses felt the existing competency-based orientation (CBO) lacked sufficient guidance to navigate practical challenges. While the CBO covers general topics like infection control and patient assessment, it fails to address essential clinic-specific skills such as pre-authorization and patient communication via in-baskets. Additionally, new staff reported stress due to inconsistent expectations from different preceptors. In response, we reviewed the CBO and introduced a weekly expectation checklist alongside check-ins with the nursing supervisor and educator. Since implementing these changes, all new staff onboarded after this new orientation system have remained in the department.

Purpose

To enhance clinic nurses’ competence and job satisfaction through a structured and supportive orientation process.

Interventions

■ New staff are paired with two regular preceptors, each focusing on different clinic skills and teaching styles. All preceptors must complete a precepting course before mentoring new hires.
■ Weekly meetings with the nurse supervisor and educator are held to review progress.
■ A weekly checklist supplements the CBO, focusing on practical skills such as sending five appropriate MyChart patient messages and completing five pre-authorizations
■ Checklists are tailored to surgical and medical oncology for more specific training
■ Nurse supervisors meet with preceptors to gather feedback, which is then reviewed with the new staff to address any challenges.

Results

A survey conducted after four weeks of orientation indicated that preceptors felt more confident using a structured system to guide clinical skill development. New staff reported increased competence and a stronger connection with leadership, allowing for better escalation of learning challenges.

Discussion

Frequent check-ins with new staff help identify and address barriers early, while the expectation checklist ensures a clear path to developing clinic-specific skills, fostering the nurses’ both competence and satisfaction

Oncology Nursing Forum. 2025 Mar 1;52(2):280.

P478. Optimizing Oncology Onboarding: Elevating Oncology-Specific Education for RN Residency & Fellowship Programs

Sandy Page ¹, Elizabeth Phillips ², Mari Ann Lewis ³, Calli Wood ⁴

Management

Significance & Background

The organizations RN Residency and Fellowship Program was expanded to the Ambulatory setting. In the Cancer Center, an RN Resident is a new graduate nurse hired into the oncology setting. An RN Fellow is a nurse with six months nursing experience looking to enter the oncology specialty. After completing the program, it was noted that the Cancer Center RN Residents/Fellows lacked self-confidence and a basic understanding of the oncology specialty.

Purpose

The goal was to increase self-confidence and success in the oncology specialty for RN Residents/Fellows by developing oncology-specific education material. The overall purpose was to increase understanding of the oncology specialty and provide a foundation of knowledge that could be utilized and built upon in the clinic-specific department.

Interventions

Initially, RN Residents/Fellows were allowed the option to attend the newly created weekly-virtual class discussion that covered the fundamentals of oncology using Oncology Nursing Society (ONS) foundations as a resource. This provided a basic education review of oncology as they rotated through different departments. Based on leadership, residents, and fellows’ feedback, the weekly class was made mandatory for the following cohorts. This provided consistency in learning and helped eliminate knowledge gaps. A pre-survey was collected to determine baseline knowledge and confidence. The Residents/Fellows were required to complete review questions before each class. This was to promote discussion and increase engagement/independent learning. A post-survey was sent to determine if there was an increase in confidence and knowledge after class completion.

Results

The post-survey was sent to our most recent cohort. It identified that the RN Residents/Fellows gained new knowledge of oncology. However, the main barrier continued to be a lack of self-confidence. We plan to distribute the pre- and post-surveys to all future cohorts to gain feedback on ways to improve the class with the overall goal of further increasing self-confidence during independent practice.

Discussion

The weekly oncology class helped close the gap in knowledge for the Residents/Fellows related to the oncology specialty. However, based on post survey feedback, the class could be more interactive and include real-life scenarios to help build confidence, which could then be transferred into everyday practice. Building relationships, communicating with leaders, reviewing learning and additional resources are other ways to increase Resident/Fellow self-confidence. Overall, the oncology class was valuable to RN Resident/Fellow learning.

Oncology Nursing Forum. 2025 Mar 1;52(2):280–281.

P479. Empowering Excellence: A Comprehensive OCN Study Session for Oncology Nurses

Sandy Page ¹, Elizabeth Phillips ², Fatemeh Youssefi ³, Mari Ann Lewis ⁴, Calli Wood ⁵

Professional Development

Significance & Background

Our organization is Magnet designated and encourages professional certification. One characteristic of a Magnet Organization is the percentage of clinical nurses certified by a nationally recognized organization (Characteristics of magnet® organizations, 2018). According to the Oncology Nursing Certification Corporation (2023), “Oncology nursing certification validates a nurse has specialized knowledge and experience in cancer care. Certification makes a difference - to patients who want knowledgeable nurses, employers who want qualified and experienced staff, and individual nurses who want to demonstrate their knowledge.”

Purpose

As a Magnet-designated site, most of our Cancer Center RNs should obtain an oncology-specific certification. This promotes utilizing specialized knowledge/skills to ensure we provide the highest quality care.

Interventions

We met with the Cancer Center Director to discuss the need for an oncology study session as none was currently offered. Data showed that 66% of Cancer Center RNs held an oncology specific certification in 2023. We created an informal, virtual format oncology study session that was conducted for over a year. Discussion and data review with Executives led to a revamp of the course. Data showed that 54% of Cancer Center RNs are certified in 2024. The revamped course was conducted in a virtual instructor-led format with electronic self-enrollment. The weekly session was offered quarterly, and attendance was capped at ten employees per session, requiring Leadership approval. The material presented included Oncology Certified Nurse (OCN) exam topics, Oncology Nursing Society (ONS) standards, and ONS study resources. A post session survey was sent to participants to gain feedback.

Results

Data collection is ongoing to determine the impact on certification numbers for implementing a formal oncology study session. The participants are still preparing to sit for their exams in the coming months. A post survey of the formal course showed that participants found strategies helpful in their learning and gained new knowledge/existing knowledge which was reinforced.

Discussion

Participants reported being unable to fully engage due to the lack of staff coverage during the study session which was held midday. The timeframe for future sessions has been adjusted to the end of the day to promote increased staff engagement. We have also included additional practice questions per feedback. We plan to re-evaluate the course at the end of the year to determine if further restricting is needed.

Oncology Nursing Forum. 2025 Mar 1;52(2):281.

P480. Bridging Access to Care through the Power of Network Affiliation Programs

Andrea Palka ¹, Anna Buehl ², Jennifer Bowen ³

Coordination of Care and Navigation

Significance & Background

It is estimated that over 2 million people will be diagnosed with cancer in year 2024. As cancer care has become more complex and personalized, the need for subspecialized care has increased. Patients diagnosed in rural communities aren’t always awarded the same access to tertiary and/or quaternary services as patients living in regions near National Cancer Institute Designated Cancer Centers, thus potentially creating a disparity in cancer care.

Purpose

Through network affiliations, community cancer programs collaborate with NCI-Designated Cancer Centers to provide cancer care close to home while receiving access to expanded tertiary/quaternary continuity of care and resources. Patients benefit from coordinated patient care, access to clinical trial screenings, advanced treatments such as cellular therapies and/or targeted therapies, and cancer education while receiving the majority of their care close to home. Additionally, community cancer providers have access to receive support, oncology education, and training.

Interventions

Through network affiliations, NCI-Designated Cancer Centers collaborate with community cancer programs by providing consultative operational services for cancer operation initiatives, provide peer to peer support for oncology providers, elevate nursing care through continuing education to nursing staff, provide access to clinical trial screening programs, and designate care coordinators to ensure seamless transitions in care. The network team collaborates to address the specific needs of the community cancer programs to ensure patients are receiving equitable care regardless of their physical location.

Results

In 2023, 632 patients from 8 community oncology programs received coordinated care through the network affiliation collaboration. These patients were seen for second opinions, treatment recommendations, tertiary treatments, cancer genetics, and clinical trials at an NCI-Designated Cancer Center. Additionally, these patients and their families were offered enhanced survivorship support through patient care supportive services.

Discussion

Cancer care is rapidly evolving as new treatment options are found to be successful in treating complex diseases. Many of these treatments are only offered at NCI-Designated Cancer Centers and require specialized training for clinical staff. Because community oncology programs are not always equipped to provide these complex treatment options, patients in these communities are at a disadvantage. When community oncology programs and NCI-Designated Cancer Centers align through an affiliation agreement, patients are given expanded oncology care while still receiving care close to home. Patients can avoid long unnecessary commutes for care, while still receiving sub-speciality support.

Oncology Nursing Forum. 2025 Mar 1;52(2):281–282.

P481. Increasing Chemotherapy Naïve Patients’ Confidence and Knowledge through Pre-Education Sessions and Post Treatment Follow-Up

Deborah Pallito ¹, Vy Santana ², Sarah Spaulding ³, Nicol Hedgpeth ⁴

Patient Education

Significance & Background

Cancer patients can experience a variety of symptoms after treatment, which can be challenging to manage. These toxicities can lead to distressing and potentially life-threatening side effects. Early management can improve patient outcomes, decrease morbidity, and limit hospitalizations. Performing individualized pre-treatment education that provides patients with information on how to manage their side effects can reduce incidence and severity of symptoms and increase confidence.

Purpose

To assess the effectiveness of individualized pre-treatment education sessions and follow-up phone calls after treatment from a frontline infusion nurse, increasing patients’ knowledge and confidence to manage symptoms at home.

Interventions

Prior to starting treatment, patients are scheduled for an education appointment performed by a frontline infusion nurse. This appointment addresses potential side effects, upcoming schedule, symptom management at home, and the infusion process. Three days after receiving their treatment, a follow up call is made to assess tolerance of treatment and symptom management. A standardized education guide and summary note is used to ensure continuity between each nurse’s teaching practices and monthly collaboration meetings. Nursing works with the education department to ensure all education materials are up to date. Documents are provided to the patients virtually and in person at their initial treatment visit.

Results

Prior to education appointments, a pre-education survey is given to chemo naïve patients that assesses their knowledge of the treatment and how to manage their symptoms at home. A follow-up survey is then given to the patient on their 3-day call, evaluating their continued knowledge and confidence to self-manage symptoms. This project’s goal is to show the importance of effective education to improve patient outcomes and increase their independence outside of the cancer center.

Discussion

Our initial data shows patients benefit from pre-education sessions and follow up calls by increasing treatment preparedness, confidence in self-management, timely clinical interventions improving patient outcomes. The future data is anticipated to show continued benefits and increase the knowledge and confidence for the patent. Limitations in this project are surveys being missed, patients unreachable for a follow-up call, and lack of involvement in their plan.

Oncology Nursing Forum. 2025 Mar 1;52(2):282–283.

P484. Where Science Meets Social Hour: The Fun and Impact of Journal Clubs on Clinical Practice

Kallie Palmer ¹, Zachary Pitts ², Kim Davis-Mitchell ³, Tara Ridgeway ⁴

Professional Development

Significance & Background

On a busy oncology unit, it is rare to have time to sit down with fellow nurses and providers to discuss current topics in practice. The rationales behind common treatment interventions can get lost in everyday practice, and the rapid pace of new drug rollouts compounds the knowledge gaps that can exist. Nurses often feel they are not able to take the time to thoughtfully research oncology topics due to constraints posed by other important duties such as direct patient care, charting, and hospital required education. Nurses are at risk of missing important aspects of care if they do not have time to thoughtfully research the treatments they work with daily.

Purpose

Create an interdisciplinary oncology journal club to fill knowledge gaps and set aside protected time for education and discussion in an ambulatory oncology setting.

Interventions

Infusion nurses and an Advanced Practice Provider (APP) collaborated to recruit journal club participants from multiple disciplines. The APP identified areas where nurses needed more education. A peer-reviewed article related to oncology was then sent via email to participants to read before sessions. Teams met for hour-long discussions. Subject matter experts spoke at these sessions. Some topics discussed included immunotherapy for lung cancer, disparities among racial groups in clinical trials, management of tumor lysis syndrome, antiemetic prophylaxis, and prevention of anthracycline-associated cardiotoxicity. Participants were polled before and after each session to assess learning. A continuing education credit of 1.5 hours was earned for participation.

Results

The journal club consisted of nurses, APPs, doctors, and pharmacists. Nurse buy-in was high among the unit, with more nurses requesting to attend than patient care needs allowed, as sessions were hosted during working hours. Most sessions were attended by 6–10 nurses on a unit of more than 40 nurses. Of those who attended, 95% reported their knowledge of the topics increased and 100% said the information presented would impact their nursing practice.

Discussion

Journal Club increased oncology education on the unit and stimulated broader discussions of oncology-specific topics. These sessions encouraged engagement and helped close knowledge gaps. This model could be easily adapted to any unit, both inpatient and outpatient. Next steps would include recording sessions so nurses who were unable to attend could watch at a later time.

Oncology Nursing Forum. 2025 Mar 1;52(2):283.

P483. Community Cancer Center Workflow Project Optimizing Patient Care & Resource Utilization

Megan Palmer ¹, Susie Nichols ², Kelli Issacs ³

Healthcare Delivery

Significance & Background

A Community Cancer Center (CCC) infusion clinic initiated a Quality Improvement project for chemotherapy administration. A review of clinic flow identified gaps in care such as unexpected cancellations, errors in order dates, and lab related tolerance windows. Implications from these gaps affected infusion bay utilization, overage in FTE staff allocations, increased waiting times and caused delays in treatment for patients. A need was identified to increase clinical efficacy in care delivery and improve patient satisfaction with treatment appointments.

Purpose

To describe an interdepartmental coordination system implemented to assure observation of patient safety parameters, efficacy of chemotherapy orders, and optimize utilization of clinic resources in a CCC.

Interventions

The flow of infusion clinic patients was analyzed by infusion nurses who made recommendations for programmatic changes. The workflow changed scheduling of blood draws to occur before infusion day for timely lab data review and case decisions utilizing an EMR system (EPIC). A system of color coding was established utilizing EMR features for the communication of labs, treatment changes, and provider questions to be addressed prior patient infusion appointment.

Results

The ability to review labs and weights 1–2 days prior to patient’s infusion date improved patient satisfaction, assuring safety and increasing best utilization of staff and infusion resources. Utilization of the EMR feature “In Basket” facilitates the addressing of discrepancies, questions, and lab parameters and optimizes nursing and patient time for infusion day care delivery. Nursing has reported the chart review process has improved their shift by allowing 2RN checks to be completed ahead of time, reducing in-person cancellations, decreasing urgent provider contact, and maximizing chair utilization.

Discussion

This system has shown clinical efficiency benefit and will have ongoing evaluation to ascertain for further refinements to improve care outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):283–284.

P482. Blockbuster Video: at Home CVC Education for Pediatric Clabsi Prevention

Payton Palmer ¹, Anna Evans ²

Patient Education

Significance & Background

Pediatric hematology oncology patients are at an increased risk for central line-associated bloodstream infections (CLABSIs) due to their need for central venous catheter (CVC) access and their low immune system function following oncologic treatment. Video-based tools have a greater impact of learning than printed materials and are helpful in keeping pediatric patients healthy at home after hospital visits, (Brice et al., 2017; Deshpande et al., 2023).

Purpose

The purpose of this project was to implement a video-based educational intervention in the pediatric oncology population and to measure impact on CLABSIs.

Interventions

The nursing team obtained executive stakeholder support to obtain funding for development of a patient specific training video using Mytonomy software system. The video took approximately 2 weeks to design and create using the standard of practice for CVC care and was completed in March 2024. It was available in English and Spanish. Flyers were posted throughout the unit to encourage nursing staff to utilize the video prior to discharge.

Results

The data retrieved from the internal electronic dashboard allowed the comparison of CLABSI rates over a one-year period from Aug 2023 to Aug 2024 on the pediatric oncology unit. Review of metrics pre- and post-implementation of this project were used to determine the effectiveness of using the video-based education. Five CLABSIs were reported from Aug 2023 to March 2024 and only one CLABSI was reported from March to Aug 2024. As of the end of August 2024, the unit had been CLABSI free for 80 days. This data shows that video-based educational materials assist in lowering CLABSI rates among pediatric hematology oncology patients compared to previous practices.

Discussion

Ensuring that patients and families have CVC video-educational materials easily accessible at home helps reduce CLABSI rates for pediatric oncology patients. Continuing implementation will further assist in keep CLABSI rates decreased for this patient population. Limitations for our project included the minimal implementation time of 5 months and inconsistent nurse compliance in handing out forms and QR code to patients/families at discharge.

Oncology Nursing Forum. 2025 Mar 1;52(2):284.

P485. Streamlining Pathways: Creation and Implementation of a Referral Order for Enhanced Care Coordination and Improved Chair Time Usage

Francis Panebianco ¹, Christine Usher ², Rachael Coyle ³, Kayla Boegly ⁴, David Ortwein ⁵, Lauren Cullen ⁶

Healthcare Delivery

Significance & Background

The Infusion department at a large academic medical center houses a same-day urgent care service (SDUCS) designed to cater to oncology patients experiencing new symptoms related to their cancer, treatment, or other health conditions. The SDUCS traditionally operated Monday through Friday, employing a multidisciplinary team including Registered Nurses, Advanced Practice Providers, and a Certified Nursing Assistant. The group collaborated to triage and schedule patients via various avenues, however there was no standard process for patient referrals or staff messaging.

Purpose

The lack of a standardized referral and scheduling process resulted in chaotic workflows, extended scheduling turn-around times, inaccurate appointment lengths, and underutilized chair space. This not only negatively influenced patient care, leading to delays in treatment, but also negatively impacted staff satisfaction. Establishing a streamlined referral and scheduling process was critical for enhancing operational efficiency and improving patient access to urgent oncology care.

Interventions

Responding to the need for a more structured approach, a multidisciplinary task force was established and completed a comprehensive review that included a needs assessment, staff interviews, and data analysis. The determined intervention was twofold: first, the creation of a standardized referral order, streamlining all communication to one location; second, the development of a treatment grid specifically tailored for the SDUCS, optimizing scheduling accuracy and efficiency.

Results

Data analysis was conducted for the pre and post implementation periods, comparing the median volume of completed appointments and the median patient hours completed per day. The median completed appointment volume increased from 7 to 10 and the median patient hours completed improved from 16 to 31 per day. Further, post-implementation results demonstrated a significant increase in staff satisfaction regarding communication and scheduling workflows, evidenced by staff interviews.

Discussion

After the implementation of a standardized referral and scheduling process, the department nearly doubled the daily completed patient hours and decreased the time between initial referral and appointment scheduling. The department also saw an increase in staff satisfaction related to streamlined communication throughout the referral process. Not only did the intervention meet its original goals, but the newly established referral order protocol was adopted during the department’s expansion from a 5-day to 7-day operation, proving it to be easily replicated for future opportunities.

Oncology Nursing Forum. 2025 Mar 1;52(2):284–285.

P486. A Multimodal Learning Experience for New Oncology Nurses

Nicole Pappaterra ¹, Emily Frederick ²

Professional Development

Significance & Background

Role transition in a specialty area possesses unique challenges for new teammates and requires additional need for training and support. Newly licensed nurses have limited hands-on experience in nursing school with many aspects of care they will encounter as oncology nurses. In previous state, feedback included the need for a more focused and hands-on approach to chemotherapy and oncology-related skills.

Purpose

The aim of the multimodal learning experience was to support role transition, increase nurse preparedness and bridge knowledge gaps. The course was created to provide an engaging, hands-on, collaborative experience for nurses new to oncology to gain confidence and competence with chemotherapy administration, central line care, drain management, and other oncology skills.

Interventions

Learners complete preparatory work including self-paced content, the Oncology Nursing Society chemotherapy provider course, and a review of facility policies and procedures. During the course, nurses participate in a mock event of chemotherapy administration and spill management. Course content emphasizes infection prevention, safety, and management of the oncology patient. Simulated skill practice with implanted ports, peritoneal/pleural catheters, central line dressing changes, blood cultures, and various methods of chemotherapy administration are included to promote proper technique.

Results

Nursing confidence was measured before and after the intervention with a 5-point Likert scale. Before the course, on average, 27.2% participants rated themselves ‘confident’ or ‘extremely confident’ with skill performance. After the intervention, the average increased to 81%. Before the intervention, the average rating ‘not confident’ on a skill was 28.7% compared to the post-intervention average of 0.7%. All nurses were able to effectively demonstrate appropriate chemotherapy-related skills after completion of the course. Participants stated in post-surveys that they enjoyed that the offering was in-person and valued the opportunity for hands-on practice.

Discussion

With a more robust approach to oncology education, the implications for practice include increased confidence in nursing care of the chemotherapy patient and decreased medication administration errors. With additional support and professional development, retention of new oncology nurses is anticipated. Preceptor burn out is also predicted to decrease related to the increased preparedness of their orientees. Future adjustments will be made based on participant feedback and environmental scanning of the needs of the department.

Oncology Nursing Forum. 2025 Mar 1;52(2):285.

P487. Development and Implementation of a Program of Oncology Nurse Navigation at a Comprehensive Cancer Center in Colombia

Elvy Milena Parra Coronado ¹, Adriana Carolina Aya Porto ², Beatriz Andrea Prada Alvarez ³, Andres Felipe Cardona Zorrila ⁴, Juanita Granados ⁵, Francisco Sabogal ⁶

Coordination of Care and Navigation

Significance & Background

Oncology nurse navigation programs improve care coordination and patient satisfaction

Purpose

To evaluate the effect of an oncology nursing navigation program on access to care, patient and provider satisfaction, challenges, and clinical outcomes in a cohort of patients with solid and hematological tumors treated in a center for comprehensive cancer care in Colombia.

Interventions

A cross-sectional study was carried out at the Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC) between June 2022 and May 2024. The navigation model was implemented following the recommendations of the Oncology Nursing Society (ONS, Pittsburgh, Pennsylvania, US) and The George Washington (GW) Cancer Center (Washington, US). Initially, a multidisciplinary focus group was formed to establish the priorities of cancer navigation in Colombia and the leading indicators to measure the program’s impact. Eight oncology nurse navigators were selected and trained after forming the Clinical Functional Units (CFUs). In parallel, an instrument was designed to identify the patient’s and her family’s educational needs.

Results

649 patients were included in the study, with a mean age of 57 years (SD +/− 15.7) and a predominance of the female population (60%). The implementation of the navigation program made it possible to reduce the time to the first oncological evaluation (mean 10.1, SD +/− 2.9) and to the start of treatment (mean 12.8 days, SD +/− 2). In addition, the mean score for the level of satisfaction using the NPS scale (The Net Promoter Score) was 71.3 (SD +/− 7.47). The primary educational needs identified by navigation were related to access to the health system and different administrative problems. In the second moment of application of the instrument, the needs focused on diagnosis, treatment, and rehabilitation. The education provided by the navigators was primarily verbal (99%) and understood by the patients (mean proportion of understanding 76%, 95% CI 0.73–0.78).

Discussion

Implementing a navigation model in cancer patients allows the articulation of the different phases of comprehensive cancer care, control of the barriers that favor the critical disconnection between the moment of diagnosis and the start of treatment, and improvement of the experience of patients and their families through timely education.

Oncology Nursing Forum. 2025 Mar 1;52(2):285–286.

P488. Morning Sync-Up for Nurse Leaders: Daily Virtual Wellness Check-Ins to Unite Nurse Leaders with Real-Time Results

Christina Passio ¹

Management

Significance & Background

In oncology specialty hospitals, nurse leaders encounter significant challenges, including managing staffing concerns, patient census and acuity, resource allocation, and continuous process improvement. These operational demands lead to stress and burnout, as well as fragmented communication, which siloes decision-making. Implementing a daily wellness check-in using an innovative technological platform, such as Microsoft Teams, provides a mechanism for nurse leaders to address these challenges through efficient communication, collaboration, and real-time problem-solving. This strategy has reduced departmental silos and promoted cohesiveness across inpatient units.

Purpose

The purpose of the daily inpatient nurse leader wellness check was to conduct focused morning meetings that address issues originating from staff safety huddles, staffing concerns, patient flow, resource needs, operational updates, as well as to provide moral support for nurse leaders. This approach leverages technology that streamlines communication, enables real-time discussions, resolves issues quicker, and enhances decision-making cohesion across the hospital.

Interventions

The strategy encompassed an introduction of a virtual daily morning check-in. The meetings were structured and inclusive of a standardized agenda that involved critical aspects such as patient flow, staffing, supply chain, and ongoing process improvements. The use of this platform was well received from nurse leaders as it promoted ease of access, real-time discussions, document sharing, and collaboration. Nurse leaders shared that additional sequalae resulting from the check-ins was a reduction in the tendency to work in silos and a more unified and consistent approach to the inner workings of hospital operations.

Results

Preliminary outcomes revealed that the wellness checks led to enhanced communication and collaboration among nurse leaders, and frontline staff. Identification and resolution of staffing and resource issues, coupled with an improved patient flow management process, as well as a heightened responsiveness to safety concerns were key indicators supporting effectiveness. Nurse leaders reported reduced stress levels and increased support resulting in even greater team morale and retention. The intervention not only reduced siloed decision-making but ensured a more cohesive and consistent approach to patient care delivery and hospital operations.

Discussion

The adoption of a daily virtual wellness check-in for inpatient nurse leaders in an oncology specialty hospital demonstrated significant benefits to further support leadership well-being, promote cohesiveness, enhance patient outcomes, and improve operational consistency. Utilizing Microsoft Teams platform proved an innovative approach for meeting management, allowing for real-time resolutions, and dynamic leader-to-leader communication.

Oncology Nursing Forum. 2025 Mar 1;52(2):286–287.

P489. Utilization of Principal Illness Navigation Codes

Kinjal Patel ¹, Danielle Brown ², Colleen Lewis ³, Jane Porter ⁴, Norma Jean Carlile ⁵

Coordination of Care and Navigation

Significance & Background

With help from the White House’s Cancer Moonshot Initiative, oncology practitioners can begin billing Medicare for Principal Illness Navigation (PIN) services on January 1, 2024. Two billing codes (G0023 and G0024) for PIN services have been accepted by the Centers for Medicare & Medicaid Services (CMS.) CMS requires that incident to services providers, including auxiliary staff, adhere to state-specific licensing criteria. PIN service providers must train their personnel in areas such as patient advocacy, communication with patients and their families, professionalism, developing capacity, service coordination, individual and community evaluation, and knowledge growth in jurisdictions where these regulations do not yet exist.

Purpose

Nevertheless, because the initiative is so new, it presents a challenge for community practices trying to fulfill CMS criteria for billing and learning how to use the new PIN codes to serve patients and generate revenue for community practices.

Interventions

100+ clinics across the state of Florida under the same practice,

■ Patient identification: based on, MD referral, risk stratification & standing order policy for navigation patients are enrolled in the PIN program. The navigation program requires a patient with a high-risk disease expected to last three months or more, with a significant risk of death, nursing home stay, or functional loss, necessitating a personalized care plan and regular medication adjustments regardless of type of insurance.
■ Certification and training for the Navigation team: The entire team assigned to care for patients completed George Washington University’s Oncology Patient Navigator’s Training: The Fundamentals to qualify as certified oncology patient navigator.

Results

From February – August 2024, 829 patients enrolled in the navigation program. Of these enrolled patients the navigators addressed the following barriers: 185 referrals for Behavioral Health, 59 referrals to Financial Counselor, 296 referrals to Registered Oncology Dietician, 333 referrals to Supportive Services, and 107 referrals to FCS Foundation providing financial assistance for non-medical needs.

Discussion

The use of Principal Illness Navigation Codes remains a work in progress. The program team encountered the following challenges during implementation: staffing, concern of patient cost sharing, documentation requirements, meeting the minimum 60-minute lead time requirement using code G0023, providing organizational return on investment, cost avoidance estimation, and the manual billing process.

Oncology Nursing Forum. 2025 Mar 1;52(2):287.

P490. Utilizing Digital Resources to Empower Nurses

Brittany Pease ¹

Management

Significance & Background

On our oncology Bone Marrow Transplant unit, ninety percent of our patients received chemotherapy. With safety and quality outcomes being the foundation of our culture, it is imperative that we provide the tools necessary for the influx of new nurses, to build their confidence, provide knowledge, and promote self-sufficiency.

Purpose

Chemotherapy administration being a multi-dimensional skill generates a lot of unease. Providing easy access to evidenced based chemotherapy education and tools is crucial to promote efficiency and confidence in our new nurses and upholding safe patient care.

Interventions

Gaps were identified with feedback from nursing, about frustrations of where to find specific chemotherapy resources and how time consuming it was to search for the necessary information, often prompting the need for additional help. An online chemotherapy Padlet was designed as an innovative one stop shop to access up to date materials to save time, decrease frustrations and improve confidence.

Results

No current quantitative data has been collected; however, staff have expressed satisfaction with the ease of using the Padlet as a resource, it promotes efficiency and their overall knowledge.

Discussion

The ability to access a digital updated evidence-based resource at any time in one place has saved time and promoted confidence allowing more independence. Next steps would be having the ability to track the Padlet utilization, gather more feedback from staff, and continually updating the resource in the ever-expanding oncology profession.

Oncology Nursing Forum. 2025 Mar 1;52(2):287–288.

P491. Continuous Infusion Home Hydration – A Quality Improvement Project

Cassandra Peat ¹, Christian Eastlake ²

Symptom Management and Palliative Care

Significance & Background

Cancer patients undergoing active treatment are at risk for side effects including, nausea, vomiting, diarrhea, dysgeusia, mucositis, dysphagia and anorexia; all of which can lead to dehydration. Care for these patients often includes preventative administration of IV hydration boluses several days per week. This requires additional trips to the infusion center and co-pays for patients already battling fatigue and financial toxicity.

Purpose

This project is intended to support patients requiring IV fluid supplementation while decreasing the time spent in the infusion center. By developing a program that allows a patient to receive IV fluids through a slow continuous home infusion pump, patients can receive the supportive care they need in the comfort of their own home.

Interventions

The project was approved by clinical leadership. The home infusion pump manufacturer was consulted to determine hydration volume capabilities. Collaboration continued with the IT team and pharmacy to build the new orderset. Supplies were procured, and infusion nurses were educated on the new program. A “show and tell” session allowed the providers to see the home infusion pump and backpack with hydration to allow for better explanation to patients. This program is voluntary, based on the shared care decisions between the patients and their providers. Patients may also choose to participate in the “home disconnect” program, further minimizing their appointments.

Results

To date there have been 8 home hydration infusion. Although there have been mixed reviews by patients, some have report improved quality of life attributed to enrollment in the program. This program also has the potential to increase patient access to the infusion center. A home hydration appointment can be scheduled in one “20-minute” appointment, as opposed to three “1-hour” bolus hydration appointments. Data collection related to improved chair time and patient satisfaction is ongoing.

Discussion

Although still in its infancy, this innovative program has been well received by patients, front line staff, providers, and leaders. While home hydration is not meant for every patient, it adds a layer of autonomy to their care, allowing them to choose what works best for their lives. In addition, it has prompted our nursing staff and leaders to consider more “out of the box” ideas to not only improve patients’ experience, but also overcome challenges such as capacity in the Outpatient Oncology Infusion departments.

Oncology Nursing Forum. 2025 Mar 1;52(2):288.

P492. How to Support Your Fellow Oncology Nurses Who Are Grieving Their Personal Loss Post Bereavement

Kristin Pegram ¹

Management

Significance & Background

My husband of almost 35 years died unexpectedly last year. I researched this topic in hopes to find literature to help me and my son who is who is also an oncology nurse. There were several other staff members who had a loss of a significant other. I was disappointed that almost exclusively the literature regarding grief interventions for the nurse referred to patient loss. As oncology nurses, we take on a significant amount of loss at work. When we add personal loss to the equation, it can be devastating. I felt it was important to share my story and research with others to assist the bereavement process while working. Inclusive Employers suggest many “don’ts and dos” .

Purpose

Support the oncology nurse upon returning to work after experiencing significant personal loss.

Interventions

I have sent an electronic, anonymous survey to staff with the questions listed below inquiring support post bereavement. This survey is still in process. The questions include:

■ Have you experienced a loss/death as a nurse? yes/ no
■ Did you take a leave after your loss? yes/ no
■ If so, how long? n/a or #
■ Did you feel you needed more time off? yes/no
■ Did your patient care change after your return to work? yes/ no if yes, how?
■ Did you feel supported by coworkers after the loss? yes/no please elaborate
■ What was most helpful by fellow staff? free text
■ What was was least helpful or offensive? free text
■ Is there a specific intervention you think would be helpful after your loss upon returning to work? free text
■ How long after your return to work did you feel you were performing your job without difficulty ? weeks, months, years.

Results

After all surveys return, I will graph, calculate the results and post free text responses. Examine current articles and include in education. I will create a poster with results and discuss my results with staff and management.

Discussion

Provide education for oncology staff to support the grieving coworker.

Oncology Nursing Forum. 2025 Mar 1;52(2):288–289.

P493. Educating Inpatient Nurses Regarding Oncologic Emergencies in a Community Hospital

Margaret Perri ¹, Elaine Spieller ², Melissa Pfeifer ³

Healthcare Delivery

Significance & Background

A new outpatient oncologic ambulatory care center was opened in an existing community hospital. The existing institution did not regularly see oncology patients. The inpatient nurses were eager to be able best serve this new demographic but wanted to ensure they had the skill set. Educating the nurses gave them the tools to ensure the best patient outcomes.

Purpose

Educating inpatient nurses on the best evidenced based practice for treating oncologic emergencies ensures the best patient outcomes. Fostering a relationship between the oncology nurses in the oncology ambulatory care and the inpatient nurses creates seamless care to the patient.

Interventions

The nursing team from the Oncology group was formed and created education for the inpatient team. This education was derived from evidenced based practice from scholarly works. The education included a summary of the oncologic emergency, signs and symptoms and the treatments for each emergency. The education team from the inpatient side met and the information was provided to each unit, along with a copy of the presentation for each nurse to refer when necessary. Contact information was provided for all staff and an open line of communication forged.

Results

The nursing team in both the Oncology ambulatory care and inpatient nursing team forged a new network to enhance patient satisfaction and better outcomes. The inpatient nurses have a greater understanding and a larger network to provide evidence based practice and ensure patient safety. Collaborating among the healthcare system ensures that patients are receiving continuum of care across the patient experience. This leads to greater satisfaction among patients, caregivers and the healthcare employees.

Discussion

Bridging the gap between inpatient and outpatient care is important to the success of the overall healthcare institution. This continuity of care will lead to greater patient satisfaction and improve patient outcomes. Providing education to the nursing staff increases their tools to provide quality care. Knowledge and experience are important factors to enhance critical thinking and enhances greater communication.

Oncology Nursing Forum. 2025 Mar 1;52(2):289.

P494. Feasibility of Implementation of a Patient Reported Symptom Assessment and Proactive Telephone Triage to Reduce Emergency Department and Inpatient Admissions in Adult Oncology Patients Receiving Chemotherapy: A Nurse Led Initiative

Barbra Pesata ¹

Symptom Management and Palliative Care

Significance & Background

Chemotherapy treatment can have severe, but predictable side effects and if managed inappropriately can reduce patients’ quality of life and increase healthcare cost and utilization. Addressing unmet needs and gaps in care among outpatient chemotherapy patients may reduce emergency department (ED) visits, reduce cost, improve patient satisfaction, and increase the patient’s quality of life.

Purpose

The American Society of Clinical Oncology 2017 annual meeting report showed that assessing symptoms in real time and alerting clinicians when symptoms worsen improved quality of life, enhanced treatment tolerance, reduced the number of emergency room visits and lengthened survival even better than some cancer therapies did. The symptom assessment tool selected for this research is the MD Anderson Symptom Inventory (MDASI) which is a multiple symptom patient reported outcome measure for clinical use. This tool is unique in that it looks at both symptom severity and how it interferes with daily life. It also applies to all cancer types and treatments and is an easy 0–10 scale that takes about 5 minutes to complete (Cleeland, 2016).

Interventions

The following question was developed to guide this pilot study:

■ Aim 1: Will implementation of a web-based symptom assessment tool (MDASI) be a feasible option for adult oncology patients 18 years of age and older (excluding bone marrow transplant and leukemia patients) who have had intravenous treatment in the last 30 days? The specific aim is to determine feasibility of the implementation of the MDASI tool utilizing MyUFHealth, a patient portal to include a patient reported symptom outcome measure. The feasibility criteria are that 90% of the participants will have communication of their symptoms/needs documented from the nurse.
■ Aim 2: To explore differences in the number of ED visit /Inpatient admissions among patients who receive the weekly web-based surveys and those who receive standard of care (no weekly surveys).

Results

Results showed a low percentage (30%) of participants completed the weekly survey.

Discussion

Previous literature suggest that patients complete weekly surveys even close to the end of life (Basch, et al., 2015). This was not the case in this study, which could be related to various factors such as being a rural community, struggle with the use of MyUFHealth, or the lack of perceived benefit from the patient.

Oncology Nursing Forum. 2025 Mar 1;52(2):289–290.

P495. Implementation of a Revised Adult Venous Assessment Tool (VAT) in an Ambulatory Oncology Infusion Center

Brittney Peters ¹, Georgina Rodgers ²

Treatment Modalities and Managing Administration

Significance & Background

Ambulatory chemotherapy infusion nurses questioned the correct use of peripheral intravenous (IV) access when administering vesicant or irritant medications. Additionally, there has been a rise in the use of midline catheters, over central lines, coupled with insufficient consultations with healthcare providers regarding the use of central lines.

Purpose

The Venous Assessment Tool (VAT) is a nursing assessment tool of venous access. Its primary purpose is to enhance nurse-provider communication for vesicant therapy and the need for placement of central lines, rather than peripheral and midline catheters.

Interventions

After tool development, a VAT was piloted with the lymphoma disease group for 12 weeks. During the provider visit when treatment options were discussed, they were to contact an infusion Team Lead RN to perform venous assessment. If this request did not occur, the venous assessment was completed during the first treatment in infusion if the patient did not have central venous access. During subsequent treatments, RNs reviewed VAT results in the Synopsis tab as part of the infusion visit to determine if a re-assessment was needed. Frequency of this re-assessment occurred every 6 weeks or if there were new issues. The nurse completed all fields within the documentation flow sheet, unless the treatment regimen was unknown. If patients did not have adequate peripheral venous access, providers were informed and a same day peripherally inserted central catheter (PICC ) was placed when possible, or the patient was rescheduled for after port placement.

Results

In total, 12 patients were assessed with the tool. Overall, three (25.0%) had adequate peripheral venous access, eight (66.6%) had ports placed, two (16.6%) had PICC lines placed the same day for treatment, and one assessment was completed (8.3%) during the provider visit.

Discussion

After a successful pilot, the VAT continues to be used for lymphoma patients receiving vesicant/irritant therapies. Although more-rigorous data collection is needed, we have observed that ports are being used more often to initiate chemotherapy. To date, a guideline was placed in our policy and procedure manual and the VAT is now used for all infusion center oncology and benign hematology patient populations, regardless of drug classification.

Oncology Nursing Forum. 2025 Mar 1;52(2):290–291.

P496. Navigating the Avalanche: Keeping Oncology Nurses and Practitioners up to Date in a Rapidly Evolving Field

Mary E Peterson ¹, Deborah Rust ²

Management

Significance & Background

Oncology’s rapid evolution presents significant challenges for nurses and practitioners to stay current. Fast-paced innovation demands constant updates in clinical practices, making integration of genetic information and clinical trial results complex. Although data is readily available online, identifying relevant information is difficult. High patient loads and multifaceted roles limit time for development, while high journal subscription costs, technology access disparities, and varying literacy levels further complicate staying informed. Developing skills to determine essential clinical information and adhering to evolving guidelines is crucial for patient benefit.

Purpose

This literature review aims to identify and analyze the persistent challenges oncology nurses and practitioners face in staying updated and to explore effective strategies for continuous professional development in this dynamic field.

Interventions

■ Continuing Education and Professional Development Programs: Structured educational activities and focused, short courses tailored to practitioners’ needs.
■ Utilization of Technology and Digital Platforms: Embedding decision support tools within EHRs and promoting online forums for information exchange.
■ Institutional Access: Organizations covering subscription costs for vital resources.
■ Pharmaceutical Company-Sponsored Education: Providing educational symposia, webinars, and workshops.
■ Grants for Continuing Education: Funding programs to ensure broader access to high-quality educational resources.
■ Mentorship and Peer Networks: Engaging in professional networks for knowledge sharing and support.

Results

■ Volume & Complexity of Information: 85% of practitioners find it challenging to stay updated.
■ Time Constraints: 78% report limited time for professional development due to high patient loads.
■ Resource Access: 65% cite high subscription costs as a barrier, and 58% highlight technology disparities.
■ Changing Guidelines and Protocols: 72% struggle with continuous learning and adaptation.

Effective solutions show high acceptance, with 82% favoring structured educational programs and 77% benefiting from technology.

Discussion

This review highlights the urgent need for innovative strategies to keep oncology nurses and practitioners informed. Developing a habit of continuous learning and honing skills to identify pertinent information are crucial. Effective interventions include structured continuing education programs, leveraging technology, and institutional support. Recommendations include healthcare organizations investing in essential resources, encouraging professional engagement, and fostering mentorship. Continuous research is necessary to refine these strategies and discover new solutions to ease the burden of ongoing education in the evolving oncology landscape. By addressing these challenges, the oncology nursing community can deliver cutting-edge care, ultimately improving patient outcomes and advancing the field.

Oncology Nursing Forum. 2025 Mar 1;52(2):291.

P497. Allergic to Chlorhexidine? A Trial of Pure Hypochlorous Acid for Skin Decontamination in Oncology Patients

Sandra Petigny ¹, Kathleen Thelus ², Patrick Treacy ³, Katie Weathers ⁴, Elizabeth Savage ⁵

Quality and Safety

Significance & Background

Central line-associated bloodstream infections (CLABSI) can significantly increase morbidity and mortality in immunocompromised patients. Chlorhexidine (CHG) is an antiseptic commonly used for skin decontamination; however, it is contraindicated for patients with compromised skin integrity and for those with an allergy to it. Although a small population of patients, the care team decided to trial a different product with the goal of equitable alternative disinfection in the prevention of CLABSI. A collaborative decision was made to trial pure hypochlorous acid (pHa) with the patients who are allergic to CHG or have compromised skin integrity.

Purpose

To evaluate the efficacy of pHa for skin decontamination in reducing the incidence of CLABSI in patients with a CHG contraindication compared to standard skin decontamination protocols.

Interventions

Patients identified as requiring an alternative to CHG disinfection included those with cutaneous T-cell lymphoma (CTCL) in addition to those with compromised skin integrity. As the addition of pHa would be a practice change, approval to trial the product needed to be obtained. An interdisciplinary team, consisting of Infection Prevention Medical Director, Oncology Medical Director, Wound & Ostomy, Clinical Nurse Specialist, Nursing quality, and Dermatology reviewed published data on pHa to determine the effectiveness as an alternative. CLABSI rates, skin irritation, and patient tolerance were monitored for eight months to ensure pHa is an acceptable substitution for CHG.

Results

During the eight-month monitoring period there were no reports of CLABSIs, no skin irritation was reported by patients and the use of pHa was well tolerated.

Discussion

Pure hypochlorous acid is a promising alternative for skin decontamination in an immunocompromised patient population. Next steps include reviewing the CLABSI policy to include the use of pHa for patients allergic/sensitive to CHG or those with compromised skin integrity. The updated policy will then be shared with all campuses to ensure awareness of this enterprise-wide initiative and change. Monitoring this patient population for CLABSI, skin irritation or intolerance will be continued beyond implementation. The use of pHa in specific populations may further enhance infection control when used as directed. This product may be considered for use on a variety of patient populations, beyond what was discussed, to prevent infections, discomfort and intolerance of CHG.

Oncology Nursing Forum. 2025 Mar 1;52(2):291–292.

P498. Escapeoside: Using an Escape Room to Verify Competency and Enhance Oncology Nursing Knowledge Related to Chemotherapy Administration

Kelly Petrulevich ¹, Jessica Stonis ², Laura Young ³, Jenna Lisk ⁴, Gabrielle Berns ⁵, Tara Rausch ⁶

Management

Significance & Background

Historically, our inpatient adult oncology nurses have completed an annual online chemotherapy test to verify competency. The test does not sufficiently demonstrate the nurses’ knowledge and understanding of chemotherapy administration, personal protective equipment (PPE) requirements, managing chemotherapy reactions, or chemotherapy-related policies. The ambulatory oncology nurses have not had a defined method of annually verifying their chemotherapy competency. Chemotherapy agents are high risk medications. Thus, it’s imperative that the competency of administering nurses is verified.

Purpose

The purpose of our chemotherapy escape room was to provide an innovative method of verifying and enhancing nursing knowledge related to chemotherapy administration. This fun interactive activity also served to bring together the inpatient and ambulatory oncology nurses to work as a team using a creative teaching/learning method. The associated institutional policies were imbedded within the escape room scenarios, clues, and hands-on demonstrations.

Interventions

The facilitator identified the escape room objectives and outline. Next, a patient scenario was created to intertwine all pertinent policy information. The escape room clues included information about online chemotherapy plans, accessing hospital policies about chemotherapy excreta precautions, the proper use of PPE, the basics of chemotherapy administration, managing chemotherapy reactions and escalation of care, managing a chemotherapy spill, and proper disposal of trace and bulk hazardous waste. Each session consisted of up to six staff nurses strategically selected from different clinical areas. After each session, nurses participated in a debriefing. The scenarios, clues, and pertinent hospital policies were reviewed and discussed within the groups. During the debriefing, questions and concerns from the nurses were also addressed.

Results

A knowledge and attitudinal survey was conducted before and after each escape room session. To date, twelve of the twenty scheduled escape room sessions have been completed. The remaining eight sessions will be completed in October 2024. Higher scores on the post-surveys indicated that oncology nurses gained substantial knowledge and understanding of information, requirements, and policies necessary for the safe administration of chemotherapy. (See figure)

Discussion

The nurses expressed appreciation of the debriefing after each session. Participating nurses expressed the desire to have additional collaborative oncology educational activities. The future use of escape rooms and other innovative teaching methods is highly recommended for verifying competency and enhancing oncology nursing knowledge.

Oncology Nursing Forum. 2025 Mar 1;52(2):292.

P499. Effectiveness of Survivorship Programes in Improving Health-Related Quality of Life in Colorectal Cancer Survivors: A Systematic Review and Meta-Analysis

Do Pham Nhat Vi ¹, Wong Cho Lee ², Nguyen Thi Khanh ³

Survivorship

Significance & Background

Colorectal cancer (CRC) survivors often experience a range of health-related quality of life issues during the post-treatment phase. Survivorship programs have been implemented to provide supportive interventions to address these issues. However, there is currently limited evidence to guide the optimal design of such a program.

Purpose

This systematic review aimed to analyse and synthesise the available evidence on the effectiveness of the survivorship program in addressing health-related quality of life among CRC survivors.

Interventions

A comprehensive literature search was conducted in nine relevant English-language databases. Quantitative results from comparable studies were pooled using meta-analysis in RevMan 5.4. If the heterogeneity of studies is too high for a statistical summary, a narrative summary is provided to describe the study results.

Results

This review included 20 randomized controlled trials (RCTs) involving 2,581 CRC survivors. The meta-analysis results indicated a low heterogeneous effect on overall quality of life (Standardised mean difference [SMD] = 0.19, 95% CI [0.05, 0.32], p = 0.006, I2 = 0%). Significant improvements were observed in anxiety (SMD = −0.32, 95% CI [−0.51, −0.13], p = 0.0009, I² = 43%), depression (SMD = −0.22, 95% CI [−0.35, −0.08], p = 0.001, I² = 0%), and distress (SMD = −0.51, 95% CI [−0.78, −0.24], p = 0.0003, I² = 0%). However, no effects were found on fatigue (SMD = 0.11, 95% CI [−0.04, 0.26], p = 0.16, I² = 0%) and bowel function (SMD = −0.01, 95% CI [−0.35, 0.32], p = 0.93, I² = 51%). Overall, these studies ranged from some concerns to high bias in methodological quality.

Discussion

Survivorship programs hold promise for improving various health-related outcomes among CRC survivors, particularly in the psychological domain. However, the heterogeneous nature of the current evidence warrants caution in interpreting the overall impact on quality of life. Further high-quality research is needed to confirm the benefits of these programs and inform their optimal design.

Oncology Nursing Forum. 2025 Mar 1;52(2):292–293.

P500. Importance of a Nurse Coordinator Role when Growing a Theranostics Program

Lisa Philipp ¹, Roselle Okubo ², Mysti Motz ³, Aja Scott ⁴

Healthcare Delivery

Significance & Background

In 2018, a National Cancer Institute (NCI) designated comprehensive cancer center, set out to administer Lutathera, a theranostic radiotherapeutic treatment for neuroendocrine tumors (NET), in the ambulatory infusion center. This was originally managed by an Advanced Practice Registered Nurse (APRN) under the referring provider. In 2023, a new provider was recruited to chair the NET department and demand grew exponentially. This increased volume presented the challenge of care coordination.

Purpose

A Nurse Coordinator was hired to take on care coordination of these complex patients. A collaboration was established across all departments to manage increasing volumes and ensure an exceptional patient experience. Interdepartmental workflows were developed to establish a clear and consistent process engaging all stakeholders.

Interventions

The Nurse Coordinator implemented several interventions to enhance and grow the program. By developing interdepartmental workflows and optimizing existing processes, departments were able to streamline operations to meet the demands of the expanding program. Improved communication and collaboration between departments was essential, along with creating a multidisciplinary theranostics policy for the institution. As the primary theranostic resource, the Nurse Coordinator provided education to patients and staff to establish expectations and facilitate treatment compliance. Theranostics training was developed and integrated into nurse onboarding, preparing staff to manage the increasing patient volume.

Results

From 2022 to 2024, the introduction of the Nurse Coordinator role significantly impacted theranostic treatment volume. In 2022, before the role was introduced, 20 treatments were completed. The following year, after the Nurse Coordinator joined the team, the number of completed treatments rose to 67, a 235% increase. The program is continuing its exponential growth and is projected to double in volume again this year.

Discussion

Collaboration with all stakeholders is crucial, communication with a diverse group of individuals from Providers, Nursing, Infusion, Operations, Nuclear Medicine, and Radiation Safety is essential. Each group must elucidate their processes, and the gaps must be filled with creative solutions and constant communication. Safe medication administration will look different. Although the medication is administered by Nuclear Medicine, we aimed to ensure Oncology Nursing Society Chemotherapy Administration Safety Standards were adhered to in the infusion center. The environment of care needed to meet multiple regulatory requirements. Radiation Safety assisted in meeting these requirements while prioritizing our commitment of becoming a premier organization for the administration of theranostic treatments.

Oncology Nursing Forum. 2025 Mar 1;52(2):293.

P501. Evaluating the Impact of Staff Educational Materials

Kristin Phillips ¹, Whitney Carpenter ², Alaa Muslimani ³, Kris Blackley ⁴, Laura Kabrich ⁵

Management

Significance & Background

Patient education materials were needed in the subjects of marijuana use and surgery complications, cancer and sexual health, and osteonecrosis of the jaw symptom awareness in relation to oncology medications. In discussing these topics, RMA (Registered Medical Assistant)/RN (Registered Nurse) knowledge level was low, creating the opportunity to increase their confidence/knowledge. The teaching materials were created and then approved through the Education Committee approval process.

Purpose

Three separate patient educational topics were identified; marijuana use and surgery complications, cancer and sexual health, and osteonecrosis of the jaw symptom awareness in relation to oncology medications. One-page educational handouts were developed to improve and increase knowledge of these topics.

Interventions

Research was performed on all three topics using well-established and evidence-based sources. This research was then compiled into three, one-page teaching sheets, keeping to the standard level of learning, and concise instruction. The teaching sheets were submitted for the Education Committee to critique and approve. Once approved, the RMA/RNs were surveyed before and after reading the teaching sheets.

Results

RMA and RN Confidence level before and after education for the three teaching sheets is as follows: Marijuana Use and Surgery Complications teaching sheet–RMA confidence level rose from 30% to 100%. RN confidence level rose from 19% to 98%. Cancer and Sexual Health teaching sheet–RMA confidence level rose from 10% to 80%. RN confidence level rose from 25% to 89%. And the ONJ Symptom Awareness teaching sheet–RMA confidence level rose from 0% to 60%. RN confidence level rose from 5% to 71%.

Discussion

Staff education can be effectively completed through one-page education sheets, increasing the awareness of potential problems and the overall value of oncology-specific education provided to patients. This, in turn, can contribute to positive patient outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):294.

P503. Expanding Horizons: Enhancing the Scope and Impact of Certified Medical Office Assistants

Elizabeth Phillips ¹, Sandy Page ², Mari Ann Lewis ³, Calli Wood ⁴

Healthcare Delivery

Significance & Background

Through surveys, dissatisfaction was identified by our Cancer Center cMOAs due to their limited scope in the hospital-based clinic setting (HBC). The organization’s Ambulatory Department had an established scope of service (SOS) for certified Medical Office Assistants (cMOA). A HBC cMOA SOS was then established and adopted by the Cancer Center to expand the cMOA scope and increase employee satisfaction. There had never been a cMOA SOS and cMOAs were limited in their practice.

Purpose

Our purpose was to increase employee and patient satisfaction, retention, and improve overall workflow. As well as standardize cMOA scope across our campus.

Interventions

Data was collected from Leadership to compare the current cMOA scope to the expanded HBC cMOA SOS. We then determined which skills the Cancer Center cMOAs would adopt. We conducted a manual review of each individual cMOA online learning transcript, consisting of fifty-four cMOAs across our main campus and three regional site locations, revealed an education gap. New education material was created and assigned via our online learning management system (LMS). These modules were required to be completed before skills validation. Multiple in-person skills validation sessions followed. This included fifteen different skills with hands-on practice conducted by two nursing professional development practitioners (NPDP) and volunteer registered nurses. Fifty-one out of the fifty-four cMOAs attended a skills session. Cancer Center Supervisors were required to attend to function as their Clinic super users in the future. The cMOAs learning transcripts were reviewed post skills day to ensure online learning was complete and checklists were documented.

Results

During skills checkoff, cMOAs verbalized satisfaction with learning new skills to implement into practice. Leadership provided positive feedback with the newly expanded cMOA scope and workflow improvement. Evaluation of employee retention and patient satisfaction is ongoing.

Discussion

The expanded cMOA scope resulted in an increase in employee satisfaction and morale. They felt empowered in their practice and a valued member of the team. A post survey could have been collected after the completion of the skills day to gather additional data. Evaluation of implementation of skills to ensure cMOAs are practicing to the top of their scope is ongoing. NPDPs will continue to evaluate cMOA competence, confidence, and independence in skills.

Oncology Nursing Forum. 2025 Mar 1;52(2):294–295.

P502. Oncology Nursing: Developing Skills for High-Acuity Patient Care

Sarah Phillips ¹

Professional Development

Significance & Background

Oncology nurses are vital for delivery of high-quality care. As patient acuity increased across multiple hematology-oncology units within a large comprehensive cancer teaching hospital, educational gaps emerged around care of intermediate level oncology patients. Attempts to address gaps began with nurses taking the AACN Essentials of Critical Care Orientation (ECCO). Rounding and shadowing staff in practice areas, and feedback from new hires revealed lack of comfort in caring for complex oncology patients. Unit leadership reported few RNs felt prepared to care for the intermediate level oncology patient. Oncology NPDS review of ECCO content determined the specialized needs of the oncology population were not being met. Literature reviews highlighted emerging specialties of onco-cardiology and onco-pulmonology in medicine; however, no specialized education existed to meet the needs of nurses caring for these complex patients.

Purpose

Aimed to provide oncology-focused education around care of higher-acuity cancer patients with cardiac and pulmonary complications/risk. Simulations enhanced skills in care of cardiac drips, cardiac arrythmias, NIPPV, and emergency response in first 3–5 minutes of code/rapid response situations. Interactive eLearning’s aimed to familiarize staff with resources, policies and clinical indications for nursing interventions.

Interventions

NPDS created e-learnings reviewed common onco-cardiology/pulmonary causes of patient change in condition. Hands-on simulation scenarios and gamification based on SOFI reports, nurse feedback, and collaborations with respiratory therapy validated competency and supported individual coaching. Focused intermediate oncology education decreased training time from 40hours to 8hours, demonstrating cost savings while improving nurse specialty practice preparation.

Results

Unfolding case studies with decision trees were incorporated into interactive eLearning’s, before live simulation sessions to validate/reinforce learning. Likert-style pre/post questionnaires evaluated alignment with objectives. Survey results determined intended output of improved nursing role competence, training satisfaction and confidence in delivery of safe, high-quality care to an increasingly complex patient population was met.

Discussion

The growing complexity of cancer care, coupled with increasing patient acuity, requires a new level of expertise from oncology nurses. Cancer treatments often carry significant cardiac and pulmonary risks, making early recognition and intervention critical to prevent unnecessary ICU transfers. Equipping oncology nurses with specialized training to meet higher-level care needs improves patient outcomes, minimizes healthcare costs, and provides the highest quality of care for oncology patients. Investing in specialized training is crucial to meet the evolving needs of oncology populations.

Oncology Nursing Forum. 2025 Mar 1;52(2):295.

P504. Follow the Yellow Brick Road: Building an Onboarding Pathway Towards Oncology Nursing Excellence and Retention

Sarah Phillips ¹, Jacqueline Redeemer ²

Management

Significance & Background

Effective onboarding is key to a new nurse’s success; However, professional development is a lifelong journey and commitment to the patients we serve. Nursing burnout and compassion fatigue are exacerbated by poor support structures including a lack of preparation for practice. At a comprehensive cancer center, prior nurse resident cohorts experienced turnover before completion of first year of hire.

Purpose

To develop a comprehensive oncology onboarding pathway for new hire RNs that aligns with the ONS core competencies for the oncology nurse generalist, supports retention, and culminates in oncology certification.

Interventions

NPDS and CNS collaborated to create an oncology fundamentals immersion for nurse residents and new hires. Beginning with how cancer occurs and progressing through disease management, oncologic emergencies and palliative/end of life care. Incorporating simulation and role play to practice patient education techniques, oncologic emergency recognition and simulated cellular therapy administration, CLABSI prevention, drains , tubes, ostomies and medication error simulation scenarios. This 5-day immersion into oncology nursing practice is the beginning of a one-year professional development support system that includes chemotherapy/biotherapy safety and annual competency, oncology intermediate level of care training and certification preparation. The oncology fundamentals immersion is provided on hire, following hospital orientation, before beginning unit-based preceptorship.

Results

Pre-post questionnaires were provided at start of class, immediately post and 10 weeks post hire to evaluate effectiveness of onboarding education and applicability to practice. Additionally, self-rated burnout scales were used to measure the impact of preparation for practice on nurse coping and connection to organization/intent to stay.

Discussion

An evidence-based plan for professional development and education of oncology nurses in their specialty practice is a tool that supports nursing excellence, decreased novice nurse burnout and improved new graduate RN retention.

Oncology Nursing Forum. 2025 Mar 1;52(2):295–296.

P505. All Hands on Deck! Implementing a Team Based Admission Approach to Increase Nurse Satisfaction and Improve Quality Intervention Compliance

Brittany PIckney ¹, LaTarvia Moore ², Cindy Paredes ³

Healthcare Delivery

Significance & Background

Cancer patients are vulnerable to a sequela of complications due to their disease processes and treatment-induced immunosuppression. These physiological changes coupled with their prolonged hospital stays put patients at risk for events such as falls, pressure injuries, and central line infections. Admissions and transfers coupled with existing patient complexities can lead to poor patient outcomes.

Purpose

To evaluate whether implementing a team-based admissions strategy can lead to decreased incidence of hospital acquired infections or events and increased adherence to quality prevention interventions such as central line associated infection (CLABSI) rates, catheter-associated urinary tract infection (CAUTI) rates and two nurse skin assessment compliance.

Interventions

All direct admissions and transferred patients to a 36-bed oncology unit were greeted with a team-based approach. Upon admission, a team of unit staff including nurses and patient care technicians, reported to the patient room and assumed a role. Each role highlighted key nurse sensitive quality indicators like performing the Hester Davis Fall score assessment with patient and tailored fall prevention education. Staff assisted with a chlorohexidine bath at this time as well and patients were educated on its daily requirement and the rationale. Two nurse skin assessments were completed and documented in real time.

Results

Data was collected from audited compliance data for 2 RN skin assessment completion and documentation, appropriate HAPI interventions, CHG bathing compliance, and correct fall interventions in place on admission. Prior to the team-based admission approach the compliance rate for 2RN skin assessment and documentation was at 9%, overall compliance for appropriate fall interventions was 39%, CHG bath compliance within 24hrs of admission 80%, and compliance with implementation of appropriate HAPI prevention interventions was 45%.

Discussion

The integration of a team-based admissions approach in healthcare settings can significantly impact practice by improving compliance with quality interventions which leads to better patient outcomes. This approach may foster a collaborative and supportive team environment while decreasing acuity burden and individual workload, creating more support for compliance to various quality prevention initiatives.

Oncology Nursing Forum. 2025 Mar 1;52(2):296.

P506. Standardizing the Process for Checking Investigational Oral Medications to Improve Patient Safety in Clinical Trials

Jodie Pindulic ¹, Elizabeth Joy ², Lisa Klempner ³, Faye Inumerables ⁴, Marlon Lasa-Blandon ⁵

Quality and Safety

Significance & Background

Clinical trials are critical in advancing cancer care by exploring new treatments and therapies that can improve patient outcomes. At this NCI-designated institute, a policy defined the medication safety verification process of a two-nurse independent double-check before intravenous chemotherapy and biotherapy, however, one did not exist for oral investigational medications. In 2021, an error occurred where a patient received the wrong investigational oral medication which highlighted the need to enhance patient safety during investigational oral medication administration.

Purpose

This abstract discusses the implementation of an independent double check (IDC) process for investigational oral medications to improve patient safety.

Interventions

A literature search for best practices for verifying investigational oral medications before administration was conducted. Due to gaps in the literature, the review expanded to include safety standards for high-alert medications. Evidence exists supporting the IDC method to improve safety. In September 2023, an interprofessional working group, including clinical trial nurses, clinical nurse specialists, nurse leaders, and the clinical research team, met to define the implementation of the investigational oral medication IDC. The process described two nurses independently verifying the correct patient’s name, strength, dose, route, frequency, treatment start date, IRB number and the number of pills on the label match the physician’s order. Documentation of the check was standardized in the electronic health records or pharmacokinetic documentation form.

Results

The investigational oral medication IDC process was reviewed through the shared governance structure to strengthen stakeholder engagement and ensure clear workflows across departments. The policy went live in May 2024. Since then, eighty investigational oral medication protocols have been updated to include IDC requirements and the nursing policy was revised. Dissemination of the change occurred via email announcements in our monthly “Evidence-Based Practice Updates” and education was provided to approximately 80% of the infusion units.

Discussion

Implementing the investigational oral medication IDC protects patient safety and ensures policies are supported by the best available evidence. Instituting a verification process for investigational oral medications can minimize risks to enhance patient safety and align with the broader goal of advancing cancer care through the development of new therapies. This translation of evidence into practice involved the collaboration of multiple departments for the success of the new process.

Oncology Nursing Forum. 2025 Mar 1;52(2):296–297.

P507. Acute Gastrointestinal (GI) Toxicity: Does Pretreatment Colonoscopy Impact Acute Gastrointestinal Toxicity Following Curative Stereotactic Body Radiation Therapy for Localized Prostate Cancer

Andrew Pipher ¹, Kathleen Maloney-Lutz ², Vianca Santos ³, Jennifer Gillespie ⁴, Maureen Oliveri ⁵, Kayla Figuera ⁶

Radiation

Significance & Background

Invasive procedures including biopsies in freshly irradiated tissue is a known risk factor for high-grade toxicity. This can increase the likelihood of complications if performed prematurely after radiation therapy. Screening colonoscopies (SC) are recommended and performed before radiotherapy given the need to rule out comorbid gastrointestinal conditions, to decrease toxicity, and avoid the need to obtain a colonoscopy post SBRT.

Purpose

To determine any difference in toxicity levels in those who received the colonoscopy screening as opposed to those who did not.

Interventions

The association of pre-treatment colonoscopies and the colonic finding therein with subsequent GI toxicity was investigated utilizing our previously approved registry of prostate cancer patients treated with five fraction SBRT from January 2021–May 2024. Patients were categorized into those who did and did not undergo SC within six months of SBRT. Analysis of colonoscopy findings such as presence of diverticulosis, hemorrhoids, and polyp resection were reviewed. Toxicity grading was determined based on the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE).

Results

Two hundred two patients out of 234 had pre-treatment colonoscopies. Identification of polyps requiring resection, diverticulosis, and the presence of hemorrhoids through pretreatment colonoscopies did not increase post SBRT GI toxicity. There was no difference between the two groups in regards to grade 1 GI toxicity. There was a demonstrated lower rate of grade 2 GI toxicity in those who had a colonoscopy prior to initiating therapy.

Discussion

This finding may be due to a lack of knowledge of a patient’s current GI function and those who did have the colonoscopy had potential problems remedied before initiating therapy. Those who did not receive a colonoscopy screening did have significantly higher grade 2 GI toxicity. Based on these findings; colonoscopy screenings may be beneficial in reducing post treatment complications as well as reduce the need to obtain a colonoscopy after SBRT. Patient encouragement from nursing to obtain a SC may decrease the need for a colonoscopy after SBRT potentially reducing adverse reactions.

Oncology Nursing Forum. 2025 Mar 1;52(2):297–298.

P508. Challenging Pain Issue in the Oncology Setting: A Multidisciplinary, Collaborative Approach Integrating Reiki Ryoho; Japanese Healing Art for Pain Relief and Symptom Management in Graft-versus-Host-Disease: A Case Study

Karen Pischke ¹, Antonia Maloney ², Caroline Ireland ³, Jamie Asci ⁴, Kathleen Coughline ⁵, Laura Doherty ⁶

Symptom Management and Palliative Care

Significance & Background

Pain is the most reported symptom in oncology, resulting in emotional distress, decreased energy, impaired activities of daily living and decreased quality of life. Graft-Versus-Host-Disease (GVHD) pain is one of the more challenging to manage. Pain may be unrelieved by biomedical therapies. Side effects of available treatment options may be intolerable. Many cancer patients prefer a holistic and patient-centered approach for their care, with about 50% reporting use of various complementary and alternative medicine (CAM) therapies. A combination of pharmacological and non-pharmacological interventions can often provide the most effective pain management. There is a national initiative towards incorporating non-pharmacological treatments for pain management. Nurses play a pivotal role in this movement, especially in collaboration with team members and patients.

Purpose

Reiki is safe, gentle and aids in healing by activating the parasympathetic nervous system. No clinical trials or published reports using reiki therapy for pain management for GVHD are in PubMed and Ovid. The following case study illustrates the potential for reiki as adjunctive pain management therapy. A middle-aged female c/o severe fatigue along with joint pain, related to HVGD post allogeneic stem-cell transplant. Pain in the low back, knees and lower legs affected ambulation.

Interventions

Referrals for reiki came independently from clinical and non-clinical staff and patient. Reiki was offered by an RN/Reiki Teacher when in-patient and out-patient visits in Infusion Clinic and Stem Cell/BMT Unit. Sessions ranged from 20 – 60 minutes.

Results

Each time reiki was offered, comfort level improved based on the VAS scale. Patient expressed improvement of painful symptoms, “relaxation,” and at times, drifted asleep. They described “warmth” in their affected areas, “lingering” up to “a few hours” after treatment. Staff observed: relaxation of muscle tension, improved mood (smiling). Patient expressed gratitude expressed for relief. Subsequent reiki sessions replicated similar response.

Discussion

Reiki therapy is low cost, safe and accessible therapy that can be easily integrated in a multi-disciplinary, collaborative approach for symptom management and palliative care in oncology. Literature suggests reiki may be helpful for pain management in cancer-related pain, but more study is needed. There is a lack of large-scale, randomized controlled studies and replicated studies incorporating reiki. Particularly for challenging pain conditions such as CIPN and GVHD. Pain relief in the oncology setting, even when transient, provides a sense of ‘hope.’

Oncology Nursing Forum. 2025 Mar 1;52(2):298.

P509. Integration of the Chemotherapy Consent into the Electronic Medical Record

Jenna Podlucky ¹

Healthcare Delivery

Significance & Background

The documentation of informed consent for chemotherapy and availability of the consent form to health care professionals are essential to efficient and safe care delivery. Currently, the workflow surrounding the completion of paper consent forms and their availability in the electronic medical record (EMR) is highly variable. Delays in documenting informed consent can lead to duplicate consenting and delayed visibility of completed consent forms in the EMR. Furthermore, the timing of chemotherapy preparation and administration, downstream clinical workflow, and appointment duration can be altered.

Purpose

This project involves the transition of the current practice of obtaining paper chemotherapy consent to electronic consenting (e-consent) at our cancer center. E-consent can result in automatic population of the consent in the EMR in real time which can streamline consent-related workflow through increased visibility of the consent across care delivery areas.

Interventions

A group of assigned health care professionals from ISD, WCI ambulatory myeloid hematology group (RNs, APPs, MDs), WCI stakeholders, Health Information management and Informatics representatives convened to build an e-consent within EPIC’s Beacon function which mirrored verbatim the paper consent. Prior to GoLive of the pilot project, RNs, APPs, and MDs within the pilot group completed a knowledge-based review training module on workflow and implementation of e-consent. Twelve signature pads were installed and configured to clinic workstations to be available for providers in cancer center clinics to engage patients in e-consent.

Project Outcome/Results

The feasibility of the e-consent practice compared the median time of pre-project paper consent visibility in the EMR over a period of 4 months to real time visibility of electronic consent in EMR after implementation of the project.

Discussion

The EMR is at the center of patient care delivery and streamlining how it is utilized for chemotherapy consent documentation can be beneficial for patients, providers, and other health professionals. Presently, there are over 400 paper consent forms being utilized across all subspecialties and disease groups that exist outside the EMR. E-consent can reduce the time to consent form visibility which can minimize treatment delays. The project findings will inform decisions regarding e-consent feasibility with the potential to expand e-consents to the institutional level across a variety of specialties. Integrating the consent into the EMR is another step in modernizing healthcare delivery that is beneficial to both healthcare professionals and patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):298–299.

P510. The Role of Nurses in the Management of Oncohematology Registries in Armenia

Lilit Poghosyan ¹, Gohar Melkonyan ², Anna Koshetsyan ³, Viktoria Babajanyan ⁴, Lusine Sahakyan ⁵

Coordination of Care and Navigation

Significance & Background

Oncohematology registries serve as an essential tool for collecting data that can be used to improve clinical practice and scientific research. In Armenia, the blood disease registry at the Hematology Institute has been developing over the past five years. Currently, it contains information on 16,000 patients with oncohematological diseases, 12,000 patients with benign hematological conditions, and 6,700 patients with coagulation disorders, including hemophilia. The successful operation of these registries requires the involvement of a multidisciplinary team, with nurses playing a key role in data collection and patient interaction.

Purpose

This study aims to analyze the contribution of nurses to the management of oncohematology registries in Armenia and to highlight the challenges they faced in collecting patient data, particularly in terms of communication barriers due to cultural factors and the impact of the COVID-19 pandemic.

Interventions

Nurses are responsible for collecting patient histories, laboratory and diagnostic data, and ensuring proper follow-up. In Armenia, where patients often exhibit reluctance to openly discuss their health conditions, nurses played a pivotal role in facilitating communication, thereby improving the accuracy of the data collected. During the COVID-19 pandemic, nurses also adapted registry workflows to maintain data collection despite the challenges posed by the crisis.

Results

Through the systematic efforts of nurses, the registry now contains comprehensive and reliable data for thousands of patients. The personalized approach nurses employed in interacting with patients contributed to improved data quality. Despite the disruptions caused by the pandemic, the registry remained operational, ensuring the continuity of its functions.

Discussion

The role of nurses in managing oncohematology registries in Armenia underscores the importance of their involvement in data collection and registry maintenance. The experience gained during the COVID-19 pandemic highlighted the necessity of adapting to evolving circumstances and fostering better communication with patients within a culturally specific context. These lessons can be applied to further improve registry operations and inform future guidelines for data management.

Oncology Nursing Forum. 2025 Mar 1;52(2):299.

P511. Results of a Quality Improvement Project Addressing Clabsi Risk by Standardizing Central Venous Line Selection for Cellular Therapy Patients

Margaret Pohl ¹, Brooke Henry ², Michael Keng ³, Judy Kauffman ⁴, Carly Grubbs ⁵, John Wagner ⁶

Quality and Safety

Significance & Background

In Fall of 2022, central line-associated bloodstream infection (CLABSI) numbers among cellular therapy patients at our academic medical center exceeded target.

Purpose

To create a standardized protocol for selecting the type and duration of central venous catheters (CVCs) used during the cellular therapy process.

Interventions

After conducting an extensive literature review on CLABSI risks related to central lines in cellular therapy patients, a multidisciplinary team then developed an evidence-based algorithm to optimize central line selection. The algorithm prioritized minimizing the number of lumens required and leveraged existing implanted ports, avoiding the placement of additional multi-lumen CVCs. It also stipulated the removal of lines following two consecutive outpatient infusions that did not involve caustic medications. The first Plan-Do-Study-Act (PDSA) cycle was implemented in January 2024, targeting autologous (aSCT), allogeneic (allo-SCT) stem cell transplants, and CAR-T therapies.

Results

Initial data indicated a decrease in median line days for aSCT patients from 30 to 20, along with a reduction in average lumens from 2.7 to 2.2. For allo-SCT patients, median line days decreased from 54 to 49, with no significant change in lumen count. CAR-T patients showed a reduction in lumens from 2.4 to 1.6. Notably, prior to algorithm implementation, 40% of CAR-T patients with an implanted port required an additional CVC; this figure fell to 8% post-implementation. The confirmed CLABSI rate among cellular therapy patients from January to August 2023 was 3.3%. Following the algorithm’s implementation from January to August 2024, the rate dropped to 2.2%, achieving a 50% reduction in CLABSIs within the aSCT population.

Discussion

The standardization of line selection contributed to a significant decrease in both the number of lumens used and line days, which correlated with a reduction in CLABSIs among cellular therapy patients. Future efforts will focus on further refining the line algorithm to optimize lumen use and explore additional strategies for reducing line days.

Oncology Nursing Forum. 2025 Mar 1;52(2):299–300.

P512. Integrative Whole Person Oncology Care: an Educational Program for Oncology Nurses

Laura Pole ¹, Susan Yaguda ², Catherine Dodd ³

Professional Development

Significance & Background

Integrative oncology (IO), a patient-centered approach combining conventional treatments with complementary and self care, is gaining recognition. The ASCO-SIO integrative clinical practice guidelines underscore its value. Surveys show that 70 to 80% of cancer patients have awareness or interest in complementary and alternative medicine (CAM), but only 14% discuss this with healthcare providers. Surveys show over half of oncologists recognize the benefits of IO but often underestimate the prevalence of CAM use and fail to ask their patients about it. This lack of inquiry, plus patients’ non-disclosure, call for better education. Oncology nurses, often viewed as trustworthy and approachable, are pivotal in supporting patients’ use of IO.

Purpose

Patients often feel their care isn’t holistic. Most are unaware of integrative care and how to access it. Many are using CAM without expert guidance, seeking CAM information from non-medical sources. Many oncology nurses have limited awareness and knowledge of integrative care. All these factors pose barriers to optimal outcomes.

Interventions

To bridge these gaps, a non-profit evidence-based IO information service implemented a three-pronged educational approach for nurses:

■ Nurses Guide: An enduring online resource with comprehensive IO information.
■ Presentations and Webinars on IO at oncology nursing conferences and online, most offering CE credits
■ Three-Part Class Series at Veterans Administration (VA) Medical Centers covering integrative oncology, evidence-based practices, and the oncology nurse’s role. These included guidance in coaching patients in responsibly selecting evidence-based complementary therapies, and actionable steps for nurses, including certifications, resource libraries, practitioner partnerships, research, program development and self-care, plus enduring materials and CE credits.

Results

The program has reached 350 nurses through conferences and 60 through the live class series, with further engagement anticipated. Future plans include a course on IO for chemotherapy for oncology nurses, a workshop at a major VA oncology conference, repeating the VA course, contributing to the AONN’s Integrative Oncology Nursing Navigation Tool-Kit, and collaborating with major cancer centers to integrate the handbook into nursing education.

Discussion

The project fostered new collaborations and generated significant interest among IO and conventional oncology nurses. The VA’s rapid engagement and nationwide support were notable. Future efforts will focus on expanding the program’s reach and continually updating the educational materials. The project can be a model and resource for nursing education on IO.

Oncology Nursing Forum. 2025 Mar 1;52(2):300–301.

P513. A Nurse Practitioner LED LU177 Treatment Program

Terri Pollack ¹

Treatment Modalities and Managing Administration

Significance & Background

Neuroendocrine tumors (NET’s) are rare and found in the lungs, appendix, small intestine, rectum and pancreas. Treatment is based on type, location, hormones, aggressiveness and metastasis. Lutetium 177 (Lu177) is a radiolabeled somatostatin analog, FDA approved in 2018 to treat somatostatin receptor-positive (SSRP) gastroenteropancreatic neuroendocrine tumors (GEP-NETs). Trials have shown Lu177 is effective in symptom control, quality of life and progression free survival (PFS). NETTER-1 showed PFS of 28.4 months.

Purpose

Lu177 program at an academic center led by an Nurse Practitioner (NP) with skillful coordination of care between oncology, nuclear medicine and chemotherapy unit. Improvement in symptoms, quality of life, prolonged overall survival and PFS.

Interventions

From August 2018 to June 2023, 38 persons (35 SSRP NET’s and 3 off label), followed with 1 medical oncologist and 1 oncology NP, who progressed, were treated with Lu177. Coordination of care clinically and logistically were led by the NP. Patients were seen in clinic and educated about the treatment which was infused every 56 days for 4 cycles. PET CU 64 dotatate scan was performed 4 weeks prior to C1 D1 and 8 weeks after C4. Somatostatin analog injections were given on D5 and D27 of each cycle. Clinic and lab tests were on D −2 and D27. Patients were also seen in the CTU by the NP on D1 of each cycle. Demographics, response, symptom control, QL, OS and PFS were determined.

Results

Thirty-eight patients, with progressive, heavily treated disease, received Lu177. Sites of tumor origin were pancreas, small bowel, rectum, and off label. Thirty-seven patients (97%) completed four Lu177 cycles. Complete response, partial response, stable disease, and disease progression were all evaluated. Median PFS and OS were analyzed. Symptom control improved in 96 %, QL increased in 97 %. Related toxicities were minimal as compared to NETTER-1.

Discussion

We highlight the success of an NP led treatment program that fostered strong collaboration and superb patient outcomes as evidenced by response to treatment, improved symptom control and survival rates. Looking forward there is a need for further expansion of the role of APPs to lead treatment program development, continuity of care and coordination between multidisciplinary groups especially amongst medical oncology, nuclear medicine and the infusion center.

Oncology Nursing Forum. 2025 Mar 1;52(2):301.

P514. Impact: Improving and Maximizing Patient Preparedness at Cellular Therapy and Transplant

Jennifer Polo ¹, Carrie Marvill ², Melissa Brown ³, Rebecca Pesce ⁴, Sarah Kagan ⁵, Mary Pat Lynch ⁶

Patient Education

Significance & Background

An urban academic hospital is one of the only centers performing autologous stem cell transplants (ASCT) without supportive use of blood products. Adult patients, many of whom are Jehovah’s Witnesses, are referred for treatment from across the country. ASCT is a rigorous process requiring patient engagement and preparedness and is commonly one-directional. Understanding that up to 80% of information is forgotten from a medical visit (Kessels, 2003), it is essential to have ongoing bi-directional education for complex procedures like ASCT. Pre-intervention, patients attended a one-time pre-transplant evaluation and were given a binder of educational materials.

Purpose

Cellular therapy and transplant program nurses sought to create a bi-directional education platform for patients and caregivers use throughout ASCT.

Interventions

Oncology nurses led a workgroup including a physician, nurse practitioner, administrator, electronic medical record (EMR) analyst, and other health professionals. The group adapted an EMR feature to design a multi-modal, interactive, on-demand program. Patients and caregivers access the program from their EMR portal on computers, tablets, and mobile phones. The educational program contains information spanning the ASCT care continuum, including eligibility testing, cell collection, high-dose chemotherapy, hospitalization, and recovery. The content was developed focusing on health literacy and varied learning styles. Multimedia includes written content, videos, images and evidence-based resource links. Patients are sent Patient-Reported Outcomes Measurement Information System (PROMIS®) questionnaires at intervals, allowing screening for readiness and potential barriers to care. The patient can contact the care team with questions through an integration feature. The care team accesses a dashboard displaying patient engagement rates, responses, and questions.

Results

The platform launched in July 2024. Nineteen patients were enrolled in the first three months. Patients have successfully submitted questions and completed questionnaires, allowing for interventions to address pain management, social work resources, and further education.

Discussion

Oncology education is the cornerstone of patient-centered care. Effective education requires focus on health literacy and individual learning style. Ensuring patients have evidence-based information in the internet age is vital. Creation of an on-demand platform providing education with integrated connection to providers meets these needs, potentially leading to improved outcomes in patient engagement, safety, and experience, and aids ASCT optimal readiness and recovery.

References

Kessels RP. Patients’ memory for medical information. Journal of the Royal Society of Medicine. 2003;96(5):219–222. doi: 10.1177/014107680309600504. [DOI] [PMC free article] [PubMed] [Google Scholar]

Oncology Nursing Forum. 2025 Mar 1;52(2):301–302.

P515. The Surface: Leadership in Preventing Hospital-Acquired Pressure Injuries in Hematology-Oncology Patients

Herson Portillo ¹

Quality and Safety

Significance & Background

In a hematology-oncology unit, a troubling increase in Hospital-Acquired Pressure Injuries (HAPIs) among high-risk patients prompted urgent action from nurse leaders. Due to their compromised immune systems and the intense treatments they receive, these patients are especially susceptible to skin breakdown. The existing preventive measures proved inadequate, necessitating a more targeted and strategic approach to curb the rising incidence of HAPIs and protect this vulnerable population.

Purpose

The primary goal of this initiative was to harness leadership to significantly reduce HAPIs among high-risk patients while fostering a culture of continuous improvement in nursing practices to enhance safety and quality care.

Interventions

The Pressure Ulcer Prevention (PUP) Stars, an interdisciplinary team comprising nurses, clinical partners, and unit managers, was established to tackle the issue. They conducted a thorough root-cause analysis, which revealed several contributing factors: inconsistent adherence to protocols, educational gaps, and insufficient frequency of skin assessments. In response, the team implemented several critical interventions: enhanced educational sessions on the latest pressure injury prevention practices, a mandatory “two-hourly” rounding protocol, standardized skin assessment procedures, and the deployment of pressure-relieving devices. Leadership played a pivotal role by providing the necessary resources and cultivating a culture of accountability and staff engagement.

Results

These targeted interventions have yielded a significant 60% reduction in HAPIs during FY24, a testament to the effectiveness of the team’s efforts. The combination of ongoing education, diligent skin assessments, and proactive measures, such as using specialized mattresses, played a crucial role in this success. Furthermore, the unit celebrated 100 consecutive days without a single HAPI, marking a significant milestone not achieved in several years.

Discussion

This initiative underscores the vital role of nursing leadership in driving systemic change and significantly improving patient outcomes. By integrating evidence-based interventions with robust leadership support, the team successfully reduced the incidence of HAPIs. This initiative sets a precedent for other unitsce care standards and patient sa aiming to enhanfety and underscores the importance of continuous education, vigilant monitoring, and regular protocol reviews to sustain and further improve these outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):302.

P516. Divide and Conquer – The Success of a Phased Nursing Orientation

Mariah Powell ¹, Tracey Dilas ²

Management

Significance & Background

Experienced nurses new to oncology bring a wide range of skills but face a steep learning curve. A fifty-chair rural outpatient infusion clinic saw an influx of nurses transferring from inpatient and emergency room settings during and after the COVID-19 pandemic. These nurses were becoming overwhelmed with new information, multiple medications, and documentation requirements when entering the outpatient oncology setting.

Purpose

Our team developed a phased orientation plan to better leverage the nurses’ skillset and meet their learning needs rather than the uninterrupted traditional structure. The new model subdivides learning into digestible components, allowing the skills and knowledge to be acquired in a metered, logical sequence.

Interventions

The orientation is divided into 3 parts. Phase 1 is preceptor-guided, focusing on general clinic orientation, non-chemotherapy infusions/injections, IV/Port access, electronic health record training, and hypersensitivity reaction management. Upon competency validation, the nurse transitions to Phase 2, a 4-week period of assuming a full patient assignment limited to the medications and skills learned in Phase 1. No chemotherapy agents are administered during this time. The nurse also completes the ONS/ONCC Chemotherapy Immunotherapy Certificate course during Phase 2. Phase 3 is again preceptor-guided, focusing heavily on chemotherapy regimens and associated treatments. By the end of these 4 weeks, the nurse will complete chemotherapy competency verification and successfully conclude their orientation.

Results

The phased orientation has been beneficial for experienced, yet novice oncology nurses to learn the components of their role gradually. The 15 nurses who have completed this updated orientation stated they felt much more confident in their knowledge and skill building, especially related to chemotherapy administration by learning the other aspects of the role earlier in the orientation. These comments are in contrast to the 14 nurses who completed traditional orientation and although successful, felt as if they did not fully grasp all of the information due to overload.

Discussion

Orientation does not need to be linear. Phased orientation allows novice oncology nurses to first gain comfort with documentation, time management, and general outpatient oncology care. When transitioning into the chemotherapy phase, they build upon the basic skills and knowledge to learn and administer the complex regimens. Employing the phased orientation has ensured our nurses are supported, competent, and validated in both knowledge and skill, ultimately creating a safer and stronger oncology care team.

Oncology Nursing Forum. 2025 Mar 1;52(2):302–303.

P517. A Collaborative Project Between Inpatient and Outpatient Nurses to Enhance Clinical Practice and Confidence

Jeanette Prado ¹, Carrie Patton ², Angela Yencer ³, Dea Kurtovic ⁴

Management

Significance & Background

Recent data indicates that approximately 80 percent of oncology treatment is administered in the ambulatory setting. Oncology nurses play a pivotal role in providing high-quality care and delivering up-to-date, disease-specific, and treatment-related information. As liaisons between patients and the broader healthcare team, inpatient and outpatient nurses must function competently and confidently to manage patient care effectively. Ensuring proficiency is critical to optimizing patient outcomes and maintaining continuity of care.

Purpose

To enhance nurse confidence and top-of-scope practice in administering chemotherapy, managing side effects and complications as well as strengthening their ability to deliver patient education and teaching.

Interventions

Leadership and education teams identified barriers preventing oncology nurses from delivering high-quality patient education, addressing symptom management, and decreasing hospital admissions and clinic visits. Barriers included limited resource utilization and a self-reported lack of confidence with providing oncology specific education. A quality improvement project was launched to enhance collaboration, standardize education, and improve clinical practice among oncology nurses. An eight question Likert scale survey was developed to assess nurses’ confidence with educational tasks, evidence-based nursing, and use of current resources. Additional data was gathered on preferred methods and times for education. Based on these results, didactic education sessions were conducted to address gaps related to pathophysiology, pharmacology, and symptom management. The sessions were organized for both inpatient and outpatient settings and were led by advanced practice nurses and physicians. Additionally, a new outpatient nurse educator role was proposed to provide ongoing education and dedicated support to the outpatient setting.

Results

17 pre and 31 post surveys were collected, predominant responses for both were “agree” and “strongly agree” except for those related to treatment regimens, use of current resources and disease process. Time constraints and lack of available resources were cited as severe and major barriers to providing patient education.

Discussion

This process was helpful in identifying nurses’ educational needs, gaps in ambulatory educational support, and opportunities for providers and APRN’s to engage with nurses during didactic sessions. Increasing nurses’ confidence and top of scope practice has been shown to improve patient outcomes in both settings. Key discrepancies were identified with nurses reporting a lack of knowledge and resource utilization despite a high level of confidence when surveyed. This project highlighted the importance of providing multi-modal continuous education to address gaps in knowledge and confidence.

Oncology Nursing Forum. 2025 Mar 1;52(2):303–304.

P518. Taxane Titration: Tailored for Better Outcomes

Terri Price ¹, Jennifer Budig-Rubbelke ², Bridget Dorkewitz ³, Cathryn Letton ⁴, Kelly Pabst ⁵

Treatment Modalities and Managing Administration

Significance & Background

The Dana Farber Cancer Institute (DFCI), Boston, MA, conducted a project to evaluate the benefits of taxane titration to reduce hypersensitivity reactions (HSRs). They concluded that the patient group with titrated taxanes had significantly less taxane related HSRs than the non-titrated patient group. Outpatient Infusion Quality Team (OIQT) decided to implement our own quality project and attempt to replicate their project outcomes. Taxanes are at greatest risk of causing HSRs during the first and second lifetime exposures. HSRs need immediate care and can interfere with the continuation of preferred treatment. Currently, our infusion nurses use different approaches of slow titration to prevent HSR. In preparation for this project, a literature review was conducted and identified no published standardized recommendations for taxane titrations to prevent HSRs. DFCI came to the same conclusion and stated they used a desensitization protocol developed by their allergy team. We trialed the DFCI protocol to standardize our administration guidelines for all taxanes given in infusion.

Purpose

The goal was to determine if a standardized gradual infusion rate titration would decrease the incidence and severity of immediate HRSs during the first two exposures to taxanes.

Interventions

Education was created by the OIQT and presented to the infusion nurses at a staff meeting. The charge nurses and preceptors served as resources for any questions encountered throughout implementation. Any HSRs to taxanes were documented in the medical record and occurrence report (OR) system so the OIQT could track outcome data.

Results

A key objective addressed by the DFCI project was to “prime” the administration tubing with medication, so the titration volume was drug, not saline. It was hypothesized that desensitization would be more reliable if the taxane was delivered from the initiation of the infusion via slow titration. We contacted the IV tubing manufacturer to verify recommended prime volumes. A three-month baseline review of ORs revealed four documented HSRs with the first and/or second taxane cycles. The OIQT chose to match the same timeframe for the quality project. Outcome data identified zero HSRs to taxanes when using the standardized titration method.

Discussion

The project demonstrated similar outcomes to our peers, utilizing a standardized titration protocol results in a decrease in HSRs during first and second exposures to taxanes.

Oncology Nursing Forum. 2025 Mar 1;52(2):304.

P519. End of Week Update: A Structured Framework for Clinical Knowledge Dissemination

Brittany Puccia ¹, Megan Corbett ², Crystal Derosier ³

Management

Significance & Background

Expectations for professional nursing practice include staying abreast of advancements in evidence-based practices, as well as organizational policies, procedures, and guidelines. Nurses must be familiar with regulatory guidelines, certification requirements, and participate in clinical inquiry to stay informed about the ever-changing oncology landscape. Given the overwhelming amount of information available, it is crucial to develop clear, and efficient communication pathways. A Nurse Clinical Specialist (CS) team developed a structured and accessible weekly email to disseminate best practices and important updates to the clinical teams.

Purpose

To provide a consistent electronic pathway for information sharing to nursing teams through a reoccurring and organized approach within a large ambulatory cancer center.

Interventions

A structured template was necessary to ensure effective information sharing. This template includes recurring sections such as “Certification Corner”, “Joint Commission Corner”, “Question of the Week” and “Riddles”. These sections provide updates, highlight professional development opportunities, and encourages engagement, while adding an element of fun. The weekly update also features clinical pearls and practice guidelines to promote adherence to evidence-based guidelines and institutional policies. The CS team meets weekly to review and finalize the update before disseminating to clinical teams across all regional campuses.

Results

An anonymous electronic survey found that clinical staff appreciate the structured communication pathway. 72% of respondents found the updates were valuable, with an overall rating of 4.33 out of 5 stars. 93% of respondents reported referring to archived weekly updates, demonstrating the value and accessibility of the electronic format. While 62% of staff concluded that the weekly update had no impact on their interest in certification, there is room for improvement in this area. Survey feedback indicates staff would like more information on new drugs, reminders on clinical guidelines, and an improved search functionality.

Discussion

The weekly update serves as an efficient and effective way of information sharing within clinical teams. It promotes continuous staff learning and competency development by disseminating best practices and knowledge. Interdisciplinary teams across the organization, including pharmacy, informatics, and medication safety, have adopted the weekly update to meet the needs of many clinical teams. The Clinical Specialists are committed to meeting the needs of all teams and recognize opportunities exist to improve the framework to ensure continued staff engagement and learning.

Oncology Nursing Forum. 2025 Mar 1;52(2):304–305.

P520. Identification of Educational Barriers in Cancer Care and the Impact of Navigation in Resolving them: a Retrospective Cross-Sectional Study at a Specialized Oncology Center in Colombia

Edwin Orlando Pulido Ramirez ¹, Beatriz Andrea Prada Alvarez ², Lady Alejandra Masmela ³, Julieth Montaño ⁴, Adriana Carolina Aya Porto ⁵, Carlos Arbelaez ⁶

Coordination of Care and Navigation

Significance & Background

Nurse navigation in oncology is a crucial approach that supports patients throughout their cancer care journey, addressing barriers such as financial, psychological, logistical, and language challenges. Research has shown that this model not only improves clinical outcomes but also promotes equitable care. Since the introduction of navigation in 2003, the role of nurse navigators has evolved from community-based programs to integrated care centers, emphasizing the need for navigation programs to be tailored to specific populations. This adaptation is vital for reducing morbidity and mortality associated with cancer.

Purpose

This study aims to identify and address the educational barriers faced by Colombian patients referred to an oncology referral center and to evaluate the effects of an educational intervention provided by oncology nurse navigators. Recognizing that educational needs are unique to each environment, the study seeks to implement targeted educational strategies that can mitigate these challenges.

Interventions

A retrospective, cross-sectional study was conducted at the Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC) in Bogotá D.C., Colombia. During navigation consultations, a specialized nurse navigator used a standardized tool to identify educational barriers. The educational intervention involved providing tailored materials developed by the CTIC and assessing patient comprehension through explanations of the information presented.

Results

Out of 819 patients included in the study, 82.1% reported having educational needs. The primary areas of need were:

■ Health system and administrative management (70.9%)
■ Diagnosis, treatment, and rehabilitation (61.9%)
■ Physical and daily living aspects (23.6%)
■ Psychological and social aspects (10.5%)
■ Sexuality and body image (1.7%)

Post-intervention, 78.6% of patients adequately understood administrative management information, while 75.7% grasped the details regarding diagnosis and treatment. Overall, 99.5% of educational interventions resulted in improved knowledge.

Discussion

This study underscores the importance of recognizing and addressing educational needs in oncology care within Colombia. Most patients, particularly at early diagnostic stages, encounter significant barriers due to a lack of knowledge about the healthcare system. The intervention led by nurse navigators markedly improved patient understanding, indicating a strong need for culturally tailored educational strategies. While these findings are representative of Colombia, similar barriers likely exist across Latin America, warranting further research into the impact of these interventions on treatment adherence and survival outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):305–306.

P521. Keep Moving: Early Mobilization to Reduce Fall Rates

Kira Radstrom ¹, Kaya Brannen ², Amanda Tran ³, Jennifer Martinez ⁴

Quality and Safety

Significance & Background

Falls during hospitalization are a significant concern and can have serious consequences for patients, including physical injury, prolonged hospital stays, and increased morbidity and mortality. Current fall prevention strategies on the home unit for this project include bed and chair alarms, non-skid socks, fall-risk wristbands, and call light education. Despite these measures, the unit continues to experience high fall rates compared to established goals.

Purpose

This project aimed to investigate the impact of an early mobilization program on fall rates in a 26-bed inpatient oncology unit. The program combined patient education with exercises tailored to individual patient ability.

Interventions

A mobility education poster (Figure 1) was developed and placed in each patient room, outlining independent exercises appropriate for patients based on their mobility score, as determined according to the Bedside Mobility Assessment Tool (BMAT). The selection of specific exercises was informed by a literature review and collaboration with the hospital’s physical therapy department. One-on-one educational sessions were conducted throughout the implementation period, and nurses were reminded to encourage patient participation in the program during each shift.

Results

During the pre-intervention period (4/18/24 – 6/17/24), 6 falls were recorded, out of which 4 were unwitnessed and attributed partly or entirely to patient noncompliance with fall precautions (Figure 2). The other 2 falls were witnessed, but not assisted. In the post-intervention period (6/18/24 – 8/17/24), 2 falls were recorded, both of which were witnessed and assisted descents to ground by staff. Qualitative feedback indicated that patients desired to stay active during hospitalization and were willing to participate in early mobilization exercises.

Discussion

The impact of this project shows substantial promise, but the implementation process illuminated opportunities for improvement and future directions. Additional education should be provided to staff and patients to encourage continued participation and promote documentation. In the future, researchers intend to investigate different avenues for distribution of patient education materials and integrate mobility charting more effectively into the standard workflows of nurses and care partners.

Oncology Nursing Forum. 2025 Mar 1;52(2):306.

P522. Nursing Management of Infusion-Related Hypersensitivity Reactions Protocol

Alice Ramones ¹

Treatment Modalities and Managing Administration

Significance & Background

The absence of a formalized protocol for managing infusion-related hypersensitivity reactions (IRHRs) in the Medical-Oncology Unit has led to inconsistent patient care during chemotherapy. Without standardized guidance, healthcare providers face uncertainty, which can delay treatment and increase the risk of severe reactions (Sullivan et al., 2020). Early recognition and timely intervention are crucial for managing IRHRs (Kim et al., 2021). Structured education and competency training have improved nursing proficiency and patient outcomes (Brown et al., 2022). This initiative addresses these gaps to improve care consistency and patient safety.

Purpose

This quality improvement (QI) project aims to implement an in-service training program and formalize an IRHR protocol to enhance the knowledge, competence, and confidence of chemotherapy- and immunotherapy-certified nurses in the Medical-Oncology Unit. The project fosters interdisciplinary collaboration, aligns with institutional policies, and strengthens nursing competencies to improve patient safety.

Interventions

Reviewed and approved by a California university’s Institutional Review Board (IRB), the project is expected to be completed by November 2024. A formal IRHR protocol was developed, and pre-and post-tests were created to assess nurses’ knowledge and competence in managing IRHRs. In-service training will be administered, followed by post-testing. Nurses requiring additional support will receive further training and mentoring. The protocol will be incorporated into the chemotherapy checklist and guide non-oncology staff, such as cross-cover doctors and the rapid response team (RRT), during IRHRs.

Results

The IRHR protocol is expected to improve nurses’ knowledge and competence significantly. Post-test scores are anticipated to increase by 30%, with 90% of nurses meeting competency thresholds on the first attempt. Nurses requiring additional training are expected to achieve competence after further sessions. Additionally, nurses are expected to report increased confidence in managing IRHRs.

Discussion

This QI project will advance nursing practice in the Medical-Oncology Unit by standardizing the management of IRHRs. Through structured education and continuous quality improvement, the initiative aims to enhance nursing competencies, improve patient safety, and promote interdisciplinary collaboration for better clinical outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):306–307.

P523. A New Initiative: The Administration of Intravesicular and Intra-Nephrostomy Medications for Bladder Cancer

Rosmary Ramos ¹, Sarah Mendez ², Patricia Hughes ³, Qiao Yan Mamie Li ⁴, Claire Post ⁵, Michael Wuckovich ⁶

Management

Significance & Background

Patients with non-muscle invasive bladder cancer have traditionally been treated with systemic chemotherapy and at our Genitourinary (GU) surgical practice via an indwelling urinary catheter. For those with low-grade upper tract urothelial carcinoma (LG-UTUC) science has come a long way and there is now a direct method of targeting this tumor type to chemotherapy via a nephrostomy tube. The ambulatory nurses at this NCI-designated comprehensive cancer center very rarely handled indwelling urinary catheters and nephrostomy tubes, thus leading to a need for education regarding placement, management, removing an indwelling urinary catheter and also managing a nephrostomy tube.

Purpose

To educate the nursing staff on indwelling urinary catheters, and management of a nephrostomy tube for administration of chemotherapy.

Interventions

Our standing procedure for intravesicular medication administration needed updating as products changed. Our clinical resource nurse (CRN) observed at the GU clinic to determine what was necessary for the procedure. Once all necessary information was compiled the procedure was reviewed and updated to ensure it met hospital standards. Nurses on the unit were then educated on indwelling catheter management along with how to administer medication through it. The intra-nephrostomy procedure was new to us and required a new policy to ensure all managed the patients in the same manner: the CRN went to the GU clinic to observe this procedure and determine supplies necessary. A policy was developed and nurses were educated on the procedure along with the instrument that was necessary for administering the medication. This medication is very viscous requiring a specific instrument to administer to the patient within a very specific time frame. Each nurse trained in these procedures performs 3 separate administrations with a competent nurse to become competent themselves.

Results

The nurses who are trained and educated on indwelling urinary catheter, and on the management of a nephrostomy tube for administration of chemotherapy are caring for this patient population effectively. The patients have been giving positive feedbacks.

Discussion

Our nurses are successfully caring for this new patient population, and they keep training other nurses on the unit. Nurses continue to receive education on the procedure of administering intravesicular chemotherapy/biotherapy and administering chemotherapy via nephrostomy tube. The plan is to continue training until 100% of nurses on the unit are trained on these two procedures.

Oncology Nursing Forum. 2025 Mar 1;52(2):307–308.

P524. A Multidisciplinary Educational Intervention to Promote Efficiency of the Discharge Process and Optimize Hospital Inpatient Flow

Natasha Ramrup ¹, LaMonte Bullock ², Odalis Cortes ³, Maria May Mariano ⁴, Taylor Krupa ⁵, Magalie Bruneus ⁶

Healthcare Delivery

Significance & Background

Discharge planning starts at the time of admission. At this NCI-designated Cancer Center, the discharge huddle occurs daily with a multidisciplinary team to discuss, review, and address all issues for patients anticipated discharge 24–48 hours before release. The hospital’s organization has a goal of discharging patients early. For example, 50% of intended discharges should leave before 2 PM and 10% before 11 am. Barriers to early discharge include delays due to poor communication, lack of education on discharge steps, and insufficient handoff from previous care teams. Using data collected from analyzing the discharge process, we created a multimodal intervention to address these challenges, focusing on education and communication.

Purpose

This abstract discusses a multimodal intervention to quickly orient house staff about discharge process, including the order of various necessary steps, while maintaining efficiency, promoting patient safety, and enhancing the patient experience.

Interventions

The multidisciplinary team created an Orientation Packet: Previously overwhelming, now streamlined with added content to aid in discharging complex patients. A “Discharge Person” visual aid: to review the discharge process, it contained a QR Code which provides a quick overview of pertinent discharge information, including steps, personnel, and patient-specific details. In addition, a Discharge Checklist (MCARES): Systematizes steps: medication reconciliation, caregiver/patient awareness, transportation availability, home care referral, homecare equipment, and supplies. Communication about the above interventions is utilized at daily huddles.

Results

The creation of new education content led to a twenty-minute decrease in discharge time and earlier placement of a discharge order by one hour. Incidence of unplanned or “surprise discharges” was reduced by 10 percent due to improved communication. The House staff team response from our education survey indicated that their understanding of the necessary steps for discharge improved from 15% to 62 %, and their knowledge about the timing of the discharge steps improved by 37%. Finally, 62% indicated that the discharge visual aid was helpful in the discharge process. Most importantly, these interventions have significantly enhanced the patient’s experience.

Discussion

Patients’ experience is the center of improving discharge operations on this disease management team. Discharge planning, communication, education, and readiness are vital to improving the efficiency of early discharges before 11 am. The multidisciplinary collaboration on improving these discharge processes allows for safe discharges while meeting the organizational goal.

Oncology Nursing Forum. 2025 Mar 1;52(2):308.

P525. Creation of a Nursing Centric Tumor Infiltrating Lymphocyte Therapy Program

Linda Ramsdell ¹, Caitlin Guerrero ², Devin Miller ³

Treatment Modalities and Managing Administration

Significance & Background

Tumor Infiltrating Lymphocytes (TIL) therapy is newly FDA approved for treatment of relapsed/refractory unresectable or metastatic melanoma. Cellular therapy programs are currently adopting this treatment within their existing portfolios. TIL therapy has novel components within the standard cellular therapy process, it was important to build a program with sustainable nursing centric workflows at its core.

Purpose

Our IEC program addressed the integration of TILS therapy into an existing portfolio. Utilizing a foundation of nursing and programmatic workflows we sought to enable patients to successfully receive these novel aspects of the TIL therapy.

Interventions

TILS therapy demands collaborative communication across multiple disciplines. Patients are identified by the disease center and referred into the IEC program. The IEC nurse navigators coordinate their care throughout treatment. While there are many parallels to CAR T-cell therapy, there are distinct differences for TILS. Patients undergo tumor procurement surgery instead of leukapheresis and receive high dose interleukin-2 (HD IL-2) following cell infusion. The logistics of OR scheduling and tumor transit to the lab requires collaboration. Inpatient and outpatient teams, including APPs, nursing and MDs built the workflows for IL-2 administration. Workflows needed to include touch points for toxicity assessment, intervention, and utilize institutional policies. These workflows promote safety and collaboration during treatment. Prior to each dose of HD IL-2, there is a discussion between nursing, APP and MD to determine eligibility to dose. There is defined criteria for review, and standardized documentation. Escalation processes to the ICU are clear, with a low threshold for transfer. Prior to launch, thorough education was given to all stakeholders. All members of the team are aware of the implications of chemotherapy, cellular therapy, HD IL-2 toxicity, and escalation pathways.

Results

We have successfully infused one patient to date utilizing the workflows. The patient tolerated the cells and HD IL-2 dosing. Pre-dose safety checks were employed without difficulty or concern.

Discussion

Implementing TIL therapy within a robust cellular therapy portfolio was an iterative process that transpired over years. Development and refinement of the administration of HD IL-2, scheduling specialized procedures in the OR, and introducing new workflows for communication was a nursing led multidisciplinary approach to ensuring TILs therapy was implemented with safety as the primary objective. This process will continue to evolve but has a solid foundation built on strong communication.

Oncology Nursing Forum. 2025 Mar 1;52(2):308–309.

P526. Supporting Nursing Certification in a Rural Cancer Center

Krystal Ramsey ¹

Professional Development

Significance & Background

Leadership in a rural, community cancer center set a goal to increase the number of oncology certified nurses. 10 nurses at the cancer center were oncology certified in January 2024. Various resources were available to staff within the organization. However, staff voiced unmet needs and lack of awareness of resources as barriers to certification.

Purpose

The goal was to identify barriers and resource knowledge gaps to develop an action plan to support the leadership goal of increasing the number of certified nurses.

Interventions

January 2024, a pre-survey was sent to nurses. After results were analyzed, a mentor program was implemented in February and participation in the ONCC FreeTake Program began in May. Communication of resources occurred via email, meetings, and flyers in May and June 2024. In September, a post-survey was sent to nurses to evaluate effectiveness of interventions.

Results

In the pre-survey, 47% of total respondents identified cost as a barrier. 53.8% of non-certified nurses reported not feeling prepared. 69.2% of non-certified nurses identified interest in a mentor program. In the post-survey, 50% of non-certified nurses were aware of the ONCC FreeTake Program and mentor program. 55% of barriers correlated with upfront cost or reimbursement of exam cost. 37.5% of non-certified nurses reported not feeling prepared. 50% of non-certified nurses reported a lack of reward for certification, which was reported by 30.8% in the pre-survey. Between surveys, the organization communicated a plan to cease pay increases for nursing certification, which may have impacted the results. As of September, 6 nurses have submitted authorization to test (ATT) via the ONCC FreeTake Program and are pending test dates, 1 nurse stated intent to submit ATT by end of 2024, 3 nurses have participated in the mentor program, and 5 nurses contacted the nurse educator to discuss resources with the intent to take the certification exam by end of 2025.

Discussion

Barriers to certification are multifactorial and evolve over time. Addressing staff barriers provides support to nurses to pursue certification. To continue to provide support, a periodic gap analysis to identify barriers and knowledge gaps of resources should be completed. Based on survey results, additional communication regarding certification resources should occur multiple times throughout the year to reinforce resources, educate new hires, and highlight organizational rewards/recognition programs for certified nurses.

Oncology Nursing Forum. 2025 Mar 1;52(2):309.

P527. Effect of Oncology Shadowing Program on Nurses’ Perception of Floating

Ashley Ramsey ¹, Meghan McDannald ²

Management

Significance & Background

Based on staffing needs, oncology nurses may float to another unit within a seven-unit oncology service line in an academic medical center. Concerns around floating were brought forward by staff nurses during Oncology Employee Engagement Task Force meeting. Oncology nurses in a sub-specialty may not be as familiar caring for patients in other sub-specialties. Working in an unfamiliar environment can increase stress, leading to negative feelings towards floating. A familiarization program may increase nurse satisfaction and decrease apprehension around floating.

Purpose

The purpose of the oncology service line shadowing program is to reduce apprehension around floating and increase familiarity in caring for alternate oncology patient populations.

Interventions

The shadowing program was designed for nurses 4–6 months post-hire to shadow alternate units within the oncology service line. Pre-survey data were collected from eighteen staff nurses with less than 1 year experience to determine timeline of shadow day. Units are divided into four sub-categories: bone marrow transplant, medical oncology, gynecology oncology, and critical care. Staff members shadow alternate units for a 12-hour shift, divided into three 4-hour segments in each sub-specialty excluding their primary sub-specialty. Prior to shadowing, nurses receive an informational packet including population, standard protocol, and nurse leadership information for each unit. Individual unit nurse leaders are expected to check in with shadowing nurse during their experience.

Results

At the one-year mark, a post-survey was sent to participants with a response rate of 28%. When asked if nurses felt apprehensive about floating prior to shadow day, 58.3% agreed and 25% strongly agreed. Six (50%) have floated to another unit since attending the shadowing day, and all reported feeling familiar with unit layout. Of total participants, 66.7% agreed and 25% strongly agreed they were more knowledgeable caring for other oncology populations after the shadow day. All participants reported increased understanding of nursing workflow on other units. Some reported communication concerns, including lack of unit preparedness and leadership engagement.

Discussion

Increased nurse perception of comfort and decreased apprehension was significant for participants. Nurses reported increased familiarity with unit layout and decreased apprehension around caring for populations within oncology outside of their main subspecialty. Based on comments, pre-assigning preceptors to shadow and reducing time spent in each unit may be more beneficial. Shadowing units prior to floating may have a positive impact on nurse satisfaction.

Oncology Nursing Forum. 2025 Mar 1;52(2):309–310.

P528. Enhancing Nursing Practices in the Assessment and Management of Taste Alterations in Cancer Patients

Mary Grace Ray ¹, Mary Grace Ray ², Sweet Jessica Galvarole ³, Sweet Jessica Galvarole ⁴, Rose Egbutu ⁵, Tracy Meissner ⁶, Vivian Arrindell ⁷

Symptom Management and Palliative Care

Significance & Background

Dysgeusia, a condition characterized by altered or lost taste, is a significant issue for oncology patients and can contribute to high malnutrition rates. It affects 50–70% of cancer patients undergoing cancer treatments such as chemotherapy, radiotherapy, or bone marrow transplant, often lasting for weeks, months, or even years. Oncology nurses must understand the risk factors for dysgeusia and know how to assess it effectively. Nurses should work closely with dietitians and providers to effectively address patients’ nutritional challenges, enhancing both their quality of life and clinical outcomes.

Purpose

To minimize its impact, the goal is to enhance nurses’ understanding of risk factors and nutritional management. This involves educating nurses on identifying the causes of dysgeusia and implementing proactive interventions for its assessment and management. Evidence-based research was reviewed to uncover the underlying causes of taste alterations and effective coping strategies.

Interventions

A literature review was conducted using ONS and Medscape databases. The words: “cancer,” “risk factors,” “dysgeusia,” “chemo,” “bone marrow,” “radiation,” and “managing taste alterations” were used to generate articles. Articles were analyzed for variables causing dysgeusia and recommended care plans. Retrospective data collection from hematology, bone marrow transplant, and solid patients that indicated taste alterations during assessment were used to identify variables that might influence their taste alterations. An in-service was presented to the nursing staff regarding the evaluation and management of dysgeusia. A survey was captured to grade improvements in the nurses’ improved understanding of managing dysgeusia.

Results

Evidence-based journals indicate that chemotherapy and radiation are the primary causes of dysgeusia in cancer patients. This might suggest that dysgeusia is often temporary and may improve after treatment. Further retrospective data collection showed variables such as xerostomia, candidiasis, oral mucositis, head and neck tumors, pain medications, antibiotics, zinc deficiency, etc. Educated nurses offer positive feedback and feel more empowered and proactive in assessing and helping patients cope with dysgeusia.

Discussion

This project seeks to enhance front-line nurses’ clinical practice by fostering effective collaboration with registered dietitians and physicians. The goal is to empower oncology nurses with the knowledge and skills to evaluate and manage taste alterations that may contribute to poor appetite or weight loss. By improving the assessment and management of these issues, the project aims to enable timely interventions that enhance patients’ nutritional intake and overall care.

Oncology Nursing Forum. 2025 Mar 1;52(2):310–311.

P529. Redefining Ringing the Bell: Increasing Inclusivity and Improving the Patient Experience

Ashley Todd ¹, Alexia Rayburn ², Kathleen Murphy ³, Martie Steinfeld ⁴, Chelsea Traughber ⁵

Healthcare Delivery

Significance & Background

“Ringing the Bell” is a tradition in many organizations, celebrating a patient’s completing treatment. For many patients though, this “celebration” may feel exclusionary and even upsetting (Greer, 2022). One survey indicated patients who participated in bell ringing at the completion of treatment had increased negative emotions associated with the end of treatment (Williams & Hu, 2019). A recommendation from the Oncology Nursing Society (2022) was to redefine the bell and expand inclusivity for patients thus increasing associated positivity. At our community-oncology practice with 30+ locations, bell ringing varied widely as far as who, when, and how the bell rang.

Purpose

Oncology Nurse Residents (ONR) at our practice must identify a relevant topic and complete a literature review project (LRP) that improves patient care or journey.

Interventions

During ONR clinic rotations, differences in practice were observed. An LRP topic was submitted to and approved by a multidisciplinary team to redefine ringing the bell. LRP parameters included the significance and impact of bell ringing traditions, their effect on patient satisfaction and feelings of inclusivity as well as types of bells, locations, and cost. Once completed, findings and practice change recommendations were made, by formal presentation, to organization leaders.

Results

With our current practices of ringing the bell with treatment completion only, many patients never have an opportunity to “ring the bell.” For that reason, some clinics totally banned ringing the bell which deprived all patients of the opportunity. A practice change was needed to increase access to and broaden definitions of celebratory milestones. Bells needed to be located throughout patient care areas and patients encouraged to ring the bell anytime they feel appropriate. Implementation of “redefining the ringing of the bell” is projected for Spring 2025. The updated practice will be introduced organization wide. Collaboration with physician leaders and local teams will determine bell type and locations. Post implementation surveys will be done at defined intervals to measure patient and staff satisfaction and identify any needed modifications.

Discussion

ONR LRPs allow organizations to identify areas of improvement and determine next course of action. In this case, creation, and implementation of a broader definition for” the bell” will bring consistent practice, promote inclusivity, and improve overall satisfaction.

Oncology Nursing Forum. 2025 Mar 1;52(2):311.

P530. Back to the Bedside: Bedside Validation of Antineoplastic Administration Knowledge and Skill

Markie Rearik ¹, Valerie Hess ², Wendy Lucas ³

Professional Development

Significance & Background

The nursing workforce is facing a cycle of turnover and staff shortages where vacant positions are being filled with inexperienced nurses. Nursing shortages and inexperienced nursing can significantly compromise the safety of chemotherapy administration, a complex and high-risk process requiring precision, expertise, and attention to detail. At a large Western Pennsylvania hospital, annual competency on chemotherapy administration and order verification are required for all nurses who are certified to administer antineoplastic therapy as per institutional policy. Annual competency validation has historically been performed in a didactic setting simulated with groups.

Purpose

Validating nursing competency at the bedside offers a realistic assessment, as it involves performing procedures on actual patients with varying conditions, providing a true test of a nurse’s ability to adapt and respond. This approach also allows for immediate observation and feedback from experienced professionals, fostering continuous learning.

Interventions

To individualize validation and to offer a realistic assessment of performance with real time feedback, one on one competency assessment was tested under authentic conditions at the patient bedside during antineoplastic administration order verification during the 2024 year. Each antineoplastic nurse had competency validated for one order verification, one continuous Intravenous (IV) administration, and one IV push administration for either real time administration at the bedside or as a simulation. Policy-based questions were asked regarding possible emergency scenarios or rare circumstances (e.g. extravasation, hazardous drug spill). Validation was performed by nurse educators who were experts in the policy and procedures for antineoplastic therapy administration and order verification. Simulations were privately performed with individuals who were unable to perform validation of skills in real-time for various reasons.

Results

One hundred total nurses completed antineoplastic competency validation. There were 168 real time performances, and 129 simulations validated. Topics of reinforcement included proper PPE administration and removal, excretion safety, infection prevention, proper order verification performance by a second nurse. Validators were not involved during the two-nurse verification of order verification and administration to ensure a natural environment was being observed. Surveys were distributed to all antineoplastic nurses regarding satisfaction of learning methods.

Discussion

Opportunities for bedside validation of competency allows for real time feedback that simulations do not have to offer. Observations of antineoplastic therapy administration allows to assess a natural environment to ensure safety, and that best practice is being performed.

Oncology Nursing Forum. 2025 Mar 1;52(2):311–312.

P531. Reducing Hospital-onset C. Difficile in the Bone Marrow Transplant Unit

Sydney Redland ¹, Megan Wood ², Annsley Buffington ³, Barbara Wenger ⁴, Shannon Vernon ⁵, Katrina Espiritu ⁶

Quality and Safety

Significance & Background

Bone Marrow Transplant (BMT) patients are at risk of developing C. difficile infection (CDI) during hospitalization due to their immunocompromised status. This increased infection risk can lead to additional treatments, prolonged hospitalization, and potential complications. Hospital-onset C. difficile is defined as any positive PCR test after the first three days of admission. The occurrence of CDI in the hematology-oncology patient population, is estimated to be between 6%–33% (Rovolinski, 2019). For these patients, environmental factors should be addressed to ensure transmission of nosocomial infections is limited.

Purpose

The purpose of this initiative was to reduce the overall number of hospital-onset (HO) C. difficile cases in the BMT unit. We aimed to reduce occurrences from an average of four events per month to a target of three or fewer events per month by the end of May 2023, resulting in a 25% reduction of CDI.

Interventions

A structured process improvement project was initiated in November 2022 utilizing a formal DMAIC (Define, Measure, Analyze, Improve, and Control) method. Stakeholders from BMT provider and nursing leadership, Environmental Services, and Infection Prevention collaborated over a two-month period to identify barriers to improvement, propose root causes, and develop interventions to overcome identified obstacles. Interventions focused on environmental factors as a primary concern for transmission. Tactics included: place red bouffant cap over hand sanitizer dispenser at room (provides visual cue for soap and water hand hygiene); partner with EVS to develop and disseminate “Who Cleans What” list for equipment (unit versus EVS responsibilities to ensure all patient care equipment is appropriately cleaned); develop discharge room checklist to support staff completion of cleaning needs at discharge.

Results

In the pre-implementation phase, a total of 28 CDI occurred (4 per month). In the post-implementation phase, the team reduced to 3 per month. This effort thus met the pre-project goal of a 25% reduction in incidents.

Discussion

Immunocompromised patients in the BMT unit pose a unique challenge in preventing C. difficile infections. Ongoing work to control for environmental transmission has resulted in reduced monthly occurrences of hospital-onset infections. Learning and best practices were collated into a C. difficile reduction toolkit that was disseminated in August 2023. This environment-focused endeavor, coupled with ongoing work in diagnostic stewardship, has resulted in sustainable improvement.

Oncology Nursing Forum. 2025 Mar 1;52(2):312.

P532. Improving Communication Between Infusion Nurses and Providers: A Quality Improvement Project

Victoria Reifel ¹, Heidi Mason ², Mary Franklin ³

Healthcare Delivery

Significance & Background

Patients with head and neck cancer (HNC) require care from a large multidisciplinary team during treatment. Quality communication between multidisciplinary team members is essential to effective oncology care, especially during patient care transitions in the setting of “bad news”. Lack of communication between multidisciplinary team members results in care that does not align with patient goals and may result in unmet needs. Furthermore, this limits opportunities for nursing staff to support patients and their families through transitions. Improved communication between providers and infusion room nurses, as a way provide patients with seamless support and education, was targeted as a quality improvement project at a Midwest Cancer Center.

Purpose

The purpose of this project is to improve multidisciplinary communication between providers and infusion nurses through the development and implementation of a standardized communication process. This will, in turn, improve communication, reduce barriers to patient care, and create further opportunities for nursing staff to provide support and education to the patient and family during care transitions.

Interventions

A standardized communication template will be developed within the electronic medical record (EMR) system for provider- to-nurse communication that will relay care transitions to the infusion nurses. Anonymous pre- and post-surveys will be administered to the clinic providers and infusion nurses to assess team satisfaction with communication, impact on barriers to patient care, and ability to support patients during care transitions.

Results

This quality improvement project will offer a streamlined protocol to help reduce barriers to care, improve patient satisfaction, and promote a more multidisciplinary approach to patient care.

Discussion

The positive impact demonstrated by the pilot project could be easily adapted for use by institutions utilizing EMR systems.

Oncology Nursing Forum. 2025 Mar 1;52(2):312–313.

P533. Implementation of CHG Chlorhexidine Gluconate Mediport Dressings

Mary Kate Reilly ¹, Jane Sallustro ²

Quality and Safety

Significance & Background

At a large metropolitan comprehensive cancer hospital, the use of CHG Chlorhexidine Gluconate impregnated dressings were used on all central lines with the exclusion of mediport dressings. The organization was struggling to meet benchmark data with central line acquired blood stream infections (CLABSI) rates and mediport infections accounted for approximately 30% of all central line acquired blood stream infections. A clinical nurse IV and a Nurse Leader on a medical surgical oncology floor commissioned a working group to conduct a pilot using evidence based practice.

Purpose

A pilot was conducted on three inpatient units to measure the effectiveness and ease of the CHG Chlorhexidine Gluconate I.V. Port Dressing, and it was determined that it was successful and it was decided to be implemented throughout the organization.

Interventions

Partnering with the Clinical Device and Procurement Committee, it was determined that it was fiscally advantageous to add the CHG Chlorhexidine Gluconate impregnated dressings to the existing kits and place on each applicable accessed mediport. Education was completed with the company and the organization’s Nursing Professional Development Specialists and a scheduled go live was completed. Additionally, it was determined that because the mediport kits span across the organization outside of the inpatient hospital, any patient with an accessed mediport would receive the CHG Chlorhexidine Gluconate impregnated dressing. This proved to be helpful as some patients can be transferred to the inpatient setting unexpectedly and the dressing would already be in place preventing an infection.

Results

Preliminary results show a decrease in central line acquired blood stream infections with mediports as well as increased patient satisfaction, increased nurse satisfaction, and decreased dressing changes required in between the scheduled dressing changes.

Discussion

Implementation of a CHG Chlorhexidine Gluconate impregnated dressing has improved the CLABSI rates and has additionally resulted in fewer dressing changes in between the required dressing change at a 7-day mark. This initiative also served as an example to staff that a clinical nurse can make a pivotal impact in patient care when identifying and opportunity for improvement. While there are many components in CLABSI prevention, this addition of the CHG Chlorhexidine Gluconate impregnated dressing has a significant role in decreasing infections.

Oncology Nursing Forum. 2025 Mar 1;52(2):313.

P534. “Hapi” Hour: Reducing Nursing Sensitive Indicators

Mary Kate Reilly ¹, Jane Sallustro ²

Management

Significance & Background

On a complex, acute oncology medical surgical floor, there are many new nurses that are hired each year lending towards a novice staff. The retention rate of nurses at 12 months is 75.7% and at 24 months 59.3%. Additionally, the unit does not meet benchmark with falls with injury, CLABSI, or HAPI rates. While nurses are driven to complete tasks, there was a need identified to expand the nurse’s perspective of their impact on patient care and how it contributes directly to Nursing Sensitive Indicators (NSIs) of the unit.

Purpose

At a large comprehensive cancer hospital, an educational forum was created to increase awareness of the unit’s NSIs. Additionally, the educational forum was built into the unit’s Quality and Safety Council dissemination to help improve the unit’s NSIs and generate ideas on how to enhance patient care and ultimately outcomes.

Interventions

There are two-unit representatives from each unit that are on the Inpatient Nursing Quality & Safety Council within the Shared Governance structure. Each month, representatives from each unit meet at the council to discuss NSI data, quality improvement projects, and overall themes occurring hospital wide. After the meeting, the unit representatives return to their respective units and help to disseminate the information learned. We began a planned meeting called “HAPI Hour” that was a forum for information to be disseminated, staff to share concerns, and review how our patients are measuring with Nursing Sensitive Indicators.

Results

Preliminary results show improvement in nursing sensitive indicator rates and decreased errors on the unit. Presentation will include final data review including full statistical analysis and educational content. This educational forum serves as an opportunity for nurses to identify issues or concerns and to review approved hospital policies and procedures related to prevention of NSIs. To date, this has proven that together as a team we can combine efforts to reduce our NSIs.

Discussion

Implementation of a unit specific educational forum improved nursing sensitive indicators and helped to mitigate several reoccurring errors happening in nursing care. Additionally, nurses expressed that they were more confident in speaking about the Nursing Sensitive Indicators and understanding the unit specific contribution. The goal of this educational initiative is to share with colleagues on other units who could benefit from enhancing their dissemination of Nursing Sensitive Indictors and unit-based concerns.

Oncology Nursing Forum. 2025 Mar 1;52(2):313–314.

P535. Improving Nurse Navigators (NN) Knowledge and Confidence in Discussing Advance Care Directive (ACD) with Cancer Patients

Hunter Reno ¹, Jessica MacIntyre ²

Management

Significance & Background

Through observations and discussions in clinical practice, healthcare providers perceive ACD discussions as held mainly by Palliative Medicine, or Social Workers. This assumption within the interdisciplinary team may be attributed to either provider time constraints, lack of awareness and/or comfort discussing end-of-life, and/or culture. Assessing baseline knowledge, identifying gaps, and reinforcing ACD education amongst the interdisciplinary team may increase confidence in having ACD discussions.

Purpose

To identify gaps in Nurse Navigator’s (NN’s) baseline knowledge and reinforce education when having ACD discussions with patients and families. As NN’s develop rapport with patients, they can assist in introducing the topic of ACD earlier in a patient’s cancer journey and promote advance directive completion.

Interventions

This quality improvement (QI) project collected data from 40 NN’s, capturing changes before and after an educational intervention. All participants were registered nurses. A multiple-choice questionnaire was provided using the same questions pre-and post-intervention. The questions included defining Healthcare Surrogates, Living Wills, and Proxies, identifying where ACD forms were located, and elaborating on State and Federal laws, including the Patient Self-Determination Act. After the pre-intervention questionnaire was completed, an educational presentation was conducted during the NN’s weekly huddle. Afterward, the post-intervention questionnaire was distributed.

Evaluation

Responses from the questionnaire were analyzed. Descriptive percentages were obtained. Results indicated NN’s scored 95% on average on pre and post-questionnaires in 8/10 questions. However, there were two areas that scored lower. The first differentiating Health Care Surrogates versus Proxies, with 52% median score pre and 69% post-education. The second area was whether the Patient Self-Determination Act was a Florida Statute or a Federal Law, with 53% median score pre and 69% post-education. Despite these two areas, knowledge still improved post-intervention.

Discussion

This QI project aimed to determine NN’s baseline knowledge and confidence in ACD discussions. It found that oncology nurses could benefit from repetitive and ongoing discussions on how to build their confidence and explore when to initiate these discussions in a cancer patient’s journey. Engaging in ACD discussions and promoting ACD completion across the interdisciplinary team can empower patients to make sure their preferences for critical or end-of-life care are met.

Oncology Nursing Forum. 2025 Mar 1;52(2):314–315.

P536. Standardizing Education for Self-Care in Post-Allogenic Transplant Patients: A Nursing Initiative

Sheila Reynolds ¹, Emily Wakins ², Marsha Knudsvig ³, Hannah Regal ⁴, Laura Larsen ⁵, Rachel Askelson ⁶

Patient Education

Significance & Background

Allogenic stem cell transplant patients require lifelong medical management due to the complexity and potential complications of their treatment. Proper education at the optimal time can provide benefits to both patients and their healthcare team by increasing the patient’s knowledge of who and when to contact when concerns arise. Improved self-care can impact survivorship and post-transplant outcomes by reducing the incidence of complications. Additionally, well-informed patients are more likely to adhere to their care plans, leading to better overall health outcomes.

Purpose

The purpose of this project was to standardize the education that post-allogenic transplant patients receive prior to leaving the medical center community. This standardization aimed to aid patients in self-care and survivorship by ensuring they have the necessary knowledge and resources to manage their health independently. By providing consistent and comprehensive education, the project sought to empower patients to take an active role in their post-transplant care.

Interventions

A nursing work group reviewed evidence-based recommendations to implement a 60-minute nurse education visit for allogenic patients approximately 60 days post-transplant. During this visit, patients were provided standardized education, including a newly created educational document outlining which medical team—primary care versus transplant team—to contact for specific concerns. The project team also developed checklists for the nurses to ensure a follow-up patient portal message was sent, reminding patients to review the educational materials prior to their day 100 visit, when they are formally discharged from the medical center community.

Results

Early results from the project have shown increased nursing staff confidence to 100% in providing standardized patient education on self-care to allogeneic patients. Ongoing evaluation includes assessing patient portal messages to ensure patients are reaching out to the appropriate team at the appropriate time for new signs or symptoms. Final project results will be available in November 2024.

Discussion

A key to the successful implementation of this project was the engagement and commitment of the post-allogeneic nurses. Their active participation ensured that the standardized patient education was effectively delivered and tailored to meet the needs of patients. The new educational handout has been instrumental in helping patients recognize concerning symptoms and understand which team is best equipped to assist them, thereby expediting care closer to home.

Oncology Nursing Forum. 2025 Mar 1;52(2):315.

P537. Utilizing Advanced Practice Providers for Spacer GEL Placement Procedure in Prostate Cancer Patients

Shaghayegh Rezaie ¹

Radiation

Significance & Background

In prostate cancer patients undergoing external beam radiation therapy, nearby organs may get injured by radiation. Due to its proximity to the prostate gland, rectum is the first organ that could be negatively affected by radiation treatment. The side effects could be short-term or long-term. Side effects include bowel problems, such as radiation proctitis, diarrhea, bowel incontinence, hemorrhoids, and pain. In our facility, we use a product made from hyaluronic acid as a spacer to move the rectum further away from the radiation field. Hyaluronic acid is a substance naturally present in the human body, and is highly compatible and fully absorbable. It is important to have an even, symmetrical implant. The symmetry provides a better protection to the rectum by moving it away from unwanted radiation exposure. The result is an implant personalized to the unique contours of the patient’s anatomy.

Purpose

Currently, this procedure is only performed by trained physicians. The purpose of this presentation is to evaluate the feasibility of training advance practice providers to perform this procedure.

Interventions

Applying the hyaluronic acid spacer requires extensive training, including didactic lectures, observation of the procedure performed by a trained physician, hands-on training on phantoms, and performing the procedure on at least five actual patients.

Results

A single nurse practitioner in radiation oncology has successfully completed training for this procedure, and is the only advance practice provider in the country certified to independently perform this procedure under physician supervision.

Discussion

Our facility successfully trained an advance practice provider in placement of hyaluronic acid spacer gel in patients who will be undergoing external beam radiation therapy for prostate cancer. The advantages of utilizing advance practice providers to perform this procedure include increased physicians’ time to see patients for new consultation, free up valuable physician’s clinical time for other direct patient care activities, increased patient throughput, increased efficiency, and improved economical use of departmental resources. Furthermore, advanced practice providers are uniquely positioned to spend ample time with patients to provide comfort and education prior, during, and after the procedure.

Oncology Nursing Forum. 2025 Mar 1;52(2):315–316.

P538. Changing Patient Care Assistant Assignments to Improve Registered Nurse Collaboration

Lisa Ridge ¹

Coordination of Care and Navigation

Significance & Background

Communication is key to providing safe patient care. Different disciplines in the healthcare team need to work closely together to provide the best quality of care. Registered Nurses and Patient Care Assistants work most directly with patients. Collaboration between the two disciplines is essential to safe patient care.

Purpose

Patient Care Assistants on our 36 bed inpatient BMT unit expressed feeling isolated from Registered Nurses. They were seeking better communication from Registered Nurses.

Interventions

I gathered pre-intervention surveys that showed opportunity for improved communication from RNs to PCAs. We changed PCA assignments on our unit to be assigned to specific RN assignments rather than solely geographical location in an effort to simplify communication for RNs. Teaching provided to staff and charge RNs to help optimize PCA assignments and reinforce the need for communication. Post surveys gathered after 3 months of the intervention.

Results

PCAs reported increased confidence that they had the information they needed on shift to provide safe patient care (p=0.039). PCAs reported feeling more comfortable asking RNs about plan of care for patients (p=0.0404) PCAs reported feeling more comfortable asking RNs for help when they were behind (p=0.029).

Discussion

While we were able to increase the percentage of PCAs that feel more comfortable approaching RNs with questions, there is still room for improvement in RN and PCA communication.

Oncology Nursing Forum. 2025 Mar 1;52(2):316.

P539. First, do no Harm: Assessing and Addressing Deficiencies in Knowledge, Skill and Attitude Toward Safe Intramuscular Injection

Tara Ridgeway ¹

Management

Significance & Background

Intramuscular injections (IM) are given frequently within the ambulatory oncology infusion setting. The risk of using the dorsogluteal site for IM injections is well documented throughout medical literature, as there is a higher risk of damage to the sciatic nerve and gluteal artery and a risk of incidental administration of medication into the subcutaneous tissue. However, nurses often feel most comfortable with this site for various reasons; the most frequently documented reason is the lack of knowledge or confidence in finding the anatomical landmarks associated with safer site choices. The Nursing Professional Development (NPD) Specialist identified this knowledge and practice gap through audits and education check-ins at a multi-site facility.

Purpose

To promote patient safety by increasing nurses’ knowledge, skill, and confidence in applying evidence-based best practices when administering IM injections.

Interventions

Using evidence-based practice, the NPD specialist created a 20-minute in-service incorporating an interactive presentation, demonstration, and return demonstration using an anatomical model. After the in-service, the NPD specialist or designated champion was consistently available to support staff during subsequent IM medication administrations, ensuring the ongoing effectiveness of the training.

Results

Seventy-eight nurses participated in training across four ambulatory oncology infusion centers. The percentage of nurses who considered the dorsogluteal site safe decreased from 66.3% to 21.8%. Before training, 50% of participants stated they would most likely choose the ventrogluteal site for administering an IM injection. After the training, 94% of nurses indicated they would select the ventrogluteal site. It is essential to note the NPD specialist found many nurses were mistaking the dorsogluteal and ventrogluteal sites, thereby unintentionally administering IM injections at the dorsogluteal site and documenting site choice incorrectly.

Discussion

The data shows the training significantly changed nurses’ knowledge, skill, and confidence regarding IM injection and safe site selection. As a result, nursing staff aligned their practice with current evidence-based practice and facility guidelines. These results highlight the need for continued assessment of learning needs and the effectiveness of targeted educational interventions in improving clinical practice and ensuring patient safety. The NPD specialist recommends that other cancer centers thoroughly assess and observe current practices of nurses administering IM injections, as this knowledge gap was consistent across a multi-site facility.

Oncology Nursing Forum. 2025 Mar 1;52(2):316–317.

P540. Tracheostomy and Laryngectomy Post-Operative Care Checklist

Tamar Riedel ¹, Kate Sweeney ²

Healthcare Delivery

Significance & Background

Head and neck cancers (oral, pharynx, and laryngeal) accounted for 3.5% of new cancer diagnoses in the United States in 2024. Due to the proximity of these surgical procedures to the airway and how complex the procedures are there is an increased risk for airway complications and bleeding. As a high risk, low volume surgical population, our hospital chose to create a checklist so nurses had a ready reference for how to manage this patient population post-surgery.

Purpose

The checklist creates a guideline for what needs to happen during the patient’s hospital stay. It includes supplies needed at bedside, supplies needed for discharge, and lays out the most important things to remember for care of the patient like education and discharge needs. A portion of the checklist shows step by step what to do if the patient starts bleeding and the best way to manage the bleeding.

Interventions

The nurse receiving the patient from PACU starts the checklist during report. It begins with information about the size of the trach/lary tube. At this time, another trach/lary tube of the same size and one a size smaller are put with the patient. This means there is always one available in case of complications. The checklist is also used by the nurse to set up the room with all the necessary supplies and equipment. This way nothing is forgotten in case of emergency.

Results

This checklist has been used on two occasions since it was created. Both times nurses said it helped make the care of the patient easier. They stated that they were able to provide better education to the patient about what to expect after surgery and how to care for themselves after discharge. Care management also reported less confusion from patients during after discharge phone calls.

Discussion

Using an aid, like a checklist, for high-risk, low-volume procedures has helped both our patients and nurses. Nursing staff are more comfortable caring for head and neck cancer patients after surgery using this ready reference. Patients are receiving all of the care and education they need during hospitalization. Patients are also kept safe by laying out needed emergency equipment at bedside. Patients are also better prepared for discharge with all the supplies they need.

Oncology Nursing Forum. 2025 Mar 1;52(2):317.

P541. Lessons from Launching: A Story of Rural Resilience Expanding Infusion Services

Marie Riehl ¹, Erin Longstreth-Papsun ²

Healthcare Delivery

Significance & Background

Efforts were concentrated on establishing oncology care in a rural community with limited resources, offering consultations, treatment, and multidisciplinary support. This facility provides a comforting and accessible environment, staffed by skilled oncology professionals from a comprehensive academic cancer center. Experienced oncology certified nurses were hired managing care coordination and infusion services in this state-of-the-art facility. The physical space and equipment were ready, and staff had been oriented, while leadership faced challenges with unexpected timelines for licensing and accreditation, which hindered the center’s full operational capacity.

Purpose

Sharing the experience of establishing a network infrastructure— along with the unforeseen challenges and successes— informs the next phase of expansion. Mentorship plays an important role in facilitating organizational progress, helping to minimize obstacles and disseminate the knowledge gained.

Interventions

Collaboration with the revenue cycle team included weekly meetings providing updates on timelines. Implementation of shared drives assisted with clear communication and standardization of tasks. Leadership executed strategies keeping staff engaged and productive including cross coverage, precepting and mentoring, focused learning, and community stewardship. Policies and procedures were developed and shared with the newest network site preparing to open, including activation plans, workflows, and essential information about the overall project.

Results

Regulatory constraints and licensing delays prevented many patients from accessing the facility for six months, with insurance approvals extending the accreditation process further. This period offered opportunities for professional development, team building, and community outreach. There was zero percent turnover during this time. Quality assurance and improvement initiatives were implemented to enhance clinical outcomes and overall quality of care. Despite a slow start, the volume of new consultations and treatments has since increased significantly month over month. Through patient experience surveys, the team has been able to quantify their success. Sharing lessons learned and successes has been invaluable for transforming new network locations.

Discussion

The sustainability and expansion of network infusions are vital for communities in need of accessible care. Key elements for successfully launching an infusion center include regulatory compliance, financial planning, insurance contracts, and a commitment to patient-centered care. Effective communication and strong teamwork are essential for implementation of a community infusion site. Additionally, flexibility and the identification of key metrics are crucial for operationalizing new services, as growth and productivity will ultimately drive the network’s success.

Oncology Nursing Forum. 2025 Mar 1;52(2):317–318.

P542. ‘Clinifusion’ Nurse Readiness: A Feasibility Study on Training Clinic Nurses on the Two Registered Nurse (RN) Chemotherapy-Immunotherapy Verification Process Before Moving to a New Cancer Center

Debrah Rigg ¹, Sabrina Keheley ²

Healthcare Delivery

Significance & Background

Clinical expertise in chemotherapy verification and administration is an expectation when working with oncology patient population. Registered Nurses must be able to safely validate and deliver chemotherapy to patients therefore competency in pre-treatment, chairside verification and having chemotherapy/immunotherapy certification is a requirement when caring for patients receiving antineoplastic treatment. Specialized training must be given to nurses administering chemotherapy, targeted therapy and immunotherapy.

Purpose

To determine the feasibility of training medical oncology clinic nurses over a one-month period to do the second RN verification for chemotherapy/ immunotherapy administration.

Interventions

A background knowledge probe and direct observation was done to get baseline data. A pre-tested survey was sent to registered nurses assessing their knowledge, attitude and practice on the two-nurse verification process and chemotherapy administration. The curriculum content comprised of handouts on commonly used chemotherapy regimens, charting for test patients showing pre-chemotherapy, chairside documentation and chemotherapy administration competency checklists used by the clinic. Teaching methodologies included simulations and day in the life rotation. 17 clinic nurses were paired different days with infusion nurses for training over a one month period, education by clinical pharmacist on commonly used chemotherapy drugs at huddles over the period. A total of 9 infusion nurses participated as preceptors. A summative evaluation was done using a post survey and a competency checklist.

Results

It is feasible to train clinic nurses in assisting infusion nurses in doing the two RN verification process to conduct pretreatment and chairside verification of chemotherapy. 29% of the clinic nurses are now fully cross trained in infusion. Their knowledge, attitude and their practice have improved based on direct observations. 41% are chemotherapy/immunotherapy certified an improvement from 5%. Post survey results showed increased confidence level of participants in performing the two RN chemotherapy verification.

Discussion

Clinic RNs trained by an infusion buddy to conduct pre-treatment and chairside chemotherapy verification are now part of a new model of care where clinic and infusion nurses are merged into one setting bringing care to the patient. Interventions are ongoing to re-enforce aspects of the 2 RN chemotherapy verification training through chart audits. Limitations included short time frame initially to grasp and practice the process.

Oncology Nursing Forum. 2025 Mar 1;52(2):318–319.

P543. Stop the Bleed! The Implementation of Statseal to Control Central Line Insertion Site Bleeding in an NCI-Designated Comprehensive Cancer Center

Stephanie Rivera-Gamma ¹, Kristie Murphy ², Megan Leary ³, Brian Hutto ⁴, Justin Laracy ⁵

Quality and Safety, e.g. CLABSI, Falls, Accreditation

Significance & Background

Central venous catheter (CVC) insertion site bleeding poses significant challenges to the care and maintenance of long-term catheters. The accumulation of blood at the CVC insertion site contributes to frequent catheter manipulation which can increase the risk of central line blood stream infection (CLABSI). Protocols to standardize the management of bleeding CVC insertion sites may improve outcomes by reducing the need for unscheduled dressing changes and preventing infections.

Purpose

The purpose of this project was to create a standard process in preventing and managing CVC site bleeding by determining the efficacy of a hemostatic agent, StatSeal®.

Interventions

This twelve-week pilot used StatSeal® upon the insertion of CVCs (PICC lines, non-tunneled, and hemodialysis catheters) in the Intensive Care Unit (ICU) and upon the insertion of PICC lines on an inpatient hematology unit. StatSeal® was also used on any existing CVC with bleeding at the insertion site. Daily audits were performed to assess for further bleeding and the CVC dressing status.

Results

Prior to initiating the pilot, audits revealed 35% of dressings on the hematology unit and 33% of dressings in the ICU had blood at the site. Since the pilot began, CVCs treated with StatSeal® on the inpatient hematology unit and ICU had a 100% decrease and a 48.5% decrease in blood noted at the site, respectively. At week eight of the pilot, clinicians from both units and vascular access team were asked to complete a survey about their experience with StatSeal®. Sixty-eight clinicians responded. When asked how effective the agent was in stopping bleeding, 81% responded it was more effective or much more effective than other products, and 13% replied it was equally effective. CLABSI rates have decreased on both units since this pilot. For the first quarter of 2024, the ICU had one CLABSI prior to the intervention and the hematology unit had 2. Four months post, both units have had zero CLABSIs.

Discussion

The pilot implementation of the hemostatic agent StatSeal® to control bleeding and decrease CVC dressing changes has been successful. Clinicians have embraced the product, finding it is easy to use. The product helps maintain a clean, dry insertion site and has decreased the risk of infection. Due to the success of this pilot, StatSeal® implementation will be expanded to all inpatient units at this institution.

Oncology Nursing Forum. 2025 Mar 1;52(2):319.

P544. Transforming the Practice Environment while Implementing a New Graduate Nurse Infusion Float Pool

Kyle Robbins ¹, Lisa Guthrie ², Heather Figary ³

Management

Significance & Background

Nursing shortages are a global problem. Retaining nurses has become a priority. A multi-site Midwest NCI Comprehensive Cancer Center hired new graduate nurses (NGN) into the outpatient cancer center infusion float pool for the first time in 2022. Experienced RN had to precept and work alongside NGNs for the first time in this practice environment.

Purpose

The purpose of this quality improvement project was to understand the practice environment and personal experience of established cancer center nurses during the implementation of a novel NGN cancer center infusion float pool.

Interventions

A multi-methods design using qualitative semi-structured interviews and a quantitative cross-sectional survey, using Lewin’s Model of change as the framework. A purposive sample of cancer center nurses with over one year experience and nursing leaders (N = 11) were interviewed using a semi-structured interview guide. Multi-site cancer clinic staff were invited via email and flyers to assess their practice environment using the revised Practice Environment Scale of the Nursing Work Index (PES-NWI), for ambulatory cancer settings (Cronbach’s alpha for five subscales ranged from .80–.90 (N =37).

Results

Data were collected in August–October 2023. Qualitative data were analyzed into key themes, focusing on three timepoints of the NGN float pool implementation. Results of PES-NWI were analyzed using descriptive statistics and correlations.

Discussion

Results from this study offered improvements to implementing an NGN float pool within the cancer centers and provided strategies to improve the overall practice environment, leading to increased nurse retention. The results helped develop strategies to improve NGN Float Pool onboarding, the overall practice environment, and measured outcomes of nurse retention in float pool and PES-NWI after implementation. This quality improvement project can help inform how to create a healthy practice environment that fosters nurse retention. The data gathered has also be used to facilitate change as the cancer center continues to hire NGNs.

Oncology Nursing Forum. 2025 Mar 1;52(2):319–320.

P545. Equipping Nurses with the Tools Needed to Provide Palliative and End-of-Life Care to Cancer and Chronically Ill Patients

Kathryn Robinson ¹

Professional Development

Significance & Background

Caring for patients with cancer and chronic illnesses is complex, requiring knowledge of palliative care to manage symptoms, pain, and psychosocial aspects of illness. These patients often are near or at End-of-Life, requiring much support. The need for training due to lack of understanding and staff comfort was recognized on multiple units in a 358-bed hospital.

Purpose

Increase bedside nurses’ knowledge and comfort levels when providing Palliative and End-of-Life care to cancer and chronically ill patients.

Interventions

End-of-Life Nursing Education Consortium (ELNEC) Core Training was offered onsite to all nurses in a non-mandatory format. The nurse educator obtained an ELNEC Trainer Certificate and permissions to provide an interactive in-person course on hospital campus. To increase accessibility, the eight modules were split into four interactive classes, each consisting of two modules, offered on a rotating basis. Staff were able to attend in any order and received continuing education hours following sessions. Upon completion of all four parts (eight modules) an ELNEC Core Training Certificate was provided. Pre and post surveys to evaluate knowledge and comfort levels prior to and following each training occurred. Participants who completed the full program received a three-month follow-up survey to further evaluate staff comfort levels and impact to current practice.

Results

Offerings began October 2023, as of September 2024, 84 individuals attended at least one session. Of the 84, 55 (66%) completed the full program, 17 (20%) attended two or more sessions and 12 (14%) completed one. The surveys following each class showed an increase in comfort and knowledge. The 3-month follow-up survey was completed by 47 (85%) of the 55 participants who completed the full curriculum and 100% report a positive impact to practice, improved comfort and are applying learned methods to practice.

Discussion

Providing ELNEC on campus in a non-traditional non-mandatory format improved accessibility and staff accountability. Nurses from multiple departments participated and recognized the positive impact providing palliative care for cancer and chronically ill patients has on one’s practice. Therefore, ELNEC courses will continue to be offered on a rotation and remain open to all staff. In addition, training will be built into the onboarding of inpatient oncology nurses to ensure optimal care is provided. To further enhance growth, subject specific supplemental offerings will be created and offered in the future.

Oncology Nursing Forum. 2025 Mar 1;52(2):320.

P546. Advancing Oncology Nursing Excellence: A Unit Council Initiative to Increase Certification Rates

Nadeen Robinson ¹, Christina Osorio ², Shannon Forty ³, Archana Shenoy ⁴, Nicole Turkoglu ⁵

Professional Development

Significance & Background

Certification in oncology nursing is a key indicator of advanced clinical expertise and commitment to high-quality patient care. Despite its importance, achieving certification can be challenging due to the demands of nursing practice and the barriers to accessing preparation resources. Recognizing the need to enhance the professional development of nursing staff and improve patient outcomes, our unit council launched an initiative aimed at increasing the number of certified oncology nurses within the unit.

Purpose

The purpose of this initiative was to increase the number of certified oncology nurses on our unit by providing support and resources for certification exam preparation. This aimed to bolster the overall competence of the nursing staff, improve patient care quality, and promote professional growth among nurses.

Interventions

The unit council implemented a multifaceted approach to support certification efforts, including Certification Preparation: The monthly unit council meetings covered key exam content, test-taking strategies, and study techniques; Study Groups: Peer-led online study groups were established to foster collaborative learning and mutual support; Financial Support: The nurses received exam fee reimbursement for passing certification exam results fees and shared study materials; Mentorship Program: Ongoing mentorship of nurses by experienced certified nurses with those pursuing certification to offer guidance and encouragement; and Time Management: Adjustments were made to work schedules to allow nurses time to attend oncology education programs.

Results

Over a six-month period from June 2023 to Dec 2023, the initiative led to a notable increase in certification rates on the unit. The percentage of eligible certified nursing staff increased from 10% to 28% with five nurses passing their certification exams. Nurses felt better prepared for the certification exam and appreciated the support provided. Additionally, the workshops and study groups were noted by nurses to be effective and relevant.

Discussion

The unit council’s initiative demonstrated that targeted support and resources can significantly enhance certification rates among oncology nurses. The combination of educational meetings, financial reimbursement, and peer support contributed to a higher number of certified oncology nurses, which is expected to positively impact patient care and staff morale. Continued efforts to sustain and expand these support systems could further increase certification rates and drive ongoing professional development. Future evaluations should explore the long-term effects of increased certification on patient outcomes and nursing satisfaction.

Oncology Nursing Forum. 2025 Mar 1;52(2):320–321.

P547. Enhancing Oncology Nursing Practice and Knowledge through Staff-LED Education: An Inservice Series

Nadeen Robinson ¹, Shannon Forty ², Brenda Goode-Marshall ³, Katherine Blair ⁴, Archana Shenoy ⁵, Nicole Turkoglu ⁶

Management

Significance & Background

In the rapidly evolving field of oncology nursing, staying current with the latest evidence-based practices is essential for improving patient outcomes and ensuring high-quality care. Despite this need, ongoing education can often be overlooked due to time constraints and competing priorities in caring for acute oncology patient needs. Recognizing this gap, a staff-led education in-service series was launched in May 2024 on a medical oncology step down unit to address the need for continuous professional development in oncology nursing.

Purpose

The purpose of the in-service series was to provide oncology nursing staff with updated knowledge and skills on emerging treatments, best practices, and evidence-based protocols. This initiative aimed to enhance clinical competence, promote professional growth, and ultimately improve patient care in the oncology setting.

Interventions

The in-service series consisted of daily sessions led by experienced oncology nurses and other interdisciplinary team members. Sessions focused on different aspects of oncology care, including treatment modalities, symptom management, and supportive care for oncology patients. Interactive elements such as case studies, and Q&A were incorporated to facilitate engagement and practical learning. Post-session evaluations were conducted to assess knowledge gains and identify areas for improvement.

Results

Preliminary results from the first three months of the series indicate significant improvements in nursing staff knowledge and confidence in applying new treatment protocols. Post-session evaluations on a 5-item 5-point Likert scale showed that nurses (n=25) strongly agreed with the educational series being relevant to practice, helpful information, a valuable learning experience, and helped to improve their practice to care for complex oncology patient needs. In addition, nurses strongly agreed that the educational series should be repeated in the future.

Discussion

The initial outcomes of the staff-led in-service series suggest that targeted, regular education can effectively address knowledge gaps and enhance clinical practice among oncology nurses. The interactive and practical nature of the sessions was well-received and contributed to meaningful learning experiences. Moving forward, it will be important to sustain this educational initiative, evaluate long-term impacts on patient care, and adjust the content based on ongoing feedback and emerging trends in oncology. Future studies could explore the correlation between in-service participation and patient outcomes to further validate the effectiveness of such educational interventions.

Oncology Nursing Forum. 2025 Mar 1;52(2):321.

P548. Standardization of Ivad Flushing Protocols to a Saline-Only Approach in a Large Health System

Georgina Rodgers ¹, Diana Karius ², Sheila Kelly ³

Treatment Modalities and Managing Administration

Significance & Background

Implanted vascular access devices (IVAD) are commonly used in the oncology patient population to administer anti-neoplastic therapy, supportive care medications, hydrations and transfusions. Maintaining port patency and blood return is essential both during and in between treatments. Many healthcare systems across the US have transitioned to saline only flushes as the standard for post administration and maintenance of IVADs. The Cleveland Clinic health system transitioned away from heparin lock flush years ago with an exception for IVADs.

Purpose

This health system utilizes multiple IVAD devices, encompassing valve technology and open-ended catheters. Identifying the kind of port and previous flushing protocols can be challenging, with heparin lock flush used for certain IVADs and saline-only for others. The aim of this initiative is to unify the flushing and upkeep procedures for IVADs throughout the extensive health system.

Interventions

A review of literature was conducted, and evidence was found to support a practice chance. A Cochrane review found no evidence to support the use of heparin being superior to normal saline (Zhong et al., 2017). The flushing protocol was standardized to Standardized IVAD flush to 20 ml normal saline using the pulsatile/turbulent flow method prior to de-access and every 12 weeks for maintenance. Enterprise protocols were moved through approval bodies, nursing education completed, the change was rolled out on January 1, 2024.

Results

The implementation of the standardized adjustment to saline-only flush for all IVADs has been effective for close to nine months, with no indications of a rise in catheter blockages. Additionally, since this change was put into practice, monitoring of alteplase usage shows no signs of increased occurrence of catheter occlusions or greater use of alteplase.

Discussion

A number of systematic reviews and retrospective analyses indicate that normal saline (NS) is just as effective as heparin in maintaining the patency of central lines with port systems (Egnatios & Gloria, 2021; Klein et al., 2018; Regina de Silva et al., 2021; Zhong et al., 2017). Complications such as bleeding, allergic responses, and thrombocytopenia are associated with heparin use (López-Briz et al., 2018). The findings of this project further corroborate the adoption of a saline-only pulsatile flushing protocol as a standard practice for IVADs.

Oncology Nursing Forum. 2025 Mar 1;52(2):321–322.

P549. Evaluation of Zap-X and Synaptive MRI Patient Guide

Ma Rhudelyn Rodrigo ¹, Michael Chaga ², Timothy Chen ³, Wenzheng Feng ⁴, Shabbar Danish ⁵

Patient Education

Significance & Background

The Hackensack Meridian Neuroscience Institute at Jersey Shore University Medical Center (JSUMC) is the first center in the world to combine ZAP-X stereotactic radiosurgery (SRS) with Synaptive Magnetic Resonance Imaging (MRI). The ZAP-X is the newest intracranial SRS platform. Guided by high-definition imaging and computer-controlled robotics, ZAP-X delivers high doses of radiation to targeted tissue with 1 mm precision. The ZAP-X can deliver precise, painless, and non-invasive outpatient treatment for patients with malignant and benign brain tumors, facial pain, and AVM. The Synaptive is the only head and neck MRI designed to specifically image the nervous system. The small bore and 0.5 T magnet allow for greater patient comfort and provide a quieter experience compared to standard MRI systems. Additionally, the mid-field MRI provides improved safety, with its small 250 square feet footprint and cryogen-free superconducting magnet. This enables greater accessibility and allows the system to be operated in the Radiation Oncology Department. Currently, there are no reports describing the treatment process of these technologies for patients.

Purpose

To create a robust patient guide that will serve as a tool in educating patients undergoing ZAP-X and Synaptive MRI.

Interventions

During Radiation Oncology consultation, patients received a brochure and detailed patient guide containing information on how ZAP-X and Synaptive MRI works, the treatment process from start to finish, and follow-up assessment. After treatment, explanation of what to expect during treatment was evaluated by questionnaire using a Likert scale from 1–5 (1 = “very poor”, 5 = “very good”) along with comfort scores.

Results

For n = 51 patients, the average explanation score was 4.9 ± 0.3, the average comfort during simulation was 4.7 ± 0.7, the average comfort during mask creation was 4.6 ± 0.6, the average comfort during MRI was 4.7 ± 0.5, the average comfort during ZAP-X treatment was 4.4 ± 0.9, and the average comfort post-treatment was 4.7 ± 0.5.

Discussion

Implementation of a patient guide for ZAP-X and Synaptive MRI educates the patient about their treatment and workflow process, allowing patients to feel more comfortable and possibly lead to more positive outcomes. The patient guide can be used as a framework by Radiation Oncology Nurses and Physicians to incorporate into their ZAP-X SRS and Synaptive MRI program.

Oncology Nursing Forum. 2025 Mar 1;52(2):322–323.

P550. The Educational GAP Faced by Nurses After Graduation

Leighanne Romo ¹, Melissa Kerr ²

Management

Significance & Background

Education is an essential part of an oncology nurse’s daily tasks. It is critical to patient outcomes and essential to how nurses protect and advocate for patients. The need for nursing knowledge doesn’t stop once a nurse graduates from their nursing program. Technologies, medications, and evidence-based processes continue to evolve, and nurses are held responsible for having current and updated knowledge and being able to educate their patient population. A question was proposed as to how nurses obtain updated knowledge.

Purpose

The purpose of this project was to illuminate the ways nurses seek education after graduation while in clinical practice. There is a substantial lack of nurses’ access to changing information on the newest medications, their indications, and the most current targeted therapies and their cellular markers. While there are avenues to be explored, they may not be suitable or accessible to most nurses. Conferences have educational lectures but can be cost-prohibitive. Meetings and lectures held during the week may not be available due to staffing shortages or even the location of the event. Some conferences are after hours or on weekends and may pose a problem for those trying to maintain a work-life balance or needing childcare. Online education is available but can be cost-prohibitive as well.

Interventions

Nurses were surveyed to determine where they turn when they need new technology, medication, or diagnosis education. Do nurses rely on the internet for information, their colleagues, or pharmaceutical companies for education? A qualitative study was done to determine the results of these questions.

Results

This qualitative study determined that there are not enough educational options or opportunities for nurses to stay readily current on new nursing knowledge. Additional educational venues are needed. The preferred educational method was to get information from pharmaceutical companies.

Discussion

As quickly as the healthcare landscape changes, nurses need access to education just as fast. Nurses advocate for patients and provide the bulk of the education they receive. To improve patient outcomes, nurses need to be able to obtain and understand education promptly. Oncology nurses are at the forefront of a quickly growing and changing field and need the tools to be prepared for all patient contingencies.

Oncology Nursing Forum. 2025 Mar 1;52(2):323.

P551. Oncology Nurse Navigators Embedded in Urology and Interventional Pulmonology Specialty Clinics for Efficient Early Care Coordination and Navigation Setup for Patients

Maria Victoria Roque ¹

Coordination of Care and Navigation

Significance & Background

According to the National Cancer Institute, for 2024 there will be 2,001,140 new cancer cases. In men, 48% are prostate, lung and colorectal cancers. In women, breast, lung and colorectal will account for 51% of newly diagnosed cases. We need to navigate these patients earlier at the time of screening when suspicion of a cancer diagnosis is high, or when the patient is first given the news of a cancer diagnosis at the specialty clinics. Cancer care is complex, especially for those who are diagnosed for the first time where being focused on the management and treatment of the disease is a challenge.

Purpose

To provide care coordination early in the care continuum, specifically at the level of the specialty clinics (eg urology, interventional pulmonology) and increase the number of referrals to the cancer center.

Interventions

The plan was to embed an oncology nurse navigator in the urology clinic at least two days a week. The oncology navigator talks to the patient right after the urologist explains the new cancer diagnosis, informing about the schedules with radiation and/or medical oncologists, and other diagnostics, educates the patient, and provides other resources based on patient needs. An oncology navigator was also embedded in the interventional pulmonology clinic, talking to the patient right after when the patient agrees to have a bronchoscopy for a highly suspicious lung cancer diagnosis. Once pathology confirms it, the navigator is present during the second visit when news of the diagnosis is shared to the patient, then care coordination begins.

Results

For the Interventional Pulmonology clinic, the number of referrals from 2022 increased by 42% in 2023, and as of Aug 2024 it has increased by another 29.6% from 2023. For the Urology clinic, the number of referrals for 2024 is projected to increase by 66% compared to the referrals in 2023.

Discussion

Early introduction of the navigators allows for identifying and addressing barriers, provide scheduling and arranging appointments and education specific to the procedure or the disease and its management, become the liaison between specialty providers and the oncology team, monitoring and/or following up with the patient until the patient is established with oncology.

Oncology Nursing Forum. 2025 Mar 1;52(2):323–324.

P552. Management Strategies for Talquetamab Skin and Oral Toxicities

Evanica Rosselli ¹, Jennifer Bucknall ², Kristina Gigante ³

Symptom Management and Palliative Care

Significance & Background

Talquetamab is a promising new bispecific antibody treatment for relapsed and refractory multiple myeloma. However, the therapy is known to cause significant oral and skin toxicities that can be difficult for patients to manage. These expected side effects are not only painful but cause decrease in reported quality of life and weight loss.

Purpose

The purpose of these strategies is to manage expected talquetamab toxicities through education, prophylactic supportive medications, and extended dosing interventions.

Interventions

Patients are prescribed “scheduled” and “as needed” medications (see table) prior to starting treatment and educated to use them prophylactically. Pharmacy, nursing, and providers created this regimen as there was no evidence available for these specific toxicities. Patient reports of side effect characteristics were used from clinical trials to assess which medications would be beneficial for dry mouth and skin, pruritis, and rash. Oral rinses and skincare start inpatient prior to patients receiving the first step-up talquetamab dose. Prescriptions and recommendations for follow-up care are given prior to discharge. Patients have the medications at home and understand when to use them rather than waiting until they have symptoms. Patients experiencing complete response (CR) or very good partial response (VGPR) after 3 months of talquetamab were extended to every 4 week dosing. Patients experiencing severe oral toxicities were also switched to 4 week dosing to avoid drug discontinuation.

Results

8 patients were treated before strategies were implemented and 7 patients with the management strategies in place. Chart reviews show patients diligently using recommended skin and mouth care showed less skin toxicities and reported an ability to tolerate oral toxicities. Patients with 4 week dosing adjustment recovered sense of taste up to 80% improvement, reported less dry mouth, and experienced less weight loss. Prior to mitigation tactics, we had two patients discontinue treatment who were unable to tolerate talquetamab. Since implementation, no patients have discontinued treatment due to side effects.

Discussion

We are encouraged by the results thus far. Patients receiving talquetamab often already have side effects from previous lines of treatment which make it somewhat difficult to isolate the talquetamab effects. Data was limited due to number of patients, prior treatment-related toxicities, and patients taken off treatment due to no response. Clinical trial patients were excluded. We will continue to gather data with increased sample size.

Oncology Nursing Forum. 2025 Mar 1;52(2):324.

P553. Advancing the Nursing Care of Clinical Trial Patients: The Development of an Inpatient Oncology Translational Research Unit

Theresa Rudnitzki ¹, Kate Hartman ², Azure Grossman ³, Allison Baus ⁴, Joseph Narewski ⁵, Lisa Ferguson ⁶

Healthcare Delivery

Significance & Background

Oncology clinical trials are intricate, demonstrating the need for a heightened level of nursing care. As our organization’s clinical trial program continued to evolve, the trial volume continued to grow. With an increasing number of early phase trials requiring admissions for administration of novel agents, overnight observations for patient safety, and timely completion of research tasks by nursing, the need for a dedicated inpatient unit and model of care to focus on the special needs of patients who are taking part in oncology trials became apparent.

Purpose

To adhere to the increased complexity of protocols and provide meaningful data while providing high quality care, we reexamined and redefined the care of patients admitted for oncology clinical trials.

Interventions

A team of inter-professionals worked together on the development of a new unit within an existing unit. Other reputable inpatient research and oncology units were investigated, but no institution had a dedicated inpatient oncology research unit as we envisioned. Drawing from our success in the creation of our outpatient Translational Research Unit (TRU), we took many of the same principles and tools and adjusted them to fit the needs of around-the-clock, acute care. We also created an inpatient staffing model and offered detailed trial education to the core group of nurses. Completion of an orientation and training checklist occurred prior to the unit opening. The individual days of the protocols were evaluated to determine which required the specialized care from a TRU nurse as well.

Results

Since the creation of the inpatient TRU and training of dedicated nurses, there has been increased comfort in caring for patients on trials. Based on collected data, there has been a decrease in deviations related to nursing care provided to inpatient clinical trial patients.

Discussion

Creating an inpatient unit with dedicated trial nurses allows us to take on new and innovative protocols, which translates to more options for patients. Having nurses with an appreciation for the detailed care an oncology clinical trial requires, along with enhanced communication between research staff and the clinical team, leads to decreased deviations and to the overall success of trial implementation.

Oncology Nursing Forum. 2025 Mar 1;52(2):324–325.

P554. Two Become One: The Story of Combining Separate Ambulatory Oncology Residency Programs

Jeanine Rundquist ¹, Michelle Ranaghan ², Colleen McLaughlin ³

Professional Development

Significance & Background

Clinical research and infusion are unique nursing roles in a comprehensive cancer center for which we developed two separate ambulatory nurse residency programs. Each program had resources assigned from different departments and ran in parallel. Curriculum focused solely on the roles of clinical research and infusion. In 2022, a gap analysis for national accreditation revealed the need to develop a common curriculum for both tracks.

Purpose

The purpose of this project was to align two nurse residency programs, clinical research and infusion nursing, providing a common curriculum for all new graduate nurses to transition to practice. Achieving national accreditation for the residency program was also a goal for the organization.

Interventions

The common curriculum followed monthly themes including the professional role, communication, patient safety, emergencies, stress management, ethics, relationship-based care, palliative care, quality, evidence-based practice, leadership, and future career development. The residency team clinical educator designed a variety of learning experiences to match each theme. Educational methods included live didactic, online learning, high and moderate fidelity simulation, crafts, games, journaling, and peer support. The two departments collaborated to form one residency team and set up roles and responsibilities for each team member. The new residency team held a series of retreats to complete this work and develop the one-year curriculum that still allowed for role-specific education to successfully transition our new graduate nurses.

Results

The common curriculum was used for the fall 2022 cohort of new graduate nurses. Feedback from the residents was positive regarding the peer support they experienced in having a larger, combined cohort during their first year of practice. The common curriculum provided a streamlined, innovative, consistent approach to onboarding new graduate nurses into a complex ambulatory oncology environment. The combined residency team was able to reduce duplication of effort in scheduling and providing education, allowing fulfillment of other job responsibilities. The organization submitted for national accreditation in fall 2023 and achieved Accreditation with Distinction in March 2024.

Discussion

New graduate nurses require significant support to successfully transition in their first year of practice. It was inefficient to provide two separate residency programs and did not utilize resources wisely. Creating a common curriculum for all new graduate nurses, regardless of sub-specialty, created harmony between the two tracks, with common goals and outcome measures.

Oncology Nursing Forum. 2025 Mar 1;52(2):325.

P555. Development and Implementation of a Novel Outpatient Clinical Procedure

Bryana Rutherford ¹

Treatment Modalities and Managing Administration

Significance & Background

A large academic cancer center adopted the Hepatic Arterial Infusion (HAI) pump and therapy in December 2022 as a treatment option for patients with colorectal cancer with liver metastases. Initial training sessions were provided by the device company to a small group of nurses with the intention of later expanding the competency training to all infusion nurses. However, during the implementation phase, several challenges emerged, including knowledge gaps among nurses transitioning from the online training modules to real-world practice, as well as the absence of an effective documentation tool to ensure accuracy.

Purpose

The creation of nurse-led, hands-on in-services centers on essential topics such as the refill procedure, dosage calculations, documentation, patient education, and troubleshooting techniques for accessing challenging HAI pumps. These in-services, along with modifications to the documentation process and the introduction of new policies, are aimed at facilitating the expansion of this procedure to satellite outpatient clinical areas within the organization.

Interventions

The interventions implemented in this process included collecting the resources for nurse education, collaborating with an interdisciplinary team to develop the process and policy, as well as adjusting the electronic medical record. After finalizing these details, nurse education was provided in small groups of two to three nurses each.

Results

Evaluation of the success of the implementations in this process was done in a subjective manner. Feedback from nurses was positive as the education helped to clarify HAI concepts initially introduced through online training modules. The clinical area also observed fewer complications with HAI access and refill procedures.

Discussion

Involving a direct-care nurse in the interdisciplinary team was crucial for the successful rollout of HAI therapy. Collaborating with providers, pharmacists, nurse educators, and nurse informaticists, the infusion nurse identified the practice gaps, optimized initial competency, and improved documentation to enhance patient safety. The successful implementation of HAI therapy has significantly benefited patients who would not otherwise have access to such opportunities.

Oncology Nursing Forum. 2025 Mar 1;52(2):325–326.

P556. Improving Cancer Prevention and Early Detection through a Nurse Led High Risk Clinic

Sarah Sabin ¹, Ernesto Justo ², Juliana Reynolds ³, Nayely Magan ⁴, Sheyla Acosta ⁵, Jessica MacIntyre ⁶

Screening, Early Detection, Genomics

Significance & Background

The goal of cancer prevention is to improve survival outcomes by detecting early-stage disease. Identifying cancer risk can improve awareness, education, and support screening recommendations. Recommendations are frequently overlooked resulting in patients being lost to follow-up. As a result, a multidisciplinary clinic was developed to reduce barriers to care and provide ongoing, comprehensive support for those identified with a high risk for cancer or genetic predisposition. Utilizing various nursing roles, including Nurse Practitioners (NPs) and Nurse Navigators (NNs), has illustrated improvements in access, follow up, and outcomes.

Purpose

The purpose of the nurse led clinic is to decrease wait times to see a provider and increase adherence to recommended screening protocols and follow up for risk reduction treatments.

Interventions

Before the initial appointment, the NN reaches out to new patients to perform an intake; ensure they are scheduled with the appropriate provider; and gather pertinent medical records. The NN discusses each case with the NP prior to their initial visit and the NP develops a pedigree. On the initial visit, the NP performs a history and physical exam; confirms pedigree; reviews pertinent records; identifies appropriate screening protocols based on their risk level; and orders for genetic testing and other relevant labs and imaging.

Results

Before implementation of the nurse led clinic, the wait time to see a provider was four months. Post implementation, between June 2023 to May 2024, provider wait times for risk evaluation decreased to one week and wait times for cancer patients in need of testing for treatment decisions decreased to 11 days. Additionally, time to initial NN patient contact and intake completion was within one business day. Cancellations also decreased by 10%; while the number of appointments increased 42%. Patient satisfaction scores remain at 100%. Furthermore, the NN has significantly improved completion rates, with specialty physician follow-through increasing from 29% to 57% and radiology completion rates from 23% to 59%; highlighting the crucial role NNs and NPs play in coordination of care.

Discussion

Findings indicate a nurse led high risk clinic has a positive influence on resource utilization and care coordination. NPs and NNs can efficiently evaluate patients and provide comprehensive visits. The nursing led clinic has enhanced scheduling efficiency and adherence to recommended guidelines, ensuring early detection and risk reduction for patients at high risk for cancer.

Oncology Nursing Forum. 2025 Mar 1;52(2):326–327.

P557. Improving Critical Thinking Skills to Promote Safety and Reduce Avoidable Financial Losses in Outpatient Infusion Center

Miwa Saito ¹, Jonathan Morales ², Sarah Middlekauff ³, Tara Simon ⁴

Quality and Safety

Significance & Background

With the rising complexity of cancer cases, cancer systematic treatment such as chemotherapy, immunotherapy, and other therapies, the cost of drugs has also risen. Understanding the cost of cancer care delivery is a crucial responsibility of nursing leadership. By being aware of these costs, identifying areas for potential cost savings plays a pivotal role in preventing unnecessary expenses. An ambulatory infusion center within a large metropolitan area provides approximately 40,000 chemotherapy/ immunotherapy treatments annually. In 2023, there were 102 instances of drugs being prepared but not administered, resulting in a loss of approximately $ 108,000. Although the reasons for this wastage were varied, nursing assessment that highlighted poor critical thinking accounting for 22% of the loss, equivalent to approx. $65,000. Understanding these reasons is crucial in devising strategies to minimize such wastage and reduce costs and promote safety.

Purpose

The purpose of this project was to improve critical thinking skills and ensure that all aspects of patient conditions are assessed during the chemotherapy/immunotherapy dual verification processes, promoting safety and reducing financial losses associated with nursing assessment.

Interventions

All 102 cases that resulted in drug waste were reviewed, and the opportunities related to nursing assessment that highlighted the improvement in critical thinking skills were identified. In collaboration with oncology nurse educators, to improve critical thinking skills, real-life cases were incorporated into nursing orientation and annual competency exams. In addition, four-weeks purposeful morning huddles that reviewed the actual cases that resulted in the drug wastage, such as missed abnormal labs that were not necessarily specified in the treatment parameter, were conducted.

Results

Data from post-educational sessions demonstrated a 7 % reduction in nursing-related drug wastage and an approximately $47,000 reduction in financial loss compared to 2023.

Discussion

Providing case studies to promote critical thinking skills that evaluate all aspects of clinical conditions that patients are in, which are not necessarily drug-specific, improves nurses’ overall assessment skills. Nursing leadership must be cognizant of the practice’s impact on finances. Improving critical thinking skills not only reduces avoidable financial losses but also promotes safety.

Oncology Nursing Forum. 2025 Mar 1;52(2):327.

P558. Diversity, Equity Inclusivity and Belonging in Oncology Nursing Practice: Continuing the Conversation

Aliènne Salleroli ¹

Management

Significance & Background

Diversity, equity, inclusivity and belonging (DEIB) is key to providing quality care. To be effective, it needs to be woven into all areas of nursing practice which means full engagement by staff and leadership. In 2022, we began work in our ambulatory clinic to improve our nursing practice with respect to DEIB. Through regular education sessions, we created a path for change by fostering active conversations and setting expectations regarding DEIB and its relevance in current nursing practice. Creating engagement of staff in the DEIB conversation has been an obstacle frequently discussed, as our journey continues, we set out to find answers to what motivates staff.

Purpose

We sought to find different ways to actively engage our staff in DEIB projects and to start thinking about nursing practice in a more inclusive manner.

Interventions

We created a DEIB-based survey to discern what the staff wanted to learn consisting of five questions. A post-intervention survey of three questions was also given. The surveys enquired what DEIB topic or community they wished to learn about and if they felt they had the knowledge, tools and resources to give appropriate care to this community. The post intervention survey focused of perceived efficacy.

Results

We learned this team had a high population of patients who identified as either Hispanic or Latinx and many were Spanish speaking only. The staff requested education and identified specific tools they needed to give equitable care. A second virtual translator device was obtained to account for the high population of Spanish speaking patients. Patient education and literature were translated into Spanish. They also noticed their patient brochures were filled with Caucasian patients only. They escalated this concern by requesting new brochures that directly reflected the diverse communities we serve. The post intervention survey showed that the staff felt that they were more aware of disparities facing Hispanic and Latinx patients.

Discussion

Having the staff decide which topics are most relevant to them results in their becoming actively involved in the changes they want to see. This engagement changed how they thought about inclusivity and belonging from the patient’s perspective, and they continue to include DEIB strategies in their practice. By continuing the conversation as part of regular practice and with active engagement we are now in the work of meaningful change.

Oncology Nursing Forum. 2025 Mar 1;52(2):327–328.

P559. Optimizing Prevention of Chemotherapy-Induced Nausea and Vomiting (CINV): a Patient-Centered Approach

Hannah Samley ¹, Heather Coyne ²

Symptom Management and Palliative Care

Significance & Background

Chemotherapy remains one of the foundations of cancer treatment, but it can cause severe side effects including nausea and vomiting which can impact patients’ quality of life, social interactions, and adherence to treatment plans. It can also lead to higher healthcare expenses. CINV affects up to 80% of patients receiving chemotherapy, though it varies in severity. It is influenced by chemotherapy type and dose, patient characteristics, and individual susceptibility. Many institutions utilize national guidelines for antiemetic regimens that are based on the emetogenicity of the chemotherapy, but these guidelines frequently overlook individual patient characteristics that may heighten the risk of CINV.

Purpose

To review existing research and guidelines to identify patient-specific factors that heighten the risk of CINV, and to assess a validated risk assessment calculator, which incorporates these patient-specific factors, to predict the incidence of CINV for individual patients.

Interventions

Predicting or examining a patient’s risk for developing CINV based on patient-specific factors such as age, gender, hours of sleep before chemotherapy, smoking history, history of alcohol use, history of morning sickness, and patient’s expectation of nausea.

Results

Overall, the studies in this review found that younger age, female gender, history of non-smoking, no history of alcohol use, sleeping fewer than seven hours the night before chemotherapy, history of morning sickness, and having the expectation of nausea all increased a patient’s risk for CINV.

Discussion

Creating an antiemetic prophylaxis plan based solely on the emetogenicity of the chemotherapy regimen can inadequately prevent nausea in those at higher risk of developing CINV. Utilizing a validated risk assessment calculator based on known risk factors specific to individual patients may lead to better prevention of CINV and therefore, higher patient satisfaction and quality of life.

Oncology Nursing Forum. 2025 Mar 1;52(2):328.

P377. An Innovative Approach to Patient Delays in Notifying Nurses of Early Symptoms of Hypersensitivity Using “Rubber” Chickens

Christi Marcotte ¹, Christi Marcotte ², Marisa Rossy ³, Marisa Rossy ⁴, Ivonn-Ed Sanchez ⁵, Lauren Davis ⁶

Healthcare Delivery

Significance & Background

Infusion Nurses (RNs) often treat patients presenting for the first cycle of treatment (C1D1) for various illnesses. These patients may feel nervous as they are facing a regimen that can cause serious side effects and hypersensitivity reactions (HSR). Patients are educated prior to C1D1 regarding HSR symptoms that require prompt intervention to prevent harm, but they sometimes delay notification due to minimization, fear of bothering and other factors. The size and layout of the infusion room can challenge RNs to promptly assess and to initiate treatment protocol for the HSR, as well.

Purpose

To share a cost-effective method that assists patients receiving C1D1 to manage their feelings of unease, build rapport with care staff and alert RNs early to the onset of symptoms of HSR using noisemaking “rubber” chickens.

Interventions

After obtaining informed consent, patients receiving C1D1 with a moderate to severe risk of HSR were offered a “rubber” chicken prior to initiating regimen. RNs reviewed with each patient the symptoms of HSR and use of the chicken to alert staff.

Results

While implementing the intervention, RNs found patients to exhibit a more relaxed demeanor. Upon handling the rubber chickens, patients began to smile and laugh, often sharing this unique experience with loved ones or with a treatment neighbor. This intervention has been helpful in assisting staff in their prompt assessment and treatment of HSR, and in decreasing feelings of unease among C1D1 patients.

Discussion

The practice of using noise-making rubber chickens enhances the patient’s experience during initial infusion treatment. RNs found this practice to be feasible, cost-effective and of benefit for patients who reported decreased fear and unease and increased likelihood of alerting RN in early HSR. The use of rubber chickens may improve patient experience and impact response times for RNs during early HSR. RNs plan to formulate surveys for patients to complete before and after the initial treatment for measurable, standardized, and qualitative data on patient experiences.

Oncology Nursing Forum. 2025 Mar 1;52(2):328–329.

P561. Role of Nursing Leadership in Supporting Nurses with Moral Distress

Sarah Merkle ¹, Kelly Sanchez ²

End of Life

Significance & Background

Nurses spend a great deal of time at the patient’s bedside compared to other providers. The work of the nurse is sacred as they bear witness to all stages of life. Nurses may face ethical and legal issues in decision-making related to end-of-life care. These dilemmas have a strong potential to elicit moral distress among those involved in patient care.

Purpose

The purpose of this project is to describe interventions set forth to support the nursing team who was caring for a patient who was placed on palliative sedation in an acute care community hospital and the role of the nurse leader in assisting the bedside nurse in navigating moral distress.

Interventions

Through the collective wisdom of the healthcare team, the following interventions took place to ensure the ethical principles were being honored while supporting the frontline nurses: (a) ethics committee meeting including frontline staff; (b) frequent multidisciplinary meetings to address the plan of care; (c) daily check in with assigned nursing staff and charge nurses by unit leadership; (d) provided session with a Medical Ethicist to address moral distress, debrief on nursing care experiences and questions; and (e) a 30-minute staff meeting debriefing.

Results

A Likert Scale survey was administered to 58 registered nurses after the interventions were completed. 89% of staff feel confident in understanding the resources available to assist in addressing an ethical dilemma. 82% feel confident in understanding the resources available to address moral distress. 94% feel comfortable communicating their moral distress with others to obtain support. 77% feel confident in understanding of the role of the ethics committee. 93% feel supported by management when ethical issues arise.

Discussion

It is important to accept that even with formal education and training, moral distress may impact the professional nurse when faced with an ethical dilemma. There must be a continuous assessment of moral distress in the nursing team. While all nurses have a duty to support their colleagues as ethical dilemmas arise, the nurse leader can play a critical role in identifying opportunities to support their nursing teams, create an infrastructure of support, and provide education on resources. Decisions regarding ethical dilemmas require thoughtful discussions. Examining ethical principles and how they are applied to each unique patient scenario is essential to ensure the nurse leader creates, maintains, and contributes to a morally good environment.

Oncology Nursing Forum. 2025 Mar 1;52(2):329.

P560. Proactive Approaches: Strategies for Preventing Patient Falls in Outpatient Settings

Lisa Sanchez ¹, Terri Ruiz ², Jerelyn Julien ³, Jaclyn Andronico ⁴

Quality and Safety

Significance & Background

Oncology patients are at highest risk for falls due to their intense treatments and sequalae. Falls also contribute to patients’ hospital admission and complication in care. At one National Cancer Institute (NCI)–designated cancer center, patient fall occurrences increased at an outpatient regional location. An interdisciplinary team led by nursing collaborated to identify contributing factors and implement strategies to decrease the number of falls.

Purpose

The project aimed to enhance the knowledge of outpatient staff regarding fall prevention strategies, proper documentation in the electronic medical record, and the effective use of safe patient handling (SPH) devices (i.e. Sara Stedy, Golvo lift and Re-Turn). The task force also sought to strengthen patient education on fall prevention and appropriate footwear.

Interventions

The task force met monthly to review incident reports and identify strategies to decrease falls. Areas of improvement included limited wheelchair access, lack of signage within the building and knowledge deficit with staff on safe patient handling devices. Several strategies were implemented which included the creation of a falls algorithm for staff to improve documentation, environmental rounds to identify hazard conditions and increased signage and wheelchair availability. Patient education information sessions were held quarterly to re-enforce safe environment and footwear. An email address was created for staff to contact champions for patients requiring SPH equipment. The task force held quarterly education days for staff to familiarize themselves with SPH devices.

Results

A total number of 42 staff have completed the quarterly training for SPH devices. These include nurses, patient care technicians, radiology technicians, radiology aids and radiation therapists. A pre and post survey was completed to identify comfort with device usage. Post survey results showed a 46% increase in comfort with the Sara Stedy, a 78% increase in comfort with the Golvo lift and a 71% increase in comfort with the Re-Turn device. Additional champions were recruited during these sessions to be primary resources to staff requiring assistance while using devices for patients.

Discussion

Oncology patients are vulnerable to falls due to the impact of cancer treatments and related health conditions. By implementing fall prevention strategies and adapting successful approaches from oncology to other healthcare settings, nurses can play a crucial role in creating safer environments and improving patient outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):329–330.

P562. Healing Bridges: Nursing Collaboration on the Cancer Care Continuum

Jasmine Sandoval ¹, Shannon Merkovsky ²

Healthcare Delivery

Significance & Background

Transitions between inpatient and outpatient care are critical for oncology patients, who face complex treatments and heightened vulnerability. Disruptions can negatively impact recovery and increase stress for patients and caregivers. Outpatient nursing teams provide primary care, triage services, and care coordination, but often experience compassion fatigue from repeatedly addressing patients’ educational gaps. As outpatient clinics handle more post-surgery care, providers and nurses are overwhelmed by increased patient volume and limited resources. Staffing shortages and lack of appointment availability may lead to unintentional treatment noncompliance, later requiring higher level of care. At a metropolitan outpatient oncology clinic, patients are typically diagnosed during clinic visits with an oncology specialist. Following diagnosis, patients receive a personalized treatment plan which may include surgery, radiation, and/or chemotherapy. Post-surgery, patients are admitted to the inpatient unit for care and education until discharge. The outpatient nursing triage line observed post-operative patients frequently called with questions regarding care instructions which should have been answered during inpatient education.

Purpose

The purpose of this project is to bridge the gap between inpatient and outpatient oncology care, with a focus on improving post-operative education of the cancer care continuum. By addressing gaps in patient education and reducing disruptions in care, this initiative aims to alleviate the burden on outpatient nursing teams, minimize the risk of treatment noncompliance, and ensure timely patient recovery.

Interventions

To address the knowledge gap, the outpatient nursing team initiated a meeting with their inpatient counterparts. Both teams reviewed and aligned their protocols and educational tools to improve continuity of care between settings.

Results

Through these efforts, outpatient nurses discovered a comprehensive ears, nose, and throat course designed for newly onboarded inpatient nurses. Both teams agreed to involve outpatient nurses, promoting greater collaboration and consistency in patient education. Now accessible to both inpatient and outpatient nurses, the course enhanced nursing staff’s skills and knowledge while fostering a sense of mutual support between the teams.

Discussion

Transitions between inpatient and outpatient care are especially critical for oncology patients. With the increasing reliance on outpatient clinics to care for post-surgical patients, it is imperative that efficient communication exists across healthcare settings. The outpatient and inpatient nursing teams aligned their protocols and educational tools to foster greater collaboration and consistency in patient education.

Oncology Nursing Forum. 2025 Mar 1;52(2):330–331.

P563. Setting the Foundation: Implementing an Institutional-Based Chemotherapy/Immunotherapy Administration Course

Amanda Sarafin ¹, Andrea Wagner ², Melanie Longo ³, Gonxhe Hadzi ⁴

Professional Development

Significance & Background

Oncology patients require specially trained, interdisciplinary team members to provide high-quality, safe patient care. The principles of systemic therapy, which include chemotherapy, immunotherapy, and the administration of targeted therapies, may not be familiar to newly hired oncology nurses. Due to the complexity of these agents, it is encouraged that all oncology nurses undergo specialized education before administering these therapies to ensure safe patient care. Among the inpatient oncology units in a large academic medical center, a gap was noted between the application of theoretical concepts learned through online coursework and practice.

Purpose

After six months of hire and completing the online Oncology Nursing Society’s (ONS) Chemotherapy/ Immunotherapy Certificate Course, the nurses enroll in the new instructor-led, 8-hour course which compliments their existing education.

Interventions

At the beginning of 2023, this instructor-led course was created with the inpatient oncology education specialist and oncology nurse specialists from the solid, liquid, and stem cell transplant divisions. Incorporating institutional policies and protocols, this course draws from national standards and evidence-based guidelines and practices, which cover various topics, including safe handling, the verification process, side effects/toxicity management, and the importance of patient education. This course was approved for seven and a half continuing education hours and requires a survey on completion. All nurses are considered competent to safely administer chemotherapy after completing the course and going through a 3-step validation process.

Results

Since implementing this course, we have taught 10 classes and received 61 survey responses. These survey responses reflected positive feedback regarding knowledge acquired during the course and confidence in handling chemotherapy safely. Limitations include only offering the course to inpatient nurses.

Discussion

Safe outcomes for patients receiving chemotherapy are of the utmost importance, and a solid foundation in chemotherapy administration through education and hands-on practice ensures a confident and knowledgeable oncology nurse. This foundation has proven to be clinically relevant and significantly improves the knowledge level of oncology nurses by using evidence-based clinical guidelines and institutional standards to assist them in safely administering chemotherapy and comprehending various adverse effects. Since classes are still in session, data for this project is ongoing. In the future, we hope to offer this class to outpatient nurses and other institutional sites.

Oncology Nursing Forum. 2025 Mar 1;52(2):331.

P564. Maximizing Efficacy and Accuracy in Chemotherapy Administration: Implementing a Pretreatment Validation Checklist for New Oncology Nurses

Amanda Sarafin ¹

Quality and Safety

Significance & Background

The safe administration of chemotherapy drugs presents unique challenges that call for additional safety measures. Chemotherapy drugs are known to have a small margin for error and are utilized in complex combination regimens, especially within the inpatient setting. Therefore, chemotherapy-related medication error prevention remains a top priority for patient safety.

Purpose

This evidence-based quality improvement project within our inpatient medical oncology unit set out to establish and assess the efficacy of a chemotherapy pretreatment checklist. The goal was to improve nursing confidence, prevent patient harm, and standardize the administration of chemotherapy and documentation procedures while adhering to national chemotherapy safety guidelines and practices.

Interventions

The chemotherapy pre-treatment checklist was created as a paper checklist for our chemotherapy-competent nurses to use before releasing the chemotherapy from the treatment plan. The nurses received training on how to complete the checklist in its entirety, the steps to take if interventions were needed, and where to document their findings. Weekly chart audits were carried out to monitor checklist compliance and use.

Results

The top priority for safe patient care is the safe administration of chemotherapy. Our medical oncology unit has significantly benefited from the addition of the chemotherapy pre-treatment checklist, which has improved and streamlined our verification process. This checklist has also increased knowledge about adhering to evidence-based practice guidelines and chemotherapy safety measures. Implementing the chemotherapy pre-treatment checklist has decreased administration-related errors and improved patient safety, evidenced by clinical observations and decreased event report rates.

Discussion

Implementing a chemotherapy pre-treatment checklist improves nursing confidence and prevents patient harm while streamlining chemotherapy administration and nursing documentation processes in compliance with Oncology Nursing Society (ONS) guidelines. Since more nurses are continuing their chemotherapy training, data for this project is ongoing. In the future, we hope to build this checklist into a smart phrase that will assist in furthering adherence and compliance.

Oncology Nursing Forum. 2025 Mar 1;52(2):331–332.

P565. Much Ado About Mentoring: Collaboratively Achieving Smart Goals

Mildred Sattler ¹, Erica Scott ², Bridget Kim ³, Nancye Fiestritzer ⁴, Erika Armstrong ⁵

Professional Development

Significance & Background

Staff satisfaction and retention are critical challenges in nursing workforce. To address, a system-wide mentor program was designed and implemented across multiple units, leveraging nurse engagement. Since 2018, the program aimed to advance nursing knowledge and leadership development through promotion of cross-generational learning focusing on nurses at every level of practice.

Purpose

To foster a culture of excellence, enhance professional development, promote nursing retention, a peer mentor program paring novice and experienced oncology nurses was designed and executed across the system.

Interventions

Prior to the program’s implementation, a dedicated mentor-focused committee was established. Extensive secondary research on mentoring was then conducted, allowing the committee to craft a pre-post survey evaluation design for mentorship metrics, to develop a structured program, created a comprehensive Toolkit, streamlined a matching process, and defined various evaluation parameters to ensure uniformity across the program. Multiple communication methods— including emails, shared governance meetings, and hospital-wide newsletters—were used to inform nursing staff across the healthcare system about the program’s initiation and promote participation from potential mentors and mentees. Since 2018, the program spans from September to May, with monthly education provided to mentors and mentees on topics such as crafting SMART goals and building communication skills. At the end of each month, a survey is then conducted to gather feedback on the program, the mentor/mentee relationships, and the education provided at monthly sessions.

Results

Over its history, more than 250 nurses, LPNs, and MAs have participated in the program. Retention rates are also strong, with the 2018 cohort having a current retention rate of 78.1%, last year’s cohort at 97.1%, an overall average retention rate of 83.4% among all cohorts. Last year also showed significant outcomes, with 95% of all mentorship members participating in educational sessions, 88% of mentees completing their designated personal SMART goals, and 81% of members reporting an overall positive experience in the mentorship program. The monthly survey highlighted several individual outcomes and successes, such as achieving desired specialty certifications, advancing on the clinical ladder, improving their ability to set and accomplish professional goals.

Discussion

Overall, the nurse mentorship program has demonstrated strong participant satisfaction, engagement, and retention. It has also shown success in supporting the advancement of nursing knowledge and leadership development across generations through its ability to foster relationships and provide monthly educational sessions to participants.

Oncology Nursing Forum. 2025 Mar 1;52(2):332.

P566. The Impact of Cancer Diagnosis and Treatment on Self-Perceived Identity and Support Systems

Peter Scarperi ¹, Peter Scarperi ², Amy Kaiser ³, Aimee Baiungo ⁴

Psychosocial Dimensions of Care

Significance & Background

Each year, 2 million individuals receive a cancer diagnosis. The diagnosis can impact patients physical and emotional self-perception, straining social relationships, romantic partnerships, family connections, and friendships. The added psychological distress of a cancer diagnosis can affect mental health, often leading to feelings of guilt, burden, and fear. The financial strain of medical related costs adds considerable stress for both patients and their caregivers.

Purpose

The purpose of this evidenced based practice qualitative project was to examine the changes in identity and support systems that patients with a cancer diagnosis may experience.

Interventions

This evidenced based practice project employed narrative inquiry, ecomaps, and thematic analysis to explore patients’ self-perceived identities and roles. Erikson’s Theory of Human Development provided the theoretical framework to guide the interviews and contextualize participants experiences. A total of six patients were interviewed to examine identity and roles within their lives. Six participants, aged 48–85, were interviewed for 15–45 minutes, with questions aimed at examining self-perceived identity and support systems.

Results

None of the participants perceived a fundamental shift in their personal identify. However, they often report major shifts in relationships and an increased desire for life satisfaction. Participants’ acceptance was impacted by their stage of life and diagnosis. Those who were in middle adulthood with a poor prognosis reported experiencing feelings such as loss, poor acceptance, and despair. However, those in older adulthood reported experiencing feelings aligned with Integrity vs. Despair, such as acceptance with integrity and regret associated with despair.

Discussion

While patients may not report distress related to their self-identity, they often need to adapt to how their lives and relationships are changing. Treatment should include trained therapeutic providers in a supportive environment where patients can express their feelings and better adapt to these changes. While it is important to identify patients most in distress, it is beneficial for all patients to have the opportunity to share their thoughts and feelings towards their diagnosis and experiences throughout their cancer journey. This work was conducted by a student in the Flynn Fellowship program.

Oncology Nursing Forum. 2025 Mar 1;52(2):332–333.

P567. Siblings of Pediatric Cancer Patients: Support & Coping

Peter Scarperi ¹, Peter Scarperi ², Amy Kaiser ³, Dylan Krsulich ⁴

Psychosocial Dimensions of Care

Significance & Background

Pediatric cancer is the leading cause of death by disease after infancy among children in the US. When a child is diagnosed with cancer, it impacts the whole family. Changing family dynamics, increased responsibilities, fear of loss, isolation, and neglect can lead siblings to feel overlooked and present with signs of inadequate coping. These signs include depression, anxiety, decreased quality of life, and behavioral problems. All of which can affect the sibling long-term.

Purpose

The purpose of this evidence-based practice literature review is to determine the interventions that best support siblings of pediatric cancer patients.

Interventions

A comprehensive literature review of PubMed and CINAHL was conducted. Key words such as “sibling” and “pediatric cancer” were included while “bereavement” was excluded. A total of 288 results were found, while a total of 5 studies met inclusion criteria. Interventions and outcomes were examined across five selected studies to assess the effects on positive coping for siblings of pediatric cancer patients. The selected studies measured outcomes using quantitative and qualitative analysis from data gathered using questionnaires and guided interviews.

Results

The primary interventions discussed were psychosocial screening for the sibling, group therapy, summer camp programs, educational/informational counseling, and involvement in treatment. The outcomes that were measured in siblings included depression, quality of life, behavioral problems, anxiety, personal growth, and adjustment to change. The previously listed interventions all had positive impacts on siblings by lowering depression and anxiety while increasing quality of life.

Discussion

Evidence-based recommendations were developed based on the results of the literature review. Educational counseling, group therapy, camp programs, involvement in care, and further screening for depression and anxiety were all determined to be beneficial for siblings of pediatric oncology patients. It is recommended that pediatric oncology treatment centers include these interventions for sibling as a part of treatment to increase sibling quality of life while strengthening the family unit. This work was conducted by a student in the Flynn Fellowship Program.

Oncology Nursing Forum. 2025 Mar 1;52(2):333.

P568. Evaluating Acupuncture as an Adjunct to Cancer Treatment

Peter Scarperi ¹, Peter Scarperi ², Amy Kaiser ³, Isabelle Stewart ⁴

Symptom Management and Palliative Care

Significance & Background

Cancer patients use integrative therapies, combined with mainstream treatments, to aid in managing cancer treatment side effects. Acupuncture, an integrative therapy, addresses a wide array of symptoms and side effects, including but not limited to nausea, fatigue, and peripheral neuropathy. Research investigating acupuncture as an adjunct therapy is expanding, with patients demonstrating a strong willingness to incorporate acupuncture for effective symptom management.

Purpose

The aim of this evidenced based practice project was to examine the experiences of patients using acupuncture as an adjunct to their cancer treatment. This project aims to explore patients’ motivation behind starting acupuncture and examines its perceived effectiveness to treat and manage side effects from cancer treatments.

Interventions

This project utilized a qualitative interpretive approach to explore patients’ experiences with acupuncture alongside infusion therapy for cancer treatment. Data was gathered through semi-structured interviews. Eight patients participated with each interview lasting 15–20 minutes. Observations of acupuncture sessions and interviews were conducted on participants’ treatment day. Thematic analysis was used to analyze interview data, aiming to capture patients’ overall experiences and feelings about acupuncture.

Results

Patients’ experience with acupuncture can be divided into two main themes: treatment for side effects from cancer therapies and a positive psychological response to acupuncture to help their overall well-being. Acupuncture was reported by patients to alleviate the intensity of side effects. It also provided a relaxing and pleasant experience during or after treatments that empowered patients and allowed for them to actively engage in a positive treatment for their bodies.

Discussion

While patients do not believe acupuncture is curing their cancer, they recognize it as a vital component of their multidisciplinary care. Acupuncture may help patients manage the side effects from cancer treatments, find relaxation during a stressful time, and fosters a sense of proactive self-care. It is recommended that facilities treating patients with cancer diagnoses make acupuncture accessible as part of holistic patient care. Education for cancer patients regarding acupuncture as an adjunct therapy is encouraged as it can enhance their overall treatment experience as well. This work was conducted by a student in the Flynn Fellowship Program.

Oncology Nursing Forum. 2025 Mar 1;52(2):333–334.

P569. Paperless Healthcare: Streamlining Nursing Monitoring and Documentation of Cellular Therapy Infusions

Samantha Schad ¹, Carrie Marvill ², Sarah Lenhard ³

Healthcare Delivery

Significance & Background

Cellular therapy product administration is a specialized task for inpatient and outpatient oncology nurses. Many steps of care are documented across the complex care continuum of patients receiving cellular therapy. Documentation can be fragmented when some elements are documented on paper and others electronically. Additionally, documentation compliance is imperative for regulatory purposes. Oncology nursing leaders from two entities within an academic medical center sought feedback from bedside nurses on how to improve the process of cellular therapy product administration. The group focused on the paper cellular therapy flowsheet as a starting point.

Purpose

Oncology nursing leaders sought to reduce variations in care (e.g., vital sign monitoring, administration procedure) to align nursing documentation of cellular therapy product administration through the design and implementation of an Electronic Medical Record (EMR) flowsheet. The secondary aims of transitioning from paper to EMR documentation were to increase awareness and compliance of regulatory requirements related to cellular therapy infusion documentation, improve data collection, and promote alignment with the quality management plan.

Interventions

Oncology nursing leaders assembled an interdisciplinary team including cellular therapy quality personnel, an EMR analyst, bedside nurses, and other subject matter experts. The group met over several months to revise the flowsheet before it was built. Development of the flowsheet followed a Plan-Do-Study-Act methodology. The end result is one flowsheet with multiple display options for administration of cryopreserved products, noncryopreserved products, and immune effector cells. Prior to implementation of the flowsheet, the project leads developed and provided end-user education.

Results

The Cellular Therapy Flowsheet was implemented in January 2024 across multiple hospital entities. All elements of the administration of cellular therapy products now occur in discrete fields. This allows for simple reporting and auditing of the data elements recorded. With the optimization, it is not necessary to scan paper infusion record flowsheet into the EMR. Both hospitals now follow a standardized vital sign protocol and administration procedure for cellular therapy product administration.

Discussion

It is important for oncology nurses to have technology solutions that enhance their workflows. Many out-of-the-box EMR flowsheets do not match the workflows of the end-users. Collaboration with EMR analysts is essential to develop custom EMR workflows that streamline systems for a workforce that has many complex tasks.

Oncology Nursing Forum. 2025 Mar 1;52(2):334–335.

P570. Implementing an Electronic Study Screening Tool to Enhance Communication in a Clinical Research Unit (CRU)

Shelley Burcat ¹, Trissa Morrell ², Laura Mulderrig ³, Hallie Schermerhorn ⁴, Judy Scotto ⁵, Karen Mortimer ⁶

Healthcare Delivery

Significance & Background

The outpatient clinical research unit (CRU) at an urban cancer center is a specialized infusion unit providing direct care to patients enrolled in Phase 1 oncology clinical trials. The CRU supports protocol screening visits which includes labs, EKGs, and vital signs. Screening determines a patient’s eligibility to enroll in a clinical trial. Screening is a crucial step to recruit and select patients for trials and requires close communication between the clinical research coordinator (CRC) and CRU nursing staff to ensure all criteria is collected correctly as to not delay eligibility determination.

Purpose

Protocol screening visits are scheduled in the CRU. The following information is essential to complete a screening visit: protocol/IRB #, study arm, if protocol labs are required, total number of EKGs needed (including study number and type of EKG machine to be utilized), as well as anticipated patient start date and treatment length if eligible. This information is sometimes missing or incomplete when patients present for their screening visit as the CRCs are currently using paper communication sheets to deliver this information to the CRU. This paper can be misplaced or have illegible or incomplete contents. A streamlined method of obtaining screening visit information needed to be created and implemented.

Interventions

An electronic method of providing screening visit information to a group of CRU nursing staff members was developed leveraging Epic. A “CRU Infusion Nurses Pool” was created for CRCs to electronically send screening visit information, also serving as a central repository for all CRU staff to access information needed to screen a potential patient. An Epic Smartphrase was created for the CRCs to utilize. This prepopulates all headings of information needed to be provided for a screening visit. Education was conducted for all team members.

Results

Results are currently being monitored and tracked, based on compliance from CRCs, and on accuracy of screening data provided to the CRU staff.

Discussion

The CRU is a highly specialized nursing unit providing care to patients enrolled in Phase 1 oncology clinical trials. It is essential to leverage the EMR functionality, especially in Screenings, to streamline clinical activity, increase continuity of care, and to provide staff with concise and correct information necessary to initiate a patient on a clinical trial.

Oncology Nursing Forum. 2025 Mar 1;52(2):335.

P571. Escape the Fall: Nursing Meets the Safety and Quality Challenges Head-On

Linda Schiech ¹

Quality and Safety

Significance & Background

Nurses are frequently responsible for remaining current with quality measures pertaining to the provision of direct patient care. One of the more significant quality measures and patient safety issues is patient fall prevention. Patient falls can cause injury which may necessitate further care leading to an increase in their hospital stay.

Purpose

Nurses, in collaboration with other members of the interprofessional health, are accountable for preventing and reducing patient falls. As a discipline, nursing predominantly spends the majority of their time with patients, for that reason, nursing is well positioned to identify mechanisms aimed at preventing patient falls. Within our organization, a bundle of evidence-based strategies is utilized to educate patients about their unique role in fall prevention. Specific patient-centered education includes alarming the call bell for assistance with ambulation as well as the rationale for the yellow arm band and skid-free socks.

Interventions

The clinical practice leadership team identified a need to create educational sessions that pertained to all of the quality indicators. Beginning in spring 2025, an Escape Room focused on patient fall prevention will be launched. The team plans to integrate a simulated patient room with correct and incorrect aspects of the fall bundle. In order to escape the room, each of these aspects must be completed. The activity facilitators must confirm all aspects of each station are satisfactorily met before the team can move onto the next station. Once the nurses successfully complete all aspects of the escape room activity, a debrief will occur to ensure the educational objectives were met. The first escape team to complete all stations will be determined according to clocked time for competition validity.

Results

After implementing the escape room activity, the team will review the participant feedback and parlay it with objective input from the activity facilitators as a means to ensure that the intended outcomes of the strategy were achieved.

Discussion

Through the application of new nursing knowledge via this active learning strategy, content retention will be increased, which will support our patient fall prevention initiative.

Oncology Nursing Forum. 2025 Mar 1;52(2):335–336.

P572. Reducing Patient Anxiety During Radiation Treatments by Teaching Them Simple Breathing Techniques

Rosanna Schifilliti ¹

Psychosocial Dimensions of Care

Significance & Background

Radiation therapy can be an overwhelming experience for many patients, often bringing additional stress and feelings of fear. Relaxation breathing techniques have demonstrated positive outcomes in reducing anxiety along with the potential for increased healing. Engagement in relaxation breathing may also allow for better patient outcomes such as reduced anxiety levels.

Purpose

To relieve patient anxiety and stress during their radiation treatments and increase their overall sense of wellbeing, leading to improved patient satisfaction and experience during their treatment journey.

Interventions

A sign describing relaxation breathing was placed in the waiting room to inform patients of this opportunity and how to proceed if interested. A survey was distributed to screen for interest in participating, prior knowledge of relaxation breathing, and willingness to have follow up encounters. Cards were created, “Just Breathe” with a QR code patients could scan and access these instructions. The ease of access to the instructions encouraged patients to practice the breathing when home. A second survey was distributed, either on completion of therapy or at a 3 week follow up, evaluating the benefits of using these learned practices.

Results

Patients have shown genuine interest in learning relaxation breathing techniques. Initially, patients learned and used these during their treatments. Many patients showed promise in maintaining this skill and the nurses would be present during treatments for questions and support. Vital signs were obtained before and after using relaxation breathing during their treatments. Most showed a reduction in pulse and blood pressure. This positive result encouraged them to keep up the practice and many remain actively using relaxation breathing beyond their treatment as identified in follow-up visits. This initiative led to having professionally made signs in our exam rooms to incorporate relaxation breathing into regular practice.

Discussion

Many cancer patients experience anxiety over their diagnosis and subsequently during treatment. Patients have been shown to benefit by learning ways to relax during their treatments. Additionally, patients will be able to carry this learning into their everyday lives. Having a tool they can use during these times has empowered these patients and led to a reduction of anxiety and greater feelings of wellbeing. This ultimately leads to greater patient satisfaction with their overall experience.

Oncology Nursing Forum. 2025 Mar 1;52(2):336.

P573. “Bottom Line Breakthroughs: High Resolution Anoscopy and Navigating Barriers to Butt Care”

Kristi Schimberg ¹, Kristi Schimberg ², Kim Gafford ³, Jennifer Euton ⁴, Syed Husain ⁵, Stephanie Mitchem ⁶, Charles Alexander ⁷

Psychosocial Dimensions of Care

Significance & Background

Anal cancer incidence has increased, with an estimated 1.7 cases per 100,000 people annually in the U.S. Human papillomavirus (HPV) is a major risk factor, being responsible for 90% of anal cancers. Discussion about anal health can be uncomfortable and embarrassing, due to the association with HPV and sexual contact. This is compounded by social stigma, particularly affecting men who have sex with men (MSM). Lower socioeconomic status (SES) is also linked to higher anal cancer rates due to limited access to healthcare & lower education levels. Additionally, financial constraints can delay diagnoses and result in advanced disease.

Purpose

To identify barriers in HPV and anal cancer care and propose strategies to improve care.

Interventions

Dedicated HRA clinic nurses provide education to patients including vaccinations, links to anal cancer, and screening procedures. A medical history with a focus on bowel changes is completed. Nurses facilitate discussions on sensitive topics which offers emotional support and normalizes conversations about anal cancer. Collaboration with colleagues addresses logistical issues and patient compliance. Initially, we had just two trained physicians serving all of Ohio and neighboring states, which led to long wait times and follow-ups extending beyond a year due to high patient volume. To address this, we added two nurse practitioners, bringing our total to four providers. With this increase, we are now able to meet the American Society of Colon and Rectal Surgeons’ guidelines by scheduling new patients and follow-ups within six months. Additionally, we added a patient navigator to support underserved populations. We have also launched a research study on anal cancer screening trends.

Results

Patients express anxiety about the procedure, fearing pain without general anesthesia. After their first visit, they report feeling more at ease due to support given. Referrals increased from a major LGBTQ+ and HIV/AIDS organization. We aim to expand our network by educating providers and increasing community outreach efforts that improve patient understanding and access to care.

Discussion

HRA clinics provide crucial services, but there are a shortage of clinics and providers. Misconceptions, perceived biases, and inadequate education can exacerbate substandard care. Nurses can mitigate this through education, support, and collaboration, ensuring patients feel understood and valued.

Oncology Nursing Forum. 2025 Mar 1;52(2):336–337.

P574. “Does Perception Meet Reality?” Patient Perception of Second Line or Greater Treatment

Laura Schmidt ¹, Rene Woolard ², Taylor Brinkley ³, Thomas Harris ⁴

Psychosocial Dimensions of Care

Significance & Background

In the field of oncology, treatments can vary. Cancer can be unpredictable, and the initial treatment may not work. Second line and greater treatments are often employed to attack or manage the disease. Those who choose to undergo these lines of therapy typically have a concerning prognosis but may not fully understand or participate in their treatment goals. Multiple research studies have shown comfort levels, satisfaction, and coping skills increase when patients are knowledgeable of their treatment plan.

Purpose

The goal of this research was to gauge the patient’s perception of the treatment plan and evaluate if additional support was warranted.

Interventions

The lead researcher collaborated with physicians to develop a 3-part questionnaire based on the treatment plan. Patients completed the questionnaire on their first day of treatment. These were then reviewed by the provider and researchers to identify if additional support and education was needed. Conversations were held addressing disease progression, the need for advanced care planning, palliative care, and hospice. Patients were offered various psychosocial services including, but not limited to, advanced care planning, dieticians, social work consults, and pain control.

Results

After evaluating 33 participant responses, 73% of patients’ perceptions did not align with their disease progression and prognosis. All participants were shown to need additional support in either education or psychosocial determinants. Post questionnaire conversations were held to reevaluate the patient’s goals and treatments. Forty-two percent of which accepted hospice and or palliative care services. This research revealed a lack of resource utilization especially in social work and advanced care planning. The study also showed a need for additional education within the nursing team regarding the psychosocial resources available in our community.

Discussion

The questionnaire showed that treatment perceptions were not always aligned with the physician’s goals. By evaluating the responses, this allowed for additional opportunities to address patient and family psychosocial needs. Oncology nursing strives to promote the best quality of life for the patient. Adoption of this questionnaire is a straightforward way to gauge the patient’s perception versus the reality of their disease and treatment. By bringing goals to light, patients are more engaged, and treatments can be better tailored to individual needs. Nurses utilizing this tool early on and throughout the disease progression, can increase patient engagement in their care and quality of life.

Oncology Nursing Forum. 2025 Mar 1;52(2):337.

P575. Implementation of a High-Level Disinfection Champion in the Radiation Oncology Clinic

Ashley Schmitte ¹

Management

Significance & Background

Radiotherapy is one of the treatment modalities commonly used for patients with head and neck cancer. The workup for head and neck cancer can be extensive, requiring the patient to complete multiple tests and procedures. A typical procedure in the Radiation Oncology outpatient clinic is a nasopharyngoscopy. This procedure examines the nose and throat using a small flexible tube called a scope. Radiation Oncology providers will typically scope patients during follow-up visits to assess for treatment response. After the procedure, the nurses and ambulatory clinic technicians ensure the scope is appropriately cleaned using high-level disinfection (HLD) processes. Improper handling of the scope can lead to catastrophic consequences related to patient safety, infection control, and scope damage. Lack of proper HLD training also causes unnecessary stress and decreases staff satisfaction.

Purpose

This project aimed to define and standardize the HLD process for the nursing staff within the Radiation Oncology clinic. Standardized HLD training is necessary to maintain patient safety and improve the overall quality of patient care. The HLD Champion role was created to educate staff on efficient care and scope cleaning. This role also provided staff with a representative to help address any HLD and scope-related concerns.

Interventions

A significant contribution of the HLD champion is creating and implementing the HLD training checklist, which details training resources and competencies needed to ensure comprehensive orientation to the process. The HLD champion guides staff through all HLD processes and ensures proficiency.

Results

All nurses, current and onboarding, must complete this checklist under the guidance and supervision of the HLD champion. This serves as an evaluation tool to establish a baseline and annual competence. It is the responsibility of the champion to routinely check-in and assess staff comfort level when performing HLD. The champion will address any identified needs and provide additional education when indicated.

Discussion

The champion attends the larger institutional regulatory meetings that guide all HLD-related protocols. They also serve as a bridge for information sharing while enhancing staff’s skill level and job satisfaction. The addition of the HLD champion role in the Radiation Oncology clinic ensures patient safety and provides a necessary support system for the nursing staff.

Oncology Nursing Forum. 2025 Mar 1;52(2):337–338.

P576. Expanding Chemotherapy Competence: Enhancing Nurse Training in Community Hospitals

Corey Schuller ¹, Allison Baus ², Colleen McCracken ³, Sarah Davis ⁴

Management

Significance & Background

Our community hospitals provide care to many patients living in rural areas. To date, these hospitals have offered limited inpatient cancer care. For example, in 2023, two community hospitals administered chemotherapy only 51 times (6 and 45 respectively). Units providing chemotherapy are medical-surgical focused rather than specialized in oncology and lack an oncology educator. Due to the increasing demand for chemotherapy delivery at these sites, the limited number of nurses prepared to deliver chemotherapy, and nurses’ request for additional training, we revised the curriculum and educational resources to better support these nurses.

Purpose

To meet the demand for chemotherapy training at our community sites, four expert oncology educators developed a robust curriculum that included active learning strategies and a resource tool kit.

Interventions

Our expert team developed an array of short videos and step-by-step written tipsheets highlighting specific pieces of the chemotherapy administration process. Resources were placed on a dedicated site that is accessible to all staff in our health system. We redesigned our in-person chemotherapy administration course to focus on interactive case studies that required participants to search for and utilize available resources including our systems hazardous drug administration policy. The goal was to better prepare nurses to find critical resources when needed. To solidify learning and application to practice, participants completed additional 1:1 training on chemotherapy administration with an expert oncology educator at our main campus. Additional resources included a Webex chat for just in time support of the community hospitals educators.

Results

In 2024, seven classes have been held, and 23 community nurses have completed competency verification at the main campus. We assessed nurses’ confidence and knowledge of chemotherapy administration before and three months post in-person class. Data collection is ongoing; feedback from leaders, educators, and staff has been extremely positive. The number of chemotherapy-competent nurses increased from 24 to 45 post interventions.

Discussion

In 2024 our community hospital’s chemotherapy administrations increased substantially (121 administrations). This increase has offset capacity issues at our main campus and helped keep patients closer to home as they receive treatment. Importantly, the number of chemotherapy competent nurses at the community division has almost doubled, improving our ability to provide this cancer treatment. The educational curriculum will continue to be optimized, but overall, staff appreciate the hands-on support with this essential oncology nursing skill.

Oncology Nursing Forum. 2025 Mar 1;52(2):338–339.

P577. Yoga and Increasing Nurse Resiliency and Retention

Jaclynn Sciulli ¹

Management

Significance & Background

The Surgeon General issued a Public Health Advisory on May 23, 2022, highlighting the need to address the significant levels of burnout and increased number of resignations among healthcare workers nationwide. Stress and burnout are often listed as a reason for resignation among my peers. Healthcare workers reported experiencing at least one symptom of a mental health condition, including depression, anxiety, and post-traumatic stress disorder (Office of the Surgeon General, 2022). Nurse retention impacts health care in numerous ways. (Presler, 2020) “It is widely acknowledged that many newly licensed registered nurses leave their first position within the first 1–2 years of employment, and stress is often cited as one of the main reasons” (Austin, Saylor, & Finley, 2017).

Purpose

Yoga sessions were established to increase nurse retention by decreasing stress and fostering resiliency—retention of experienced nurses results in better patient outcomes while reducing turnover rates.

Interventions

Thirty-minute biweekly yoga classes led by a Yoga Alliance instructor were created to help improve nurses’ well-being and improve nurse retention. Classes include stress-reducing breathing exercises and yoga poses in a calming environment for all levels. “Interventions focused on developing a growth mindset, yoga and mindfulness, reflective practice, and resilience are strategies that have been identified to reduce burnout and stress in health care professionals” (Berstein et al.,2015; Cohen-Katz et al., 2005).

Results

We will compare the turnover rates per quarter with the results of our survey measuring stress and resiliency levels of staff. Participants will complete a pre- and post-class survey to measure perceived stress levels before and after class. As of September 2024, survey results have shown a 100% decreased stress level post-yoga class and increased perceived resiliency.

Discussion

Classes began in January 2024. We faced challenges of increasing staff participation. Participants reported not having the time to take the class during their shift. We encouraged leadership to allow staff time to participate and scheduled classes early to allow nurses to attend before their shifts. Participants knew the class time and location by sending an Outlook invite and by placing flyers in staff breakrooms. We reserved meeting rooms to allow for a calm yoga environment. The surveys completed thus far have shown a positive result, proving yoga to be a sustainable healthy intervention for our nurses.

Oncology Nursing Forum. 2025 Mar 1;52(2):339.

P578. Unleashing Your Nursing Practice through a Clinical Ladder

Erica Scott ¹, Mildred Sattler ²

Professional Development

Significance & Background

The Professional Lattice for Advancement in Nursing (PLAN) is a nursing clinical ladder platform that promotes and rewards professional development and clinical excellence, serving as the bedrock of a thriving nursing organization. This opportunity is extended to all oncology nurses after six months of employment in the system. Nurses can explore various tracks and roles associated with pay increases when creating a professional portfolio. Successful candidates receive a pay raise and a title change.

Purpose

This project aimed to educate the oncology nurses regarding the PLAN so they could make an informed decision on whether to participate.

Interventions

Strategies were developed and implemented by reviewing the literature on professional development, mentoring, and progression plans for oncology nurses. These strategies included individual meetings, relationship building, webinars, retreats, in-person and virtual workshops, mentor programs, leadership development and clinical ladder evaluation. Nurse leaders developed and redesigned the clinical ladder criteria, checklist, nursing webpage, and career development. Oncology frontline nurses provided feedback to nurse leaders on learning electives that they felt were important to their professional practice. Oncology nurse leaders took this feedback and created a significant list of electives that were added to the nurses’ achievements. They also included the frontline nurses to serve as PLAN champions.

Results

Through developing a nurse-centered PLAN, oncology nurse leaders created a culture where professional development is about the nurse. Over 54 clinical ladder electives are available for nurses. Monthly clinical ladder reviews were hosted, creating opportunities for professional development and personal and professional connections. Nurse leaders found value in providing in-person and virtual workshops and monthly webinars for the nurses. One hundred twenty-four oncology nurses advanced on the PLAN from 2019–2024. Since its introduction, there has been a 69.2.% increase in oncology nurses who advanced on the clinical ladder over five years. Incidentally, the higher the percentage of nurses who advanced on the PLAN in several oncology settings, the lower the nurse bedside turnover rate was.

Discussion

According to the American Nurses Association (ANA), some effective strategies for motivating nurses include focusing on communication, recognizing and rewarding hard work, offering development opportunities, and mentoring (American Nurses Association, 2023). In doing this, several of the new nurses were able to see the big picture and act to increase their professional development by advancing on the PLAN.

Oncology Nursing Forum. 2025 Mar 1;52(2):339–340.

P579. Infusion Center Competency Escape Room

Sara Scuralli ¹

Management

Significance & Background

Competence in a variety of skills, including the knowledge to carry out those skills, is a requirement for all oncology nurses. Each year our organization determines which competencies need to be assessed within the Oncology Service Line. In 2023, we implemented an escape room for competency assessment at one of our infusion centers to incorporate a more interactive environment.

Purpose

This escape room was designed to create an interactive environment where nurses could work together as a team, critically think, and demonstrate competence in a variety of topics related to caring for the patient receiving oncology treatment.

Interventions

We researched how to create escape rooms focused on healthcare topics and created an outline based on the competencies and skills identified by our leadership team. Each team, consisting of 4 nurses, was read the patient scenario prior to entering the room. Once they entered the room, they needed to follow sets of clues to reveal codes to unlock various bags and boxes located around the room. Each box/bag included a different topic: extravasation, safe handling of hazardous drugs, pre-treatment clearance, calculating carboplatin dose, restoring patency of a central line, infusion reactions, sterile urinary catheter insertion. To “escape” the room, each nurse had to successfully complete a PICC line dressing change.

Results

By completing this escape room, competence was demonstrated by a blend of policy knowledge, skill, and critical thinking. Using this method also helped the leadership team (who served as moderators) determine which nurses needed further education on each topic based on their responses and behaviors and allowed us to tailor education to meet individual needs. The feedback received from the staff was very encouraging. Staff expressed that the escape room was a fun alternative to competency stations used in past years.

Discussion

Using an escape room for competency assessment was a fun way to engage the staff in important topics needed for safe patient care. Limiting each session to 4 nurses helped to ensure everyone participated. A bonus was the conversations between nurses during the clue solving. They were able to share their own thoughts and interpretations on current practice, resulting in discussions on best practice and why certain practices are incorporated into our policies and standards.

Oncology Nursing Forum. 2025 Mar 1;52(2):340.

P580. Hazardous Drug Administration Cart

Sara Scuralli ¹

Quality and Safety

Significance & Background

Oncology nurses at our organization administer all intravenous, subcutaneous, and intramuscular chemotherapy/biotherapy/immunotherapy in our organization. One of the challenges faced by the oncology nurses was to find a way to prevent the risk of incidental exposure while administering these hazardous medications both on the dedicated oncology unit and throughout the hospital. The current practice of using a computer on wheels increased the potential of incidental exposure and did not translate to easy travel to other units as these workstations are not very mobile when transporting via elevators. The administration of these medications also requires specific equipment and PPE unique to the dedicated oncology unit. The nurses were met with a challenge if all the required pieces were not handy for administration off the oncology unit.

Purpose

The purpose of this project was to obtain a cart that would strictly be used for the administration of oncology indicated hazardous medications and would contain all the necessary equipment needed for safe administration.

Interventions

A mini-grant was applied for and received from our organization to build a more user-friendly cart that would be used on the dedicated oncology unit and then transported throughout the facility to administer hazardous anti-cancer medications. This cart had a large workspace on top including a computer and scanner. Necessary equipment was loaded inside the cart drawers.

Results

Having this cart available saved time in obtaining supplies while both on the dedicated oncology unit and off. Staff expressed satisfaction that they were not potentially contaminating computers on and off the units.

Discussion

The cart consists of a well-defined workspace, a laptop and scanner, and storage space to hold the tools needed to administer hazardous medications safely. These tools include stock of the closed system transfer device, PPE and a spill kit. The use of this cart is restricted specifically to the administration of hazardous anti-cancer medications, thus reducing the risk of hazardous medication exposure to staff members.

Oncology Nursing Forum. 2025 Mar 1;52(2):340–341.

P581. Oncology Resource RN Program

Sara Scuralli ¹

Management

Significance & Background

Our healthcare system follows these ASCO/ONS standards by requiring two Chemotherapy Certified RNs (as deemed competent based on organizational policy) to administer anti-cancer medications. Due to a limited number of inpatient nurses at two of our smaller campuses deemed competent to administer these medications, patients often have a delay in treatment or be referred to other campus for their treatment. Additionally, cancer patients in our community may come to these two campuses with complications and side effects related to their diagnosis and/or treatment. It had been identified that nurses throughout these campuses have decreased comfort caring for oncology patients due to lack of experience/knowledge.

Purpose

To increase the number of RNs competent to administer anti-cancer medications safely and to create a consortium of Registered Nurses with oncology knowledge that will function as a resource to provide cancer patients at these two campuses with the highest quality of care.

Interventions

An open invitation was sent to all nurses at the two campuses to attend an 8-week Oncology Resource RN Program in 2024. Staff was invited to participate to become an Oncology Resource RN on their unit with an additional request to become Chemotherapy/Biotherapy Certified Registered Nurse to administer antineoplastic therapy. The program included sessions on cancer basics, oncologic emergencies, oral anti-cancer treatment, care of the oncology patient, and symptom and treatment management. A survey was offered at the start and completion of the program to assess comfort levels of nurses caring for oncology patients.

Results

In total, 36 nurses attended this program. This included some nurses who were already considered certified by the organization to administer anti-neoplastic therapy but wanted to expand on their oncology knowledge. To date, organizational certified nurses has increased from 1 to 3 (Campus A) with an additional 3 in the process to become certified and from 7 to 9 (Campus B) with additional 3 in the process to become certified. Survey results showed a shift from uncomfortable levels to comfortable levels following this program.

Discussion

Offering this program has helped to increase the number of nurses deemed competent to administer anti-neoplastic therapy at two campuses. The goal is to increase the number of competent nurses by 6 at each campus. We identify that this project is an ongoing process related to the time it takes to ensure competence.

Oncology Nursing Forum. 2025 Mar 1;52(2):341.

P582. Beating the Clock: Navigating the Complications of Completing Gyn Brachytherapy Within an 8-Week Window

Nicole Seeley ¹, Sharon Charyszyn ²

Radiation

Significance & Background

Completion of concurrent chemoradiation therapy with brachytherapy within an 8-week window is associated with superior overall survival rates for patients with locally advanced cervical cancer. However, this is a complex, resource-intensive process for both patient and providers. Cervical cancer also disproportionately affects women of color and low-income/ underinsured populations. This leaves oncology providers challenged with overcoming the disparities and complexities that restrict timely completion of therapy, such as health illiteracy, emotional distress, past sexual trauma or abuse, transportation or housing needs, financial concerns, and childcare or family needs.

Purpose

In order to ensure timely completion of treatment, highest-quality care, and best outcomes for this vulnerable population, our brachytherapy team recognized the need for individualized care coordination which includes robust patient education, creation of a trustworthy environment for patients, improvement in interdisciplinary collaboration, and early intervention from social services.

Interventions

A multidisciplinary gynecologic brachytherapy team was created, consisting of 3 brachytherapy providers, 2 gynecologic radiation nurses, 1 brachytherapy nurse, Chief Anesthetist, Chief Radiation Therapist, Chief Physicist, and Clinical Nurse Manager. Care coordination begins even before treatment is initiated. A weekly team meeting was developed to discuss all brachytherapy referrals. This team formulates an individualized treatment plan for each patient, addressing both physical and psychosocial needs. Social services and financial counselling are consulted without delay. The brachytherapy nurse then acts as care coordinator for each patient, building trust and providing support, pre- and post-procedure. This nurse remains with the patient throughout the duration of brachytherapy, to assist with implantation of instrumentation, assist in CT/MRI, provide pain control and emotional support, and provide post-procedure care and education.

Results

When patients feel that they can trust their care team to meet their needs and are given the tools to be able to withstand the rigors of chemoradiation plus brachytherapy, compliance increases. In 2018, before these interventions were implemented, we had a 33% rate of cancellation for Tandem & Ring cases. Since the creation of the brachytherapy team’s comprehensive care coordination, we saw that rate cut in half, with a 16% cancellation rate in 2023. In September, our cancellation rate for calendar year 2024 was just 9%.

Discussion

Cancer centers should be prepared to provide comprehensive care coordination to patients with locally advanced cervical cancer, in order to ensure the best outcomes for vulnerable patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):341–342.

P583. Breaking the Invisible Barrier: Enhancing Patient Safety and Experience through Improved Communication Between Disciplines

Nicole Seeley ¹

Radiation

Significance & Background

Although Radiation Nurses and Radiation Therapists work toward mutual goals of optimal treatment outcomes and experience for patients undergoing radiation therapy, they have historically worked in separate silos to achieve these goals. This creates a lack of cohesiveness between colleagues and can affect the quality of patient care.

Purpose

A disconnect in streamlined workflow was identified between nurses and therapists at a busy Radiation department in an NCI designated cancer center. Radiation leadership sought to create tools for better interdisciplinary communication and collaboration. The goals for this initiative focused on increasing patient safety, staff engagement, and collective performance improvement initiatives.

Interventions

A staff survey investigated attitudes, beliefs, and perceived barriers to communication and teamwork. A data analysis of zero harm events and patient satisfaction scores was also performed. To achieve meaningful impact, managers had to evaluate their own communication at a department level and work to create a forum for nurses and therapists to problem solve together and collaborate. A monthly newsletter was created, highlighting unit & hospital updates, a quarterly joint staff meeting was implemented, a joint RN-RT Fall Prevention Task Force was organized, and a Mock Code Blue committee was formed to hold monthly emergency drills for staff. Both groups worked together to celebrate themed patient appreciation days quarterly, bringing hope and joy to patients undergoing the rigors of radiation treatment. An electronic safety report was created using the acronym INFO--Inpatient issues, Name alerts, Fall risks, On-treatment visit needs. Through use of this tool, nurses and therapists were able to report patient or machine issues to one another in a timely, efficient manner throughout the day.

Results

In 2023, 7 patient falls occurred, and since this initiative launched, the department has seen only 1 over 3 quarters. Patient satisfaction scores for likelihood to recommend climbed to a high of 99% in July 2024. The most rewarding outcome of this project has been the increased strength of communication between nurses and therapists. Once given the appropriate tools and opportunities to communicate, these groups have been more successful, making a greater impact on the delivery of high quality patient care.

Discussion

Expanding these initiatives to include ongoing professional development opportunities for both nurses and therapists could deepen their understanding of each other’s roles, ultimately enhancing collaborative culture within the department.

Oncology Nursing Forum. 2025 Mar 1;52(2):342–343.

P584. Onward: a Virtual Breast Cancer Survivorship Program Bridging Support from Acute to Extended Survivorship

Amy Selly ¹, Beth Johnson ², Alicia Cain ³, Liat Goldman ⁴, Bethany Kenny ⁵, Heidi Ganzer ⁶

Survivorship

Significance & Background

Support groups have long been utilized and impactful in providing emotional and educational support to patients with cancer throughout their active cancer journey, however, they are rarely continued for the extended phase of cancer survivorship. While traditional in-person support groups were stopped in 2020 during the Covid-19 pandemic, patient feedback helped identify a gap in supportive care in the transition from acute to extended survivorship phases.

Purpose

Patients shared the benefit of the established Advance Practice Provider (APP) led survivorship visit and subsequent education provided. However, this is a single episode encounter and the appetite for additional education and support to empower patients to maximize quality of life beyond their cancer diagnosis was recognized.

Interventions

A multidisciplinary survivorship program committee of Advanced Practice Providers (APPs), Licensed Clinical Social Workers, Cancer Rehabilitation Physician, Oncology Registered Dietitian and Integrative Medicine Providers launched a virtual breast cancer support group to provide education and support to curative intent breast cancer survivors to ease the transition to life after cancer treatment. The multidisciplinary team established criteria for participation and structure of the group. The structure was four 90-minute sessions focusing on emotional support and educational topics. The initial topics were selected based on anecdotal feedback from APP based survivorship practice. The educational portion of the weekly sessions focused on nutrition, integrative medicine, cancer rehabilitation, sexual health, and survivorship pearls.

Results

Participant feedback of the program from the pilot session was strongly positive. When asked to describe the survivorship support group experience in one word, participants responded with descriptions like, “lifesaving”, “supportive”, and “reassuring”. Feedback validated the need for additional support after the conclusion of active treatment.

Discussion

Since the initial session in October 2021, bi-annual sessions are offered in April and October. Participant feedback and Provider insight continue to help enhance and grow the subsequent survivorship support groups. Launching the virtual survivorship support group not only met the patient identified gaps in survivorship care but also provided valuable information and feedback to the team on how to improve whole person care and enhance holistic approaches for patients with breast cancer. Anecdotally, the facilitators and presenters reported elevated levels of professional satisfaction and meaning, which was an unexpected and welcome outcome.

Oncology Nursing Forum. 2025 Mar 1;52(2):343.

P585. Listen to the People: A Comprehensive Multi-Site Learning Needs Assessment

Nicole Sennebogen ¹, Leslie Landon ²

Management

Significance & Background

Providing opportunities for nurses to expand their knowledge via educational events has been shown to improve retention. During environmental scanning of a large multi-site comprehensive cancer center, we found pockets of experienced nurses voicing their desire for additional learning opportunities.

Purpose

A system wide learning needs assessment was conducted to identify knowledge gaps and create an implementation plan to address the gaps. Interventions and

Results

An open-ended learning needs assessment (LNA) survey was developed. The survey consisted of open-ended questions inquiring about the desired learning topic, potential subject matter experts, and the ideal envisioned learning session. A total of 143 survey responses from 6 campus locations were submitted by frontline nursing and support staff. The open-ended LNA was categorized into a total of 26 topic categories. Topic category frequency ranged from 1.5% to 6% of the total survey responses. Categories were then assessed by the Nursing Professional Development (NPD) team during monthly meetings to determine which topics could be combined and organized to address the system wide knowledge gaps most efficiently.

Evaluation

The NPD team evaluated current educational programs to determine if they could satisfy any of the identified gaps through the expansion of target audiences. An example of utilizing this approach included expanding the audience for an in-person chemotherapy course. This course was initially marketed towards nurses new to the organization directly responsible for administering antineoplastic therapies. After the LNA, the audience was expanded to include all oncology nurses interested in the content regardless of seniority or current administration responsibilities. In addition to expanding target audiences of current programs, the content of regularly scheduled educational offerings were modified to include more requested topics discovered from conducting the LNA. The LNA also provided individual NPD practitioners the opportunity to filter the results by location and department to provide customized education to their local frontline teams.

Discussion

Performing an LNA provides frontline staff the opportunity to voice their needs and interests. It also provides information to NPD practitioners to develop a plan to address common knowledge gaps and promote the professional growth of frontline nurses. Dissemination of LNA results and subsequent plan encourages transparency and accountability between the NPD practitioners and the frontline nursing team members they serve.

Oncology Nursing Forum. 2025 Mar 1;52(2):343–344.

P586. Use of the Oncology Nursing Society’s Nutrition Learning Library to Enhance Nurses’ Confidence and Improve Patient Care

Jennifer Servant ¹, Jeanine Rundquist ², Lisa Foertsch ³, Patricia Tuite ⁴

Symptom Management and Palliative Care

Significance & Background

Quality nutrition has an impact on the prevention of cancer and the patient experience during cancer treatment. Lack of or poor nutritional status can impact the overall course of treatment, including dose reductions, treatment delays, or discontinuation of treatment regimens.

Purpose

The purpose of this project was to develop and implement education for outpatient oncology nurses on common nutrition concerns during cancer treatment and assess the impact of that education on nurses’ confidence with education patients on nutrition. The second aim was to determine if the inclusion of this education for nurses would impact the use of nutrition resources.

Interventions

Outpatient infusion nurses completed a nutrition-focused educational program that included materials from the Oncology Nursing Society’s Nutrition Learning Library and a module that focused on the institution-specific resources. Data was collected pre- and post-intervention on nurse confidence, use of nutrition teaching sheets, assessment of patient’s nutrition-related symptoms, and nutrition consults placed by the infusion nurses. Patients were surveyed on their experience receiving nutrition education post-intervention as well.

Results

The education program was completed by 16 nurses (>25% of sample). Mean self-confidence increased in all areas after the intervention. A moderate effect size was noted for most items, with a large effect size in regard to confidence with ordering a nutrition consult. Post-intervention there was a 40% increase in the number of nutrition teaching sheets downloaded throughout the organization. There was also a slight increase in the number of nutrition consults placed and completed. The number of patients who identified as having a nutrition concern or symptom outweighed the number of nutrition consults placed both pre- and post-intervention. Weight loss was noted to be the biggest concern pre- and post-intervention on patient assessments and in the indications for nutrition consult. Nine patients responded to the post-intervention survey, with varied responses to questions about diet, symptoms, and confidence related to nutrition. These patients also reported several remaining questions related to nutrition.

Discussion

The implementation of nutrition-focused education for outpatient, oncology, infusion nurses increased their confidence with teaching patients about nutrition. This intervention may have also increased the use of nutrition resources, including teaching sheets and placement of nutrition consults. Further work is needed to continue to enhance patient assessments, patient-facing resources, and completion of nutrition consults.

Oncology Nursing Forum. 2025 Mar 1;52(2):344.

P587. Improving Discharge Process in an Outpatient Chemotherapy Infusion Center

Megha Shah ¹

Quality and Safety

Significance & Background

From 30%–60% of visits to the emergency department (ED) by oncology patients are preventable (Gallaway et al., 2021). Using the ED to treat post-chemotherapy toxicities can lead to increased health care costs, patient costs, patient anxiety, and exposure to unnecessary pathogens (Gallaway et al., 2021). A community hospital realized that avoidable oncology ED visits were increasing. Evidence supports the use of standardized discharge processes in outpatient cancer centers to reduce these visits; however, the project site had no such processes in place; therefore, this project filled a gap in the state of discharge care for patients receiving cancer treatment.

Purpose

This project aimed to reduce avoidable oncology-related ED visits at a community hospital associated with a large health care institution.

Interventions

The project was implemented using quality improvement project methodology with a pre/postintervention design to assess the oncology ED visit rate, discharge callback compliance rate, and responses from nurse feedback surveys by using an evidence-based self-developed algorithm and questionnaire for management of nausea, vomiting, diarrhea, and dehydration. The algorithm as well as the questionnaire was developed using ONS guidelines.

Results

Oncology-related ED rates decreased by 17.1%, and 100% (n = 78 patients) of eligible oncology patients were prevented from seeking care at the ED during the 12-week implementation. A 100% compliance rate of discharge callback was achieved, and 100% of nurses expressed satisfaction with the new process.

Discussion

Seeking care in the ED to treat post-chemotherapy infusion side effects can lead to increased health care costs, patient costs, patient anxiety, and exposure to pathogens, which can in turn lead to poor health outcomes in the immunocompromised oncology population (Gallaway et al., 2021). The project of implementing an evidence-based, self-developed, post-chemotherapy discharge callback process of nurses making follow-up telephone calls to patients 48 hours after they receive the first dose of chemotherapy was implemented to attempt to reduce the rate of oncology patients’ ED visits at the community hospital. Oncology-related ED rates decreased by 17.1%, and 100% (n = 78 patients) of eligible oncology patients were prevented from seeking care at the ED during the 12-week implementation. Implications for nursing practice include expanding the project to include all cancer patients who receive chemotherapy, rather than chemotherapy-naïve patients only, include more toxicities in the questionnaire, and future opportunities to collaborate with nursing informatics.

Oncology Nursing Forum. 2025 Mar 1;52(2):344–345.

P588. All Aboard! Take the Transition National

Jennifer Shamai ¹, Kate Sweeney ², Christine Tarver ³, Christopher Okamoto ⁴, Kimberly Crum ⁵, Stephanie Barendt ⁶

Management

Significance & Background

Organizations are currently faced with challenges in retaining oncology nurses and maintaining adequate staffing levels. Contributing factors are: high turnover rates of up to 50% of novice nurses quitting within year one, retirements outpacing the number of new graduates entering the workplace, increased focus on well-being, and increased demand for oncology care due to an aging population. An expanding NCI-designated cancer center needed to develop a creative way to retain both new graduates and new-to-oncology-specialty nurses amidst these workforce realities. The organization already had an accredited statewide nurse residency program and a robust fellowship program, and with a recent merge, had the ability to expand transition to practice (TTP) services across the USA. This provided for unique unified programs that ensured nurses at all sites were afforded standardized and consistent TTP training in oncology nursing, and that they leveraged and maximized program resources.

Purpose

A group of nurse executives, leaders, and educators across multiple states sought to establish a collaborative virtual model for a residency and a fellowship program. The development of the nationwide virtual programs was fueled by the desire to leverage experts across the country, enhance collaboration between newly merged sites, share resources, decrease costs of conducting separate site-specific TTP programs, and achieve nurse retention goals.

Interventions

Developing TTP programs was accomplished through nationwide collaboration of the program director and clinical coordinators at each location. A key intervention also was a nationwide Residency and Fellowship Advisory Council, allowing for frequent feedback from and dialogue with key stakeholders, including nurse residents/fellows. The nationwide programs included system-wide skills days, virtual interactive education didactic days, ONS® online courses, robust virtual group mentoring programs, virtual EBP education, and professional governance shadow days.

Results

Implementation of this innovative model has resulted in ANCC PTAP Accreditation® of the national nurse fellowship program in 2024, decreased turnover, program satisfaction, access to mentors and resources across the nation, increased engagement in professional governance, and successful graduation of residents and fellows from each state. Program satisfaction remains high, with the top three items related to mentorship, peer support, and professionalism.

Discussion

Providing effective TTP programs for new graduate and experienced nurses is an investment an organization cannot afford to pass by. With collaboration between sites, consistent evaluation of outcomes, and virtual engagement with an advisory council, superior outcomes can be achieved.

Oncology Nursing Forum. 2025 Mar 1;52(2):345–346.

P590. Analysis of Demographic Data

Kathleen Shannon Dorcy ¹

Screening, Early Detection, Genomics

Significance & Background

Cancer care disparities exist across Black, Indigenous, and People of Color (BIPOC) populations and in LGBTQI+ populations. Disparities are seen across the cancer continuum, in diagnoses, treatment, and survival data evidenced in increased morbidity and mortality rates. (ACS, 2024) Traditional methods of demographic data collection rely on aggregated data and so fail to capture the specific identities of individuals thus contributing to a lack of comprehensive knowledge of disparities. These gaps in comprehensive identification of who is being treated and the cancer outcomes perpetuate a lack of equity in cancer care.

Purpose

To examine attitudes and understanding of survey data collection for comprehensive population demographics representation.

Interventions

A group of nursing students working with oncology educators at a NCI designated comprehensive cancer center created a survey designed to gather demographic information, including questions concerning gender identity, gender expression, racial background and explore how essential these questions were for authentic demographic data collection. Interviews were conducted and transcribed for analysis from a convenience sample. (n=30) Qualitative methods were utilized and themes identified were: a. Data privacy & Transparency b. Importance of accurate minority representation c. Valuing of Gender norms & expressions d. Ambiguity of American Culture.

Results

The random convenience sample demonstrated the process of demographic data collection should become more inclusive of minority populations to address biases, discrimination, and adverse health outcomes. Only by know who we are caring for precisely can we address gaps in care begin to establish equity in oncology care and recognize who is not included.

Discussion

Research is central to improving morbidity and mortality in cancer patients and demographic data must be representative of the populations of all people. Understanding the complexities of individual identities, ensuring transparency in data collection and usage, and promoting accurate representation of minority populations are essential steps towards achieving authentic health equity inclusive of all people. It is time to work for change in methods and classifications of demographics across health care and within national, state, and regional statistical tracking systems.

Oncology Nursing Forum. 2025 Mar 1;52(2):346.

P589. Demographics are Important in Achieving Equitable Cancer Care

Kathleen Shannon Dorcy ¹

Healthcare Delivery

Significance & Background

Cancer care disparities exist across Black, Indigenous, and People of Color (BIPOC) populations and in LGBTQI+ populations. Disparities are seen across the cancer continuum, in diagnoses, treatment, and survival data evidenced in increased morbidity and mortality rates. (ACS, 2024) Traditional methods of demographic data collection rely on aggregated data and so fail to capture the specific identities of individuals thus contributing to a lack of comprehensive knowledge of disparities. These gaps in comprehensive identification of who is being treated and the cancer outcomes perpetuate a lack of equity in cancer care.

Purpose

To examine attitudes and understanding of survey data collection for comprehensive population demographics representation.

Interventions

A group of nursing students working with oncology educators at a NCI designated comprehensive cancer center created a survey designed to gather demographic information, including questions concerning gender identity, gender expression, racial background and explore how essential these questions were for authentic demographic data collection. Interviews were conducted and transcribed for analysis from a convenience sample. (n=30) Qualitative methods were utilized and themes identified were: a. Data privacy & Transparency b. Importance of accurate minority representation c. Valuing of Gender norms & expressions d. Ambiguity of American Culture.

Results

The random convenience sample demonstrated the process of demographic data collection should become more inclusive of minority populations to address biases, discrimination, and adverse health outcomes. Only by know who we are caring for precisely can we address gaps in care begin to establish equity in oncology care and recognize who is not included.

Discussion

Research is central to improving morbidity and mortality in cancer patients and demographic data must be representative of the populations of all people. Understanding the complexities of individual identities, ensuring transparency in data collection and usage, and promoting accurate representation of minority populations are essential steps towards achieving authentic health equity inclusive of all people. It is time to work for change in methods and classifications of demographics across health care and within national, state, and regional statistical tracking systems.

Oncology Nursing Forum. 2025 Mar 1;52(2):346–347.

P591. Take Care of Yourself: Incorporating Wellbeing Education for Oncology Nurses and Support Staff

Ashley Shelden ¹

Professional Development

Significance & Background

Wellbeing within oncology nursing is essential due to the high stress and complexity of patient care. Educating oncology nursing and supportive staff in identifying compassion fatigue, burnout and stress within themselves can improve mental health and resilience. Self-care and mindfulness can reduce stress levels, which improves mental health within oncology nursing. Short mindfulness sessions within the workday can improve mental clarity and regain focus. The education sessions were designed to give oncology professionals a sense of empowerment to prioritize their own wellbeing.

Purpose

To educate and promote self-care and mindfulness within the workplace and at home.

Interventions

10 Virtual education sessions were offered on compassion fatigue and burnout, stress management, self-care, and workplace bullying. Education sessions contained interactive polling, engaging conversations, and strategies on how to improve overall wellbeing and everyday mindfulness. Education sessions were designed to encourage participants to identify signs and symptoms of compassion fatigue, burnout, and stress. Participants were given valuable resources that were offered within the health system and resources to explore outside of work. Resources and strategies included a wide variety of tools, such as, meditation, breathing exercises, the health systems employee resource center, additional education sessions, books, and podcasts.

Results

A total of 210 participants attended these virtual education sessions throughout the large cancer hospital. Out of the total participants, 96% increased their knowledge of the presented topics. The attendees indicated that the content was well received and highly informative. The oncology professionals commented that the information was timely given the increasing demands of oncology care.

Discussion

The educational topics were tailored to oncology professionals which emphasized the key elements in emotional and physical health. The information was evidence based and practical, which could be implemented within the clinical setting and at home. The topics were designed to provide oncology professionals with actionable steps to handle high pressure situations effectively. The presentations successfully delivered valuable insights equipping them with tools to enhance their overall health, which benefits patient care. The content was engaging and highly relevant to the attendees addressing real challenges faced within oncology care.

Oncology Nursing Forum. 2025 Mar 1;52(2):347.

P592. Humor and Humility: How Much is Enough?

Gary Shelton ¹

Psychosocial Dimensions of Care

Significance & Background

Humor with laughter is good medicine, supporting socialization as well as a diversion from pain and suffering. The impact on cardiovascular disease, the immune response, endorphin release and decreases in stress hormones is well documented. Incorporating humor and laughter into our work lives is challenged by barriers; humor has no place in healthcare. Utilizing Travelbee’s Human to Human Relationship model as a framework for establishing rapport with others, allows for us to connect. Acknowledging that our humility facilitates our self-awareness, fosters better communication.

Purpose

Reviewing the current literature regarding the psychologic and physiologic benefits of humor and laughter, facilitates an understanding for establishing human to human relationships. Attendees will hear various hypotheses, and concrete results from scientific inquiry. Passive humor from observation and active humor whereby one creates or finds humor within unpleasant or stressful situations will be discussed. Strategies for the appropriate implementation of humor are outlined. The use of case studies and examples of humor therapy is included.

Interventions

Attending this presentation allows for a better understanding of the place for humor in healthcare and provides strategies for its implementation. An understanding of Travelbee’s Relationship model further promotes an understanding of how to create rapport with other human beings. Understanding that humor goes beyond telling a joke, that to find humor within the setting of stress or illness can have benefits that go beyond socialization or diversion is clarified. Humility reminds us that we are not adequately able to care for others, without self-knowledge.

Results

The complimentary use of humor and laughter therapy in the setting of illness provides diversion, a feeling of well-being, and has been shown to improve health by a multitude of physiologic and psychologic processes. By facilitating connections with other human beings, nurses find the usefulness of humor as a tool to decrease barriers to implementation. Attendees learn that laughter and humor are human responses, promoting quality of life and adaptation to illness.

Discussion

Nursing is an interpersonal process whereby the professional nurse assists an individual, family or community to promote health, prevent or cope with the experience of illness and suffering, and if necessary, to find meaning in these experiences. The use of humor and laughter should lessen barriers and facilitate the connections with other humans, that fosters rapport and interrelatedness, necessary to improve outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):347–348.

P593. How Gender Identity Influences Diversity, Equity, and Inclusiveness (DEI)

Gary Shelton ¹

Professional Development

Significance & Background

Despite our attempts at decreasing racial and social inequities, healthcare providers fall short of inclusiveness across diverse patient populations. The underrepresentation of such patient characteristics, as age, race, socioeconomic status and sexual orientation / preference, affects quality of care and survival for all of humanity. Understanding that gender identity occurs independently from genital differentiation should encourage acceptance. Individual prejudice and implicit bias, though often unconscious, facilitates incorrect assumptions that limit our approach to inclusivity.

Purpose

Diversity education is not enough. Healthcare providers need self-reflection and insight in order to detect and challenge assumptions and therefore overcome unconscious bias that leads to unintentional discriminatory behavior. We understand the issues, but do we see how we are also part of the solution?

Interventions

This didactic educational presentation includes the four principles of respect: autonomy, beneficence, nonmaleficence and justice. Understanding that genital development and gender identity occur independently, prior to birth, encourages self-reflection and insight that should change the way we consider differences. DEI programs and guidelines provide a framework for patient advocacy. Addressing assumptions and unconscious bias, of which we all harbor, through questionnaires, and case studies, facilitates our connections to humanity, thus improving healthcare outcomes.

Results

Unconscious bias and erroneous assumptions hinder all-inclusiveness, that we generally consider we provide. Self-reflection and insight from ongoing education encourages rapport and connections with other human beings. Solving the issues begins within each of us.

Discussion

Understanding how inequities and non-inclusiveness decreases quality care for all, and impacts survival and universality of our interventions, facilitates diversity, equity and inclusiveness. Through self-reflection and insight, healthcare providers imagine a better approach that is inclusive of greater diversity.

Oncology Nursing Forum. 2025 Mar 1;52(2):348.

P594. Apn Infusion Oversight: It’s More Than Awaiting Infusion Reactions

Gary Shelton ¹, Hope Washington ²

Healthcare Delivery

Significance & Background

Outpatient infusion provides safe, convenient therapeutic and oncology drug delivery. Historically, Physicians have provided oversight. APNs are knowledgeable, capable, and assure safe, cost-effective delivery. APNs performing at the top of their scope, increase job satisfaction, professional development, and provide opportunities to engage and educate patients, peers and colleagues.

Purpose

It is more than a novelty: Empowering NPs to oversee infusion suites, offer infusion nurses a deeper understanding of complex treatment plans and symptom management while enhancing patient education. This game-changing strategy deepens nurses’ understanding of treatment plans and symptom management while elevating patient education. This practical, cost-effective strategy allows healthcare providers to focus on new and existing clinic patients. This streamlines healthcare operations, boosts patient confidence, and reduces wait times for provider responses. NPs alleviate stress, enhance job satisfaction, and bolster retention rates by providing real-time support to infusion nurses.

Interventions

A multidisciplinary team mined the literature as well as reviewed attempts by major centers, supporting the use of APNs in the role of infusion management. Collaborative education was developed for APNs / RNs / MDs designed for quick assessment of reactions, grading them mild, moderate, or severe with management strategies and risk reduction and mitigation. Orientation was designed to phase out the role of the physician manager with precepting and mentoring of the APNs. EMR smart sets were developed to streamline documentation. Metrics were created. QI projects were planned.

Results

A review at 3 months and 6 months revealed safe and consistent multidisciplinary care; decreased ED visits and increased physician clinical visits and infusion referrals. Infusion RNs shared their sense of comradery and decreased anxiety with APP close at hand. Documentation improved with smart sets developed by APP and multidisciplinary team. This proved to be cost effective.

Discussion

Empowered NPs to oversee the infusion suite is a game-changing strategy that deepens infusion nurses’ understanding of treatment plans and symptom management. It is a cost-effective strategy that allows healthcare providers to focus on new and existing patients, while streamlining operations. NPs alleviate stress, enhance job satisfaction, and bolster retention rates by providing real-time support to infusion nurses.

Oncology Nursing Forum. 2025 Mar 1;52(2):348–349.

P595. Vectra Integration in Skin Cancer Surveillance

Irina Sheyman ¹

Screening, Early Detection, Genomics

Significance & Background

In keeping with highest standards of state of the science oncology innovation, a large NCI designated comprehensive cancer center invested in Whole Body Photography system. This cutting-edge advancement in 3D imaging technology, provides detailed three-dimensional analysis of the human body. This system is specifically designed to play a crucial role in the early detection of cancer, particularly for patients at high risk. A notable feature of the Whole-Body Photography is its built-in artificial intelligence (AI) capabilities, which aid in identifying and evaluating suspicious lesions. Initially, there was a misconception this technology could function as a standalone tool, allowing providers to leverage its advanced scanning capabilities in isolation. This assumption represented a gap in integration of this technology with existing clinical practices in high-risk skin cancer population.

Purpose

To describe essential elements for successful clinical integration and utilization of technology in high-risk skin cancer population to improve early detection and monitoring.

Interventions

The planning phase for this technology involved extensive collaboration with multiple interdisciplinary teams, including three project managers from Facilities and Construction, Informatics, and the Clinical Projects Office. Systematically teams were engaged with bringing this new service to patients, identifying potential risks, developing workflows, and integrating new scientific and technological advancements with clinical expertise and judgment. Effective utilization of the system required adjustments of clinical team engagement to fully integrate this advanced technology and AI features into the diagnostic process and surveillance of high-risk skin cancer patients. Consequently, a strategic reevaluation was needed to ensure that Whole-Body Photography’s potential is maximized and that its implementation aligns with the overall objectives of early cancer detection in high-risk populations.

Results

Confirmation of technology with medical assessment and alignment has enhanced the comprehensiveness and accuracy of patient evaluations.

Discussion

Ongoing data collection is being conducted to support long-term evaluations in clinical practice, aimed at enhancing early detection and surveillance, thereby improving outcomes for high-risk patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):349.

P596. Utilization of Radiology Incidental Findings for Earlier Diagnosis

Jennifer Shickler ¹

Coordination of Care and Navigation

Significance & Background

The timely detection & management of incidental findings in radiology play a critical role in improving patient outcomes. By implementing a comprehensive navigation system, healthcare organizations can ensure that patients are promptly informed about these findings and receive the necessary support to navigate their subsequent care.

Purpose

A key component of this initiative is ensuring that patients are aware of incidental findings. This involves clear and effective communication strategies, including written notifications, phone calls, and face-to-face discussions with healthcare providers. By informing patients of their results, we empower them to make informed decisions about their health and seek appropriate follow-up care.

Interventions

Furthermore, it is essential to provide providers with the necessary resources to support their patients. This includes access to cancer navigation programs that can offer specialized guidance and assistance throughout the care process. By connecting patients with these resources, we can help to alleviate their anxiety and ensure that they receive the best possible care. A critical aspect of this initiative is the establishment of a real-time connection between patients and nurse navigators. This allows for immediate communication and support, facilitating timely referrals and coordination of care. By expediting the care process for patients with highly suspicious findings, we can increase the likelihood of early diagnosis and treatment. To ensure that no patient is overlooked, the Upstream Navigation team receives a daily worklist from radiology, identifying all patients with incidental findings that suggest a potential cancer. A dedicated coordinator then contacts the ordering provider to confirm their awareness of the finding and offer navigation assistance. This proactive approach helps to prevent delays in care and ensures that patients receive the necessary support.

Results

By analyzing data through a Radiology Incidental Findings dashboard, we can gain valuable insights into the prevalence of incidental findings, the types of scans involved, and the characteristics of the patients affected. This information can be used to identify areas for improvement and tailor our navigation services to meet specific needs of different patient populations.

Discussion

In conclusion, by implementing a comprehensive navigation system, healthcare organizations can ensure that patients with incidental findings are promptly informed and provided with the necessary support to navigate their next steps in care. This initiative not only improves patient outcomes but also enhances the overall quality of care delivered within the healthcare system.

Oncology Nursing Forum. 2025 Mar 1;52(2):349–350.

P597. Reduction in No-Shows and Same-Day Cancellations

Jennifer Shickler ¹

Healthcare Delivery

Significance & Background

The R.J. Zuckerberg Cancer Center was experiencing a significant issue with patient no-shows and same-day cancellations, averaging 8.4 per day from January 1, 2023, to August 1, 2023. This led to disruptions in scheduling, reduced access to care for other patients, and inefficient resource utilization.

Purpose

The goal of this initiative was to reduce patient no-shows and same-day cancellations for treatment appointments, thereby improving scheduling efficiency, maximizing resource utilization, and enhancing patient access to care.

Interventions

To achieve this goal, several interventions were implemented. Real-time communication: Enhanced communication between Infusion Nurses and Chemo Scheduling Coordinators through chair-side scheduling and “next day” Teams chat. Collaborative scheduling: Established Collaborative Treatment Scheduling meetings to improve coordination among clinical and non-clinical teams. Improved reporting: Increased use of the Next Day Northwell Hospitalization In-House Report and daily Missing Treatment Order Reports. Regular auditing: Weekly auditing of no-shows and same-day cancellations to identify trends and areas for improvement. Monitoring non-compliant patients: Capturing and monitoring frequent patients who were non-compliant with appointments.

Results

As a result of these interventions, the average no-show and same-day cancellation rate decreased from 8.4 to 6.0 per day, representing a 28.6% reduction from August 1, 2023, to September 1, 2024.

Discussion

The reduction in no-shows and same-day cancellations at the R.J. Zuckerberg Cancer Center demonstrates the effectiveness of the implemented interventions. Improved communication, collaboration, and reporting played a crucial role in optimizing scheduling and enhancing patient access to care. The challenges associated with predicting changes in cancer treatment plans highlight the importance of effective communication among healthcare teams.

Oncology Nursing Forum. 2025 Mar 1;52(2):350.

P598. Using Purposeful, Proactive Rounding to Reduce Falls in the Ambulatory Setting

Jennifer Shickler ¹

Quality and Safety

Significance & Background

Patient falls are a significant safety concern in healthcare settings, leading to injuries, increased healthcare costs, and diminished patient satisfaction. Numerous interventions have been implemented to mitigate this issue, including proactive rounding. However, the effectiveness of purposeful proactive rounding, which involves structured rounds focused on specific patient needs, remains unclear.

Purpose

To investigate the impact of purposeful proactive rounding on the reduction of patient falls in an ambulatory oncology setting.

Interventions

The intervention implemented purposeful proactive rounding, involving hourly rounds focused on assessing patient needs, addressing pain, and ensuring environmental safety. Patients fall rates were compared between the pre intervention period compared to the post intervention period.

Results

Many sites experienced a significant reduction in patient fall rates compared to the pre intervention period. Some sites were even able to eradicate patient falls or maintain 0 falls.

Discussion

The findings of this study suggest that purposeful proactive rounding is an effective strategy for reducing patient falls. By focusing on specific patient needs, addressing pain, and ensuring environmental safety, this intervention can mitigate risk factors associated with falls. The implementation of purposeful proactive rounding requires adequate staffing, training, and ongoing evaluation to ensure its effectiveness.

Conclusion

Purposeful proactive rounding represents a promising approach to improving patient safety and reducing the incidence of falls. Future research should explore the long-term impact of this intervention, as well as its applicability in different healthcare settings.

Oncology Nursing Forum. 2025 Mar 1;52(2):350.

P599. Paclitaxel Dosing Recommendations to Reduce Hypersensitivity Reactions

Jennifer Shickler ¹

Treatment Modalities and Managing Administration

Significance & Background

Paclitaxel, a widely used chemotherapeutic agent, is associated with a significant risk of hypersensitivity reactions. Despite the high incidence of these events, there is no standardized dosing approach. This study aimed to address the increasing rates of paclitaxel-related reactions and explore the effectiveness of a novel dosing algorithm.

Purpose

The objective of this study was to develop and implement a dosing algorithm for paclitaxel to reduce the incidence and severity of hypersensitivity reactions in patients receiving the drug.

Interventions

A dosing algorithm was developed based on the 3-step model presented by Dana Farber. This algorithm was implemented in the Ambulatory Oncology Med Safety and P&T Committees.

Results

Analysis of case reports revealed a significant increase in paclitaxel reactions from 2020 to 2023. However, the implementation of the dosing algorithm demonstrated a reduction in the severity and frequency of these reactions. Patients pretreated with the algorithm experienced fewer severe reactions or no reactions compared to those who did not receive pretreatment.

Discussion

The findings of this study highlight the importance of standardized dosing approaches for paclitaxel to mitigate the risk of hypersensitivity reactions. The developed algorithm represents a valuable tool for healthcare providers in reducing the burden of these adverse events. Future research may explore the long-term efficacy of the algorithm and its applicability in different patient populations.

Oncology Nursing Forum. 2025 Mar 1;52(2):350–351.

P600. Improving the Patient Experience for the Oncology Patients in the Ambulatory Care Sestting

Jennifer Shickler ¹

Healthcare Delivery

Significance & Background

Patient satisfaction surveys conducted at the Cancer Center indicated a downward trend in overall scores. Specifically, the likelihood to recommend, cleanliness, and waiting time in the chemotherapy area had fallen below baseline levels. Addressing these concerns was critical to maintaining a positive patient experience and improving the center’s reputation.

Purpose

The primary goal of this initiative was to achieve a 5% positive conversion in patient satisfaction scores within a six-month period.

Interventions

A collaborative, multi-disciplinary approach was employed to identify and implement strategies to address the identified areas of concern. Key interventions included the following. Enhanced leadership engagement: Daily leadership rounding in waiting areas to directly engage with patients and gather feedback. Improved cleanliness: Implementation of cleanliness rounding and cleaning logs to ensure a clean and hygienic environment. Enhanced communication: Use of headsets to promote better communication among staff, streamlined treatment chair turnover, and improved patient information flow. Patient experience focus: Education of hospitality liaisons to better understand the patient journey and address their needs. Tracking and monitoring: Use of a greeter board to track patient location, regular tracking of Press Ganey survey results, and in-depth review of verbatim comments. Continuous improvement: Bi-weekly meetings to review data, plan next steps, and ensure project adherence to timeline.

Results

The implemented interventions led to significant improvements in patient satisfaction scores. The likelihood to recommend, cleanliness, and waiting time in the chemotherapy area all exceeded the baseline levels, demonstrating the effectiveness of the strategies employed.

Discussion

The success of this initiative highlights the importance of a collaborative approach, patient-centered focus, and continuous improvement in enhancing patient satisfaction. By addressing specific areas of concern and implementing targeted interventions, the Cancer Center was able to significantly improve the overall patient experience.

Oncology Nursing Forum. 2025 Mar 1;52(2):351.

P601. Effects of Art Therapy on Psychological Outcomes Among Children with Cancer: A Systematic Review

Zhou Shishuang ¹, Wong Cho Lee ², Yang Yuan ³, Qi Yishu ⁴

Psychosocial Dimensions of Care

Significance & Background

The increasing incidence of pediatric cancer has given rise to considerable psychological challenges for affected children. Art therapy, classified within the realm of complementary and alternative medicine interventions and psychotherapy, holds the potential for addressing these challenges, although its impact on pediatric cancer patients remains uncertain.

Purpose

This systematic review aims to determine the effects of art therapy on enhancing psychological outcomes in children under the age of 14 with cancer.

Interventions

A comprehensive search was conducted across ten English language databases, two Chinese databases, and grey literature. Two researchers independently carried out study selection and data extraction. The quality of the included studies was evaluated using Cochrane’s risk-of-bias assessment tool (ROBINS-I). Cohen’s effect size (d) will be calculated in a single study with the control group. Findings were described using narrative synthesis.

Results

Six quasi-experimental studies with acceptable quality were included, involving 285 participants from four countries. Art therapy demonstrated the potential to improve overall psychological symptoms (d=0.24, p<0.001), depression (d=1.64–1.94, p<0.001), and stress (p<0.05). However, no significant differences were observed in terms of happiness and anger, and there were conflicting results regarding anxiety.

Discussion

The efficacy of art therapy in pediatric cancer patients primarily stems from its utilisation of visual art materials (drawing, sculpture, and clay), offering non-verbal outlets for children to express their emotions and experiences that they may struggle to articulate verbally. Children with cancer can improve their psychological outcomes by engaging in artistic making. However, the limited number of available studies and methodological heterogeneity weaken the overall body of evidence. Overall, art therapy shows promise in improving overall psychological symptoms, depression, and stress in children with cancer. However, additional high-quality randomised controlled trials with larger sample sizes are needed to confirm and augment the existing evidence.

Oncology Nursing Forum. 2025 Mar 1;52(2):352.

P602. The Making of A Mobility Motivator: Decreasing Falls by Increasing Movement for Patients with Cancer

Dena Shore ¹, Dena Shore ², Kimberly Sadler ³, Ryan Minnix ⁴, Michelle Payne ⁵

Quality and Safety

Significance & Background

Hospitalized patients are at risk for falls, particularly patients with cancer. Myelosuppression can prove catastrophic for a patient with cancer who falls, potential hemorrhage, prolonged hospitalization and death. Fall prevention continues to be multifactorial and effective solutions elusive. Deconditioning and fatigue are risk factors for falls in cancer patients. A medical/oncology unit in a Comprehensive Cancer Center experienced a statistically significant increase in falls during the baseline period of December 2022–August 2023, with an average of 6.67. While mobility nursing assistants (M-NA) have been utilized previously on this unit, an opportunity for specialized onboarding was noted.

Purpose

This quality improvement project was to decrease falls on an inpatient oncology unit by increasing mobility via a specialized M-NA.

Interventions

The onboarding M-NA completed orientation specifically targeted at mobilization. The M-NA completed training time with a physical therapist, the oncology nurse practice specialist, and surgical oncology M-NAs. The M-NA’s tasks were focused on the Johns Hopkins Mobility and Activity Promotion (JH-AMP). Based on this model, the M-NA utilized the Johns Hopkins Highest Level of Mobility (JH-HLM) score to determine the patient activity goal for the day. The mobility NA attends safety huddles and maintains communication with nursing, physical and occupational therapists to be sure that patients are mobilized effectively.

Results

Since the implementation in August 2023, the unit has been eight months below the baseline mean of 6.67, causing a shift in the data, with a mean of 3.25 falls a month during the intervention period. With an estimated cost of a fall with injury to be $6,694 per event, this data represents a significant decrease not only in cost of falls, but also in patient harm.

Discussion

Early and continued mobilization of patients while in the hospital is proven to decrease falls. A dedicated M-NA assists patients in reaching activity goals, thereby decreasing falls on an inpatient oncology unit where most of the patients are at high risk for falling. Continued interdisciplinary feedback on the mobility NA role will be vital and input from the mobility NA role themselves.

Oncology Nursing Forum. 2025 Mar 1;52(2):352–353.

P603. Back to Basics: Improving Patient Hygiene to Decrease Central Line Associated Blood Stream Infections

Dena Shore ¹, Dena Shore ², Jennifer Mitchell ³, Cory Kassen ⁴, Ryan Minnix ⁵, Kimberly Sadler ⁶

Quality and Safety

Significance & Background

Many oncology patients require a central line for treatment, which compounds other risk factors for infection such as patient co-morbidity, poor nutritional status, and type of treatment. Central line associated blood stream infections (CLABSI) are known to increase morbidity and mortality, particularly in patients with cancer. Patients undergoing treatment for cancer are at risk for adverse effects such as mucositis and diarrhea. Interruption in the mucosal barrier is established as an increased risk for infection. An inpatient unit in the Comprehensive Cancer Center experienced a statistically significant increase in CLABSI in calendar year 2023. An in-depth review of potential causes revealed an opportunity to improve patient hygiene practices.

Purpose

There were two aims of this quality improvement project: to change oral care products to formulations recommended for oncology patients, and to increase patient oral and hand hygiene practices.

Interventions

After discussion with staff members, educators, and leadership, patient hygiene was determined to be a “low risk, high benefit” intervention that could impact CLABSI rates. The “Plan, Do, Study, Act (PDSA)” method was utilized to implement changes. Staff members were involved in the piloting of oral hygiene product changes to align with best practice recommendations from the Oncology Nursing Society. Education regarding product changes and patient hygiene was deployed across the unit. Chart audits were used to verify documentation of patient hand and oral hygiene, and product usage monitoring.

Results

Baseline chart audit for hand hygiene was 0%, as patient hygiene was not documented in a specific place in the electronic medical record. Baseline oral hygiene documentation was 18%. A goal of increasing patient hygiene documentation will increase to 50% October 31st, 2024, was set. While CLABSI rates have fluctuated, mucosal-barrier injury CLABSIs (MBI-CLABSI) decreased by 50% during the intervention timeframe.

Discussion

Understanding that CLABSI is a multi-faceted issue, plans are underway for additional projects surrounding hemostasis of lines, central line dressing alternatives, and peripheral IV care. As CLABSI is a potential complication of any setting, nursing leaders may consider performing in-depth reviews of patient population, focusing on basic hygiene. Reviewing patient hygiene practices, particularly oral health and hand hygiene, may provide for a quick, effective intervention to decrease CLABSI infections in patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):353.

P604. Bite Therapy: Just in Time Education for Newly Approved Medications

Kathleen Shuey ¹, Stephanie Bradshaw ²

Management

Significance & Background

In 2023, 13 new drugs were approved for treatment of a variety of cancers. Additionally, 67 drugs were approved for expanded use or treatment of additional patient populations. One cellular therapy, omidubicel-only, was approved to reduce time to neutrophil recovery in individuals receiving umbilical cord blood transplant after a myeloablative regimen. Medications administered in the outpatient setting may require admission to the inpatient area where nurses are not familiar with the specific agent. BiTE therapy has been available since 2014 (blinatumomab) with additional drug approvals in 2021 through 2024. Once a provider determines that a patient will receive BiTE therapy, approval is required from the hospital Pharmacy and Therapeutics Committee (P&T). After approval, there is not always lead time to schedule formal in-services or have a pharmaceutical representative present on site or via a video call to educate nursing staff.

Purpose

The goal of this project was to provide just-in-time education and resources available, specifically on BiTE therapy, for staff prior to the day of treatment.

Interventions

Project interventions included creation of a one-page summary specific to the agent. Information included indication, medication safety (toxicity concerns), administration specifics, and events requiring provider notification. A longer presentation addressing information from the package insert and treatment orders/protocols was available for leisurely review. An overview of the product was provided by either the clinical nurse specialist or the nursing professional development generalist prior to initial administration.

Results

Information for six agents are currently available on the hospital oncology nursing Microsoft Team site. The site is available to all oncology nursing staff at the facility. A copy of the package insert is also posted on the Team site. Additionally, a binder was provided to the inpatient BMT, hematology, and medical oncology units containing copies of all presentation information.

Discussion

In person in-services or sessions offered via a video call can also provide current updates on medications approved by P&T. However, there is not always lead time to schedule these events. Although just-in-time education may not be the preferred delivery method and can be time consuming for the education team and the nursing staff, this method allows for timely staff updates.

Oncology Nursing Forum. 2025 Mar 1;52(2):353–354.

P605. Assuring Staff Safety with Radiopharmaceuticals: Multidisciplinary Education Awareness Across Institutional Sites

Ella-Mae Shupe ¹, Roberta Anderson ², Ana Kiess ³, Robert Hobbs ⁴

Radiation

Significance & Background

On March 23, 2022, the Federal Drug Administration approved 177 Lu-PSMA-617 therapy for prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC) who failed taxane-based chemotherapy. Traditionally, this infusion was administered in nuclear medicine departments. However, to better serve radiation oncology patients and allow them to continue their care within our department, a radiopharmaceutical infusion program was initiated for established radiation oncology patients or those referred through consult. The radiation oncology provider administers the treatment while the physicist monitors radio activity in and around the room.

Purpose

177 Lu-PSMA-617 therapy has potential to expose healthcare providers to radioactive materials up to 48 hours post infusion through bodily fluids. Therefore, it is critical that healthcare providers receive proper radioprotection education. Given that these patients may be admitted to various areas outside of radiation oncology (inpatient, oncology urgent care, ED, etc.) or to other systems sites (of which there are six), a health system education program was developed for all sites and all staff who may be exposed to these patients.

Interventions

In collaboration with nuclear medicine, radiation oncology stakeholders, and radiation safety officers across systems, an attestation was created that was accompanied by educational material on radiopharmaceutical infusions and necessary precautions. Education covered radiation safety following a radiopharmaceutical infusion, appropriate staff interventions, including the use of personal protective equipment required for patient care, and the proper disposal of bodily fluid-soiled waste and linens. Since non-clinicians such as housekeeping, nutritional support, facilities personnel may also enter patient areas and risk exposure, it was essential to create an attestation specifically for them. We also worked with our electronic medical record (EMR) team to develop a treatment plan that flags patients under radiopharmaceutical care. Staff can hover over this plan in the EMR to view necessary precautions and the timeframe during which these precautions should be maintained.

Results

By educating all staff who may be exposed to radiopharmaceutical patients, we ensure compliance with Nuclear Regulatory Guidelines for the use of radioactive materials including adherence to the Code of Federal Regulations “Standards for Protection Against Radiation”. Staff will be monitored to ensure an 80% compliance rate for completion.

Discussion

Additional education on radiation safety post radiopharmaceutical infusion will be included in the mandatory 2025 annual educational bundle for all staff and in orientation programs for new hires.

Oncology Nursing Forum. 2025 Mar 1;52(2):354.

P606. Oncology Nurse Led Helping Hands Fundraiser to Support Financial Toxicity of Cancer Therapies

JoAnn Silcox ¹

Management

Significance & Background

Financial support for patients and families who face high-cost therapies not covered by insurance is often essential for affected patients to be able to continue treatment. The need to support this burden is critical as often patients are not financially able to purchase drug costs or co-pays, provide transportation/gas back and forth to treatments, or pay parking costs. Often patients are prohibited physically to work and essential everyday costs of utilities, mortgages/rent, and supportive devices present challenges that directly affect their ability to complete therapies. The ability to purchase food items or clothing also adds to this burden.

Purpose

This nurse driven fundraiser is to support the financial burden oncology patients and their families face during the course of cancer therapies. An additional purpose is to highlight the financial toxicities of cancer therapies and increase community awareness to support those affected.

Interventions

The oncology nurses were using their own funds to support financial deficits of patients and families. The idea to create a fund was born from oncology nurses’ desire to support higher cost items that are presented to families and patients. Thus is the formation of the Helping Hands Fund. This fund is led and run by oncology nurses and was initiated 15 years ago. This committee holds fund raises throughout the year, solicits donations and holds an annual fundraising event. The event has two former patients present their story to highlight this effort of support. Basket sales add to the event as well as donor contributions. This event has grown to include senior leaders, providers, oncology patients and their families and staff nurses from all areas, as well as non-nursing participates and our Office of Institutional advancement leaders.

Results

This fund has developed in sophistication and gained much attention from senior leaders and the community. The committee has expanded and added a community member to bring a new view and depth to the event as well as how to increase financial support.

Discussion

This year was the largest event held with participants from many disciplines, families, students, as well as senior leaders and families. This year also brought in the highest donations from the community to support this cause. Next step to expand the event and engage marketing to support attention and participation and donations.

Oncology Nursing Forum. 2025 Mar 1;52(2):354–355.

P607. Improving Access to Survivorship Care for Lymphoma Patients

Chandley Silin ¹, Deepa Shah ²

Survivorship

Significance & Background

Quality survivorship care is a crucial component of successful recovery and reintegration following cancer treatment. Our review of registry data revealed that only 16% of eligible patients completing treatment for lymphoma had a Lymphoma Survivorship Clinic visit within the first 2 years following treatment completion, suggesting they were not fully utilizing survivorship resources.

Purpose

Our quality improvement project sought to increase the number of referrals to the lymphoma survivorship clinic from 16 to 30% over the course of 3 months through team engagement, patient education and workflow optimization.

Interventions

A multidisciplinary team was assembled to develop and implement a multifaceted intervention. The key components include the following. Team engagement: physicians and nurse coordinators were educated regarding which patients to refer, how and when to refer them to the Survivorship Clinic. A tracking form was developed for nurses to use. Patient education: A document informing patients about the survivorship clinic was developed, translated to Spanish and incorporated into the EHR. Workflow optimization: administrative tasks including scheduling and collecting patient reported outcomes via surveys were delegated from providers to support staff to improve clinic efficiency and capacity.

Results

The expected impact of this intervention is two-fold. The primary outcome is an increase in referrals to the lymphoma survivorship clinic as tracked through the nurses’ tracking form. Secondary outcomes include improved patient satisfaction and patient-reported outcomes which are being tracked through surveys.

Discussion

This quality improvement project seeks to increase access and utilization of survivorship care for patients with lymphoma through education and clinic workflow optimization. Further evaluation will focus on sustaining these changes and scaling the interventions to other departments.

Oncology Nursing Forum. 2025 Mar 1;52(2):355.

P608. Developing A Smoking Cessation Program in A Rural Community Cancer Center

Rebecca Simmons ¹, Diane Hurtado ², Casey Allen ³

Patient Education

Significance & Background

The leading risk factor for lung cancer-related deaths is smoking cigarettes or secondhand smoke exposure. Smoking can also lead to increased risk of developing other of cancers, including bladder, cervical, colon, rectum, esophageal, kidney, larynx, liver, head and neck, pancreas, and stomach (CDC, 2023). Continuing to smoke after a cancer diagnosis can also pose great risk, including decreased treatment efficacy and decreased overall survival. Developing a local smoking cessation program that can offer behavioral counseling and nicotine replacement therapy can have a significant impact on patients who are interested in smoking cessation.

Purpose

The oncology nurse manager, clinical nurse specialist student, and oncology nurse (also a certified Freedom from Smoker Facilitator) collaborated to review current and best practices for screening active smokers and identifying individuals ready to quit smoking. Our goal was to develop a screening process to identify patients ready to quit smoking and develop our own smoking cessation program to offer smoking cessation counseling to patients locally.

Interventions

Two questionnaires from the American Lung Association were utilized to screen patients to measure their smoking dependency and readiness to quit. Patients were identified in the medical oncology clinic setting, and those who are current smokers were asked both questionnaires. Patients who answered yes at least four times on their readiness to quit and smoking dependency questionnaire were offered smoking cessation counseling by an oncology nurse/freedom from smoking facilitator.

Results

Twenty-one out of the thirty-seven (57%) patients that were screened agreed to meet with the clinical nurse specialist student or oncology nurse to go over the two questionnaires. 19/21 (90%) answered yes four times on their readiness to quit questionnaire. Additionally, 7/21 (33%) answered yes four times on their nicotine dependency questionnaire. 4/21 (19%) of participants agreed to attend smoking cessation counseling.

Discussion

Nicotine dependency can be very challenging to quit. Nicotine is a big coping mechanism for patients as they are going through their cancer journey. It is imperative that we continue to encourage and support smoking cessation among cancer patients. Future direction includes continuing to screen patients on smoking dependency and readiness to quit, smoking cessation counseling, and education sessions for patients and team members.

Oncology Nursing Forum. 2025 Mar 1;52(2):355–356.

P611. Evaluating the Development of Critical Thinking Skills Throughout Orientation in the Outpatient Setting

Tara Simon ¹, Claudine Biscocho ², Sarah Middlekauff ³

Professional Development

Significance & Background

Outpatient oncology nurses are tasked with making efficient and effective decisions throughout the day. An essential role of the outpatient oncology nurse educator is to foster the development of oncology nursing knowledge and critical thinking skills unique to each treatment setting.

Purpose

While oncology nurse educators can use a variety of techniques to assess an orientee’s knowledge level, there are limited ways to measure the development of critical thinking skills throughout orientation. A lack of critical thinking skills may not even be discovered until an orientee or nurse newly off orientation makes a patient-facing error.

Interventions

In an attempt to evaluate the development of critical thinking throughout orientation in both the office practice and infusion setting, two different electronic assessments were created and given to orientees at set intervals throughout their orientation. The assessments include questions about years of nursing experience, years of oncology nursing experience, and years of outpatient oncology experience. Assessment questions largely involve patient scenarios that require critical thinking to achieve the correct answer. There are a limited number of direct knowledge questions that pertain to each outpatient specialty.

Results

Results revealed that critical thinking and knowledge improved throughout the orientation process. In the outpatient infusion center, the initial assessment revealed an average score of 50%. The mid-point assessment revealed an average score of 70%. The end-point assessment demonstrated an average score of 82%. Interestingly, only one nurse had previous oncology experience. The second assessment was for outpatient breast cancer medical oncology nurses. The average initial assessment score was 52% and the average end-point score was 75%. Of note, orientees in the breast cancer clinic did not receive a mid-point assessment as the office practice nurse orientation is shorter than the infusion orientation.

Discussion

Results demonstrated that knowledge and critical thinking skills improved throughout the orientation process. This correlated with nurses’ improved ability to navigate challenging patient situations with increasing ease throughout orientation. The assessments will continue to be used in both the outpatient infusion and breast medical oncology practice with intentions to expand to other outpatient specialty areas in the upcoming year. Additionally, the assessments can be modified to include questions that focus on unit practice gaps as they are discovered.

Oncology Nursing Forum. 2025 Mar 1;52(2):356–357.

P609. Competency, Clickers, and Cancer: Using Gamification During Annual Training

Tara Simon ¹, Claudine Biscocho ², Sarah Middlekauff ³

Professional Development

Significance & Background

Annual competency training can be used to validate hands-on required skills and reinforce best practice and practice changes for oncology nurses. Despite providing repeated information during the 2022 and 2023 competency sessions, some incumbent nurses voiced that they were never made aware of practice changes and reported a lack of knowledge about material reviewed during re-education meetings.

Purpose

To improve engagement and knowledge retention, two Jeopardy-style games were created using Microsoft PowerPoint. One game focused on office practice and radiation oncology nurses and the other on infusion nurses. Categories for the infusion game included consents, emergency response, safe-handling, chemotherapy & immunotherapy, Central Venous Access Devices (CVAD), and miscellaneous. The office practice game included questions on consents, emergency response, miscellaneous, triage & symptom management, CVAD, and oncology emergencies. Five questions were created for each category, and each was assigned a point value between $200 and $1000. An explanation slide was created for each correct answer.

Interventions

At each competency session, nurse educators created two teams and assigned participants considering the nurses’ current role and prior oncology experience. Each team was given a buzzer and instructed to ring it after the question was read aloud. The nurse educators kept score and facilitated the game ensuring that the rationale for each answer was reviewed.

Results

Nurses reported that the Jeopardy-style game was highly engaging and promoted knowledge retention. Many nurses verbalized that they appreciated receiving information through the interactive format and that it promoted knowledge development and retention. Some even took notes during the game.

Discussion

Gamification will be implemented in future competency sessions based off of the overwhelmingly positive feedback received this year. The nurse educators followed trends in incorrect answers and are developing future education sessions to address the gaps in knowledge discovered during the competency sessions.

Oncology Nursing Forum. 2025 Mar 1;52(2):357.

P610. Using Simulation to Improve Emergency Response in Outpatient Oncology

Tara Simon ¹, Claudine Biscocho ², Sarah Middlekauff ³

Professional Development

Significance & Background

As more complex treatments are given in the outpatient setting to an increasingly fragile population, outpatient nurses must be able to respond to emergencies quickly and effectively. However, due to the scarcity of cardiac arrests in the outpatient setting, nurses may not be adequately prepared to provide this urgent care when needed.

Purpose

Despite emergency response training being reviewed at annual competency sessions, feedback received from the emergency response team and direct observation by nurse educators during a mock code revealed that challenges exist when escalating care to the emergency response team, identifying code roles, and providing emergency interventions.

Interventions

The outpatient nurse educators created a simulation that awards three contact hours focused on emergency response in the outpatient oncology setting. The activity will take place in a high-fidelity simulation center and involve a patient presenting with sepsis who devolves into cardiac arrest. Participants will navigate managing sepsis in the simulation setting and time points to interventions will be recorded by the nurse educators. Upon the simulation patient becoming pulseless, the educators will facilitate rapid cycle deliberate practice (RCDP), an educational method in which a debriefing period is held after defined endpoints have been reached. The goal is to strengthen both the skill and confidence of the learner with repeated exposure in the simulation environment.

Results

As this is an ongoing project, results regarding the outcome are currently unavailable. However, the activity has been embraced by both nursing leadership and scheduled participants.

Discussion

The activity participation is open to nurses and nurse practitioners who work in radiation oncology, the outpatient infusion center, and office practice. Eight classes will be held before the end of 2024 with 6 participants in each class. If attendees note an improvement in their perceived knowledge and confidence and timing noted during RCDP improves, the offering will continue to be held throughout 2025.

Oncology Nursing Forum. 2025 Mar 1;52(2):357–358.

P612. The Role of Spirituality in the Lives of Nursing Professionals Within the Context of Oncology Patients

Ingrid Stefani Simsen Jensen ¹, Renata Rego Lins Fumis ²

Psychosocial Dimensions of Care

Significance & Background

Spirituality plays a crucial role in coping with loss and illness, serving as a source of support and relief. For healthcare professionals, especially nurses, spirituality influences caregiving practices and professional commitment, being associated with psychological well-being and reduced stress. Nursing professionals who value spirituality are better equipped to meet patients’ spiritual needs, thus enhancing resilience against stress and caregiving burdens. This is particularly relevant in oncology care, where compassion fatigue and burnout are prevalent concerns.

Purpose

This study aimed to evaluate the association between spirituality and compassion fatigue among nursing professionals caring exclusively for oncology patients.

Interventions

The study was conducted with the nursing staff working in the oncology inpatient unit and the bone marrow transplant unit at a private hospital in São Paulo, Brazil, from September 2023 to January 2024. A total of 95 nursing professionals participated in the study. Questionnaires were administered to collect demographic and occupational data. The WHOQOL-SRPB instrument was used to assess spiritual, religious, and personal beliefs, while the ProQOL-BR questionnaire evaluated compassion fatigue, including its dimensions: compassion satisfaction, burnout, and secondary traumatic stress.

Results

The overall median score on the WHOQOL-SRPB was 17.0. Cluster analysis established a spirituality cutoff score of ≥17 for high spirituality and <17 for low spirituality. Higher spirituality scores were significantly correlated with greater compassion satisfaction (p <0.001) and lower burnout (p=0.0005). Additionally, 15.2% of participants reported experiencing compassion fatigue, which includes secondary traumatic stress and burnout.

Discussion

The results highlight spirituality as a crucial factor for job satisfaction and quality of life among nursing professionals. Fostering spirituality in the workplace could be an effective strategy to reduce burnout and enhance compassionate and integrative care, especially in high-stress environments like oncology.

Oncology Nursing Forum. 2025 Mar 1;52(2):358.

P613. Developing A Standardized Oncology Advanced Practice Provider Onboarding Program

Miri Sinclair ¹, Gerlem Manso Morin ²

Management

Significance & Background

Despite the increasing need for Advanced Practice Providers (APPs) specializing in cancer care, APPs often do not have oncology-specific training. Therefore, onboarding newly hired APPs into a cancer center presents challenges and opportunities. Standardized onboarding processes are needed to ensure high-quality patient care, interdisciplinary collaboration, and APP integration into specialized oncology teams. Standardized onboarding processes were especially important at our newly opened cancer center, requiring a large APP hiring initiative.

Purpose

The purpose of this quality project was to develop a standardized onboarding training program for a large number of newly hired APPs at a large, urban cancer center.

Interventions

In 2021 we developed a standard 12-week onboarding program for all newly hired APPs that included didactic modules, initial department-based orientation and initial core specific population competencies. The APPs received one dedicated day each week to complete their onboarding responsibilities and were expected to have completed their initial department-based orientation within 30 days of hire and the initial core specific population competencies within 90 days of hire. The APP Educators met with the APPs for individual sessions every four weeks throughout the program. At the end of the program, APPs completed surveys indicating their satisfaction with the orientation and their preceptors.

Results

For the years 2021–2023, ninety APPs completed the onboarding program. During 2022 and 2023 forty-four APPs (35 Nurse Practitioners; 9 Physician Assistants) completed our post-onboarding survey, including 12 in bone marrow transplant and malignant hematology, 14 in surgical oncology, 15 in medical oncology, 2 in infusion services, and 1 in radiation oncology. Most APPs indicated they were “very” or “extremely” satisfied with their orientation (n=37; 84%) and their preceptor (n=39; 89%). The vast majority (n=65; 90%) of APPs were still employed at our facility one year from their hire.

Discussion

We created a successful standardized onboarding program for APPs at a large, urban cancer center that included individual mentorship, didactic materials, and core specific-population competencies. In addition, most APPs reported being satisfied with the program with the vast majority remaining employed at our facility. Our curriculum can serve as an example for others to design standardized onboarding programs for APPs at their own facilities.

Oncology Nursing Forum. 2025 Mar 1;52(2):358–359.

P614. Evaluating the Impact of An Oncology Educational Program on Enhancing Knowledge and Skills in Oncology Among Primary and Community Health Nurses

Namitha Sivankutty ¹, Mashan Mohammed AlGhaithi ²

Management

Significance & Background

Recent trends in oncology have shifted oncology treatments to ambulatory settings, resulting in shorter hospital stays and follow-up at the nearest hospital for continuous care. While this approach helps hospitals to manage more patient needs, it also raises concerns about continuity of care for oncology patients post-discharge. Essential procedures, such as flushing unused ports, disconnecting ambulatory infusion pumps for chemotherapy, managing treatment-related symptoms etc. require training for nurses at the primary health center as well as nurses at the home health services. There is a critical question to ask for us as nurses before patient discharge: Are there enough oncology-trained nurses in community and primary health settings to meet these needs? Oncology nursing is a specialized field that demands unique competencies and knowledge to effectively care for patients. Nurses working with oncology patients require additional training to provide the best possible care. Discharging oncology patients without ensuring continuity of care can lead to serious complications, including increased hospital readmissions and a higher economic burden.

Purpose

This educational initiative aims to enhance the knowledge and skills of primary health and community home health nurses in oncology care. The goal is to address the care gap for oncology patients after discharge, ensuring they receive adequate support and follow-up.

Interventions

Data from incident reports at a tertiary oncology hospital revealed multiple cases of inadequate post-discharge care for oncology patients. In response, nursing leadership established collaboration with primary health nursing teams to enhance care continuity. After identifying learning gaps, a three-day educational program was developed, employing a mixed-method approach. The program focused on core oncology principles and included hands-on sessions to build competencies in common oncology nursing procedures.

Results

Using the Wilcoxon signed-rank test, we assessed changes in scores from pre-education to post-education tests. The mean score difference was 1.8 (±2.6), with a median of 1 (range: −1 to 6). The differences were statistically significant (p-value = 0.046).

Discussion

While oncology patients benefit from receiving care at home, discharging them without ensuring proper follow-up can lead to serious complications and increased hospital admissions. Integrating oncology education into the orientation of primary health nurses is crucial for ensuring continuity of care. This initiative demonstrates the need for ongoing training and support to empower nurses in providing high-quality care to oncology patients in community settings.

Oncology Nursing Forum. 2025 Mar 1;52(2):359.

P615. Oncology Nurse Navigation and Distress Screening Tools Support Best Care Outcomes

Melissa Young ¹, Lynsi Slind ², Jas Phagura ³, Abigail Malmgren ⁴, Tanika Sims ⁵

Coordination of Care and Navigation

Significance & Background

At a Community Cancer Center newly diagnosed patients experienced devastation and disruption in everyday life slowing the initiation of treatment. The multidisciplinary care team must determine best support for implementation and adherence of a treatment plan. Collaborative engagement is essential to address unique patient barriers to care including emotional and psychosocial support, financial and insurance challenges, and clinical care coordination. A gap was identified for optimal integration of effective practice across patient populations assuring best cancer outcomes.

Purpose

To design an efficient unique multidisciplinary process to early identification and mitigation of barriers in the delivery of best oncology care.

Interventions

The Oncology Nurse Navigators (ONN) piloted a new practice within a single provider’s newly diagnosed patient panel utilizing NCCN Distress screening for all. New patient packets were developed and after visit summary template created. Review of this content with patient initiates referrals to cancer support services i.e. Social Work, financial and palliative care. Comprehensive communication was facilitated by development of ONN SmartPhrases for standardized EMR documentation.

Results

ONNs followed 110 unique patients in the first two months of the pilot and referrals were made for over half to Social Work, Oncology Financial Coordinators and Palliative Care. With screening and patient summary visits it was discovered that an arbitrary cut off was not facilitating best care delivery. The establishment of standard practice of ONNs meeting with patients created a forum for patients to voice concerns. This unique patient engagement with the ONN optimized resource utilization for patients amongst multidisciplinary care teams.

Evaluation

Evaluations are ongoing and demonstrate increased patient satisfaction and staff utilization for patient care concerns.

Discussion

The NCCN Distress Screen is a validated tool in measuring distress in cancer patients, but the score identified does not comprehensively reflect patient needs and or barriers to accessing resources. The engagement of ONN expertise is essential to the integration of the NCCN Distress tool to maximize patient cancer care across the continuum.

Oncology Nursing Forum. 2025 Mar 1;52(2):359–360.

P617. Exemplifying Excellence: How An Oncology Nurse Embodies the Core Values of the Oncology Nurse Residency Program

Edna Smith ¹

Professional Development

Significance & Background

In September 2024, the Nursing Professional Development (NPD) team at a multi-site National Cancer Institute (NCI)-Designated Comprehensive Cancer Center celebrated the first year of the Oncology Nurse Residency Program (ONRP). This evidence-based, structured program supports oncology nurse residents as they transition into inpatient and outpatient settings, equipping them with essential skills and confidence. By instilling core values such as courage, compassion, collaboration, discovery, hope, and innovation, ONRP has significantly enhanced the experiences of new oncology nurses.

Purpose

To further support new oncology nurses, the ONRP integrates its core values into a comprehensive training curriculum. This approach ensures that nurses not only receive essential skills and knowledge but also embody the program’s core values of courage, compassion, collaboration, discovery, hope, and innovation.

Interventions

The Oncology Nurse Residency Program (ONRP) offers a hybrid curriculum for both seasoned and novice oncology nurses, blending in-person and online learning. The program includes five in-person classes, totaling 32 hours of immersive instruction and hands-on skills practice. Participants attend three 8-hour classes and two 4-hour classes, accumulating a total of 32 hours. Key Topics were Introduction to Oncology, Methods of Caring for Oncology Patients, Major Cancers and Symptom Management, Care Across the Continuum of Cancer Care, and Professional Development. Practical Skills were PIV Insertion, Lab Draws, Push-Pause Flushing, Blood Cultures, Port Access/De-access, and CVAD Dressing Changes.

Results

During the ONRP Professional Development Class 5, nurse leaders evaluated how oncology nurses embody the program’s core values through two guiding questions. Twenty-six oncology nurses attended, providing valuable insights into the qualities and values emphasized within their unit’s nursing practice. The evaluation revealed that the qualities of being a “Knowledge Seeker,” “Committed,” “Compassionate,” “Collaborative,” and “Hopeful” are highly valued within oncology nursing practice. Nurses who embody these qualities contribute significantly to the overall improvement of patient care standards, inspire their colleagues, and enhance the efficiency and morale of their units. Positive feedback from unit leaders during the first 12 months of employment highlights the program’s success.

Discussion

Unit leaders recognized the significant benefits of their oncology nurses participating in an evidence-based oncology nurse residency program. The findings underscore the essential role of core values in nursing practice. Knowledge-seeking nurses enhance patient care through continuous learning and professional development. Committed nurses build trust and reliability, while compassionate nurses provide emotional and psychological support.

Oncology Nursing Forum. 2025 Mar 1;52(2):360.

P618. Identifying Barriers and Solutions to Increase Palliative Care Access to Vulnerable Populations

Salinah Smith ¹

Symptom Management and Palliative Care

Significance & Background

How an individual with a life-limiting disorder such as cancer responds to adverse health outcomes can be varied depending upon their beliefs and values. However, providing timely resources can be difficult if the individual is wary of what palliative care entails, if they have barriers to receiving palliative care, and how to best identify if palliative care is needed. NIH states that vulnerable populations are people who have a high incidence of health care disparities which can compound health issues. Social determinants of health such as socioeconomic factors and physical environment, have a direct effect on an individual’s well-being which in turn compounds the barriers in receiving timely care. Understanding the barriers and identifying solutions has the propensity of improving patient outcomes in vulnerable populations.

Purpose

This project will identify the barriers facing vulnerable populations to receive palliative care, what solutions have been found, and how to best reach individuals who show a need for a palliative care consultation.

Interventions

A literature review was conducted utilizing a comprehensive search of Pubmed and Gale databases; the keywords of ‘palliative care’, ‘barriers’, ‘solutions’, ‘vulnerable’, ‘underserved”, and ‘minority’ were used. Studies were assessed for key topics regarding barriers and solutions regarding palliative care accessibility for the specific populations of vulnerable individuals as categorized by NIH. Fourteen qualitative studies were utilized, barriers and solutions, and population were delineated and compiled into common themes.

Results

Several barriers were identified such as indifference to linguistic differences, stigmatization of individuals who used substances, and discrimination against individuals who were unhoused. Several solutions were identified such as increased care coordination, technology integration into care, and increased education regarding patient’s diverse cultural and belief systems. Limitations were noted such as study sample sizes and accessibility of study participants.

Discussion

Based on these results, individuals categorized as vulnerable populations are lacking access to adequate palliative care due to barriers of logistics, linguistics, and unconscious biases. Practical implications for healthcare providers are improving the education of the multidisciplinary team and improving health literacy of vulnerable populations to view palliative as a viable option in the presence of a life-limiting illness.

Oncology Nursing Forum. 2025 Mar 1;52(2):361.

P619. Digital Safety Huddle: Enhancing Safety and Streamlining Communication on A Surgical Oncology Unit

Shevon Smith ¹, Jennifer Carcel ²

Healthcare Delivery

Significance & Background

Effective communication is essential in healthcare to prevent delays in medical treatments, misunderstandings about patient conditions, and ensure patient safety. Traditional methods, such as handwritten safety huddles and verbal communication silos among interdisciplinary teams, frequently result in problems like lost or incomplete documents and overlooked information due to forgetfulness and hectic workflows. These communication silos can compromise patient safety. To address these challenges, the adoption of digital safety huddles was explored. Technological advancements can enhance clarity and consistency in communication about inpatient unit safety concerns, ultimately improving patient safety awareness and outcomes.

Purpose

This study assesses how access to digital safety huddles improves documentation completion rates and enhances safety and awareness on an inpatient surgical oncology unit, comparing their effectiveness with traditional handwritten safety huddles.

Interventions

The intervention involved implementing digital safety huddles via Microsoft Forms, replacing the traditional handwritten documentation method. Registered nurses, assigned as team leaders, were instructed to scan a QR code and complete the form with their team members at the end of their shift, then report their findings to the incoming team. Nursing leadership received a notification and copy of all completed digital safety huddle forms. This digital approach aimed to streamline communication, provide real-time end-of-shift updates, and improve the consistency of safety documentation.

Results

A pre-survey was conducted to assess the frequency and effectiveness of traditional handwritten safety huddles and their impact on safety awareness. The survey evaluated how often huddles were completed, their influence on team safety awareness, and overall communication effectiveness. Following the introduction of digital huddles, a similar survey was conducted to gauge improvements in communication and safety huddle documentation.

Discussion

The results demonstrated that adopting digital safety huddles significantly improved team communication, leading to a notable increase in the completion of safety tasks and overall safety awareness. Digital huddles offered a more consistent and comprehensive documentation process, reducing communication barriers and enhancing team coordination with inpatient leadership to address concerns. The findings suggest that digital safety huddles provide a valuable technology-driven solution for streamlining communication, strengthening safety protocols, and boosting team efficiency. Integrating digital tools into healthcare settings can enhance patient care management and foster a more effective and supportive team dynamic.

Oncology Nursing Forum. 2025 Mar 1;52(2):361–362.

P620. Caring for Bariatric Patients in A Radiation Oncology Procedure Setting

Pamela Smith ¹, Katelyn Gotfredson ², Zachary Peterson ³, Kristen Slater ⁴, Monette Santos-Moss ⁵, Noura Khazal ⁶

Quality and Safety

Significance & Background

Endometrial cancer is closely linked to obesity and is on the rise in the United States. Our brachytherapy procedure department takes care of many bariatric patients with endometrial cancer. We have seen a rise in this patient population and expect to see an increase in the foreseeable future. Additionally, our procedure department has added anesthesia care for many of these patients. This level of care is helpful for patient comfort but prevents patients from actively participating in their care. Patients are no longer able to assist in lifting their pelvises or moving up in the bed following the procedure. Taking care of these patients safely and with dignity is imperative.

Purpose

Examine possible interventions to help mobilize patients who are under anesthesia to provide care that is safe for the patients and safe for the staff.

Interventions

Work with Environment Health & Safety team to evaluate space and workload and use of safe handling equipment for patient care. Train staff on proper use of safe handling equipment. Discuss procedure with involved staff prior to each case to ensure safety for patient and staff.

Results

Expected results are the following: no injuries for patients or staff after implementing new bariatric patient care system, and optimal patient flow using assistive devices for lifting and moving patients with use of current staffing levels rather than up-staffing when bariatric patients are scheduled.

Discussion

Implementing Hoyer lift respects patients’ dignity instead of having an all-hand-on-deck approach, which can be embarrassing for a patient. We worked with our ergonomics department and examined multiple locations on our gurney to place the half-hover mat for maximal success. Staff buy-in is expected to be easy as it was universally accepted that a need for a better approach was necessary. We also expect to no longer need to bring in extra staffing for our bariatric patients. One staff member remarked after trying the half-hover mat, “Why didn’t we think of this before?”

Oncology Nursing Forum. 2025 Mar 1;52(2):362.

P621. Decreasing Central Line Associated Blood Stream Infections by Half on A 48 Bed Oncology Unit While Doubling the Travel Nurses

Christine Smith ¹, Vickie Downing ², Dawn Tetterton ³, Erin Pearson ⁴, Jamie Hall ⁵

Quality and Safety

Significance & Background

This 48-bed Oncology unit specializes in inpatient cancer care. Patients with cancer are vulnerable to infection because of impaired immune competence as a result of their disease or chemotherapy-induced neutropenia (Page et al., 2016). This unit averages 24 lines daily. Patients with cancer who develop Central Line Associated Blood Stream Infections (CLABSIs) have increased mortality rates ranging from 12% to 40% (Garcia et al., 2022). This unit had an increased need for Travel Registered Nurses (RNs). Most of the Travel RNs did not have oncology experience. This unit had 10 CLABSIs during Fiscal Year (FY) 22 while onboarding 37 Travel RNs. Strategies were deployed with education focused on bundle compliance, validation for sterile glove donning and doffing, Central Venous Line (CVL) dressing changes, and port accesses. An eight-week CVL Team pilot was initiated. Core RNs changed all dressings, caps, tubing, and re-accessed ports every Thursday. Education was provided and data collected. This unit embraced “For the Love of the Line.” Information was disseminated twice daily in huddles. A bulletin board reinforced this information. The unit instituted a Quality Representative and CVL Champion. They assessed bundle compliance weekly, completed chart audits, and line assessments. They performed real time educations when needed. The Unit Secretaries audited daily CHG baths in real time. The Charge Nurses validated line documentation every shift. Small tests of change, educational opportunities, and focused pilots increase quality care and decrease CLABSIs. Multidisciplinary team member awareness and adherence to CLABSI prevention strategies are critical to reducing CLABSIs in the neutropenic patient population.

Purpose

This unit implemented strategies to protect this population against CLABSIs while onboarding several new non-oncology nurses.

Interventions

The interventions discussed above are hardwired. For FY24, daily CHG baths for all 48 patients was implemented. The CVL Team was instituted. Two RNs change CVL dressings, tubing, caps, and re-access ports every Tuesday. Ports are not accessed if not needed.

Results

This unit decreased CLABSIs from 10 to 5 while onboarding 80 travel RNs during FY23 saving approximately $217,240. In FY24 this unit decreased CLABSIs to 3 while onboarding 70 Travel RNs saving approximately $188,432 and many lives.

Discussion

This unit decreased CLABSIs with two-thirds of the workforce being Travel RNs while increasing patient days to over 16,200 and increasing line days to over 7,500 a year.

Oncology Nursing Forum. 2025 Mar 1;52(2):362–363.

P622. Expanding Scalp Cooling Access: Creating An Institution Wide Insurance-Based Billing Model

Andrea Smith ¹, Ikuko (Koko) Komo ², Jaclyn Andronico ³

Coordination of Care and Navigation

Significance & Background

Scalp cooling can make a big difference for patients undergoing chemotherapy, as it can reduce hair loss, which is often a distressing side effect of treatment. Recently, scalp cooling was approved by the Food and Drug Administration (FDA) for solid tumor cancer patients which allows for this service to be covered by insurance. One National Cancer Institute designated cancer center created an interprofessional team to transform workflows that would allow patients to take advantage of this service.

Purpose

The purpose of this program was to increase scalp cooling access to oncology patients with limited financial means and empower nurses to be at the forefront of this change. Transitioning an institutions self-pay model to a “buy and bill model” allows the organization to bill insurance companies directly to minimize out of pocket cost to patients.

Interventions

An interprofessional team including nurses, nurse leadership, administration, compliance, billing, and supply chain were tasked to prepare for the institutions transition. The group met weekly to develop workflows, standardize billing, insurance authorization and clearance. Institution wide education for nurses and clinicians was developed and implemented. Policies, patient education, and clinical guidelines were updated. Communication through institution’s website and patient portal were utilized. Workflows with social work to leverage philanthropic funds for patients without coverage was also developed. The team continues to meet to mitigate issues, update staff and improve workflows.

Results

Prior to the buy and bill program, the average out of pocket cost for patients who were scalp cooling was $2,400 total. Between Jan 2023 to August 2023, around 391 patients were registered for scalp cooling and had to pay an estimated $938,000 out of pocket. Since this program was implemented in September 2023 to January 2024, an increased volume of 350 patients were enrolled and 92% of those were covered either by insurance or an assistance program. Additionally, over 300 nurses were educated, and additional scalp cooling machines were purchased due to increased usage and demand.

Discussion

Nurses can help ensure that more patients benefit from scalp cooling, enhancing their quality of life during cancer treatment and contributing to a more supportive and comprehensive care approach. The buy and bill program addresses financial insecurities and makes scalp cooling accessible for all patients regardless of their socioeconomic status.

Oncology Nursing Forum. 2025 Mar 1;52(2):363.

P623. The Ins and Outs of Intake and Output

Jenna Snaza ¹, Susan Wittren ², Breanna Walker ³, Rachel McMullen ⁴, Paige Bartlett ⁵, Laura Graves ⁶

Quality and Safety

Significance & Background

Accurate measurement of daily intake, output, and weights is an important component of care management in acutely ill adult medical oncology patients. Medication and chemotherapy regimens are often based on the patients’ documented weight. Fluctuations in weight and fluid status may require daily interventions.

Purpose

Through randomized chart audits, it was found on average, intake and output documentation (oral intake, urine output, intravenous (IV) medications, tube feedings) occurred 65% of the time as ordered. The expectation is to document intake and output 100% of the time. The goal of the project was to reach 80% accuracy in intake and output documentation.

Interventions

The project team provided education to all nursing staff regarding intake and output documentation expectations through unit meetings and peer-to-peer communication. Upon admission and transfer to the unit, nurses completed education regarding the importance of accurate intake and output documentation. Patients were provided with paper tracking sheets that assisted in capturing intake and output. Project members collaborated with an oncology provider to facilitate standardization of intake and output orders.

Results

Over a period of 40 days, consistency and accuracy of intake and output documentation was increased by 6% from a baseline of 65%. Although the goal was to reach 80% compliance during this period, this improvement is a step in the right direction. When the data was broken down into subcategories, there was an increase in the consistency of documentation for both oral and tube feeding intake, as well as for continuous and intermittent IV medications. Pre and post surveys were sent to nursing and providers to assess knowledge and utilization of the intervention. Of nursing staff that utilized the tracking tool, 35% indicated it was extremely useful.

Discussion

Although the goal of 80% was not met it did help provide clarity regarding provider expectations of intake and output documentation. If this project was extended or repeated, it would be essential to reinforce education with the interdisciplinary team to ensure understanding of the importance of intake and output documentation. In a future project, it would be beneficial to explore if task reminders within the electronic health record will help improve intake and output documentation.

Oncology Nursing Forum. 2025 Mar 1;52(2):363–364.

P624. Oncology Nursing Empowerment Council: Creating Your Seat at the Table

Claire Somers ¹, Amy Davey ², Namrta Chahal ³, Elizabeth Kiss ⁴, Haley Swaciak ⁵, Linda Bell ⁶

Professional Development

Significance & Background

Nursing was pushed to the brink during the pandemic, resulting in elevated levels of burnout and an exodus of experience in inpatient nursing. After witnessing the new challenges facing inpatient units with an influx of inexperienced oncology staff, more experienced ambulatory oncology nurses eagerly offered to support. This observation provoked much consideration to how long-term mentorship and connection between all areas of the cancer institute, could strengthen the workforce, which led to the creation of the Oncology Nurse’s Empowerment Council (ONEC).

Purpose

The purpose of this council was to connect all inpatient and outpatient settings, both at the academic center and throughout the region. The focus was on revitalizing oncology nursing engagement, empowerment, wellness, recruitment, and retention, while enhancing nursing professional development in a tired, post-pandemic workforce.

Interventions

The Kotter-8-step Change Model was used as the framework for ONEC, serving as the guide for the Council Charter. The steering committee consisted of six nursing leaders, representing inpatient, outpatient, and regional areas. The steering committee recruited from each of the 20 units, resulting in 1–2 nursing members from each area. ONEC created short-term goals, establishing the mission and vision for the council, while also identifying 6–12-month goals, such as electing Staff Co-Chairs to ensure nursing inclusion in Cancer Center decision making.

Results

The meetings were offered as a hybrid format resulting in excellent attendance in the first five meetings. The meetings were both informational, sharing best practices related to patient care or operations, as well as discussion based. ONEC partnered with the Oncology Quality Institute, together promoting nursing professional development through attendance at local, national, and international conferences, and publications in peer-reviewed nursing journals.

Discussion

ONEC provides staff nurses with a direct line to nursing leadership while providing them with a better understanding of the continuum of oncology care by breaking down silos. Being able to collaborate, influence care and careers by making meaningful contributions through voices historically not heard can increase oncology nursing job and career satisfaction.

Oncology Nursing Forum. 2025 Mar 1;52(2):364.

P625. Team Nursing on A Multi-Disciplinary Surgical Oncology Department

Kristin Soper ¹

Coordination of Care and Navigation

Significance & Background

Our Multi-Disciplinary department is historically a very complex department with many different programs and providers practicing with varying needs. Care coordination has been difficult as there is little RN involvement and consistency. There is a recognized clinical gap in patient care. Because of these opportunities, we are moving towards a team nursing model which will allow for well-defined nursing roles.

Purpose

Team based care will allow a better workflow, as well as will allow each team member to work within their license, and work to their full scope to ensure excellent quality care. The roles and responsibilities in this department have not been well-defined in the past. Clear definition will lead to improved ownership, consistently and improved quality of care being delivered. Our nursing staff would feel more fulfilled and involved in their team and able to play a vital role in their patient’s care. Our patients would receive more concise and timely responses to teaching as well as to their requests and concerns, thus, increasing their overall satisfaction.

Interventions

We requested additional RN positions (2) to implement team nursing in the Multi-Disciplinary department. RN roles included: Team RN, Procedure RN, Lead RN & Triage RN. Roles and responsibilities of each were clearly defined. Each nurse was assigned to specific teams and roles for an extended period allowing individuals to like a valued member of the team and work consistently with the same providers and team members. Goals/Results were as follows: improve staff satisfaction, RNs to feel more invested/part of the team, bridge the clinical gap in Multi-D, ensure better patient follow-up, work to the full scope of license, improve care coordination, well defined roles, and improve quality of care being delivered.

Discussion

Pre and post surveys will be completed by provider teams, Multi-D RN group, and our nurse navigator group who will work closely with the RNs to measure impact.

Oncology Nursing Forum. 2025 Mar 1;52(2):364–365.

P626. Fostering Nurse Wellness: Initiatives for A Healthier Workforce

Lindsay Staiman ¹

Psychosocial Dimensions of Care

Significance & Background

Stress. Burnout. Compassion fatigue. Complicated grief. Emotional exhaustion. All of these and many others are challenges oncology nurses face daily when caring for patients and their families. Bonds are formed and exposure to trauma is endured as they care tirelessly for this complex patient population. Implementing initiatives devoted to nurse wellness is essential in fostering a healthy work environment, reducing stress, improving capacity for empathy and ensuring high-quality patient care.

Purpose

To incorporate and encourage participation in consistent nurse wellness initiatives in the outpatient oncology infusion setting.

Interventions

Wellness initiatives were conducted in the outpatient infusion setting in efforts to improve nurse mental health, decrease burnout, and encourage staff camaraderie. A monthly newsletter, Wellness Wednesday, is sent to infusion staff. The newsletter includes a healthy recipe, patient resources for staff to familiarize with, and hospital provided wellness opportunities. In collaboration with our social worker, ‘Freeing Fridays’ were implemented. A monthly grief and resiliency group for oncology nurses to share stories, learn coping strategies, and process difficult emotions. After receiving a certificate in the Use of Therapeutic Inhaled Essential Oils for the Healthcare Setting, an event was held for nurses teaching benefits of essential oils. Each participant received a scented sachet of their choosing. A community volunteer event was coordinated at a local giving garden that grows organic produce and delivers free meals to patients receiving cancer treatment. Lastly, in celebration of nurses’ week the chaplain performed a ‘Blessing of the Hands’ ceremony at the clinic.

Results

A survey was sent to all infusion staff measuring which activities staff members participated in as well as impacts on mental and physical health, work environment, and lifestyle. Staff survey results demonstrated 71.4% of nurses enjoyed taking part in wellness activities at work and 81.5% of nurses felt that wellness activities helped create a healthier work environment. In addition, 71.4% believed wellness activities improved their mental health.

Discussion

Implementing nurse wellness initiatives in the outpatient infusion setting has demonstrated significant positive outcomes in promoting healthy lifestyle, enhancing coping strategies, and strengthening staff bonds. Investing in wellness initiatives will continue to be invaluable in preserving the longevity of nurses and maintaining quality care.

Oncology Nursing Forum. 2025 Mar 1;52(2):365–366.

P627. Dialing up the Support: Enhancing Access to Care Through Implementation of an Oncology Nurse Triage Service

Kim Stanbery ¹, Terena O’Dell ², Dena Shore ³

Healthcare Delivery

Significance & Background

As oncology care becomes increasingly complex, timely access to nurse triage for symptom management is crucial. Traditional models of assigning triage as an additional responsibility for the ambulatory care nurse often leads to delays and inefficiencies in addressing patient needs, which can impact patient outcomes and satisfaction. To address these challenges an oncology nurse triage service was proposed to increase patient access to care and enhance care delivery.

Purpose

The purpose of this quality improvement (QI) initiative was to develop an innovative care delivery model, embed a digital workflow in the electronic medical record (EMR) and implement an oncology nurse triage service designed to improve patient access to care, across a large service area, while maximizing scope of practice for oncology nurses.

Interventions

The QI project employed a multi-phased approach. Phase 1 included a comprehensive needs assessment, stakeholder engagement, and design of evidenced based triage protocols. In phase 2 the triage service model was developed and structured around a call center model, staffed with experienced oncology nurses trained in triage protocols. Key components of this project included building evidenced based triage protocols into the EHR for real-time patient information access and the development of standardized triage pathways based on clinical urgency and patient needs. The third phase involved training for all involved staff, establishment of performance metrics, and a phased rollout of the service across the service area. Metrics included volumes for incoming and outgoing calls, number of in-basket messages handled, response times and call abandon rate. Data was collected and analyzed over a six-month period to assess the impact of the new service.

Results

The triage service has expanded to include five practices with plans to bring on three additional clinics by year end. Call volumes increased by 111% while maintaining service level targets for answering 80% of all calls within 60 seconds (m=82.59%) and call abandon rates decreased by 37% (m=3.45%). The integration with EHRs facilitated better continuity of care and more informed decision-making by triage nurses.

Discussion

This project illustrates how implementing a dedicated triage service with standardized workflows and evidence-based algorithms can enhance timely patient access to care and ensure safe delivery of services. Future steps include ongoing program evaluation, symptom and disposition tracker, and exploration of expanded service capabilities to further optimize oncology care delivery.

Oncology Nursing Forum. 2025 Mar 1;52(2):366.

P628. Get Me Out of Here! How Does The Use of Anti-Siphon Tubing Affect the Rate of 24-Hour Chemotherapy Hang-Time Overruns

Kristen Starr ¹

Treatment Modalities and Managing Administration

Significance & Background

Inpatient chemotherapy represents a significant time commitment by patients in their fight against cancer. Patients are admitted for several days at a time every few weeks for months. This is time that they would prefer to be spending at home, and these patients are generally interested in getting discharged as quickly as possible. Occasionally, discharge is delayed due to the chemotherapy bags running longer than the allotted time. If each bag runs longer by an hour or more for several days, discharge can be pushed back by as much as a day. One potential cause of these delays is multiple “air-in-line” error messages on the IV pump. To study this problem, we evaluated the use of a 4” extender anti-siphon tubing that is designed to reduce air in IV lines.

Purpose

By tracking the occurrences of “air-in-line” alarms and total hang time for 24-hour chemotherapy infusions, this project determined if anti-siphon tubing is effective in preventing infusions from running longer than the intended 24 hours.

Interventions

Side by side comparison of 24-hour chemotherapy hung with and without anti-siphon tubing. All chemo administering RNs recorded: use of tubing, chemo up and down time, and number of “air in line” errors for all 24-hour chemotherapy bags over a two-month period in 2023.

Results

Data collection resulted in 107 data points, each representing one 24-hour chemo bag. The average hang time was 22 minutes over 24 hours, but times ranged from almost two hours under to four hours over 24 hours. Statistical analysis revealed the following: Use of anti-syphon tubing DOES have an impact on total run time. Chemo hung without tubing had an average hang time of 20 minutes less than chemo with the tubing; this difference was statistically significant at a 5% significance level. Use of anti-syphon tubing DOES have an impact on the number of air-in-line errors. The mean number of errors without the tubing was 2.97 versus 0.88 with the tubing; this is statistically significant at the 0.4% level.

Discussion

Data demonstrates a small time advantage for NOT using the anti-syphon tubing, and a slight difference in air-in-line messages. Overall, it is fair to conclude that the anti-syphon tubing is not a major driver in chemo time overrides, and other sources for significant time overruns must be sought.

Oncology Nursing Forum. 2025 Mar 1;52(2):366–367.

P629. Increase Nurse Satisfaction Through Unit Based Council

Samantha Steidle ¹, Ashley Gutu ², Tricila Ronquillo ³

Professional Development

Significance & Background

In 2019 a large healthcare organization in the Mid-Atlantic opened the doors to a new comprehensive cancer institute and brought previously independent outpatient oncology practices and nurses together on a large teaching hospital campus. In 2022, outpatient Oncology registered nurses (RNs) from the institute’s 56-chair adult infusion clinic completed the NDNQI RN Satisfaction Survey with Practice Environment Scales, which demonstrated results below national benchmark. The RNs expressed feeling disconnected from the main hospital campus and described challenges communicating and feeling heard. A team of nurses collaborated with leaders to develop an action plan and decided to focus on building unit-based councils through increased representation and dedicated time for participation.

Purpose

The purpose of expanding shared governance participation in the clinic was to elevate the voice of Oncology nurses and ensure their participation in shared decision making at the unit, department, and organizational level.

Interventions

Empowering Oncology nurses through shared governance participation led to the implementation of four evidence-based practice (EBP) initiatives: fast track nurse, flex nurse, blood draw nurse and self-scheduling. The fast-track nurse helps relieve other nursing assignments by taking more patients. They are assigned two patients an hour for the shift and gives injections, including chemotherapy and therapeutic agents, and performs mediport flushes. The flex nurse acts as a resource or extra set of hands to help alleviate the burden on fellow nurses and facilitates patient throughput in the clinic. The mediport access nurse is assigned to the laboratory to access mediports and draw laboratory specimens to prepare patients for treatment. Lastly, the clinic implemented an online scheduling system used across the organization’s inpatient nursing units, allowing infusion nurses to also enjoy self-scheduling.

Results

Elevating the voice of the nurse through shared governance participation decreased turnover by 10%, increased retention by 3%, decreased travelers by 26% and increase employee satisfaction by 58%.

Discussion

Nurses in the ambulatory setting felt empowered by actively participating in shared governance. Nurses were able to see the benefits of shared decision making by implementing EBP initiatives. The positive effect of collaboration with nurse leaders and clinical nurses continue to grow and hopefully disseminate amongst other clinics.

Oncology Nursing Forum. 2025 Mar 1;52(2):367.

P630. Transforming Order Transmission: Implementing A Pend and Send Workflow for Enhanced Clinical Practice

Charlene Stein ¹, Brooke Ferguson ², Seth Toomay ³, Sandy Page ⁴, Elizabeth Phillips ⁵, Mari Ann Lewis ⁶

Quality and Safety

Significance & Background

A carveout in the Hospital-Based Clinic (HBC) policy allowed Cancer Center Nursing staff to sign orders under “transcribed/internal” mode. Non-providers use this order mode when entering orders into Epic on behalf of a provider. Orders entered this way are active immediately, before the provider signs it, and are subject to interpretation and transcription errors. Concerns related to physicians and nurses practicing outside of scope encouraged executive leadership to look at improvement opportunities to ensure patient safety and protect our medical staff by ensuring all were practicing within scope of their licensure.

Purpose

This initiative aims to provide the safest care possible to our medical oncology patients by eliminating the gap in unsigned orders. The process of pending orders to providers was developed to ensure orders are reviewed for accuracy and signed by the provider before they are executed.

Interventions

Key stakeholders including cancer center leadership, clinicians, nurse educators, workflow informaticists, and project management, met to develop an individualized, collaborative plan for each disease-oriented team (DOT). Initially, executive health system leadership met with cancer center leadership including project management to assess compliance and patient safety concerns, review data, and partner to develop an action plan. An Epic “pend and send” workflow was created allowing nurses to directly pend orders for signature to the provider via an Epic In-Basket message. Before each DOT go-live, the project team met to develop an implementation strategy with respective clinic leadership, including physician leaders. Education was then provided to each nursing team which included required online training via our learning management system to be completed before go-live.

Results

Genitourinary (GU) Medical Oncology was the first DOT to go live in April 2024. A phased approach was utilized to implement the workflow in the remaining DOTs, with planned completion by November 2024. Before implementation in April, the cancer center averaged over 3,000 transcribed orders entered weekly. As of the end of September, the cancer center decreased transcribed internal orders by 50%.

Discussion

The partnership between the project team, physician leadership, and clinical team was critical to this project’s success. A tailored approach to each DOT while focusing on the patient’s safety and their care was integral in the roll out of this initiative and helped increase buy-in from clinicians.

Oncology Nursing Forum. 2025 Mar 1;52(2):367–368.

P631. Lessons Learned: Operationalizing CAR-T Therapy in the Community Oncology Private Practice Health Care Setting

Martie Steinfeld ¹, Xiaoxiao Zhang ², Ashley Todd ³, Rhiannon Dorris ⁴, Kathleen Murphy ⁵, Michael Byrne ⁶

Healthcare Delivery

Significance & Background

Chimeric antigen receptor T-cell therapy has quickly emerged as a sought-after therapy for patients with relapsed/refractory hematologic malignancies. Historically CAR-T therapy has only been offered in outpatient settings affiliated with an established stem cell therapy program.

Purpose

CAR-T therapy patients treated in the outpatient space is not new. Our community oncology private practice is one of the first in the nation to successfully treat patients who meet CAR-T therapy guidelines in the private practice setting.

Interventions

Utilizing a hybrid project management methodology, collaborating across multidisciplinary specialties, and partnering with a non-stem cell transplant affiliated hospital, our private practice has successfully operationalized and implemented CAR-T therapy in the community oncology private practice health care setting, offering patients an additional safe option in cellular therapy. Discovery and lessons learned from the journey include: redefining guidelines necessary for payor support, establishing CAR-T manufacturer contracts with a paradigm shift in what is truly needed to safely and successfully receive and administer product to patients while still following FACT standards, pre-cell collection work up and evaluation with quick result turn around, apheresis of the patient in the absence of an apheresis department or team, cell storage and product thaw without a central processing lab, education of team members without previous cellular therapy knowledge, identification of cellular therapy-based clinic(s), pharmacy support and guidance, post care monitoring, and fast track admissions to a non-cellular therapy based oncology unit.

Results

Our private practice has successfully launched a cellular therapy program and continues to treat cellular therapy patients in the community oncology private practice space.

Discussion

Ensuring patients can receive safe cellular therapies in the communities where they live, although a heavy lift, can be accomplished with careful, collaborative planning, intentional processes, and thoughtful design with the patient at its center. Our team’s work will provide a blueprint for manufacturers, payers, and other community practices to onboard cellular therapies in the future.

Oncology Nursing Forum. 2025 Mar 1;52(2):368.

P632. Inclusive Care Starts with Inclusive Language in Breast Health Care for LGBTQIA+ Patients

Siobhan Stofka ¹, Rachelle Park ², Rebecca Crane-Okada ³

Psychosocial Dimensions of Care

Significance & Background

Our breast clinic has seen an increase in patients identifying as transgender and non-binary. These patients may present with breast cancer or benign breast issues. Our transgender male patients, assigned female sex at birth, may opt for gender-affirming surgery, or “top surgery” after breast cancer diagnosis. Our transgender female patients may present with high-risk breast lesions that require more frequent breast cancer screening. Yet, our intake documents fell short of honoring the diversity of our LGBTQIA+ patient population.

Purpose

The nurse navigators proposed to update the breast center’s female-focused and binary-gendered intake documents, and to change the clinic culture by educating fellow coworkers about transgender and non-binary patient needs.

Interventions

Guidelines from the National LGBT Health Education Center, American Psychological Association, and American Nurses Association were reviewed for inclusive verbiage when caring for transgender and non-binary patients. The breast center’s surgical and nursing directors reviewed the suggested revisions and chose those they felt necessary to provide safe and respectful care to our patients. Demographic fields in the Electronic Health Record software had been recently updated, providing options for documenting gender identity, sex assigned at birth, preferred name, and pronouns. Education was provided to physicians, nurses and ancillary staff to help foster inclusive care when communicating with patients and documenting demographics.

Results

Revised intake documents have been incorporated into the breast clinic’s workflow for all new patients. The breast nurse navigators, as stewards of the clinic’s effort to create a welcoming environment for our LGBTQIA+ patients, review the patients’ intake documents, update the EHR when needed, and ensure communication with ancillary staff regarding each of our patient’s gender-related needs.

Discussion

Respect for the dignity of our patients is a top priority for the nurse navigators, oncologists, and staff at our breast center. Being diagnosed with breast cancer, or being screened for potential cancer, is a stressful event in one’s life. We want our patients to feel respected and supported. Our goal is to remove the stressor of whether one will be treated with respect in our breast center, so patients can focus on positive coping strategies throughout their care. Incorporating inclusive language is an essential element of patient-centered oncology care.

Oncology Nursing Forum. 2025 Mar 1;52(2):368–369.

P633. Enhancing Patient Assignment Equity Using Technology in the Outpatient Infusion Environment

Victoria Stone ¹, Marisa Quinn ², Jeanne St John ³

Management

Significance & Background

Oncology infusion centers face various operational challenges including staffing shortages, increasing patient acuity, and complex care coordination. These issues lead to inefficiencies and more critically, they contribute to nurse fatigue and burnout. Work system factors, including excessive workloads, administrative burden, and inadequate staffing, are major contributors to burnout. Oncology nurses are particularly vulnerable due to the complexities of patient care, including end-of-life decisions and managing treatment side effects.

Purpose

In the outpatient infusion setting, unpredictability of treatment starts along with high volumes make it difficult for charge nurses to manually assign patients. Using a “pull” system, our nurses self-assign patients within the electronic health record (EHR). While this system provides autonomy, it can overwhelm nurses, leading to unbalanced workloads, lack of preparation, and missed breaks. Recognizing these issues as precursors to burnout, we turned to technology to augment existing nursing practices.

Interventions

A pilot was conducted in January 2024 on a 17-chair infusion unit using a new tool offered within our established scheduling optimization platform (iQueue for Infusion Centers by LeanTaaS). We integrated patient assignment seamlessly between our EHR and staffing systems allowing for real-time visibility into workloads. The tool suggests the most suitable nurse for each incoming patient, considering factors like workload, interval between patients, and rest breaks. Charge nurses can accept or override these suggestions based on clinical context, preserving their expertise and judgment.

Results

Pre- and post-pilot surveys were distributed to nurses to gauge perceptions of workload equity and assignment pacing. Three-month follow-up results showed a 9% improvement in workload balance, an 8% increase in nurse productivity, and 75% of nurses reporting better assignment pacing. Throughout the pilot, nurses continued to pull patients, but with the tool active, charge nurses gained real-time insights into workload distribution, patient flow, and staffing metrics. The tool allowed charge nurses to manage breaks more effectively, preventing new patient assignments during breaks.

Discussion

The initiative demonstrates how technology can enhance nursing practice and the work environment. Nurses expressed a desire for workload equity and fair assignment pacing, which the tool helped achieve. Based on these outcomes, the tool was implemented across multiple infusion units. This tool relies on nurses’ expertise and clinical judgment to be most effective. Expanding this initiative could lead to broader improvements in infusion centers facing similar challenges.

Oncology Nursing Forum. 2025 Mar 1;52(2):369–370.

P634. Implementing Aromatherapy to Improve Symptom Management in A Community Hospital-Based Cancer Center

Audrey Stoppel ¹, Jennifer Lerner ²

Symptom Management and Palliative Care

Significance & Background

During the cancer treatment process, patients often experience feelings of emotional distress or nausea. A literature review reveals a gap in the management of these symptoms. Evidence demonstrates that aromatherapy may help manage these symptoms with little to no risk to the patient through a complementary and alternative nursing approach. The cancer center received hospital grant funding to purchase aromatherapy supplies using hospital-grade essential oil blends for the twelve-month pilot program.

Purpose

The aim of the project was to provide a nurse driven, non-pharmacologic intervention for oncology patients to help manage feelings of emotional distress or nausea using a complementary and alternative approach.

Interventions

Patients undergoing oncology-related infusions or radiation therapy who identified feelings of emotional distress or nausea were candidates for aromatherapy. Nursing staff offered specific aromatherapy to assist with the identified feeling including a blend for emotional distress and a different blend for nausea. Patients were educated on inhalation of the essential oils during their visit by placing the tab under their nose and taking deep breaths as needed until symptom resolution. A smart phrase was developed to document and track patient utilization and response in the electronic health record. The project was presented to the hospital Institutional Review Board and received exempt status as it posed minimal patient risk.

Results

Over a twelve-month period, 524 uses of aromatherapy were documented. Eighty eight percent of patients had positive outcomes, reporting resolution of feelings of emotional distress or nausea after usage. Patient experience scores were also used to evaluate the intervention. The question “Infusion therapy staff concern for comfort” showed an increase in the department set goal in nine of the 11 months reviewed.

Discussion

Aromatherapy was shown to be an effective, complementary, non-pharmacologic nursing intervention for oncology symptom management. Nurses can utilize this intervention to help decrease feelings of emotional distress or nausea, which ultimately increases patient comfort during treatment. This alternative approach is a nurse-driven tool to enhance care for the oncology population. Following completion of the project, this program has expanded to the cancer resource center that serves the local community. Additionally, since presenting the results of the project at the hospital’s professional poster day during nurse’s week, other units are seeking to incorporate aromatherapy into patient care.

Oncology Nursing Forum. 2025 Mar 1;52(2):370.

P635. Lymphoma Care Neighborhood: Improving Patient Care Delivery Through A Care Model Change

Diana Su ¹, Patrick Evans ², Kiersten O’Dellick ³

Healthcare Delivery

Significance & Background

A large academic designated cancer center had a hematology dedicated floor with all diagnoses co-located. A determination was made to open a new unit dedicated to lymphoma patients. This care model change would impact the lymphoma patient population (n=4277) and demand the hiring of new infusion nursing staff (n=11). To optimize best care practices, a multiple dimensional program was needed to assure highest quality patient centered environment could established, best efficiency, and access to unique support services assured.

Purpose

Share program design experience that incorporated co-location, best practices, and patient experience to utilize best efficiency and service designation in a care neighborhood model.

Interventions

In preparation for the opening of new unit, a multidisciplinary team was convened to examine existing models of care and identify strengths and weaknesses. The team comprised of lymphoma physicians, advanced practice providers (APP), infusion nurses, clinical nurse coordinators (CNC), patient care coordinators (PCC), social workers, medical assistants, and pharmacists together were incorporated into the actual opening of the unit. Key elements identified were resource (room and staff) utilization, timely access to treatment, lab and physical assessments and delivery of treatment methods. Additional components assessed were team collaboration, communication, dynamics, and satisfaction.

Results

Moving clinic services to the newly designated floor in December 2023 and introducing infusion services in March 2024, the Lymphoma Care Neighborhood (LCN) was deemed successful. In its initial six months’ operations, the LCN team have successfully completed clinic visits (n=6386), infusion/supportive care visits (n=1677), and lab draws (n=1549). This new model was celebrated as a vast improvement to its decentralized predecessor. Increased communication between clinical teams (APP, PCC, CNC, MD) and infusion nursing teams were observed by leadership. Staff members voiced satisfaction with efficiency of care delivery and increased collaboration across teams. During leadership rounds, patients and caregivers praised the new care model on its efficiency and patient-centric focus.

Discussion

The Lymphoma Care Neighborhood sought to consolidate patient services (blood draws, provider visits, and infusion appointments) onto one floor for best patient care. Establishing this new department brought together multidisciplinary care team members, placing patient and care team satisfaction at the forefront. Co-location also increased infusion nurse expertise by providing consistent experience caring for complicated and highly reactive drug regimens. Co-location via care neighborhoods creates patient-centered environments which improve patient outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):370–371.

P636. Enhancing Recognition in Oncology Nursing: The Virtual Caring Hearts Pilot

Colleen Sutphen ¹, Jacqueline Patterson ²

Management

Significance & Background

Oncology nursing often faces challenges in recognizing the contributions of nursing staff in patient care. The Caring Heart Program was designed to allow patients and families to express gratitude, yet many patients were unaware of how to participate. This pilot project leverages technology to foster and streamline connections between patients and nursing staff.

Purpose

The purpose of this project was to improve patient engagement in the Caring Heart Program by implementing a QR code system, making it easier for patients to submit their accolades in real time. This initiative aims to enhance staff morale and foster a culture of appreciation in oncology nursing.

Interventions

The pilot involved a multifaceted collaboration including the Director of Acute Care Nursing, Marketing and Patient Experience team, the Pilot Unit Nurse Leader and Clinical Nurse Specialist. A QR code system linked to the Patient Portal was developed, supported by a comprehensive marketing strategy that included signage in patient areas, educational flyers, and staff training to promote the new system. Prior to implementation, only seven Caring Hearts were submitted via the portal in January 2024. Patients reported being unaware how to submit a Caring Heart and those who were aware found the process difficulty. to the pilot started February 2024 and spanned 3 months.

Results

The QR code system resulted in a dramatic increase in the number of virtual Caring Hearts submitted, averaging a 328.6% increase over three months (Figure 1 illustrates the monthly submission trends). Feedback from nursing staff indicated that receiving real-time acknowledgments significantly boosted morale and motivation, reinforcing their commitment to patient care.

Discussion

The QR code linked to the patient portal is now live across the organization-wide, highlighting the importance of innovative solutions in enhancing recognition and communication in oncology nursing. The success of this system not only boosts patient engagement but also strengthens staff retention and satisfaction. This initiative underscores the value of resilience and collaboration in leadership, demonstrating a commitment to meeting the needs of both patient and staff.

Oncology Nursing Forum. 2025 Mar 1;52(2):371.

P637. Resiliency Retreats for Inpatient Oncology Nurses

Bridget Sweet ¹, Meaghan Ginty ², Alina Malayeva ³, Sarah Quigley ⁴

Professional Development

Significance & Background

Oncology nurses experience stress and secondary trauma at high levels. We work on a medicine oncology 43-bed unit at a cancer center in New York City. Our floor focuses on patients with lymphoma, multiple myeloma, sarcoma, and melanoma. I noticed I felt burnt out after a few significant patient deaths. I reached out to my nursing colleagues. I assessed they felt the same. We reached out to our nursing leadership with the intent to create a staff retreat for all 108 employees including our patient technician colleagues and unit assistants. Our nursing leadership was excited and helped us implement our new idea.

Purpose

The purpose of the retreats was to spend time away from the bedside to implement resiliency training and perform team building activities. We created a stress-free environment in which staff could learn new skills together and spent time getting to know each other away from the bedside.

Interventions

We created four different retreat days to allow for appropriate staffing of our floor. The day was 8am–6pm and counted towards one of their shifts. Each of the days were unique due to availability of different speakers and participants, but the overall focus of the activities was professional development, resiliency training, stress reduction, and team building with a highlight on communication. The activities included yoga, reiki, acupressure, a mock code, a scavenger hunt, and professional speakers on communication, incivility training, and the future of our institution.

Results

We had 82 responses to our presurvey and post survey. 50% of staff members reported feeling overwhelmed and stressed at work. 77% report feeling supported by their coworkers. 95.1% of the participants who responded to the survey felt the retreat allowed them to foster better communication skills with my coworkers. 98.8% felt the retreat supported their personal wellness. One free response highlighted how the staff felt, “I think it was great and all the team building activities were so helpful! It was a great way for all of us spend time together in a relaxed setting.”

Discussion

The feedback from our colleagues was overwhelmingly positive. They felt that we created a space that fostered community and allowed for team building. We facilitated our colleagues getting to spend time together away from the stressors of bedside nursing.

Oncology Nursing Forum. 2025 Mar 1;52(2):371–372.

P638. Streamlining Post-Operative Care for Head and Neck Patients by Bypassing The ICU: A Workflow Improvement

Mohammad Taha ¹

Healthcare Delivery

Significance & Background

Head and neck cancer surgeries typically require post-operative care in the ICU, leading to increased healthcare costs and longer hospital stays. Traditionally, the lack of specific nursing protocols for these patients resulted in longer ICU stays, with an average length of stay of 18.67 days. Given the need to improve efficiency and reduce costs without compromising patient safety, streamlining the post-operative process by bypassing the ICU was explored.

Purpose

This project aimed to improve the post-operative workflow for head and neck cancer patients by transferring them directly from the operating room (OR) to the inpatient unit, bypassing the ICU. The objective was to reduce overall healthcare costs while maintaining high-quality care and ensuring patient safety.

Interventions

The intervention involved providing nurses with specialized training in post-operative care, focusing on airway and wound management, as well as early identification of complications. Collaboration with surgeons played a key role in developing a standardized protocol for direct transfer from the OR to the inpatient unit. Nurses assumed responsibility for monitoring patients immediately post-op, negating the need for ICU transfer.

Results

The intervention resulted in a 25% reduction in the average hospital stay for head and neck cancer patients, decreasing from 18.67 days to 14 days. Across 144 patients, total hospital days were reduced from 2,688 to 2,016. Importantly, there was no observed increase in post-operative complications, and nurse satisfaction with the workflow improved due to enhanced autonomy and efficiency.

Discussion

The direct transfer of head and neck cancer patients from the OR to the inpatient unit, bypassing the ICU, proved effective in reducing healthcare costs and improving resource efficiency. By standardizing protocols and providing specialized training, patient care quality was maintained. This workflow improvement showcases a successful model for balancing cost savings with high-quality care and can be considered for implementation in other surgical specialties.

Oncology Nursing Forum. 2025 Mar 1;52(2):372.

P639. Fall Risk Factors Among Oncology Patients of A Large, Urban, Public Hospital

Amil Tan ¹, Maria Scaramuzzino ², Seema Lall ³, Roseline Martelly ⁴, Patricia Tennill ⁵, Annie George ⁶

Quality and Safety

Significance & Background

Healthcare settings continue to face a burden of falls among hospitalized patients. There has been some preliminary research on falls among hospitalized cancer patients; however, there is still little information on the relationship between communication, isolation status during hospitalization, and the impact of chemotherapy.

Purpose

To examine risk factors associated with fall events among hospitalized cancer patients.

Interventions

We conducted retrospective case-control analysis of electronic medical records spanning from January 2022 to December 2022. Descriptive statistics, including odds and odds ratios, bivariate analyses, and logistic regression models, were used to investigate factors associated with fall events and falls with injuries.

Results

There were 40 patients with fall events and 148 without fall events. Bivariate analysis indicated that the following variables were associated with falls in cancer patients: Male (OR = 5.2, 95% CI: 2.24–14.95), English language preference (OR = 2.0, 95% CI: 1.07–4.29), solid tumor diagnosis (OR = 7.0, 95% CI: 1.80–6.99) and metastatic cancer (OR = 6.5, 95% CI: 3.14–16.07), not receiving chemotherapy (OR = 3.3, 95% CI: 1.67–5.88), use of psychotropic medications (OR = 3.2, 95% CI: 1.53–7.85), and have any isolation precautions (OR = 4.4, 95% CI: 1.73–15.22 ). High Morse Fall Scores, English as preferred language, and the combination of receiving chemotherapy and any isolation precaution (p <.001) were found to be highly predictive of a fall event during hospitalization among cancer patients in a multivariable model component.

Discussion

Oncology inpatients have some fall risk factors similar to all inpatients such as higher general fall risk but also have unique risk factors including language preference, chemotherapy, and isolation measures. Thus, fall prevention strategies need to be designed, implemented, and monitored with these factors taken into account.

Oncology Nursing Forum. 2025 Mar 1;52(2):372–373.

P640. Impact of A Perioperative Safety Management Program Led by Orthopedic Nurse Specialists on the Prevention of Venous Thromboembolism (VTE): A Randomized Controlled Trial

Yan Tang ¹

Treatment Modalities and Managing Administration

Significance & Background

Venous thromboembolism (VTE) is a significant complication in orthopedic surgery, resulting in patient morbidity and mortality. The implementation of efficient perioperative safety management protocols demonstrates potential in mitigating the hazards of VTE.

Purpose

This study aimed to evaluate the impact of a perioperative safety management program led by orthopedic nurse specialists on VTE prevention in orthopedic patients.

Interventions

A randomized controlled trial was conducted in 200 orthopedic surgery patients. Participants were randomly assigned to either the intervention group, which received the perioperative safety management program led by orthopedic nurse specialists, or the control group, which received routine care. The primary outcome was the incidence of VTE within 30 days of surgery. Secondary outcomes included patient satisfaction and length of hospital stay. IBM SPSS Statistics v29 was used to analyze the data.

Results

The incidence of VTE within 30 days of surgery was significantly lower in the intervention group compared to the control group (4% vs. 14%, p < 0.01). Patient satisfaction scores were significantly higher in the intervention group (mean score 9.2 out of 10 vs. 8.1 in the control group, p < 0.05). Additionally, the intervention group had a shorter mean length of hospital stay compared to the control group (4.8 days vs. 5.6 days, p < 0.05).

Discussion

The perioperative safety management program led by orthopedic nurse specialists was effective in reducing the incidence of VTE in orthopedic surgery patients. The program also improved patient satisfaction and shortened the length of hospital stay. This approach provides a valuable addition to the current strategies for VTE prevention in orthopedic surgery.

Oncology Nursing Forum. 2025 Mar 1;52(2):373.

P641. Oncology Nurse Mentoring: Frontline, Leaders And EBP Project Teams

Christine Tarver ¹, Christopher Okamoto ², Amy Altomare ³, Lesley Han ⁴

Professional Development

Significance & Background

Research demonstrates the value of mentoring and its effect on job satisfaction and retention. The goal of a national medical center was to infuse formal mentoring into the organizational culture. First launched in 2020 with new graduate oncology nursing mentoring program, the mentoring reach is now across new graduates, oncology nurse fellows, direct care oncology nurse career track development, oncology nurse and clinical leaders and EBP project teams.

Purpose

The purpose of establishing robust mentoring was to (1) improve the job satisfaction of oncology nurses from frontline through leaders; (2) to decrease turnover and increase retention of nurses at all levels; and (3) to demonstrate value of and commitment to nurses’ professional development.

Interventions

A core mentor leader team was formed to strategically roll out the mentoring programs. One of the challenges mitigated was that as the mentoring programs grew, so did the need for mentors. Strategies to cultivate mentors included: specific calls for mentors, adding “activity points” for mentoring to the clinical ladder program, and the development of “Mentor of the Year” awards. For nurse leaders, mentoring also extended beyond the Department of Nursing to include leaders from finance, quality, medical staff, and communications. For mentees, the residency and fellowship programs build mentoring into the program with dedicated time on didactic day and a group/individual model where 4–5 residents/fellows are mentored by 2 experienced oncology nurses. For the career track development program, the mentors are in 4 tracks of: nursing research, nurse leadership, advance practice nursing and nursing education.

Results

Engagement in the mentoring programs is now at over 1000 employees. The National Medical Center has achieved a nursing turnover rate of less than 10% since Q1 2022. For the Fellowship, a recent survey of the first 5 cohorts revealed “mentoring” as the component with the highest satisfaction, scoring 3.44/4.00. During the program-specific graduation showcase of residents, fellows, and nurse leaders (from their 10-month leader professional development course), mentoring is most often listed as one of the favorite program components.

Discussion

Expanding mentoring to all levels of nurses allows for enculturation of mentoring which drives improved satisfaction and lowers turnover. With the cost of a new graduate orientation upwards of $100,000, and with the need to retain experienced nurses new to oncology, mentoring has been invaluable.

Oncology Nursing Forum. 2025 Mar 1;52(2):373–374.

P642. Keeping the Dream Alive—Initiatives of California Oncology Nursing Society Chapters to Integrate Advocacy into Oncology Nursing

Siok-Hian (Suzanne) Tay-Kelley ¹, Annie Yan Dai Hong ², Nancee Hirano ³, Celine Palmiter ⁴, Precious Alviar Rivera ⁵, Kerri Stuart ⁶

Professional Development

Significance & Background

Many nurses lack legislative knowledge/skills/confidence for effective advocacy missing opportunities to improve patient care. In alignment with Oncology Nursing Society (ONS)’s core values of advocacy and inclusivity toward advancing its mission of nursing excellence, an urgent need remains to cultivate advocacy competence. In 2023, California chapters launched an inaugural ONS California Advocacy Summit (ONSCAS) inspired by ONS Hill Days in Sacramento, with attendees reporting excellent satisfaction. Chapters have since launched grassroots efforts that continue to develop nurse advocacy skills.

Purpose

Integrating advocacy development in chapter activities to empower oncology nurses at local levels, among community and policy partners.

Interventions

ONSCAS planning committee members from participating chapters applied two of three domains in a multi-pronged approach across community and government influences from the Model of Advocacy (Earnest et al., 2023). To boost advocacy expertise and engagement at the community level, California chapters initiated voter registration drives, embedded advocacy as standard chapter board agenda items, created board advocacy positions, launched advocacy podcasts, provided legislative updates or lectures at chapter events, earmarked funding for scholarships, and collaborated with professional organizations such as the American Nurses Association and institutional lobbyists (e.g. Sutter Health’s legislative advocate). A 2024 ONSCAS advanced state-level legislative agendas and enhanced networking in the government domain.

Results

Planning, execution and outcomes of our inaugural ONSCAS were showcased at the 2024 ONS Congress, sparking enthusiastic inquiries from multiple states interested in this event. California chapter engagement in planning the ONSCAS has grown since 2023, with subcommittees expanding from five to seven, and planning committee members increasing from 15 to 26. Attendees studied relevant issues and approached 10 legislative offices in 2024, building confidence to advocate for recommended legislation with policymakers. Satisfaction scores remained high in evaluations with 93% reporting they were “extremely likely to recommend the program to friends/colleagues”.

Discussion

Evaluation outcomes demonstrated the success of the 2024 ONSCAS, as well as state and national-level impact of our advocacy initiatives within the community and government domains. With the strengthened advocacy competencies in communication, relationships and policy, nurses will contribute more to oncology patient care and eventually create a pipeline of proposed legislation to optimize oncology patient outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):374–375.

P643. Mentoring Mania: A California Initiative to Boost Member Engagement and Support Novice Nurses

Siok-Hian (Suzanne) Tay-Kelley ¹, Benjamin Chen ²

Professional Development

Significance & Background

The abrupt transition from bimonthly dinner lectures by the San Francisco Bay Area ONS (SFBAONS) chapter to virtual Zoom events during the COVID-19 lockdown in 2021 limited opportunities for social interaction, professional networking and student internship/preceptorship link-ups. The 400-member chapter identified mentorship as a strategy to safely advance the ONS Core Value of Excellence amid a general sense of dispiritedness with the pandemic.

Purpose

To boost member engagement and provide an alternate professional networking avenue with virtual career guidance/support.

Interventions

A nursing student was recruited and mentored in 2021 to lead the initiative. Interest surveys were designed to match experienced and novice/student nurses based on preferences for interaction modes including phone and video check-ins, given lockdown constraints. The first cohort of eight veteran-novice pairs was celebrated with a Fall thank you brunch. In 2022, leadership transitioned to another nursing student as in-person activities resumed. In 2023 and 2024, a BSN-prepared UCSF hematologyoncology nurse increased outreach through nursing campus visits, primarily to San Francisco State University and the University of San Francisco, as well as social events including put-put golf and food truck gatherings.

Results

Since 2023, 22 additional pairs of mentors and mentees have completed the program, which ranged in length from a minimum of two months. Some pairs extended their time to 12 months. All 10 current mentees surveyed this month indicated they felt increased confidence after involvement in the program and would strongly recommend the experience to classmates and friends. One student made connections which led to a preceptorship, while others noted improved engagement with additional networking opportunities. Mentors benefited from participation as well, with one serving as chapter president in 2024.

Discussion

A mentorship program established amid COVID has yielded significant benefits for both experienced and new members, enhancing professional connections and career readiness. Suggestions from continuous feedback the program plans to implement include earlier communication regarding the program in the school year, expanding outreach to additional institutions beyond the current feeder colleges, as well as increasing the frequency of in-person interactions with or independent of chapter funds. Mentorship models best practices not only clinically but in terms of professional development toward excellence in oncology nursing and quality patient care. SFBAONS’ partnership with colleges also demonstrates integration of mentorship within professional organizations and collaboration with educational institutions.

Oncology Nursing Forum. 2025 Mar 1;52(2):375.

P644. Put A Lid on it: Protection from Toilet Plume Aerosols

Joanna Taylor ¹, Erin Taylor ², Susan Bruce ³, Kasey Robinson ⁴

Quality and Safety

Significance & Background

Industrial toilets create a plume effect that carry aerosolized particles containing hazardous drugs, bacteria and viruses and pose an unnecessary risk of exposure to staff and caregivers. Recommendations state to cover hospital toilets during flushing, but this presents challenges in the acute hospital setting. Two effective barrier methods have been demonstrated in recent literature, using a plastic backed chux pad or SplashBlocker (SB) device, developed by an oncology nurse. SB has equal effectiveness as a chux pad (99%) but is reusable, lasts for up to 18 months and is recyclable.

Purpose

The purpose of this project was to compare feasibility, acceptability by staff, and evaluate cost for each method.

Interventions and Results

Both the chux method and SB methods were trialed on two separate units. Flush counts, staff feedback, and any barriers or process opportunities were tracked and noted throughout the trial. The team conducted a cost analysis with each and will also conduct particle testing to measure the plume created from our toilets, as every toilet can pose different levels of exposure depending on the pressure of the flush as well as the ventilation in the room.

Evaluation

Both methods were deemed acceptable. Staff using the chux felt that they created too much waste, and no issues were found with the chux being pulled into the toilet. Staff using the SB appreciated the ease of use but wanted to see the product available in every room. Flush counts on both units may have been underreported due to poor compliance with data collection and utilization. Storage of the SB presented challenges that would be a barrier to implementation depending on bathroom layout. When taking into consideration the cost of the SB, chux, wipes, and disposal weight, the breakeven cost comes at about 200 flushes per SB unit. If disposable containers are used to dispose of the chux rather than reusable, then that point changes to about 58 flushes.

Discussion

Opening a new oncology service line created the need to mitigate staff exposure to hazardous drugs. Implementing “cover the flush” into the workflow with either a chux pad or SB ensures that staff are protected. Although this was a limited trial, it was effective in creating a solution that can be built upon to ensure staff compliance and safety.

Oncology Nursing Forum. 2025 Mar 1;52(2):375–376.

P645. Benefits of Advanced Practice Provider Lead Hospital-Based Oncologic Outpatient Department

Kelly Keller ¹, Ashley Thatcher ², Asha Allen ³, Lyndsey Whittredge ⁴, Laura Corrodi ⁵

Healthcare Delivery

Significance & Background

An Extended Recovery Unit (ERU) is defined as a unit where patients are monitored for up to twenty-three hours and fifty-nine minutes from the time of anesthetic induction. An ERU supports patients requiring surgical procedures that may be more complex than same-day surgery but do not require traditional admission. In a Midwest National Cancer Institute (NCI) designated cancer center, the ERU utilizes Enhanced Recovery After Surgery (ERAS) guidelines to improve outcomes for various oncologic populations, including breast, head/neck, gynecologic, orthopedic, and urology. The ERAS guidelines are initiated for each patient prior to admission and continue throughout the peri-operative and post-operative periods until discharge (Altman et al., 2019).

Purpose

The purpose of the ERU is to provide a specialized unit that bridges the gap between ambulatory surgery and inpatient admission, ensuring optimal recovery for patients undergoing complex procedures. By implementing ERAS guidelines, the ERU aims to enhance patient outcomes, satisfaction, and reduce costs.

Interventions

ERAS guidelines differ from other clinical practice guidelines and were designed with a holistic and multidisciplinary approach (Brindle et al., 2020). This process includes a rigorous literature review with a strong background in ERAS expertise. The ERU offers providers and patients the option of ambulatory surgery with same-day discharge or overnight care with close monitoring by experienced oncology staff. The ERU is led by a team of five experienced Advanced Practice Providers (APPs) who assume care of all patients upon arrival, regardless of surgical specialty. The APPs collaborate with Registered Nurses (RNs) and off-site primary teams, as needed, to ensure that all milestones are met prior to discharge.

Results

Research has consistently shown that the adoption of ERAS pathways leads to significant improvements in patient outcomes, satisfaction, and a reduction in costs. The NCI designated cancer center ERU, which opened in July 2023, is the first specialized unit of its kind and has already demonstrated these benefits.

Discussion

The implementation of the ERU at the NCI designated cancer center represents a significant advancement in peri-operative care for oncologic patients. By adhering to ERAS guidelines, the ERU provides a structured and evidence-based approach to recovery, ensuring that patients receive the highest standard of care. The collaborative efforts of APPs, RNs, and primary teams are crucial in achieving successful patient outcomes and maintaining the efficiency of the unit.

Oncology Nursing Forum. 2025 Mar 1;52(2):376–377.

P646. Building the Next Generation of Oncology Nurses: Competency-Based Oncology and End-of-Life Elective for Undergraduate Nurses

Tanya Thomas ¹, Tanya Thomas ², Regina DeGennaro ³, Samantha Hudgins ⁴

Management

Significance & Background

An oncology and end of life nursing elective course was designed for undergraduate students to provide comprehensive education regarding complexities faced by nurses in oncology and palliative care settings. A re-design included competency-based learning and the ONS Undergrad/Pre-licensure Core Competencies to equip students with essential knowledge and skills required to provide compassionate, patient-centered care to patients and families navigating serious illness and end-of-life issues.

Purpose

A competency-based Oncology and End-of-Life elective course was developed to provide basic information regarding oncology and end-of-life to students in their third or fourth year of undergraduate studies. Objectives included students would effectively assess and address the physical, emotional, and spiritual needs of patients with cancer and those at the end of life. The course enhances clinical nursing skills, supports development of resilience and prepares students nurse advocacy for patients and families.

Interventions

Through didactic content, case studies, simulations, and skills, students explored symptom management, communication strategies, ethical and cultural competencies, and psychosocial aspects of care. The curriculum allowed students to demonstrate learning through assessments, skills and reflection. Students also had clinical experiences in a variety of adult and pediatric oncology locations including the inpatient oncology unit, ambulatory oncology clinics, Gamma Knife, palliative care clinics, and hospice. They also were able to spend time learning from different types of oncology clinicians: Clinical Nurse Specialist, Nurse Practitioner, and front-line clinicians. In addition to the clinical experiences, they participated in an Oncology Emergency Management simulation using high-fidelity simulation and a simulation regarding having difficult conversations at the end-of-life and performing post-mortem care.

Results

A total of 8 students completed the elective course during the Spring semester. Of the 8 students who completed the elective, 4 participated in nurse externships in an oncology setting, 2 have requested practicum placement in one of the clinical experience settings, and all 8 indicated they are seeking employment in an oncology setting post-graduation.

Discussion

The utilization of a multimodal approach for providing the elective was identified as a key factor in increasing interest in the field of oncology nursing. The clinical hours and simulations provided safe learning environments where the students could learn from highly educated and dedicated oncology professionals. Being able to spend time in the clinical setting also helped dispel myths and decrease anxiety related to oncology and hospice nursing.

Oncology Nursing Forum. 2025 Mar 1;52(2):377.

P647. Investing in the Future: Implementation of A 12-Month Onboarding and Mentorship Program for New Graduate Nurses Working on an Inpatient Oncology Unit

Tanya Thomas ¹, Jenna van Hoose ²

Management

Significance & Background

Caring for critically ill patients, administering chemotherapy and immunotherapy, providing emotional support for patients and their families throughout the care continuum is ubiquitous in oncology nursing. Although providing holistic care to patients can be rewarding, the high patient acuity and caring for those at the end-of-life can be overwhelming for new graduates or experienced nurses transitioning to the realm of oncology. These highly stressful job-associated exposures, place oncology nurses at increased risk for burnout. New graduate nurses often lack the skills to transition quickly and successfully during an abbreviated orientation timeframe.

Purpose

A structured 12-month mentorship and educational program for nursing new to oncology was developed to provide a safe learning environment to develop skills necessary to be successful in the oncology setting. It also will provide on-going professional mentorship and support.

Interventions

The Clinical Nurse Specialist (CNS) developed a 12-month on-boarding and mentorship timeline and collaborated with the Nurse Manager to implement the program for new graduate nurses. The program includes monthly education sessions taught by the CNS, team building activities, and simulation sessions. Educational topics included Oncologic Emergencies, Ethics, End-of-Life care, crucial conversations, and self-care. Simulations regarding the care of the deteriorating patient, escalation of care, and prioritization also occur throughout the program. In an effort to increase critical thinking, each session incorporates time for the new hires to present patients they have cared for during the past week.

Results

There has been a decrease in voluntary nursing turn-over, increased engagement, and increased critical thinking noted in those who completed the program. New hires stated the program provided necessary support for successful transition to oncology nursing while providing a safe learning space. Each of the new hires successfully advanced on the clinical ladder, have started to serve as preceptors, and some have become validators and trainers for the HAI reduction efforts.

Discussion

Burn-out and anxiety can be common among new graduates entering oncology nursing without ongoing support and resiliency resources. The implementation of the on-going mentorship and educational program has been identified as a key factor in reducing anxiety related to oncology nursing, caring for the deteriorating patient, and chemotherapy administration. The intentional check-ins provided a safe space to discuss concerns and problem-solve to ensure the new hire’s needs were addressed in a timely manner.

Oncology Nursing Forum. 2025 Mar 1;52(2):377–378.

P648. Support Throughout the Care Continuum: Development of Comprehensive Educational and Support Resources for Patients Diagnosed with Acute Leukemia

Tanya Thomas ¹, Michael Keng ²

Patient Education

Significance & Background

A cancer diagnosis impacts all aspects of the lives for the patient and their support system. To ensure understanding of their diagnosis, treatment plan, and options, while facilitating self-advocacy, it is necessary to have a comprehensive educational and support process. This process should provide on-going support, education, and provide resources to address the financial and psychosocial concerns.

Purpose

To develop a structured process for providing support, education, and resources for patients newly diagnosed with acute leukemia. The process is initiated during the initial hospitalization and continues throughout their treatment journey.

Interventions

The Clinical Nurse Specialist (CNS) collaborated with the Inpatient Oncology Medical Director to develop a structured process for providing support for patients newly diagnosed with acute leukemia. The CNS meets with each newly diagnosed patient, provides a new patient binder and education related to their diagnosis, treatment plan, lab values, symptom management, lab values, advanced care planning, sexual health, and survivorship. The CNS also provides information related to support resources available throughout the medical center, community, and professional organizations. The CNS also completes thorough head-to-toe assessments, provides recommendations to the medical team, and collaborates with the interprofessional care team to address the patient’s needs throughout the care continuum. The CNS would continue to follow the patients throughout their inpatient stay to ensure continued support and reinforcement of education that has been provided.

Results

Since the implementation of this process, all newly diagnosed patients have been connected to resources from professional organizations and community sources resulting in co-pay grants to cover medical expenses, payment to cover rent, utilities, and food, and coverage of lodging fees. Patients have stated the additional resources have decreased their anxiety while increasing their understanding of their disease process, lab values, central line care, and available resources. Results also include more streamlined transitions in care and increased interprofessional collaboration.

Discussion

This intervention provided the patient and caregiver with information in a multimodal format and provided additional support throughout their hospitalization. The grants and financial assistance allowed patients to focus on their healing instead of worrying about financial barriers. Utilizing the teach-back method and return demonstration process allowed for evaluation of the patient and caregivers ability to safely manage their central line in the home setting and their understanding of infection prevention and safety interventions post-discharge.

Oncology Nursing Forum. 2025 Mar 1;52(2):378.

P649. Promoting Legislative Advocacy Through Multi-Chapter Collaboration

Terry Throckmorton ¹, Elyse Sporkin ², Meghan Jones ³, Allegra Baccinelli ⁴, Roselyn Ogunkunle ⁵, Lisa Arriaga ⁶

Professional Development

Significance & Background

Legislative Advocacy is a fundamental aspect of professionalism. Nurses working together have the power to support the profession of nursing and quality patient care. Oncology nurses in Texas, supported by the ONS local chapters, have been at the forefront of legislative advocacy at national and state levels, supporting issues for nurses and patients.

Purpose

This presentation is developed to share the legislative advocacy work of nurses in Texas achieved through collaboration among three chapters of ONS.

Interventions

The legislative advocacy work of the three chapters includes educating and mentoring the membership through interchapter collaboration. The chair of the HCONS Legislative Committee introduced the board to the Nursing Legislative Agenda Coalition that develops bills to support nursing practice and safe patient care and monitors bills that may negatively impact these goals. Building on the education and support of this group and of ONS, HCONS, the Galveston Bay Area, and WOW Chapters provided four legislative advocacy seminars. HCONS also provided ten scholarships for Nurse Day at the Capitol (NDC) plus two for Capitol Hill Days and invited the other two chapters to join its members in Austin and Washington. Board members of GBAC and WOW joined HCONS in planning the annual seminars and in attending Nurse Day at the Capitol for the last two legislative sessions. The chair of the legislative committee presents legislative updates provided by NLAC and ONS at each of the chapters’ monthly meetings during the legislative session. During the rest of the year, reminders are presented or posted regarding local and national elections including voter information sites, and election dates and sites.

Results

Each year, the number of nurses working on legislative advocacy has increased. Legislative advocacy has become an expected part of chapter meetings and annual events. Nurses from all three chapters have begun to attend CHD and NDC. We have supported legislation addressing workplace violence, full APRN practice, Medicaid expansion, and funds for nursing education.

Discussion

Our members are more cognizant of the need for legislative advocacy and increased numbers are now participating in the process. We had seven members attending CHD this year. Members are beginning to alert the boards of new legislation. This process can easily be implemented by other chapters using information from state and national government sites and the support of ONS.

Oncology Nursing Forum. 2025 Mar 1;52(2):378–379.

P650. The Acuity Board: A Practical Inpatient Oncology Acuity Appraisal System

Laura Todaro ¹, Jenna Klaudi ²

Healthcare Delivery

Significance & Background

Making assignments based on patient acuity is pivotal for nurses to provide safe and effective care. Many acuity tools are available for oncology nurses to use, however may not apply directly to the unit’s needs. These tools require additional creativity to ensure consistency in use and accessibility by staff. A silver-level Beacon designated inpatient oncology unit previously attempted to use acuity scales unsuccessfully, often because of the complexity of those tools. Charge nurses asked for a tool to use acuity in assignment making, and staff nurses requested transparency and equity with assignments.

Purpose

To create an effective, simple, and accessible acuity tool for an inpatient oncology unit that improves assignment making for nursing staff.

Interventions

The unit-based shared governance committee performed a literature review of oncology-based acuity scales. During a pre-survey, staff were asked for feedback on levels of complexity and areas of importance for the tool. Staff overwhelmingly chose a “low medium high” rating system, and included categories of chemotherapy, complex assessments and treatments, and advanced social needs. The committee investigated methods to prominently display acuity on a small white board and found that using color-coded magnets to reflect the patient’s acuity rating would be appropriate for creating a visual display at the nurse’s station for ease of use and transparency. The staff were encouraged to update their patient’s acuity throughout the shift.

Results

Following implementation of the acuity board, bedside nurses were frequently observed updating their patient’s acuity in real time, with charge nurses adjusting the oncoming shift’s assignments as necessary. Post-survey data showed that usage of the acuity board resulted in a 58% increase in charge and bedside nurse satisfaction with distribution of patient assignments. Ease of use and accessibility of the acuity board was also surveyed, where 97% expressed an improved visualization and assessment of nurse workload on the unit.

Discussion

Using an acuity board is helpful for creating equitable assignments. Effective use requires a system that is easy to use and maintain. We realized that previously used acuity systems failed without the ability to visualize patient status and allow for nurse involvement in acuity assessment. By creating an easy-to-use system that is updated in real time, charge nurses expressed an increase in comfort with adjusting assignments while bedside nurses were satisfied with improved transparency of their workload.

Oncology Nursing Forum. 2025 Mar 1;52(2):379–380.

P651. Back to the Basics—Meeting the Need for Oncology-Specific Education for Inpatient and Outpatient Nurses

Laura Todaro ¹

Management

Significance & Background

Many nurses lack formal oncology-specific education, often learning through firsthand experiences and peer explanations. When “on the spot” education is delivered, educators assume that nurses possess foundational oncology knowledge and can build on existing knowledge. Without baseline understanding of the cancer continuum, this type of education may lead to confusion or misinterpretation. Experienced and new-to-practice nurses at an NCI designated cancer center expressed a need to review the basics of oncology care, treatments, and supportive care. Nurses specifically requested education on managing oncologic emergencies and understanding treatments relative to disease processes. They also voiced concerns about discussing treatment modalities with patients in areas where they lacked professional experience.

Purpose

To develop an oncology basics course to meet needs expressed by inpatient and outpatient oncology nurses and ensure a minimum level of foundational knowledge and skills.

Interventions

The Oncology Basics Course was created to target needs expressed by nurses. The 8-hour class is required for all nurses with less than 2 years of oncology experience and is available to experienced staff at their request. Topics covered include biologic basics of cancer, oncologic emergencies, principles of radiation-oncology, outpatient clinic care delivery, cellular therapies, and supportive care. Expert guest speakers provide targeted content, guidance on evidence-based best practices, and insights into how nurses can better educate patients. Speakers are asked to present in person, rather than provide pre-recorded presentations, to keep engagement among attendees. To date, we have offered three classes since October 2023.

Results

In the most recent cycle of our Oncology Basics Course, pre- and post-education surveys were completed by all 21 attendees. The survey questions focused on chemotherapy side effects, oncologic emergencies, stem cell transplant, cellular therapy, and supportive care. All survey questions showed an increase in nurses responding agree or strongly agree, including a 150% increase in confidence when identifying and managing oncologic emergencies, and 110% increase in understanding the relationship between nursing and other roles.

Discussion

Feedback from participants was positive, with staff describing how they plan to utilize the information learned in their everyday practice. Nurses suggested the creation of an Oncology Basics 2.0 course and opportunities to shadow in different areas covered. The class is now held biannually for new and experienced staff due to increased demand from nurses, with the addition of radiation-oncology nurses in attendance.

Oncology Nursing Forum. 2025 Mar 1;52(2):380.

P652. Making Time for Education—Introducing the Infusion Center Education Hour

Laura Todaro ¹, Jan Norkis ², Joanne Seip ³, Andrea Hojnowski ⁴

Management

Significance & Background

Continued oncology nursing education is vital for safe and effective patient care. The rapid evolution in cancer treatment results in increased intellectual, psychomotor, and psychological demands on nurses. These demands warrant dedicated time for staff education to ensure job performance and quality of work life. An ambulatory infusion center in Pennsylvania sees patients from 7am–5pm Monday through Friday. Previously, the center used an hour on some Wednesday mornings for staff meetings and medication in-services. Despite the commitment to education, this reserved time was frequently cancelled in favor of patient care needs. With high volume inflexible patient schedules, nursing staff were unable to find time for self-directed education, self-care, emergency training, and other necessary education. Gaps in education resulted.

Purpose

To create a dedicated weekly structured education program with time allocated solely to nursing education to support nurses at an outpatient infusion center.

Interventions

After discussions with nursing and scheduling leadership teams, we trialed a 30-minute education period every Wednesday and developed a needs-based education plan with topics presented by the nurse manager, pharmacist, and nurse educator. Initial response was robust. All interested parties agreed that nursing staff would benefit from increasing educational time to one hour per week.

Results

At the start of the reserved education hour programing, agendas included staff meeting updates, in-service education for new medications, and overviews of key research studies. Providers who refer patients to the infusion center then expressed interest in providing education on what they deemed “hot topics” and to take part in open discussions regarding patient care. Over time, the program expanded to include emergency simulations, self-care topics, skills training, and safety reviews. Staff consistently express positive feedback for our center’s education hour and are visibly more engaged with the education provided during this hour than with self-directed education or education sessions that were presented previously during the workday.

Discussion

Dedicating time for structured in-person oncology education, with restoration of the time slot previously used, has allowed for nurses to take part in needs-driven learning without being distracted by patient care demands. Nurses are now more engaged in their learning and frequently suggest topics for further discussion. Obtaining support from the center’s scheduling team and welcoming providers to participate in the program amplifies the success of the program while avoiding conflict with scheduled patient appointments.

Oncology Nursing Forum. 2025 Mar 1;52(2):380–381.

P653. Care of Implanted Ports

Kirsten Tomaschefsky ¹, Tracy Douglas ²

Quality and Safety

Significance & Background

In our National Cancer Institute designated Comprehensive Cancer Center (NCI-CCC) there were over 3000 patient encounters with implanted ports over a six-month period in 2022. Nurses on the Evidence-Based Practice committee identified use of heparin to prevent occlusion may not be evidenced based. Given the disadvantages of routine use of heparin (i.e., allergies, cost, contamination of blood samples, and heparin-induced thrombocytopenia), the committee reviewed current literature to determine the best practice for maintaining line patency of implanted venous access devices.

Purpose

In adult inpatients and outpatients with implanted ports, does heparin flush solution decrease the incidence of line occlusion compared to saline flush solution? Alteplase use and nursing documentation or patency for implanted ports per 1000 will be the measure of occlusion.

Interventions

A literature search was completed using the Johns Hopkins Evidence Based Practice Model. IRB approved the quality improvement project. The project team included representatives from all oncology units. The review supported normal saline using the push pause method of flushing (pulsatile flushing) in adults to support catheter patency. The recommendation to switch to saline was presented to stakeholders across the hospital. In 2023 after return demonstration of the push pause method saline only flushing was implemented, practice change occurred in September in oncology and in December for the rest of the hospital following hospital policy updates.

Results

Evaluation was completed by reviewing data from nursing flowsheet (patency issues and alteplase use). Alteplase use for ports over the six months prior to the changes ranged from 34 to 44 administrations/1000 encounters per month. Alteplase use for nine months post the change ranged from 30 to 47 administrations/1000 encounter per month. Nursing documentation of patency issues did not surpass the upper control post implementation. There was a supply cost savings of over $8600 in the nine months of this project.

Discussion

There was no significant change in port patency by flushing with saline alone. Due to practice change, there has been a reduction of patient exposure to heparin and a reduction in supply usage of heparin flushes with a cost savings. Nursing documentation of patency issues did not match alteplase use and there is opportunity for better documentation. There is an opportunity to expand port access to non-licensed personnel since there is no longer a medication administered.

Oncology Nursing Forum. 2025 Mar 1;52(2):381.

P655. Leveling up the Admission and Discharge Experience to Improve Workflow Efficiencies and Staff Satisfaction

Kathryn Torres-Nicolas ¹, Cheryl Tezino ², Kathy Gonzales ³

Management

Significance & Background

Nurses are inundated with overwhelming tasks and responsibilities which often pull them away from direct patient care. A creative use of resources and the development of efficient workflows is important to ensuring safe, supportive, and patient centered care that will positively influence patient outcomes and staff satisfaction.

Purpose

A nurse was placed in a role focusing on patient admissions and discharges covering four hematology units. Units ranged from 18–36 beds. The purpose was to determine if the focused role could have a positive impact on; length of admission process, time patient began treatment, documentation compliance for skin checks and dressing changes, length of stay, and staff satisfaction.

Interventions

An on-call nurse was assigned to assist with all hematology unit admissions and discharges Monday through Friday from 9 am to 7 pm, excluding holidays. The nurse was responsible for calling all patients scheduled for admission to begin pre-assessment/screening and medication reconciliation prior to the patient’s arrival. When the patient arrived on the unit, the assigned staff nurse could call the on-call nurse to complete the admission screening/questionnaire, assist with dressing changes/line care, complete skin checks and documentation, and orient the patient to the hospital environment. The on-call nurse could also be called to assist with discharges. Discharge tasks include reviewing the after-visit summary with the patient, picking up medications at the on-campus pharmacy, and/or assisting with discontinuing intravenous fluids or medical equipment.

Results

The on-call nurses logged over 8830 minutes assisting patients and staff. Data reflects a decreased length of stay in two of the units that utilized the resource most often by an average of 1.27 days. The time the patient was admitted to the start of treatment decreased from 102 minutes to an average of 90 minutes. Staff satisfaction regarding the admission/discharge process increased from 5% satisfied to 42% satisfied and 11% very satisfied. There were no significant changes to documentation compliance for skin checks or dressing changes. The perceived length of the admission process increased.

Discussion

Further observation and data are needed to see long term implications. Variables impacting results were staffing related issues and on-call nurse office hours and availability. Attempts were made to find coverage for the on-call nurse but due to time off, over 2 weeks were left uncovered leading to missed opportunities to collect data.

Oncology Nursing Forum. 2025 Mar 1;52(2):381–382.

P654. Bridging the Gap Between Helplessness to Effectiveness

Kathryn Torres-Nicolas ¹, Monica Munaretto ²

Management

Significance & Background

Charge Nurses are an integral part of the healthcare workforce as they collaborate with other nurses, disciplines, and departments to ensure patient needs are adequately met. In an organizational nursing survey and review of incident reports and staff feedback, sources of stress in the workplace were identified. These stressors include challenges navigating through difficult situations, conflict resolution, and interprofessional communication and collaboration. It is important to mitigate and address stressors as they contribute to absenteeism, increased vacancy rates, low job satisfaction, lower quality metrics, poorer interactions with patients, and poor outcomes (Waddill-Goad, 2018).

Purpose

To bridge the gap between staff feelings of helplessness to being effective nurse leaders, supervisors collaborated with their Talent and Development Department to craft an enrichment class aimed at equipping their charge nurses with information and strategies to manage identified stressors in their immediate work environment.

Interventions

Mandatory education was required for all inpatient charge nurses. Classes were in person and held in two-hour sessions over the course of 2 months. They were conducted by a representative from the Talent and Development Department. Concepts that were shared with nurses were aimed at projecting mutual respect, building trust, employee engagement, and the importance of a respectful work environment. Prior to the class, participants completed a survey to identify their perceived knowledge of each concept.

Results

Prior to the class, the participants reported that there was only one concept that they felt knowledgeable about: The Importance of a Respectful Work Environment. At the end of the class, post survey results showed there was an improvement in scores for all class concepts and, the general perception was that the class was helpful and staff would recommend it to their colleagues. Results could imply that staff received the class content, understood the information and strategies to manage their work stressors which should help them to navigate through future challenges, conflicts, and interactions requiring interprofessional communication and collaboration.

Discussion

It will be important to continually monitor staff perceptions of work stressors and for managers to determine strategies to mitigate the effects of stress on their employees. Healthcare systems keep on expanding as does the healthcare workforce. It is critical for leaders to support staff and prevent the negative effects of work stressors on the potential feeling of helplessness and ineffectiveness.

Oncology Nursing Forum. 2025 Mar 1;52(2):382–383.

P656. Standardizing Patient Chemotherapy Education Through Nursing and Pharmacy Collaboration

Karen Tran ¹, Catherine Jansen ², Rikki Lee ³, Charleen Louie ⁴, Kimberly Beringer ⁵

Patient Education

Significance & Background

Cancer patients frequently experience significant anxiety due to the overwhelming amount of new information about their diagnosis, prognosis, and treatment plans from various multidisciplinary team members. Effective education about essential self-administered medications, potential treatment-associated toxicities, self-management strategies, and symptom reporting is crucial for the patient’s well-being. Nurses play a pivotal role in educating patients about chemotherapy regimens and what to expect during treatment. Feedback from patients and healthcare providers revealed discrepancies in the information that patients receive from various sources, highlighting the need for a cohesive educational approach.

Purpose

This project aimed to 1) create a standardized approach for individualized patient education regarding chemotherapy treatment plans, 2) streamline nursing’s educational process for patients to eliminate variation in teaching, and 3) collaborate with other disciplines regarding updated practices to improve patient satisfaction, minimize patient anxiety, and achieve better patient outcomes.

Interventions

This project began with a review of existing practices and resources, as well as the collection of specific feedback from providers and patients, to identify gaps and opportunities for improvement. Concurrently, a strengthened partnership was established with the pharmacy team: which is responsible for prescribing antiemetic protocols and educating patients about these and other supportive medications. This collaboration led to revisions in workflows, patient education materials, and documentation templates. These changes and key resources were presented to the entire team, who were encouraged to give feedback to the project leads, to facilitate any necessary revisions.

Results

Enhanced interdisciplinary communication, as well as updated guidelines and documentation, were achieved through the sharing of current practices. Oncology pharmacists continue to provide personalized education regarding supportive medications, and corresponding prescriptions with enhanced written patient guidelines. Nursing reinforces education about supportive medications and provides additional instructions on specific drug regimens, associated side effects, and self-management strategies at the chairside. Revised standardized documentation and secure messaging templates were implemented to enhance consistency, safety and patient satisfaction.

Discussion

Standardizing chemotherapy education enhances patients’ understanding of their treatment plans, helps them recognize treatment-related toxicities, and supports effective self-care strategies, ultimately contributing to improved patient outcomes and satisfaction.

Oncology Nursing Forum. 2025 Mar 1;52(2):383.

P657. Interventions for Prevention and Management of Gynecological Cancer-Related Lower Limb Lymphedema: A Systematic Scoping Review

Maide Nur Tümkaya ¹, Memnun Seven ², Elaine Marieb ³

Patient Education

Significance & Background

Lymphedema is a common complication after lymph node dissection and pelvic radiotherapy, with surgical treatment of cancer being one of the leading causes of lymphedema. The symptoms associated with lymphedema can significantly impair the patient’s ability to engage in daily activities and overall quality of life. Nurses have an important role in improving patient outcomes and improving quality of life for women undergoing gynecologic cancer treatment. They are positioned to provide primary care that directly impacts the prevention and management of lymphedema, and it is critical to incorporate these strategies into nursing practice.

Purpose

This scoping review aims to map out evidence on interventions for reducing lower limb lymphedema incidence and symptoms after gynecological cancer surgery.

Interventions/Methods

This scoping review followed the methods and protocol outlined by the Joanna Briggs Institute Methods Manual. Five databases, including Pubmed, Scopus, Web of Science, CINAHL, and psycINFO were searched in January 2024.

Results

The review included 15 interventions primarily designed to prevent and manage cancer-related lower extremity lymphedema. Most studies have examined the effect of interventions on the development of lymphedema-related symptoms and quality of life. Most studies tested complex decongestive therapy (CDT) (n=6, 39.9%), including various techniques, such as manual lymphatic drainage, compression, exercise, and skincare. Of the interventions, 78.5% improved at least one outcome measurement, such as quality of life, lymphedema incidence, symptoms and lower limb volume.

Discussion

Limited evidence shows that the use of interventions appears to have the potential to reduce the risk and symptoms of lymphedema and improve the quality of life in women undergoing gynecological cancer treatment. Incorporating comprehensive lymphedema education and management strategies into nursing practice is essential to optimize patient outcomes and enhance the quality of life for women undergoing gynecological cancer treatment.

Oncology Nursing Forum. 2025 Mar 1;52(2):383–384.

P658. Cancer Care – Moving the Needle for the Patient Experience

Shayla Turk ¹, Charlene Stein ², Chaley Pettit ³, Neko Raley ⁴, Micha Franco ⁵, Marcos Delgado ⁶

Healthcare Delivery

Significance & Background

Cancer care is complex and requires an interdisciplinary approach to provide patients with high quality, individualized care. Creating a customized care plan can result in lengthy clinic visits, leading to increased patient wait times and delays. Moving Through Your Visit is one domain of the Press Ganey® Outpatient Medical Practice Survey (PGOMPS) used to measure patient experience. Moving Through Your Visit is evaluated using two questions: information about delays and wait time at clinic. Wait time and delays were major pain points for patients with outpatient clinic appointments based on Press Ganey® benchmarks. Clinic leadership identified Moving Through Your Visit as an opportunity to improve patient experience.

Purpose

Improve Moving Through Your Visit metrics by 5% over baseline across outpatient oncology clinics, focusing on the patient experience.

Interventions

A committee including front line staff, supervisors, clinical managers, and directors was created to steer the project. A mixed methodology approach was used combining qualitative (patient comments) and quantitative (PGOMPS) data. A fishbone diagram was developed to identify root causes of why patients were not informed of delays. A task prioritization matrix was created to facilitate decision-making. The patient and family advisory council was engaged for feedback on planned interventions. Changes implemented included: ensuring patients feel seen and understood through communication with clinic staff; leadership rounding on patients with wait times greater than 30 minutes, and electronic medical record updates to identify real time delays.

Results

PGOMPS was selected as the data source to evaluate outcomes of the project interventions. The domain of Moving Through Your Visit Overall improved by 1.4% (total). Information about delays and wait time at clinic also improved 1.4% (total) from the same period last year. Additionally, 13 out of 19 clinics had improvement in the Moving Through Your Visit domain, of those 4 clinics improved by 5% or greater meeting the target goal.

Discussion

Although the project goal of improving Moving Through Your Visit metrics by 5% overall was not achieved in all clinics, 68% (n=13) of clinics improved patient experience in this domain. Analysis of clinic performance will be conducted to ensure interventions were implemented across clinics and disseminate lessons learned. Next steps include creating a frontline patient experience taskforce, with a registered nurse, certified medical office assistance, clinical staff assistance, clinic leadership, and one provider.

Oncology Nursing Forum. 2025 Mar 1;52(2):384.

P659. Improving Nurse Satisfaction on A Surgical Oncology Unit Through Enhanced Patient Flow and Communication

Nicole Turkoglu ¹, Amanda Anderson ², Anthony Sociedade ³

Healthcare Delivery

Significance & Background

A surgical oncology unit at an academic medical center experiences high PACU admissions and acute care needs, leading to workload imbalances between day and night shifts. This project assesses how changes in discharge timing and nurse satisfaction can improve patient flow and workload distribution. It uses the Plan-Do-Study-Act (PDSA) quality improvement methodology, with monthly feedback check-ins.

Purpose

The project aims to enhance patient flow and nursing workload by standardizing discharge communication and refining admission processes. The increased workload on day shifts necessitated adjustments to better balance responsibilities.

Interventions

Methodology (Plan, Do, Study, Act):

■ 1. IDR Rounds: Improved communication during shift changes.
■ 2. Discharge Timing: Encouraged discharges before noon and 2 p.m. to stagger admissions.
■ 3. Admission Rotation: Nurses starting with 3 patients receive new admissions before those starting with 4. Nurses who discharge patients receive new admissions as their patients are discharged. Nurses discharging two or more patients get additional admissions before those who did not discharge any patients.
■ 4. Charge Nurse Adjustments: The charge nurse may manage admissions based on workload and circumstances. A trial from May 6th to May 13th involved a charge nurse without patients to support staff, though challenges with workload remained.

Implementation & Adjustments

Between April and July 2024, day shift patient flow adjustments were trialed. Initial dissatisfaction with rotations and patient assignments led to a revised plan where the charge nurse managed admissions with a reduced patient load, and admissions were more evenly distributed among staff.

Results

Nurse satisfaction improved from very dissatisfied to satisfied, as measured by a 5-point Likert scale. Pre-intervention discharge rates before noon were 6% in January, 6% in February, and 9% in March 2024. Post-intervention rates improved to 3% in April, 15% in May, and 9% in June and July 2024.

Discussion

The project successfully increased nurse satisfaction and reduced burnout by improving assignment processes. However, discharges before noon showed mixed results, with a significant increase in May but no sustained improvement thereafter. Additional interventions are needed to consistently improve discharge timing.

Conclusion

Adjustments in patient flow and communication positively impacted nurse satisfaction and workload management. Ongoing evaluation and further strategies are necessary to enhance discharge efficiency and maintain staff satisfaction.

Oncology Nursing Forum. 2025 Mar 1;52(2):384–385.

P660. Building Confidence Through Simulation: Cell Therapy Administration for the New Oncology Nurse

Paola Turner ¹, Stella Dike ²

Management

Significance & Background

The global nursing workforce shortage has made it increasingly difficult to recruit and train nurses that specialize in hematology/oncology and stem cell transplantation. A lack of confidence in caring for complex patient populations has been cited by onboarding oncology nurses as one of the main causes of burnout, leading to poor staff retention and a desire to change specialties. The development of an effective educational program to help enhance the confidence, knowledge, and skills of new hematology/oncology nurses is vital to improve staff retention and patient safety.

Purpose

The purpose of this study was to improve the confidence, knowledge, and skills of onboarding inpatient stem cell transplant nurses with cell therapy administration utilizing simulation.

Interventions

A quasi-experimental design was used with pretest-posttest measurements of the simulation experience for newly hired inpatient stem cell transplant nurses. Nurses completed a 2-hour training and simulation of cell therapy administration in the cell lab. This training included a didactic presentation on the cell infusion standard operating procedure, hands-on experience with cell tubing setup and priming, spiking of thawed product bags, gravity flow administration, and saline rinses. During the simulation, open discussion was held with the nurses regarding the pre-infusion requirements, patient monitoring, and troubleshooting.

Results

Utilizing a Likert scale, nurses rated their confidence, experience, and skill level on cell therapy administration. Pre-test results revealed 13% of nurses stated they were “confident”, 0% “knowledgeable”, and 0% “skilled” in performing cell administration. Post-test results revealed 33% of nurses stated they were “confident”, 50% “knowledgeable”, and 17% “skilled” in performing cell administration. Since FY2022, the turnover rate of newly hired stem cell transplant nurses has decreased from 25% to 10.77% for FY2024.

Discussion

The simulation experience was shown to be effective in improvement of nurses’ confidence, knowledge, and skills with cell administration. Staff turnover also decreased. Providing the cell therapy administration simulation during nursing orientation allowed time for the nurses to ask questions and experience hands-on training with new and unfamiliar products. Moving forward, cell therapy simulations could also include compromised bag salvage training, infusion reactions, and establishment of annual nursing competencies for clinical nursing staff.

Oncology Nursing Forum. 2025 Mar 1;52(2):385.

P661. Reviewed Assessment of Nausea and Vomiting in Patients Receiving Cancer Treatment

Jennifer Turner ¹, Karen Roth ², Danielle Robbins ³, Lori Bronenkant ⁴

Symptom Management and Palliative Care

Significance & Background

The organization’s Nursing Leadership Team recognized a decrease in Press Ganey patient satisfaction scores in the area “response to concerns” as well as the need to improve the organization’s score for The CMS’ chemotherapy measure, OP-35. OP-35 measures admissions and ED visits for 10 conditions within 30 days of receiving outpatient chemotherapy.

Purpose

The team, with infusion pharmacists, identified that decreasing patient complaints of nausea and vomiting and improving the current screening tool for nausea and vomiting could improve scores and patient outcomes.

Interventions

During this project’s planning phase, the team identified which patients to target and reviewed screening tools and care plans. The current nausea and vomiting assessment was revised based on the MASCC Antiemesis Tool. The current assessment asked one yes or no question regarding nausea and vomiting. The assessment was revised to separately assess acute and delayed nausea and vomiting, prn medication use at home and provided an area for free hand type comments. An automated referral was made from the nursing assessment to infusion pharmacists for any perception of nausea rated moderate or severe. Once a referral was made, the pharmacists would review the patient’s care plan and home medications, make recommendations, and do patient education on nausea and vomiting prevention. The infusion pharmacists also met with the center’s oncologists to update the highly emetogenic care plans to align with NCCN Antiemesis Guidelines.

Results

The success of the project was retrospectively measured by comparing the percentage of assessments that triggered a nausea and vomiting referral from baseline through 14 months. Overall primary outcome was a reduction of reports of moderate or severe nausea for patients receiving cancer treatment from 9.7% to 2.4%, a 75.4% reduction.

Discussion

In review, this was a successful multi-disciplinary project that led to a decrease in complaints of nausea and vomiting in oncology patients. This project was implemented with Mosaiq as the electronic health record. In the future, plan to study how this project can be made possible using Epic as the electronic health record.

Oncology Nursing Forum. 2025 Mar 1;52(2):386.

P662. A Guide for Chemotherapy & Immunotherapy Instructions for Care at Home and What to Expect for Infusion Therapy: An Educational Tool for Oncology Patients in an Outpatient Infusion Center

Sara Turnquist ¹

Patient Education

Significance & Background

Education for care at home has significant importance to continuing patient care once patients are discharged. Instructions for care at home include but are not limited to when to contact the physician after discharge and how to manage side effects at home. Providing education on what to expect during the appointment, available resources, medications, and on how to prepare for infusion therapy is also essential to increase patient involvement in care for higher patient satisfaction.

Purpose

As a care team, we noticed the need for implementation of a standardized tool to help increase patient knowledge and patient satisfaction. In an outpatient infusion center with Oncology patients how will implementing an educational pamphlet on a guide for chemotherapy & immunotherapy including care at home and what to expect during infusion therapy compared to no educational tool in place affect HCAHP Scores measured in the categories of instructions about care at home and explain what to expect during infusion therapy over three months of collection of data reported monthly.

Interventions

A pamphlet was redesigned and improved for using a preset layout with education on location, service hours, parking, contact information for the Infusion center and Nurse Navigators. For each patient, it includes specific regimen, frequency, estimated duration, oncologist information and care at home instructions. The pamphlet also includes how to prepare for an infusion appointment. The intervention was completed for each patient on cycle 1 day 1 for adult oncology patient population and discharge teaching reviewed every appointment with the primary registered nurse. This will be a new process for our infusion center versus no current pamphlet or discharge education handout in place.

Results

This intervention was measured using HCAHPS scores obtained monthly from patient surveys including the categories: Instructions about Care at Home and Explain what to expect during Infusion Therapy. The project was completed over a three month period with a desire to see an increase in HCAHP scores by 1% from baseline scores of 88.68% & 92.59%. We observed increase of data to 92.86% & 94.87% after three months.

Discussion

New staff will be trained on implementing the educational tool while HCAHP scores are monitored to track success and evaluate for future improvements. The importance of HCAHP surveys will be discussed with staff and patients to encourage positive responses.

Oncology Nursing Forum. 2025 Mar 1;52(2):386–387.

P663. Development and Implementation of Hyperkalemia and Hypokalemia Treatment Algorithm Guidelines in an Adult Ambulatory Oncology Clinic

Jacqueline Tuskan ¹, Crystal Derosier ², Megan Corbett ³, Gayle Blouin ⁴, Mona Hammam ⁵, Daniel A Roberts ⁶

Quality and Safety

Significance & Background

Oncology patients frequently experience electrolyte imbalances throughout their treatment. Published evidence-based practices recommend continuous patient monitoring that ambulatory clinics are often not equipped to provide.

Purpose

A multidisciplinary team of nurses, pharmacists, physicians from oncology, cardiology, nephrology, endocrinology, and patient safety leaders analyzed safety concerns related to hyperkalemia and hypokalemia treatment. The team developed a treatment algorithm for safe use in adult ambulatory oncology patients.

Interventions

An initial literature search identified best practices applicable to our unique care setting and patient demographics. Significant factors for group discussion included operational limitations, monitoring capabilities, criteria for and feasibility of appropriate care escalation, nursing comfort levels with administering corrective therapies, and financial implications for patients. Algorithm exclusion criteria included tumor lysis syndrome and cardiac arrest. For potassium levels <2.5 mEq/L or ≥6.5 mEq/L, continuous cardiac monitoring is recommended; yet ambulatory clinics are often not equipped to provide. With hyperkalemia, potassium levels are recommended to be confirmed by a repeat draw before treatment. With hypokalemia, serum magnesium is evaluated and repleted if low prior to potassium repletion as magnesium deficiency can exacerbate potassium wasting. EKGs are obtained to determine cardiac stability for levels < 3.5mEq/L and ≥5.5 mEq/L. If cardiac instability is noted, approved treatments are administered while awaiting urgent transfer to an acute care setting via emergency medical services. Potassium serum levels were categorized to establish consistent treatment and monitoring parameters based on published guidelines.

Evaluation/Results

Through an iterative process spanning several years, the algorithms were refined and optimized. Significant modifications included the removal of intravenous insulin and the addition of sodium zirconium cyclosilicate, a newer potassium binder, to our Institute’s formulary. To improve team efficiency and safety, an electronic medical record order set was built.

Discussion

Due to limitations within ambulatory settings to perform continuous cardiac monitoring for certain patients with potassium imbalances, a multidisciplinary team developed tailored algorithms for the prompt and safe treatment of hyperkalemia and hypokalemia in adult oncology patients. To address these challenges and ensure optimal patient safety within our practice, comprehensive guidelines for managing potassium imbalances were developed.

Oncology Nursing Forum. 2025 Mar 1;52(2):387.

P664. Ostomy Care

Jenna Tyndall ¹

Patient Education

Significance & Background

Patients and families showed a lack of understanding on proper ostomy care prior to discharge. Education was needed to ensure patients and families were comfortable with providing ostomy care at home.

Purpose

The purpose was to provide education to patients and their families on how to properly care for an ostomy at home.

Interventions

Old teaching materials were reviewed and compared to the latest evidence-based research. A flyer was then made to handout to the patients and their families, which included a visual aid for reference. This updated information was reviewed over with the Skin, Wound and Ostomy nurses to ensure information was correct per hospital protocol. Materials were then distributed to the patients and their families for review during teaching and to carry home at discharge.

Results

Over 50% of the patients reported being more comfortable with providing ostomy care after education was provided compared to before educational session.

Discussion

Findings showed a lack of patient and families feeling comfortable in providing ostomy care due to a deficit in proper knowledge. Barriers included a time restraint on implementation of educational materials and uninterrupted educational sessions. Overall, education was successful as the patients and families reported to be more comfortable in completing ostomy care prior to patients discharge.

Oncology Nursing Forum. 2025 Mar 1;52(2):387–388.

P665. Health-Related Quality of Life and Its Association with Perceived Social Support in Adult Breast Cancer Patients: A Study from Karachi, Pakistan

Obaid Ul Haq ¹, Hafiz Sabghatullah ²

Psychosocial Dimensions of Care

Significance & Background

Breast cancer is the second most common cancer and ranks fifth as the cause of death from all other cancer types. In Pakistan, the most prevalent (32%) malignant cancer in females is that of breast. Survival rate from breast cancer has increased but the complications and consequences of breast cancer lead to decreased quality of life of patients. Social support play a significant role in dealing with difficulties and promoting the health related quality of liftoff breast cancer patients.

Purpose

The purpose of this study was to identify the health-related quality of life and its association with perceived social support in adult breast cancer patients, in two cancer care hospitals in Karachi, Pakistan.

Interventions

In this study, a quantitative research technique, applying the analytical cross-sectional design, was used to answer the research questions. The study was conducted at two tertiary care hospitals in Karachi Pakistan, during May 2019 to July 2019. Data was collected using EORTC-QLQ-C30, MDSPSS, and demographic questionnaires. A sample size of 282 was achieved. Data was analyzed by using SPSS version 23.

Results

The results showed that the mean age of the breast cancer patients was 47.27 (SD=10.98) years. The mean score for global health/quality of life of breast cancer patient was low. Similarly, on the functioning scale: the mean score was also low. The participants scored an average level (33.33 to 66.7) of general well-being and functional health status on a scale of poor to good. Financial difficulties, fatigue, and insomnia were the worst reported symptoms. Moreover, this study identified that the overall perceived social support was high with highest perceived social support was from family, followed by significant others, and then from friends. Furthermore, it also revealed that perceived social support was positively and significantly (p<0.05) correlated with the global quality of life and functional scales, while it was significantly and negatively correlated with the symptoms except for diarrhea and pain in breast cancer patients. Furthermore, this study showed a strong association between perceived friend support and education, and QOL.

Discussion

The study identified that breast cancer patients experience difficulties in multiple HRQOL functional and symptoms domains. Further research and interventions at hospital, community and at governmental level are needed to improve the health related quality of life and to reduce the symptoms of breast cancer patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):388.

P666. Enhancing the Nurse-Patient Communication: Commit to Sit in Oncology Care

Carolina Uranga ¹, Sadeeka Al-Majid ², Laura Sarff ³

Management

Significance & Background

Patients expect compassionate nurses with effective clinical and communication skills. It’s essential to use effective communication skills in situations that impact care such as medication teaching and when conducting difficult conversations. Being present, listening, and understanding the patient’s perspectives embodies effective communication and have been documented to lower patients’ anxiety, increase the patients’ sense of control and confidence regarding their health status. Skills and interventions to enhance a trusting nurse-patient relationship are paramount to improving nurse communication and patient satisfaction with care.

Purpose

The purpose of this project was to integrate Commit to Sit an evidence-based nurse-patient communication strategy into the organization’s existing patient experience program called The HOPE Experience: A Model of Human Compassion. This framework guides patient, caregiver, and colleague interactions on a personal and human level and consists of four principles (connect with Heart, Offer service with collaboration and a sense of urgency, Personalize, and End with excellence). Commit to Sit focuses on sitting at eye level with the patient to promote a therapeutic relationship and personalize care for the patient and family.

Interventions

A pre-and post-test design was used to measure knowledge, self-reported patient interactions, and observed nurse-patient interactions as part of an educational intervention on using Commit to Sit and The HOPE Experience. Patient outcomes were measured using the CAHPS Top Box Scores for Communication with Nurses (Nurses treat you with respect, Nurses listen carefully, and Nurses explain the way you understand) to determine changes in patient satisfaction pre- and post-educational intervention.

Results

Over 50% of eligible oncology nurses participated in the study (n=35). The educational intervention significantly improved nurses’ knowledge (p< .001) of Commit to Sit and aspects of The HOPE Experience program. Observations revealed Commit to Sit communication strategy significantly increased from baseline (p <.001). CAHPS Top Box Scores Communication with Nurses patient satisfaction mean scores improved for two of three nursing communication questions during the intervention period; however, they were not sustained post evaluation.

Discussion

Implementation of a Commit to Sit communication strategy in a busy medical oncology unit is doable. Barriers to sitting during patient interactions included insufficient chairs, especially in double-occupancy and smaller patient rooms. Commit to Sit can be easily implemented in other organizations; nevertheless, reinforcement via education and observations are essential to hardwiring this important communication strategy into practice.

Oncology Nursing Forum. 2025 Mar 1;52(2):388–389.

P667. Development of A Clinical Scheduling Coordinator Role for Clinical Support and Oversight of Same Day Infusion Scheduling Changes

Christine Usher ¹, Rachael Coyle ², Francis Panebianco ³, David Ortwein ⁴, Lauren Cullen ⁵, Kayla Boegly ⁶

Healthcare Delivery

Significance & Background

The infusion department at a large academic medical center faces capacity challenges further impacted by same day appointment changes and requests. These changes pose challenges to patient care with unclear care plans leading to multiple messages for order clarification and delays in care. A multi-department non-clinical scheduling team is tasked with fielding same day add on requests where clinical appropriateness and prioritization is often overlooked leading to patient safety concerns. Increased trends in requests for hemodynamically unstable patients, care plan changes, and symptom management, have demonstrated the need for clinical support in scheduling decisions on an already near capacity schedule.

Purpose

The implementation of the clinical scheduling coordinator role (CSC) improves patient scheduling and safety. First, it allows for confirmation of patient clinical appropriateness while determining suitable timing for appointments. Second, it reduces unplanned delays in patient care, ensuring treatment readiness prior to scheduling. The CSC role allows a clinician to review, and triage add on requests to determine what infusion can safely accommodate, collaborating with the care team on what takes priority if not all requested treatment can be completed that day.

Interventions

The leadership team repurposed an approved nursing FTE to operationalize the role of CSC. It is designed to work closely with the scheduling team to review same day add on requests for treatment and create a streamlined process for scheduling.

Results

The CSC reviews all requests for same day appointments and care plan changes for clinical appropriateness of ambulatory treatment and uses an assessment tool to collaborate with the care team to safely determine what can be accommodated within available chair space.

Discussion

Infusions near full capacity, increased same day changes, and symptomatic patient referrals demonstrated the need for clinical scheduling support. Implementing the CSC role improved patient care coordination between care teams, scheduling, and nursing through creating a single clinical contact to coordinate changes in care. The CSC ensures patients are clinically appropriate and treatment ready prior to scheduling same day appointments. The CSC also ensures the plan of care is clearly communicated to the receiving floor, reducing the need for messaging at point of service. Patients who are not clinically appropriate, are referred to the emergency department before arrival reducing the time between care escalation and instance of unstable patients reporting to the department.

Oncology Nursing Forum. 2025 Mar 1;52(2):389–390.

P668. Development of Standard Operating Procedure for Blood Transfusion Administration

Christine Usher ¹, Rachael Coyle ², Francis Panebianco ³, David Ortwein ⁴, Kayla Boegly ⁵, Lauren Cullen ⁶

Treatment Modalities and Managing Administration

Significance & Background

The infusion department at a large academic medical center administers over 600 blood products each month for transfusion support. Appointments for transfusions are scheduled at differing timelines, often without a coupled provider visit. Varying provider practices and preferences surrounding complete blood count (CBC) results for transfusion, along with differing triage workflows around anticipating needs lead to unclear care plans as well as over and under draw of labs.

Purpose

The infusion department implemented a Standard Operating Procedure (SOP) for blood transfusion management to standardize the way patients receive packed red blood cells and platelets based upon laboratory results and parameters within the blood product care plans. The SOP specifically sets a standard timeline for utilization of CBC results to determine treatment needs and requires providers to clearly communicate when a patient needs labs outside of what is defined in the SOP. The implementation allows for nursing to easily identify when additional labs are needed and reduces the occurrence of missed or extraneous labs.

Interventions

The infusion and leadership teams partnered to review current practices around blood transfusion management and define a standard of practice for nursing and providers. The group published an SOP that reduces assumptions around provider preference and practice.

Results

The new SOP is utilized by nursing staff when reviewing patient blood plans to reduce uncertainty around lab needs. It outlines if a CBC has resulted within one calendar day, transfusions will be prepared and administered based upon the previously resulted lab unless clearly stated in the blood product administration plan. Any patient with CBC results greater than one calendar day from the treatment date will have a new CBC drawn to determine transfusion needs. All post transfusion lab orders need to be clearly defined in the administration plan.

Discussion

During the leadership team’s review, it was found that there were varying practices around having a CBC drawn pre-transfusion regardless of when the lab previously resulted as well as varying parameters around drawing a post-transfusion CBC. The SOP was created and reviewed with provider leadership and disseminated to referring providers. Utilizing the SOP reduced plan clarification messages previously happening at point of service in addition to reducing duplicate labs while encouraging clear provider instructions in care plans. Staff have also expressed increased comfortability with managing patient transfusion needs.

Oncology Nursing Forum. 2025 Mar 1;52(2):390.

P669. Implementation of a Nurse Mentorship Program

Brenda Van Sambeek ¹

Management

Significance & Background

As our cancer center continues to grow, we face a challenge with the availability of specialty-educated and experienced oncology nurses. New graduate nurses and those without prior oncology experience often report a lack of support once they are off orientation. This has led to an increase in errors and challenges in nurse retention.

Purpose

The primary aim of nurse mentorship is to foster professional development by pairing experienced nurses with those who are new to the field. This partnership allows for the exchange of knowledge, skills, and guidance, ultimately enhancing the growth and success of nurses within specialty areas. Through mentorship, we can provide necessary support and constructive feedback that aid in building self-confidence among mentees.

Interventions

To address this issue, we have developed a mentorship program in collaboration with our clinical advancement nurses (CAP) and clinical educator. Key components include:

■ A mentorship scope, timeline, toolkit, and selection committee were established.
■ Identification of mentors and mentees based on a combined personality quiz and questionnaire.
■ Training sessions for mentors before engagement.
■ Mentors signing a one-year agreement.
■ Provision of a toolkit designed to guide mentor- mentee meetings and goal-setting.
■ Regular meetings (4 per year) held by the selection committee to assess progress and implement needed modifications.

Results

Initial feedback indicated low-interest levels among potential mentors due to concerns with the application process. To enhance participation, we removed the former application requirement in favor of an easier combined personality quiz and questionnaire, leading to an increase in volunteer mentors. Presently, we have successfully paired three new nurse hires with mentors, with ongoing surveys planned to evaluate effectiveness.

Discussion

Implementing a structured nurse mentorship program is essential, especially within our specialty setting where not every nurse is specialty certified—compounded by the significant number of departures we witnessed during the pandemic. Effective onboarding for new oncology nurses must encompass robust mentorship offerings backed by adequate training and follow-through strategies aimed at boosting nurse retention while supporting our colleagues to provide optimal care for our most vulnerable patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):390–391.

P670. Interdisciplinary Respect and Collaboration: Infusion Nurses Perspective

Rachel VanDemark ¹, Yuk Wong ², John Rodriguez ³, Elizabeth ElMaarouf ⁴

Professional Development

Significance & Background

As patient care becomes increasingly complex and multifaceted, interdisciplinary collaboration plays a pivotal role in today’s interconnected ambulatory oncology care setting. Respect amongst healthcare professionals is vital to provide safe patient care. Learning to work with interdisciplinary teams requires each profession to abandon profession-specific proprietorship and respect the expertise other professions may offer.

Purpose

Our goal is to explore the perceived relationships between collaboration and mutual respect among members of interdisciplinary teams to provide better understanding of factors that facilitate collaboration, and to improve interprofessional practice and optimize patient care delivery. This initiative aims to increase the effectiveness of health care services, while also creating a salubrious environment where professionals from diverse disciplines can work together seamlessly.

Interventions

As a National Cancer Institute designated comprehensive cancer center, we have taken the initiative to offer multiple solutions to enhance interdisciplinary collaboration. The following strategies have been implemented:

■ Foster Learning Culture – Holding interdisciplinary workshops in which teams explain their roles, challenges, and expertise to others which leads to greater mutual respect.
■ Role Shadowing – “A Walk in your Shoes” campaign provides an opportunity to appreciate other disciplines’ roles, workflows, and struggles.
■ Cross-Disciplinary Meetings – Monthly meetings bring together members of different disciplines to help foster better understanding of one another’s work.
■ Kindness Crusade – Reducing friction, misunderstanding and inefficiencies in team collaboration; cultivating a positive and supportive work atmosphere.
■ Clear Communication Guidelines – Ensuring that communication is respectful and effective; promoting active listening by asking clarifying questions and avoiding jargon and sarcastic comments.
■ Positive Reinforcement – Recognizing efforts through small gestures or expressions of gratitude through Peer Recognition Programs, allowing professionals to acknowledge one another’s contributions.

Results

A pre and post survey for evaluation will be collected for feedback and recommendations.

Discussion

Improving interdisciplinary respect is essential for delivering high-quality care. By fostering open communication, mutual understanding, and shared goals amongst professionals from diverse fields, a more cohesive care environment is facilitated. This approach enhances patient outcomes and strengthens the entire organization, leading to better patient outcomes. Ultimately, cultivating respectful collaboration across disciplines ensures a more efficient and integrated care system.

Oncology Nursing Forum. 2025 Mar 1;52(2):391.

P671. Achieving Transparency in Authorship: Implementing Guidelines in Clinical and Academic Practice

Maureen Varty ¹, Suzanne Mahon ²

Professional Development

Significance & Background

The Oncology Nursing Society journals conform to the International Committee of Medical Journal Editor (ICMJE) guidelines regarding authorship. In clinical and academic practice with dissemination of quality improvement and research, confusion regarding the practical and ethical application of these guidelines often arises when working in teams.

Purpose

The ICMJE guidelines are reviewed in the context of different examples and common scenarios which occur with dissemination. Practical tips are discussed to guide thoughtful conversations and effective intervention within organizations regarding authorship.

Interventions

A review of the literature was conducted to examine common issues which occur when adhering to the ICMJE guidelines for authorship. Key terms included authorship, ethics, publishing, authorship disputes, authorship standards, dissemination, and writing. Some common themes found in the literature review include the persistence of unethical authorship despite standardized guidelines, the importance of early and clear discussions regarding authorship, and institutional support of adherence to authorship guidelines. Challenges remain with determining authorship in team, student, and mentorship relationships, and a need for continued discussion addressing the use of Artificial Intelligence (AI) with dissemination.

Results

The comprehensive application of the ICMJE guidelines can ensure appropriate credit is given to creators and confers accountability and responsibility for the information and knowledge shared within the dissemination process. Publication and research fraud is an increasing concern discussed in academic communications. Ideally organizations prioritize implementation of the ICMJE guidelines by proactively educating nurses on authorship guidelines and what constitutes authorship. With the pervasive AI integration into society, organizations must ensure proper application and disclosure of AI applications within all professional writing.

Discussion

Application of practical tips for how and when to discuss authorship can guide organizational success. It may be beneficial to begin by providing didactic education and recommendations from an outside, objective consultant. Developing clear organizational policies that reflect ICJME guidelines including AI and having champions model these guidelines is the next step. This can be particularly important when students and mentees are involved who have less writing experience while needing to fairly balance the responsibilities of team members. Teams conducting projects should have conversations early and frequently to ensure accountability and clear communication. Organizational champions can provide ongoing education as well as serving as a resource. When difficult situations arise, teams need to have honest and transparent conversations to address unethical situations.

Oncology Nursing Forum. 2025 Mar 1;52(2):391–392.

P672. Variation in Advanced Practice Nursing Role Preparation: The Importance of Collaboration Between Roles as a Means to Optimal Patient Care Outcomes

Maureen Varty ¹, Barbara Wenger ², Linda Staubli ³, Suzanne Mahon ⁴

Management

Significance & Background

Collaboration between nurses with varying education backgrounds (Clinical Nurse Specialists [CNS], Doctor of Nursing Practice [DNP], and Doctor of Philosophy in Nursing [PhD]) potentially benefits the translation of research into practice and ultimately improves delivery of patient care. Misconceptions persist regarding the expertise of each of these distinct degrees and the specific value they provide to projects focused on improving nursing practice.

Purpose

A case study is explored to share how collaboration between these three degrees led to rigorous implementation of a quality improvement project to reduce blood culture contamination rates.

Interventions

During design, implementation, and evaluation of the quality improvement project, a CNS, a DNP, and a PhD-prepared nurse scientist collaborated to ensure the project considered multiple perspectives including the practice environment, the steps within blood culture collection, current state of the literature on best practices, the potential options for intervention based upon the literature, and considerations for data collection and analysis. The project involved the implementation of a new device to divert initial blood aimed at reducing inclusion of potential skin contaminants that remain after evidence-based preparation of the skin.

Results

By harnessing the strengths of the educational backgrounds and clinical expertise of each team member, it became feasible to implement a practice change to reduce blood culture contamination. The CNS provided insight into the practice setting and current workflows, ensuring the team understood the change management needed. The DNP provided expertise in blood culture contamination practices from their professional background. The PhD provided guidance on how to evaluate outcomes and assessment of intervention fidelity. After initial implementation of the project did not demonstrate the expected improvement, this team used their training background to create a more sustainable change to blood culture collection processes, guided by the evidence, by revising the project interventions and outcome assessment.

Discussion

The teamwork between the CNS, DNP, and PhD discussed in this case study demonstrates strategies for how to engage in collaboration efforts which utilize the expertise of all three degrees. The synergy of this group included clinical expertise, experience with successful implementation of quality improvement projects, skill with interpretation and appraisal of the research literature, and training in data collection and analysis which helped to ensure a rigorous and feasible project was designed and implemented.

Oncology Nursing Forum. 2025 Mar 1;52(2):392–393.

P673. Enhancing Access to Primary Care for Cancer Survivors: A Collaborative Approach to Integrating Primary Care Providers in a Cancer Survivorship Program

Adrienne Vazquez ¹, Jessica MacIntyre ², Lena Iglesias ³, Yvette Fonte ⁴, Akina Natori ⁵, Frank Penedo ⁶

Survivorship

Significance & Background

Access to primary care is essential for cancer survivors (CS), yet many lack a primary care provider (PCP). The PCP manages chronic conditions, offers preventive care, promotes healthy behaviors, and facilitates care coordination and communication with specialists. Coordinating to establish long-term survivorship care with a PCP is essential in the care of CS.

Purpose

The Sylvester Survivorship and Supportive Care program ensures all patients have an established PCP. We aimed to implement a process that streamlined and increased referrals to PCPs for patients from the Sylvester Comprehensive Cancer Center (Sylvester) Survivorship Clinics through collaboration with the University of Miami Health System (UHealth) internal and family medicine clinics.

Interventions

In collaboration with primary care leaders at UHealth, we assessed the need for primary care in our cancer patient population. Data from the electronic medical record (EMR) suggested that about 25% had no PCP. As a result, we identified PCPs within the health system who were interested in providing survivorship care and developed education and training in this area. A specific order referral was then created in the EMR to expedite scheduling appointments with PCPs. Additionally, we identified patients in the Sylvester Survivorship Wellness clinics without a PCP and referrals were placed. A Survivorship Care Plan (SCP) was created and delivered for each patient seen, alongside assessments of unmet needs and referrals. The SCP was shared via the EMR.

Results

Out of 44 patients seen in the Survivorship clinic and referred to a Survivorship PCP from August 2023 to August 2024, 43 were contacted. Of these, 17 patients (39.5%) were successfully seen, while 15 (35%) could not be contacted. Additionally, 11 (25.5%) patients were not scheduled for various reasons, including refusal, cancellation, or left without being seen.

Discussion

This initiative highlights the need to develop successful referral processes to improve cancer survivors’ access to primary care. Future directions will address identified barriers to scheduling and enhancing follow-up to ensure optimal care continuity for this population. These challenges are a stark reminder of the complexities in the field of cancer survivorship care, but they also serve as opportunities for growth and improvement.

Oncology Nursing Forum. 2025 Mar 1;52(2):393.

P674. Management of Diabetic Oncology Patients in the Infusion Center

Carrie Venegas ¹, Laura Russell ²

Management

Significance & Background

Oncology patients with diabetes who receive chemotherapy infusions in our ambulatory treatment center (ATC) pose unique challenges for clinical nurses. The competing priorities of cancer treatment and glycemic control require nurses to simultaneously manage both diseases. Optimal management of patients and supporting clinicians requires ongoing education and interdisciplinary referrals.

Purpose

■ Improve nursing assessment and implement best practices for diabetic oncology patients in the ATC
■ Increase knowledge of ambulatory clinical nurses to educate diabetic patients
■ Improve multidisciplinary input and utilization of available referrals and resources.

Interventions

A survey was created to assess nurses’ knowledge of providing care to oncology patients diabetes. Survey questions aimed to measure nurses’ cognitive data, or knowledge of diabetes and cancer, confidence in providing care and educating these patients, and behavior, or clinical decisions and practice. Pre-survey data revealed 59% of ATC nurses were aware of diabetic resources for patients and only 35% of nurses knew how to initiate an endocrine consult in our institution. The team collaborated with key stakeholders including nursing leadership, nursing education, and an endocrinology physician to develop an educational presentation to address the clinical nursing staff in the ATC. The endocrine physician presented the program at the monthly staff meeting. Recording of the presentation and dissemination of information was also provided within small group huddles. Printed and video educational materials, specific to diabetes and cancer, were ordered as supplemental material to distribute to infusion patients.

Results

A post-survey was conducted. Nursing knowledge of cancer treatment and its effects on diabetic patients improved from 52% to 75%. Familiarity with diabetic-related resources improved from 59% to 94%. Knowledge of how to initiate an endocrine consult increased from 35% to 81%. A 60-day follow-up survey demonstrated retention of information at 86%. Questions related to nursing practice, assessment, and cancer treatment effects on patients with a comorbidity of diabetes increased from 75% immediate post-survey to 93% at 60 days post-presentation.

Discussion

Diabetes and cancer are two chronic conditions that are increasing in incidence. Cancer treatment is also conducted largely in ambulatory settings. ATC nurses are uniquely positioned to assess, refer, and educate patients who have diabetes. Ensuring clinical nurses in the ATC receive adequate education, understand referral process and diabetic resources within the institution are essential to providing the best care to patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):393–394.

P675. Employing the AACN Essentials to Cultivate an Interest in Oncology Nursing Through Student Mentorship and Shared Scholarship

Cheryl VerStrate ¹

Management

Significance & Background

The number of individuals living with cancer is on the rise, with new cases expected to surpass 2 million in 2024. Regardless of area of interest, new undergraduate and graduate nurses will encounter the oncology specialty in all practice settings and must be prepared to meet the needs of this unique population. Community stakeholders, healthcare practice partners, and those in academia must work together to provide opportunities for student nurses to foster an awareness of basic oncology care. As the American Association of Colleges of Nursing (AACN) shifts toward competency-based education, emphasizing the need to examine outcomes of the educational experience, there is a clear opportunity to engage with students through mentorship and scholarship improving their exposure to the oncology specialty.

Purpose

The purpose of this presentation is to provide a framework that employs the AACN essentials and partners with the local Oncology Nursing Society (ONS) to guide students through active learning. This process engages students in scholarship related to oncology nursing and mentors them through the progression of research from proposal to presentation, while exposing them to the oncology community at-large.

Interventions

Content will include one exemplar of the implementation of this framework and a description of the active learning employed. Subject matter will include an overview of the AACN essential domains and how to link them to a student research project. In addition, opportunities for mentorship and student scholarship dissemination supported through a partnership with ONS will be discussed.

Results

Shared student scholarship offers an exceptional opportunity to apply the AACN essentials in a manner that not only achieves basic competency but displays the benefits of partnering with a professional nursing organization, ultimately increasing exposure to oncology practice. Learners will be able to identify the AACN essential domains and recognize opportunities for involving students in their local ONS to cultivate an interest in the specialty. They will explore the implementation of one framework and discern whether their community may benefit from a similar model.

Discussion

Employing competency-based education is essential in preparing nurses to administer quality oncology care. This framework provides steps to develop active learning that aims to give students equitable real-world experience, introducing strategies for professional development outside of clinical practice, and providing an opportunity for students to transform knowledge into action.

Oncology Nursing Forum. 2025 Mar 1;52(2):394–395.

P676. Identifying Barriers to Member Engagement in a Professional Oncology Nursing Organization Through the Implementation of a Needs Assessment

Cheryl VerStrate ¹, Sarah Pfennig ², Kelsey Zinkil ³, Jamie Fitzgerald ⁴, John Feyen ⁵

Professional Development

Significance & Background

Membership in professional nursing organizations benefits both seasoned and novice nurses. In oncology, one of these advantages includes continuing education, which ultimately improves the quality of nursing care, through the implementation of evidence-based practice. Membership also grants nurses a platform to engage with the community, impacting regional health and healthcare. Despite literature that demonstrates benefits associated with belonging to and engaging with professional nursing organizations, membership doesn’t always result in active participation.

Purpose

The purpose of this project was to conduct a needs assessment for a local chapter of the Oncology Nursing Society (ONS) to identify barriers affecting member engagement and facilitate program planning.

Interventions

A needs assessment was developed by the ONS local chapter board, which was then distributed via email to oncology nurse members. Nurses were invited to participate in a brief, anonymous survey. Upon completion, they were presented with a noncompulsory option to submit contact information to receive a $5 gift card incentive. Contact information was collected separately from anonymous survey responses to maintain integrity of the study.

Results

37 respondents participated, having oncology nursing experience ranging from 0–20+ years. 37.8% reported 0–5 years working in oncology, while 23 participants held a specialty certification (OCN/AOCNP/CPHON). Of those surveyed, 21.6% practice in inpatient settings while 56.8% are outpatient. Nurses reported common themes associated with the challenges of working in oncology including caregiver burnout, staffing concerns, and difficulties associated with keeping up with current practice recommendations. Participants identified knowledge deficits associated with survivorship care, oncologic emergencies, and hematologic conditions. They reported an interest in further education related to symptom management, oncologic emergencies and palliative/end-of-life care. Results demonstrated that greatest benefits associated with ONS membership were opportunities for networking and continuing education. Of interest, 73% of respondents indicated they do not regularly attend chapter meetings, and participants overwhelmingly cited a preference for a virtual option. 45% of nurses reported they had no interest in participating in a committee.

Discussion

Nurses are often disengaged with resources outside of clinical practice, despite reporting difficulties maintaining a knowledge of current recommendations and recognizing continuing education as a membership benefit of professional nursing societies. This project provides a framework for those seeking to explore barriers to active participation, with results suggesting some nurses may elect not to engage, regardless of known membership advantages.

Oncology Nursing Forum. 2025 Mar 1;52(2):395.

P677. Implementing a Mobility Initiative to Reduce Fall Rates in Oncology Patients

Alain Villanueva ¹, Kelly Tran ², Alicia Goldszer ³, Alyssa Ridad ⁴

Quality and Safety

Significance & Background

Falls pose a significant risk to oncology patients, particularly those experiencing weakness, fatigue, and compromised balance due to cancer treatments. On 4SW, 16 falls were recorded in FY23, and 15 falls in FY24, despite existing fall prevention measures such as bed alarms and non-skid socks. Hospitalized patients often experience weakness from a lack of mobility during treatment. To address this, 4SW developed mobility practices that can be implemented by all patients based on their current mobility status.

Purpose

To decrease fall rates by providing education regarding mobility exercises to both patients and staff, and to encourage the implementation of these exercises every shift in a timely manner.

Interventions

To support this initiative, educational materials and reminders were provided to staff, along with ongoing training during monthly meetings and shift huddles. Patient participation in mobility exercises was encouraged to enhance muscle strength and balance. Staff were urged to mobilize patients at least once per shift. These activities were documented in the electronic health record (EHR), and data were collected at the end of each month.

Results

Fall rates on the unit significantly decreased following the initiation of standard mobility practices. From January to June, there was an average of 3.04 falls per month. After initial staff and patient education, the average number of falls per month dropped to 1.33 from July to September.

Discussion

The implementation of a structured mobility initiative on 4SW has demonstrated a promising reduction in fall rates among oncology patients. The significant decline from an average of 3.04 falls per month to 1.33 falls highlights the importance of integrating mobility exercises into daily patient care. This initiative not only addresses the immediate need for fall prevention but also fosters a culture of proactive engagement in patient health. Ongoing education for staff and consistent reminders have been crucial in maintaining adherence to the mobility program.

Oncology Nursing Forum. 2025 Mar 1;52(2):395–396.

P678. Foundations for Mastery: Extending the Professional Practice of Advanced Practice Providers Through an Intensive Program

Karen Visich ¹, Jacqueline Norrell ², Laura Pachella ³

Professional Development

Significance & Background

Essential to the future of health care, Advanced Practice Providers (APPs) within oncology are a growing part of the workforce and care for cancer patients. Yet, APPs who want to specialize in a disease or augment their existing skill set have limited options when considering enrollment in a professional program. Within existing physician assistant and nurse practitioner educational programs, there is limited formal training in oncology.

Purpose

We aimed to create formal education, aside from on-the-job training, for “new to practice” Oncology APPs. We recognize that many knowledgeable practitioners are working among more novice providers. Physician assistants may come with a strong background in surgery, however, they may not be familiar with nuances of surgical oncology practices. APPs might have solid work experience and knowledge based on clinical experience-but not in oncology. Newer graduates may have bedside experience before transitioning to an outpatient oncology setting as a nurse practitioner. We aimed to use real-world experiences to support and educate those providers new to oncology.

Interventions

We designed an intervention and didactic program known as “Advanced Practice Provider Intensive” (APPI), where a panel of experienced Oncology APPs and physicians delivered a series of lectures to APPs who were either new to practice or new to oncology. The topics included staging for both solid tumor and hematologic malignancies, oncology-focused history and physical exam, symptom management, treatment toxicities and survivorship, and clinical trials management. Topics were presented monthly-in person and synchronous via webcast. We extended program invitations to the health care system and nursing teams.

Results

The APPI program has been a success, with evaluations consistently reflecting its positive impact. The high retention rate (96%) and low rate of attrition for APPs since the start of the program in 2022 is a testament to the program’s effectiveness. APPs report they have assimilated into oncology clinics, and their case study presentations demonstrate their growth and knowledge.

Discussion

The APPI is not just a solution, but a shift in how we educate and advance professional development for Oncology APPs. The APPI can be operationalized across health systems to significantly improve the quality of patient care. Incorporating training of this type in late-phased orientations will bring necessary and specific knowledge to APPs and facilitate their professional growth, and growth of the health system, in meeting oncology patient’s needs.

Oncology Nursing Forum. 2025 Mar 1;52(2):396.

P679. Bare it or Wear it: The Impact of Head Coverings on Patients Experiencing Chemotherapy-Induced Hair Loss

Audrey Waechter ¹, Chloe Kasbarian ², Chloe Lennon ³

Psychosocial Dimensions of Care

Significance & Background

According to the Oncology Nursing Society’s Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice, “Hair loss has been identified as the most troubling aspect of chemotherapy by 58% of patients.” During the COVID-19 pandemic, nurses on a leukemia unit in a large academic medical center, wore colorful, fashionable fabric head coverings as a means of protective equipment. They began to notice that patients with hair loss showed an interest in the various styles. Through conversation, the nurses recognized a need to provide head coverings to support and boost the confidence of oncology patients experiencing hair loss.

Purpose

To create and launch the Bare It or Wear It program, supplying head coverings to patients experiencing chemotherapy-induced hair loss on a 19-bed leukemia unit.

Interventions

The Bare It or Wear It initiative was founded in late 2020. The founder purchased the first 20 scarves. Patients and unit staff made additional donations. A brochure was created featuring unit nurses modeling different head wraps including instructions on how to style them. Nurses were also educated on different ways to tie the head coverings. Nurses identified patients experiencing chemotherapy-induced hair loss. They would then introduce the Bare It or Wear It program. If interested, the patient was given a brochure and a gift bag containing a complementary scarf or wrap. Nurses would assist the patient in styling the scarves and wraps if needed.

Results

Since late 2020, over 100 scarves and wraps have been collected and given to patients. These patients have expressed gratitude and increased confidence utilizing the scarves and wraps. They have also voiced several benefits of scarves compared to previously worn wigs, such as being less costly to maintain and offering a variety of colors and patterns. Limitations to this program include cultural stigmas surrounding head coverings and difficulty finding the time to discuss the program due to patient acuity and/or emotional state.

Discussion

The Bare It or Wear It initiative has successfully provided alternative head-covering options and boosted patient confidence. As oncology nurses, we must remember to focus not only on the treatment but also on caring for the patient’s emotional needs regardless of whether they choose to wear a head covering or bare the natural hair loss process. In the future, we plan to launch the initiative on other oncology units.

Oncology Nursing Forum. 2025 Mar 1;52(2):396–397.

P680. Cultivating Technology: An Oncology Portal to Centralize Education and Institutional Resources

Andrea Wagner ¹, Amanda Sarafin ², Melanie Longo ³, Gonxhe Hadzi ⁴

Management

Significance & Background

It is important that oncology nurses know how to efficiently access resources in order to provide quality care and increase overall efficiency in their practice. In an academic medical center, the inpatient oncology nurse specialists (ONSs) and oncology educator (OE) noticed nurses were having difficulty locating institutional policies, chemotherapy and clinical education, medication guidelines, and other information pertinent to their practice and development. Since these materials are located on various platforms, the ONSs and OE realized the need to create one space to access resources.

Purpose

To create an oncology portal serving as a one-stop source for education and resources for six inpatient oncology units.

Interventions

In May 2024, the ONSs and OE met with IT to create a google domain for the oncology portal. Over two months, the ONSs and OE built the oncology portal utilizing a block layout. The oncology portal features nine main pages including the homepage page, frequently used institutional policies, education and resources, education classes and competencies, professional development, clinical and education support, unit information, admissions, and coverage and directories. Each of these pages are further broken down into subsections. Full sitemap can be seen on table 1. The oncology portal also provides interactive features such as weekly certification questions with rationales and nominations for monthly peer recognition. The oncology portal requires minimal weekly maintenance and a larger monthly update.

Results

On July 1, 2024, the oncology portal launched across six inpatient oncology units. The units included two hematology-oncology, two bone marrow transplant, and two medical oncology units. Since launching, the site has had over 4,500 views and 266 users with an average engagement time per session of 1 minutes and 25 seconds. The most visited pages include the homepage, education and resources, frequently used institutional policies, unit information, and clinical and education support. Feedback from the staff has been overwhelmingly positive. Limitations to the oncology portal include the short time the site has been operational and challenges associated with site maintenance.

Discussion

The ONSs and OE play a pivotal part in ensuring nurses have efficient access to resources. By creating the oncology portal, access to education and other materials has been streamlined. In the future, we plan to expand the oncology portal to outpatient and other oncology continuums within the institutional network.

Oncology Nursing Forum. 2025 Mar 1;52(2):397.

P681. Establishing Radiation Oncology Nursing Competencies to Guide Continuous Professional Development

Brittany Waller ¹, Lisa E Guthrie ²

Management

Significance & Background

Radiation oncology nursing is a growing subspecialty of oncology. Continued advancements in radiation therapy have increased the complexity of radiation oncology nursing which can lead to nurses working in radiation oncology without the knowledge and competence they need. The lack of published evidence-based core practice competencies for radiation oncology registered nurses (RORNs) in the United States led to this initiative.

Purpose

The purpose is to develop RORN competencies to guide initial and continuing development programs.

Interventions

Through literature review, three foundational publications were identified addressing various aspects of the RORN specialty: the Oncology Nursing Society’s (ONS) Oncology Nurse Generalist Competencies, American Academy for Ambulatory Care Nursing Scope, and Standards of Practice, and ONS’s Manual for Radiation Oncology Nursing Practice and Education. A systematic crosswalk of content led to a comprehensive list of 26 competencies addressing the specific requirements for nurses practicing in radiation oncology. A learning needs assessment (LNA) survey based on the 26 competencies, was emailed to 34 RORNs at an NCI Comprehensive Cancer Center at an academic medical center in the Midwest.

Results

Nineteen nurses across 5 sites completed the LNA. Items were scored on a scale ranging from “1= never done” to “5= can teach others”. Correlations between demographic questions and mean LNA scores indicated more experience in radiation oncology tended to make nurses more comfortable caring for a variety of oncologic diagnoses. Nurses with an increased understanding of their role tended to better understand multidisciplinary team member roles, be more comfortable meeting patient care needs, and managing radiation toxicities. Nurses with a higher understanding of cancer pathology were more comfortable caring for patients with different types of cancers. Nurses also identified top learning needs related to caring for patients receiving radiation treatments as fatigue, pain (bone metastases and palliative care), skin care, care of older adults, distress/coping, nutrition, and developing overall goals of care.

Discussion

The successful merger of competencies from existing radiation, oncology, and ambulatory nursing evidence led to the development of competencies specific to RORNs not previously identified. Using evidence-based competencies helped focus the LNA and thus identified areas to improve the competence of care provided by the radiation oncology nursing team. A full education curriculum was developed for both new and experienced nurses. This initiative’s findings are guiding continuing education programs for the RORN specialty.

Oncology Nursing Forum. 2025 Mar 1;52(2):398.

P682. Understanding the Two RN Verification Check

Tina Walsh ¹, Alejandra Castillo ², Patricia Kretschmer ³, Cindy Wantroba ⁴, Gabriel Diaz ⁵, Christina Chiorazzi ⁶

Quality and Safety

Significance & Background

An increase in medication errors in the inpatient/outpatient oncology departments were identified through the organizations safety event reporting system. Upon investigation it was noted that the two RN verification check was not being completed per the organizations policy that reflected the 2024 ASCO-ONS Standards.

Purpose

Prevent inadvertent medication errors related to the administration of antineoplastic therapy in the inpatient/outpatient oncology departments.

Interventions

Anonymous audits were conducted on both the inpatient and outpatient units. Non-compliance was identified in multiple steps of the two RN verification check process. Education sessions were conducted to provide the nursing staff with the standards that are required to be followed within the oncology departments. Through these sessions, barriers were identified and working groups were set up to address the issues presented. The inpatient and outpatient teams collaborated to determine the most efficient and effective ways to meet each standard in the manner that worked best for the departments. Policies and procedures were reviewed to ensure they aligned with the standards. A robust over haul of the EMR oncology documentation was initiated to capture all steps in the verification process.

Results

The oncology teams have a clear understanding of the importance in following all policy & procedures. The education sessions allowed the teams to identify real issues that needed to be addressed so our nurses could follow each step of the verification check appropriately. Anonymous audits have become a part of oncology nursing leadership workflows to continue this work to achieve 100% compliance.

Discussion

Having policies and procedures surrounding the administration of antineoplastic therapy based off of the ASCO-ONS Standards is one step to preventing inadvertent medication errors. This is a constant process that requires ongoing evaluation. In the day to day it is easy to establish workarounds & as leaders it is easy to overlook the barriers to meeting expectations. Constant reminders of why we practice a certain way, having an opportunity to verbalize barriers & keeping a constant pulse on this process helps to keep all members of the team invested in providing the safest care possible.

Oncology Nursing Forum. 2025 Mar 1;52(2):398.

P683. Building it Better One Standard at a Time

Tina Walsh ¹, Alejandra Castillo ², Christina Chiorazzi ³, Cindy Wantroba ⁴, Patricia Kretschmer ⁵, Gabriel Diaz ⁶

Healthcare Delivery

Significance & Background

The release of the 2024 American Society of Clinical Oncology (ASCO)/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards highlighted areas within our oncology workflows, documentation process & policies that needed to be updated.

Purpose

Utilize the 2024 Antineoplastic Therapy Administration Safety Standards for Adult and Pediatric Oncology as a checklist for optimizing and standardizing current workflows, documentation and policies within the adult oncology department to prevent errors & provide a more congruent patient experience.

Interventions

Collaboration with multiple departments & our EMR provider was the first step to structuring the team needed to implement changes to align with the proposed standards. The 2024 ASCO-ONS standards were broken down and put into a checklist format for everyone to review and provide feedback on how we could achieve the standards. We first assessed which standards could be met instantly. Once these were checked off, a more in-depth review of the remaining standards was conducted, and we strategically mapped out which standards to approach next.

Results

This is an ongoing process that continues to evolve. With every standard we meet, we are improving patient care, employee satisfaction & the patient experience. As we work through the checklist, we will continuously be reviewing changes to best practice standards within oncology.

Discussion

The desire to make changes should be driven from the need to do better. Understanding the ASCO-ONS standards and acknowledging that we as a team were not meeting these standards provided the drive to do better. With each check mark we make, real changes are being made for our patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):399.

P684. The Impact of Climate Change Across the Cancer Control Continuum

AnnMarie Walton ¹, AnnMarie Walton ², Stacy Stanifer ³, Ryne Wilson ⁴, Deborah H Allen ⁵, Nancy Houlihan ⁶

Professional Development

Significance & Background

Nurses have been called upon to take action to address global climate change, climate justice, and health. The American Nurses Association has specifically tasked nursing professional organizations to (a) educate members on climate change-related illnesses and negative impacts on treatment, (b) collaborate with grassroots organizations for environmental justice efforts, (c) support policies that promote climate mitigation and adaptation, (d) maintain familiarity with climate justice frameworks, and (e) collectively amplify the voice of nursing to strengthen its impact on climate policy.

Purpose

To enlighten members of the Oncology Nursing Society (ONS) about the increasing impact of climate change across the cancer control continuum and the pivotal role of the oncology nurse in education, research, clinical practice, and advocacy.

Interventions

Five ONS members co-developed the ONS White Paper on Climate Change and Cancer has been approved by the ONS Board of Directors and made available to membership via website and society journal.

Results

Climate change affects all aspects of the cancer control continuum and impacts some populations disproportionately. Events such as wildfires and floods, exacerbated by climate change, can heighten individuals’ exposure to cancer-causing substances, thereby increasing their susceptibility to the disease; reducing such exposure can reduce risks for cancer and positively impact the environment. Air pollution, extended droughts, heat waves, UV radiation, extreme weather events, and food supply disruptions also impact cancer etiology. Extreme weather events disrupt preventative care, cancer detection, and screening efforts, and create workforce shortages that can lead to suboptimal care. Disruptions in the supply chain and scheduled healthcare visits impact patient care continuity. Additionally, climate-related extreme weather events have an impact on overall survival and disrupt end-of-life care, underscoring the pervasive impact of climate change on cancer care across the continuum.

Discussion

Oncology nurses are strategically positioned to contribute to multifaceted solutions, including obtaining and offering education to fellow healthcare providers, students, patients, community members, and policy makers. Oncology nurse scientists are equipped to spearhead the generation of pertinent new knowledge. Nurses in clinical care can play a crucial role in assisting their healthcare system to become carbon net neutral. Oncology nurses must answer the call to actively engage in climate and health advocacy efforts within in the communities where they live, work, and play.

Oncology Nursing Forum. 2025 Mar 1;52(2):399–400.

P685. Investigation on the Construction Status of Nurse-Led Clinics

Guorong Wang ¹, Xiaoyuan Deng ²

Professional Development

Significance & Background

Although nurse-led clinics have developed rapidly in China recently, the functional positioning and construction levels vary greatly depending on the development of nursing specialization. In addition, due to the lack of a standardized survey instrument guided by theories based on advanced nursing practice, the content and focus of the survey varied greatly, and in particular, there was a lack of comprehensive information on the regional construction.

Purpose

Based on Brown and Hamric’s theory of advanced nursing practice, we investigated the construction level of nurse-led clinics in public hospitals from four dimensions, to understand the development quality and problems, and to promote the development towards the homogenization of international advanced nursing practice.

Interventions

A cross-sectional survey study was conducted, taking nurses sitting in the nurse-led clinics of all public hospitals in Chengdu, Sichuan Province, as the research subjects, and using the Questionnaire on the Current Situation of the Construction of Nurse-led Clinics and the Registered Nurses’ Professional Core Competency Scale as the survey tools. Descriptive statistics, entropy weight method and multiple linear regression were used to analyze the data.

Results

The highest level of construction among the 171 nurse-led clinics was 4.5949, the lowest was 0.0545, and the median (quartiles) was 0.3601 (0.2275, 0.6026) points. The top five rankings for both the mean construction score and the number of openings of the 26 nurse-led clinics were: psychological counseling clinic, PICC care clinic, and wound/ostomy clinic. The mean scores of the dimensions of the nurse-led clinics, from highest to lowest, were human resource construction (1.6884), service result (1.6338), organization construction (1.2073) and practice content (0.9362). The level of clinic construction is influenced by the opening time (t=−6.023, P<0.001) and the service type (t=3.753, P<0.001). There was a significant difference in the construction level of different types of nurse-led clinics (H=16.719, P=0.005).

Discussion

Nurse-led clinics in Chengdu are developing rapidly, but there is an imbalance in development. Despite the better human resource construction and the variety of health service methods, the lack of management system, poor homogenization of service content and the prescription rights limit the scope of outpatient practice and development. It suggests that although the social demand for nurse-led clinics health services is high, the connotation of outpatient development still needs to be strengthened to enhance the homogenization level of clinic construction.

Oncology Nursing Forum. 2025 Mar 1;52(2):400.

P686. Center for Epidemiologic Studies Depression 10-Item Boston Version (CESD-10 B): A Good Quality Clinical Scale for Screening Depression

Suzan Abduljawad ¹, Jason Beckstead ², Susan Mcmillan ³, Richard Taylor ⁴, Hsiao-Lan Wang ⁵

Psychosocial Dimensions of Care

Significance & Background

As many as 60% of cancer patients have depression or anxiety, but 10% or fewer are referred for mental health treatment. The American Society of Clinical Oncology (ASCO) updated its depression and anxiety management guidelines, in which the treatment of depressive symptoms has been identified as a priority. The care map for depression begins with applying the Patient Health Questionnaire-9 item (PHQ-9) tool for screening depressive symptoms and referring for mental health treatment. The Center for Epidemiologic Studies Depression Scale 10-item Boston Version (CESD-10 B), which contains multiple dimensions, is similar in usability to the unidimensional PHQ-9. The suitability and quality of CESD-10B for cancer clinical practice and research were unknown.

Purpose

This study aimed to evaluate the validity and reliability of CESD-10 B among cancer patients.

Interventions/Methods

The confirmatory factor analysis was applied to compare two models from the CESD-10 B (N=200): (1) a single-factor model and (2) a four-factor model. Internal consistency was also evaluated.

Results

The four-factor model fitted the data significantly better than the single-factor model (x² = 227.988, df = 6, p < 0.001) with a Cronbach’s alpha of 0.74. The four factors included depressed affect, positive affect, somatic complaints, and interpersonal problems.

Discussion

This study provided strong evidence to challenge the current clinical practice paradigms and may allow researchers and clinicians to use a novel instrument (i.e., CESD-10 B) in cancer populations. Unlike the unidimensionality of the PHQ-9, the CESD-10 B has four domains. The domain of Interpersonal Problems in the CESD-10 B is a major clinical indicator of the need for mental health treatment. CESD-10 B may eliminate barriers to mental health referrals in cancer patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):400–401.

P687. Long-Term Effects of Radiotherapy on Cognitive Function in Head and Neck Cancer Patients

Laura Wang ¹, Deborah W Bruner ², Andrew H Miller ³, Nabil F Saba ⁴, Canhua Xiao ⁵

Psychosocial Dimensions of Care

Significance & Background

Head and Neck Cancer (HNC) is the sixth most common malignancy worldwide, with radiotherapy and chemotherapy being primary treatments. Patients receiving radiotherapy, with or without chemotherapy, may experience cognitive function decline. Early detection of cognitive changes is crucial for improving patient outcomes.

Purpose

This study investigates cognitive function changes among HNC patients undergoing radiotherapy, with or without chemotherapy, using patient-reported measures over time.

Interventions

This observational study enrolled newly diagnosed HNC patients treated with radiotherapy at Emory Winship Cancer Institute. Data were collected before radiotherapy, immediately after, and at 1, 3, 6 and 12 months post-treatment. Cognitive function was assessed using the items, memory and concentration, from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). Each item was scored from 0 to 4, with higher scores indicating greater cognitive decline. The average score of the two items was the cognitive function score for the study. Mixed-effect regression models were used to evaluate changes over time, controlling for demographic and clinical variables.

Results

Among 215 HNC cancer patients, cognitive function declined most significantly immediately after radiotherapy (Estimate = .412, p < .001). While there was some improvement at one year post-treatment, cognitive function remained significantly worse than baseline (Estimate = .215, p = .047). Patients that did not undergo surgery showed greater cognitive decline (Estimate = .216, p = .001) compared to those who had surgery. Patients treated with carboplatin/paclitaxel exhibited greater cognitive decline (Estimate = .281, p = .003) than those receiving cisplatin, particularly immediately after treatment, though this difference disappeared at one year post-treatment. Lower-income patients also showed greater cognitive decline (Estimate = .171, p = .014) compared to higher-income patients, and a history of smoking trended toward increased cognitive decline (Estimate = .133, p = .056).

Discussion

HNC patients experience the greatest cognitive decline immediately after radiotherapy, with the decline, although improving, persisting at one year. Patients who had surgery exhibited less cognitive decline, possibly due to better overall health. Those treated with carboplatin/paclitaxel experienced greater cognitive decline, particularly at the end of chemoradiotherapy, indicating potential selection bias as this regimen was often given to patients unable to receive cisplatin. Socioeconomic status and smoking history were linked to worse cognitive outcomes. These findings show importance for early cognitive assessments and interventions to reduce long-term effects.

Oncology Nursing Forum. 2025 Mar 1;52(2):401.

P688. Reliability and Validity of the Chinese Version of the Good Death Inventory-Short Form

Chunyi Wang ¹, Juanjuan Zhao ²

End of Life

Significance & Background

Cancer has become the leading cause of death worldwide. According to data released by the International Agency for Research on Cancer, there were nearly 20 million new cancer cases and 9.7 million deaths worldwide in 2022. China ranked first in the world with 4.82 million new cases and 2.57 million deaths. The condition of cancer is complex changeable and difficult to cure, which will affect the physical and mental state of patients and their families, leading to patients facing multiple difficulties such as interpersonal relationships and self-realization at the end of life. There are abundant research tools related to good death in foreign countries, but there is a lack of quantitative evaluation tools in China. Therefore, the purpose of this study is to test the reliability and validity of the Short version of the Good Death questionnaire among the bereaved family members of cancer patients, to investigate its application value, and to provide a rapid and effective assessment tool for good death research, to promote the development of hospice care in China.

Purpose

To test the reliability and validity of the Good Death Inventory-Short Form in the bereaved family members of cancer patients, and to evaluate the applicability of the questionnaire.

Interventions

None.

Methods

After translation, integration, back-translation, expert committee review, and pre-investigation, the Good Death Inventory-Short Form was formed. From January to December 2017, 305 bereaved family members of cancer patients were selected as the research objects by convenience sampling method to evaluate the reliability and validity of the Good Death Inventory-Short Form.

Results

The item-level content validity index and scale-level content validity of the Good Death Inventory- Short Form were 1.0. Exploratory factor analysis extracted a total of 5 common factors, including care and identity, autonomy and environment, peace, communication, and physical and mental comfort. The overall Cronbach’s α coefficient of the Good Death Inventory-Short Form was 0.790, and the split-half reliability was 0.718.

Discussion

The Good Death Inventory-Short Form has good reliability and validity, which can be used to evaluate the level of good death in cancer patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):401–402.

P689. Reliability and Validity of the Chinese Version of the Brief Grief Questionnaire

Xixi Wang ¹

End of Life

Significance & Background

The loss of a close person is a negative event, and bereaved people will feel a series of grief reactions in psychological, cognitive, and behavioral aspects. It has not been fully determined how long these grief responses would last, the full nature of the reactions, and the ultimate psychological and behavioral consequences. Some people’s grief will gradually adapt and ease over time, but others cannot accept loss, and their grief persists or even worsens, impairing their daily functioning. Compared with other assessment tools, the Brief Grief Questionnaire(BGQ) has fewer items, simple assessment methods, and strong operability in clinical use. Therefore, in this study, BGQ was translated into Chinese, and the reliability and validity of the Chinese version of BGQ were verified in the bereaved families of patients with chronic disease who died in a hospital in China to provide a scientific, convenient and accurate tool for such research in China.

Purpose

To validate the Chinese version of the Brief Grief Questionnaire (BGQ).

Interventions

None.

Methods

From May to November 2023, a cross-sectional study was conducted among 220 bereaved family members of patients who died in the hospital. This study involved the translation, cross-cultural adaptation, and the evaluation of its psychometric properties. Reliability, content validity, construct validity, and concurrent validity were tested.

Results

The average mean score of the BGQ was 5.6±2.1 and 21.4% of the prevalence of PGD. The overall Cronbach’s α was 0.719, and the split-half reliability was 0.725. The item-level content validity index ranged from 0.833 to 1.000, and the content validity index at the scale level was 0.967. The exploratory factor analysis confirmed the one-factor structure of the BGQ, explaining 54.745% of the variance and the factor loading of each item ranged from 0.674 to 0.798. The confirmatory factor analysis verified that all indicators were fit. The correlation coefficient between the BGQ and ICG scores was 0.737.

Discussion

The Chinese version of the BGQ has good reliability and validity, and it can be used to rapidly assess the level of grief among bereaved family members of Chinese hospitalized patients who died of chronic diseases.

Oncology Nursing Forum. 2025 Mar 1;52(2):402.

P690. Diversify to Certify: Creating Momentum for Nurses to Seek OCN®

Kelly Wargo ¹

Professional Development

Significance & Background

Nurses, patients and employers benefit from oncology nursing certification. Certification validates nurses’ specialty knowledge, strengthens patients’ trust, and distinguishes employers in the healthcare market. In April 2023, in this hematology/oncology outpatient infusion center, 18 out of 37 eligible nurses were Oncology Certified Nurses (OCN®).

Purpose

To increase the number of OCN® nurses, diverse approaches were used to provide resources and create momentum to seek OCN® for nurses in a community oncology setting.

Interventions

OCN® eligible nurses were emailed to gauge interest and learning needs for a review course. Eligible nurses worked in outpatient infusion, medical oncologist office, navigation, research and inpatient areas. Of the 19 eligible nurses, 18 were interested in the course. Oncology Nursing Society (ONS) resources were used to contact other nurses that developed and taught OCN® review courses to gain insight. The decision was made to hold six 90-minute sessions one day a week from January to mid-February 2024. The sessions were free of charge and the staff were paid education time. The format was in-person sessions with a virtual option. Content was developed using the OCN® test blueprint and presented in a didactic platform. Nine continuing education (CE) points were offered to those that attended all sessions. Enrollment in the Oncology Nursing Certification Corporation (ONCC) FreeTake® Program was obtained through collaboration with oncology leadership. An oncology ‘question of the day’ during twice weekly huddles was presented to reinforce content and then emailed to the staff. These questions and other oncology educational material were placed on bulletin boards around the clinic. A list of the OCN® nurses was displayed at the entrance to the clinic. And as nurses pass the OCN® exam, they are awarded an OCN® badge reel and certified nurse shirt during huddle.

Results

Of the 18 nurses that attended the review sessions, 12 completed all the sessions to obtain the CEs. An evaluation form was completed by attendees with positive feedback on the course preparing them for the OCN® exam. As of September 2024, five more nurses are OCN®.

Discussion

Providing diverse approaches appeals to different types of motivation and styles of learning. These approaches provided resources and created momentum for nurses to seek certification. The enthusiasm expressed by nurses that will soon be OCN® eligible will result in another review session in January 2025.

Oncology Nursing Forum. 2025 Mar 1;52(2):402–403.

P691. Fifty Years of Radiation Oncology Nursing, the Future is Looking Bright

Denise Webb ¹, Bridgett Harr ², Michele Gray ³

Management

Significance & Background

Over the past five decades, radiation oncology nursing (RON) has evolved from a new specialty into a fundamental part of comprehensive cancer care. This abstract will show how our institution met the staffing challenges of a changing environment and reveal what is possible in RON over the next fifty years.

Purpose

Over the past fifty years, radiation oncology has changed from a solely radiation oncologist driven field to one that shares the burden with nursing. This has led to a shift from primary patient safety and basic nursing tasks to RON now coordinating care for medically complex patients with varying oncology treatment regimes, providing complex symptom management, and triaging patient concerns. One way to meet these ever changing roles was to identify the need for a standardized on-boarding curriculum, mentorship and ongoing education.

Interventions

A radiation oncology on-boarding curriculum was implemented at a large tertiary oncology center. A committee was formed to define the role and responsibilities of RON at our institution. Two distinct roles were identified: (1) clinic nurses who coordinate daily clinic needs and (2) care coordinators who focus on managing patient care. From this, the committee clearly defined new hire weekly goals and expectations, identified educational resources, and sought multidisciplinary opportunities (ex: tumor board, grand rounds, shadowing). An on-boarding manual with a suggested completion schedule was created with this information. An emphasize was placed on teamwork to create an environment of integration.

Results

The on-boarding curriculum was initiated in 2022. Since this time, RON has the highest retention rate among the oncology nursing units within our cancer center. Over the past twelve months, there have been zero turnovers in radiation oncology. In comparison, medical oncology has had an 11.3% turnover rate. New hires and current employees alike find the on-boarding curriculum to be a beneficial resource. Feedback has shown new hires appreciate clearly defined goals and expectations.

Discussion

Radiation oncology nursing has seen exponential growth in the past fifty years. With dynamic roles and responsibilities, a RON on-boarding curriculum was essential for ensuring new hires received proper orientation and also serves as a resource for current radiation oncology nurses. As technology advances the radiation oncology nurse must stay abreast of care strategies and ongoing education to meet the patients needs. The future is bright for the radiation oncology nurse.

Oncology Nursing Forum. 2025 Mar 1;52(2):403–404.

P692. Building Confidence in Oncology Care: Integrating Simulation Training for New Advanced Practice Providers (APPs)

Evelyn Wempe ¹, Jessica MacIntyre ², Akina Natori ³

Management

Significance & Background

With rapid advances and the growing complexity of cancer care, it is critical to support Advanced Practice Providers (APPs), like nurse practitioners (NPs) and physician assistants (PAs) entering the oncology field. Specialty practices, like oncology, require specific education and clinical training to deliver optimal patient care. APP Fellowship programs provide opportunities for dedicated support, mentorship, and education. Beyond transitional orientation, education, and clinical onboarding, simulation training offers a valuable opportunity to develop skills and gain hands-on experience in a safe and controlled environment.

Purpose

The purpose of integrating oncology-based simulation training was to increase confidence in essential skills needed to care for oncology patients in early career APPs.

Interventions

As part of an institutional oncology APP fellowship program and to support newly hired APPs, the first simulation-based training session was conducted in the summer of 2024, focusing on two relevant oncology scenarios. The first scenario was focused on a new patient cancer visit and the second scenario was focused on identifying a follow-up patient with neutropenic fever, one of the more common oncologic emergencies. A pilot of six APPs participated; two APPs were part of the Oncology APP Fellowship Program and four were newly hired APPs. Before starting the simulations, a general overview, the case scenarios, orientation to the environment, and resources were provided. A questionnaire assessing confidence in the key areas of oncology care was also administered prior to starting the simulation. Debriefing sessions were performed after each scenario. The Debriefing Assessment for Simulation in Healthcare (DASH) Student Version© was utilized to assess the quality of the debriefs. Of note, both simulations utilized standardized patients (SPs) and replica clinic rooms where the APPs practiced.

Results

Exact McNemar’s test was utilized to examine the association between level of confidence and the intervention. Although, there was not a statistical significance in the results, likely due to a small sample size, the level of confidence with all learners increased from the category of strongly disagree, disagree, and neutral to agree and strongly agree.

Discussion

Integrating technology and oncology-based simulations resulted in an increase in individual learner confidence in a secure and supportive learning environment. Additionally, it unintentionally served as a team building experience. Future directions will be to continue to add relevant oncology case scenarios critical to skill building in new APPs in oncology.

Oncology Nursing Forum. 2025 Mar 1;52(2):404.

P693. Enhancing Nasopharyngeal Carcinoma Care: The Impact of Radiotherapy Nursing Outpatient Service

Xiaohui Wen ¹

Symptom Management and Palliative Care

Significance & Background

Nasopharyngeal carcinoma is highly prevalent in China. Radiotherapy, being the primary treatment modality for nasopharyngeal carcinoma patients, has a long duration and often leads to various complications such as oral mucositis, dry mouth, and skin damage. Clinicians typically lack sufficient time to educate patients on dealing with these complications.

Purpose

We established a radiotherapy nursing outpatient service for nasopharyngeal carcinoma patients and jointly constructed a nursing medical record system with the hospital’s information center. The aim is to assist patients in better coping with the damage caused by radiotherapy and in establishing correct healthy behaviors to prevent radiation-induced injuries.

Interventions

Information of 55 nasopharyngeal carcinoma patients undergoing radiotherapy from May to August 2024 was collected and compared with that of 53 patients from January to May 2024. We observed the incidence, occurrence time, and severity of oral mucositis and skin damage, as well as symptom distress and psychological status.

Results

Regarding oral mucositis, in the control group of 53 patients, the incidence was 81.13% (43/53), with an average occurrence time of 12.5 days after radiotherapy and mostly moderate or above severity. In the intervention group of 55 patients, the incidence decreased to 61.82% (34/55), and the average occurrence time was 16.8 days with mainly mild severity. For skin damage, the incidence in the former group was 75.47% (40/53) at an average time of 14.2 days after radiotherapy and mostly moderate severity. In the latter group, it was 58.18% (32/55) at 18.5 days with mostly mild severity. Additionally, the symptom distress of the intervention group was significantly reduced. Using the Self-Rating Anxiety Scale and Self-Rating Depression Scale, it was found that the anxiety and depression levels of this group were also significantly lower than those of the control group.

Discussion

The radiotherapy nursing outpatient service for nasopharyngeal carcinoma patients that we established can effectively reduce the severity and incidence of oral mucositis, prolong its occurrence time, lower the incidence of skin damage, and alleviate symptom distress, thereby improving the overall well-being of patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):404–405.

P694. Optimizing End-of-Life Care: A Collaboration Between an Academic Medical Center and Local Hospice Agencies

Barbara Wenger ¹, Madeline Rippy ², Erin Vipler ³, Daniel Skubic ⁴, Annsley Buffington ⁵, Li Ngov ⁶

Coordination of Care and Navigation

Significance & Background

In 2021,1.7 million Medicare beneficiaries were enrolled in hospice care. The top three terminal diagnoses were nervous system disorders, cancer, and circulatory failure. The Medicare Hospice Benefit provides four levels of hospice care: routine and continuous home care, respite care, and general inpatient care (GIP). GIP is for patients requiring acute symptom management provided in a facility such a hospital or hospice inpatient facility that cannot be managed in other settings.

Purpose

This large academic medical center (AMC) sought to address the needs of patients nearing end of life. Prior to implementation, patients had to be discharged from the hospital and transferred to a facility to initiate hospice benefits. In February 2024, this AMC began offering GIP level of care in the inpatient setting through a partnership with three local hospice agencies. This collaboration allows patients/families to receive hospice benefits including expert comfort-focused care and emotional /psychosocial support.

Interventions

A pathway was created to identify, evaluate, and enroll patients into GIP hospice. Patients meeting criteria are identified at daily multidisciplinary rounds which triggers a social worker consult. The social worker meets with the patient/families to explain the role of hospice care. If the patient elects to proceed, a referral is placed to a partnering hospice agency. Care is delivered collaboratively between the hospital inpatient team and hospice agency. The program started on four acute care units before full hospital implementation. Staff were educated through multiple channels including asynchronous and in person options. Daily check-ins with program management team and unit leadership occurred during the pilot to solicit feedback and adjust accordingly.

Results

During the program pilot phase (2/13/24-6/3/24), 17 patients were enrolled into GIP care. 13 patients on the oncology unit, 2 on the bone marrow transplant unit, and 2 on the neurology unit. 12 patients (71%) had an underlying terminal cancer diagnosis. 5 patients (29%) were discharged to a different level of hospice care after symptom stabilization.

Discussion

GIP transition during an inpatient hospitalization allows a larger proportion of terminal patients to access hospice services which benefits the patient, their loved ones, and the healthcare system. Following the successful pilot phase, it has become standard of care. Preliminarily, we have seen a decrease in mortality statistics due to this intervention. Annual mortality data will be available in 2025.

Oncology Nursing Forum. 2025 Mar 1;52(2):405.

P695. Enhancing Nurse Engagement in Shared Governance: Developing a Nurse-Led Committee Report-Out Structure

Susan Whiting ¹, Megan Corbett ²

Professional Development

Significance & Background

Shared governance empowers teams through active engagement and collaborative decision-making between nurse leaders and direct care nurses. This model supports a positive and inclusive environment where nurses feel informed, engaged, and empowered to contribute. Oncology infusion nurses at an adult ambulatory infusion clinic in the Northeast lacked clarity on shared governance, hindering participation (unclear role, responsibilities, and communication).

Purpose

To share one infusion clinic’s approach to enhancing shared governance culture through structure, standardization, accountability, and support.

Interventions

In 2021, low participation in shared governance committees (47%) and quality improvement activities (41%) prompted a programmatic approach to transform one unit’s shared governance structure. Nurse leaders educated on shared governance roles, committee needs and expectations to foster participation. Nurses were guided through committee selection and thorough onboarding processes were established. Adjusted schedules allowed for dedicated time for both committee meeting and pre-work/preparation. Post meeting debriefs with nurse leaders provided valuable review, updates, and mentorship, maximizing learning and impact. Monthly team meetings ensured consistency with standardized report-outs, fostering better communication, collaboration, and knowledge sharing. An online shared team page housed all relevant information. The program’s success led to its widespread adoption as a best practice across the organization.

Results

In 2024, nurse participation on shared governance committees increased to 96%. Post interventions, nurses reported 74% satisfaction rate with the new structure, along with increased shared governance participation (74%), preparedness (55%), confidence (60%) and dissemination (66%). Nurses expressed heightened feelings of engagement, stronger communication, and greater confidence in their ability to contribute to decision-making related to their professional practice. They also reported feeling better informed, updated, and included. When asked about potential areas for improvement, the only suggestion was for more committee preparation time. Overall, the new structure has been highly effective in fostering a sense of ownership, collaboration, and influence among the nursing team.

Discussion

Enhancing shared governance culture through structure, standardization, accountability, and support strengthens team culture, empowers nurse practice, fosters engagement, and aligns with the American Nurses Credentialing Center’s Magnet Recognition Program’s criteria for structural empowerment, exemplary professional practice, transformational leadership, and empirical outcomes. Building a committee report-out structure created a collaborative approach to promote evidenced-based best practices, improve quality outcomes, and enhance nurse satisfaction, professional development, and autonomy.

Oncology Nursing Forum. 2025 Mar 1;52(2):406.

P696. Working Smarter Not Harder: Incorporating ChatGPT in Navigation Administration Support

Elizabeth Wigozki ¹, Deborah Toffler ², Hadassah Herrera ³

Coordination of Care and Navigation

Significance & Background

Automated intelligence (AI) is a technology transforming modern healthcare systems (Shaheen 2021). It is important to explore how nurse and patient navigation can utilize this technology. Non-clinical administration tasks are needed to ensure oncology patients get their required care during their cancer journey. There is a financial toxicity gap for patients who cannot ambulate to a chair car independently and therefore require ambulance transport. Obtaining coverage for these patients is complex and requires patients to contact their insurance and often require prior authorization. In a complex changing landscape, oncology nurse navigators (ONNs) and financial resource staff are supporting patients but require more efficient tools.

Purpose

Leverage existing technical platforms to help navigators aggregate non-clinical work to expedite prior authorizations for ambulance transport.

Interventions

Utilized Dana-Farber Cancer Institute (DFCI) inhouse program called GPT4DFCI to develop language for letter of medical necessity for insurance and a list of questions to provide patients to insurance regarding coverage for ambulance transport. Information entered into the GPT4DFCI described patient population. This included oncology patients who are unable to ambulate independently and require ambulance transport to get to treatment and medical appointments. For questions to ask insurance company, language describing the patient population was inserted and additional question if population is covered for non-emergent ambulance transport to medical and treatment appointments.

Results

Reviewed DFCI data over the past 6 months with resource office, to identify that there are an estimated 5–10 ambulance rides needed per month which fall into the category of being wheelchair-bound patients that do not qualify for covered transportation and require ambulance transport. Of these 5–10 rides, a smaller percentage required prior authorization and needed letter of medical necessity. Due to this low volume, the template has not yet been tested nor has the questions to ask insurance company been provided to patients. However, the framework and process has been outlined and identified and ready to use when ready which will significantly reduce the amount of time to complete.

Discussion

The small number of patients requiring ambulance transport makes it very difficult for clinical teams to develop standardization. Using the tool following DFCI policy for AI use enabled teams to create and validate the information. Further testing to see if this could be used in larger capacity for navigation administrative tasks remains to be seen.

Oncology Nursing Forum. 2025 Mar 1;52(2):406–407.

P697. Transforming the FMLA/Disability Process: A Continuous Multidisciplinary Improvement Approach to Elevate the Patient Experience

Elizabeth Wigozki ¹, Ashlyn Hiserote ², Christopher Bourne ³

Quality and Safety

Significance & Background

Family Medical Leave Act (FMLA) provides eligible employees job-protected leave for qualifying family and medical reasons (Department of Labor 2024). At Dana-Farber Cancer Institute (DFCI) our oncology patients and families utilize this benefit and rely on it. The processing of FMLA/disability paperwork is time sensitive requiring input from various stakeholders (i.e. clinicians, administrative staff, insurance companies, and patients) to process. There are pain points and process gaps that create inefficiencies. Leadership and staff from both Nursing and Health Information Systems (HIS) came together to address current concerns in the process regarding communication, transparency and patient satisfaction.

Purpose

Transform the process of completing FMLA and disability paperwork at DFCI focusing on patient communication and patient engagement.

Interventions

A variety of interventions were created and launched from January 2023 through July 2024. The first step was to create a multi-disciplinary workgroup to address process gaps. This consisted of oncology nurse navigators and HIS staff to determine processes and deficiencies in current process. To address patient communication and engagement, teaching sheets about what to expect in the process of filing FMLA and disability paperwork were created. External and internal websites were updated with new content information for transparency. In-person desks staffed by HIS were implemented for patients to ask questions and submit paperwork. The workgroup leveraged current use of Press Ganey at DFCI to create new dynamic surveying that asked specific questions for FMLA/disability process. Baseline data was obtained pre-intervention and follow up questions at 6 months. Questions addressed timeliness of processing, understanding of process and satisfaction with the processing of completing paperwork.

Results

After interventions, we saw an average of 16% improvement in patient requests completed within 14 days and 27.5% within 7. An average of 27 patients utilized the staffed HIS desk to turn-in requests monthly. Baseline patient satisfaction data through Press Ganey Dynamic Surveying (80–89% scores) showed results indicating confusion and frustration with the process and indicating improved timeliness, clarity of process, and information availability was needed. Post Phase One intervention data is expected mid-October.

Discussion

The process of completing disability and FMLA paperwork is dynamic and complex. Although interventions were implemented, this did not address additional gaps in process. Next steps are to enhance transparency and cross functional internal systems through continuous improvement to improve patient satisfaction and efficiency.

Oncology Nursing Forum. 2025 Mar 1;52(2):407.

P698. Meeting Chemotherapy Safety Standards and Addressing Patient Health Literacy Using Learning Needs Assessment

Jill Williams ¹, Victoria Bradford ², Sandy Jellen ³, Shelly Kane ⁴, Jennifer Schoenecke ⁵

Patient Education

Significance & Background

Through Quality Oncology Practice Initiative (QOPI) Re-Certification Process, identified a gap in documentation of patient education prior to anti-cancer treatment. Further gap analysis revealed limited documentation of oncology patients learning needs, abilities, and readiness to learn. Patient education tailored to individual learning needs prior to the start of anti-cancer treatment is part of 2024 ASCO/ONS Chemotherapy Administration Safety Standards. Health literate health care organizations use health literacy strategies to communicate in a way that patients understand, using methods customized to their health literacy and preferences.

Purpose

Integrate nursing learning needs assessment and documentation as a standard for all new oncology patients to increase safety of anti-cancer treatment through education, deliver patient-centered healthcare, and adopt health literacy best practices

Interventions

Review of related literature, review of organizational Registered Nurse (RN) practice and documentation standards, including existing electronic health record (EHR) functionality with multi-disciplinary team including Nursing, Quality leadership, and Information Services (IS), integration of standardized learning needs assessment content into new Education section of RN Interdisciplinary Note for new and returning patients, used by all oncology clinic RNs, education provided to RNs and clinical teams on purpose and significance to safety and health literacy of learning needs assessment, advertise availability of patient education materials in various formats (print, electronic, video) and languages, and incorporation of learning needs assessment education into RN onboarding.

Results

Adoption of learning needs assessment and documentation into oncology clinic RN standard practice; learning needs assessment performed for all new oncology patients as a commitment to address health literacy and promote patient understanding of their disease and treatment options; monitor compliance reports for trending.

Discussion

QOPI recertification process represents a significant learning opportunity for oncology nurses to update and align with best practices. Multi-disciplinary approach with Nursing, Quality, and IS teams valuable for assessment, intervention, and evaluation of new processes. Emphasis on verification of patient understanding of education provided, in their preferred method(s) of learning, as an important safety standard in anti-cancer treatment. The Teach-Back method is the recommended verification method at this institution.

Oncology Nursing Forum. 2025 Mar 1;52(2):407–408.

P699. Developing Infection Prevention Guidelines for Outpatient Invasive Procedures

Marie Wilson ¹, Amy S Boswell ², Joanna Oehler ³, Terri Cunningham ⁴

Quality and Safety

Significance & Background

Infection prevention (IP) guidance is lacking for the breadth of invasive procedures being performed in outpatient clinics. Evidence-based guidelines and national standards exist only for ambulatory surgery centers. This resulted in information gaps that contributed to staff knowledge deficits for the increasingly complex care provided at an outpatient Comprehensive Cancer Center.

Purpose

The purpose is to identify the invasive procedures performed in outpatient oncology centers and develop a rubric for IP measures to apply at various levels of invasiveness.

Interventions

Using a model from Masse et al (2018) as a template, a table using simple terms was developed to differentiate the level of invasiveness and associated IP measures for procedures. Development began by generating a comprehensive list of invasive procedures with input from clinics’ operational leaders. Procedures were categorized based on current policy, established guidelines (e.g., World Health Organization’s hand hygiene guidance), and comparison with other internal references that use categorical levels for safety interventions, such as pre-procedure verification and time out processes. Stakeholder feedback on the draft was collected from providers (including physician and advanced practice proceduralists), clinical operational leaders, procedural medical assistant leads, and the Center’s Clinical Practice Council.

Results

Stakeholder input from multiple disciplines resulted in simplifying the categories and refining the categorization of four procedures. The final table (Figure 1) includes four categories and provides guidance for 11 IP measures with the aim to enhance patient safety through uniform understanding. Additionally, guidance on the type of training and competency expected was outlined. Figure 1 includes examples of procedures falling within each category. For implementation at the Center, all procedures performed at the time of its dissemination were included for staff reference.

Discussion

The literature lacks guidance on how to safely perform invasive procedures in outpatient settings, where increasingly complex procedures are being performed. Similarly, many IP programs either do not have resources to provide this level of guidance to outpatient settings or clinics fall beyond the IP program’s scope of service. This results in staff not having the tools necessary to consistently implement IP measures during invasive procedures. It is the hope of the authors this ready-reference tool can be adapted and adopted for use to bridge the gap and improve patient outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):408–409.

P700. Bridging the Gap in Clinical Trials: “From Grafting Phase to Granulation Phase.”

Jindu Wilson ¹

Quality and Safety

Significance & Background

Clinical trials are crucial in bringing cancer patient new and life-saving treatments. The Cancer Center’s ambulatory infusion unit serves a diverse population of 80–120 patients daily, including clinical trial patients. The existing clinical trials’ workflow was inconsistent and lacked a standardized process, resulting in time consuming and unsafe practices. In the literature, significant barriers to patient care, including knowledge gaps, poor communication, and inconsistent workflows, resulted in medication errors, study deviations, and patient harm. Literature supports that dedicated nurse for clinical trials, improved communication, RN education, handoffs, and standardized processes are essential for ensuring the safe quality of care in clinical trials.

Purpose

To establish best practices, standardize and consistent workflow processes, enhance team communication and collaboration, ensure safe investigational drugs administration and protocol adherence, reduce workload, minimize study deviation, bridge the knowledge gap, and eliminate patient harm.

Interventions

Pre-implementation RN surveys and multidisciplinary efforts were used to analyze the process gaps. Using the PDSA Quality Improvement methodology, the team accomplished multiple PDSA rapid cycle improvements. Staff education, standardized order sets, checklists, redesign of the physical environment for clinical trial patients, dedicated RNs, mandatory handoffs, and a staffing complexity tool were implemented. Daily audits were conducted to ensure the new practices were sustainable.

Results

The overall rating of the clinical trials workflow process improved from a Likert scale of 1–2 to 4–5. Significant increases were noted in pre- and post-education scores from an average of 50% to >80%; RNs’ confidence level from 60% to 94%; communication from 46% to 100%; workflow consistency from 50 to 96%; workload and order discrepancies decreased from 83% to 24% and 75% to 25%, respectively. Additionally, these efforts led to improvement in research protocol adherence, staff burnouts, and patient experience.

Discussion

Cancer center’s vision is to be NCI designated and recognized for the scientific leadership in clinical research, and the project aligns with the organizational vision. The process gap analysis identified several system defects requiring more than band-aid solutions. Strategies that led to the project’s success included a “no blame” culture approach, shared decision making, and the use of the PDSA framework. Building partnerships with shared goals, fostering collaborative relationships, implementing educational initiatives, and redesigning processes have all contributed to creating a better work environment with multiple layers of improvement aimed at optimizing patient care and safety.

Oncology Nursing Forum. 2025 Mar 1;52(2):409.

P701. Evaluating the Impact of Communication Training on Engagement and Turnover in Oncology Nursing

Amanda Woods ¹, Phoebe Hessen ², Katelyn Cavanaugh ³, Josee Alanis Barker ⁴, Courtney Holladay ⁵

Professional Development

Significance & Background

Communication remains a paramount competency in nursing; in response, training to improve communication skills has become ever-present in oncologic practice. Simultaneously, efforts to improve performance, foster engagement, and lower turnover are key outcomes in nursing to counter the growing concern for the nursing shortage. Implementing communication training can provide nurses with a valuable resource targeting skills essential to their interpersonal interactions. Training targeting such a foundational skill can have wide-reaching positive impacts on a variety of experiences that eventually shape how engaged nurses feel at work and eventually if they decide to remain with the organization.

Purpose

The goal of this training program was to positively impact interpersonal communication skills that in turn, promote key outcomes: performance, engagement, and retention.

Interventions

The training program, Real Colors® is a multi-hour training workshop using a personality type test, based on temperament, and applies adult learning principles, such as self-direction and experience. Our total sample included 1,527 nurses (241 APRNs, 5 Clinical Measures Nurses, 960 Clinical Nurses, 30 Clinical Nurse Leaders, 291 Outpatient Clinical Nurses) at a large academic cancer-focused healthcare institution in the Southwest United States. To evaluate program impact, we compared training participants to a control sample of nurses. Of the 1,527 nurses, 586 nurses completed the Real Colors training program, and 941 were identified as a control sample.

Results

Although no significant impact of training participation on performance was detected, we found training significantly impacted engagement and turnover. Specifically, we found nurses who participated in training had significantly higher engagement after training in comparison to the control group. Similarly, we found nurses who participated in training had significantly lower turnover rates post-training (9.8%) in comparison to the control group (17.3%) (χ²[1, N = 1,432] = 14.81, p < .001).

Discussion

We have identified a training program that positively impacts essential outcomes (engagement and turnover) through usage of a novel, robust framework aimed to guide interpersonal interactions. This form of training is feasible to implement across oncology nursing contexts; it is delivered as a one-time training event and can be administered both virtually and in-person. The need to increase engagement and promote retention in nursing remains paramount as the concern for the nursing shortage continues to rise, and the current training program addresses this need through targeting a core interpersonal nursing skill: communication.

Oncology Nursing Forum. 2025 Mar 1;52(2):409–410.

P702. Oncology Nurse-Led Virtual Group Patient Education Classes Across a Large Academic Healthcare System

Elizabeth Wright ¹, Maria Aduriz-Malbran ², Susan Hotchkiss ³, Maria Moura ⁴, Allison Pitts ⁵, Jennifer Spruyt ⁶

Patient Education

Significance & Background

Educating patients about their cancer treatment is a cornerstone of oncology nursing practice. Across our comprehensive cancer center, first treatment education is traditionally provided to patients and families during an in-person visit at one of our 16 locations. It was assumed this type of offering provides more personalized instruction. However, it requires significant nursing hours, space, and an additional patient visit. Growing challenges related to center capacity, nursing availability, and other demands were negatively impacting the consistency and quality of education delivered across the enterprise.

Purpose

To develop and provide standardized cancer therapy virtual group patient education offerings to increase 1) patient and family participation, 2) patient and nurse satisfaction, 3) infusion center capacity, and 4) organizational financial performance.

Interventions

An interprofessional steering committee was formed to develop disease-based and symptom-focused classes. Academic faculty and our Patient Family Advisory Council (PFAC) were also consulted. Collaboration with Information Technology and scheduling teams led to the development of a virtual class platform and multicenter scheduling process. An Epic telehealth group visit enabled classes. Two nurses conducted class, one teacher and one facilitator to monitor chat questions and assist with technical challenges. Post-class patient surveys were provided at the conclusion of class.

Results

During the first 3 months, 9 Breast and 5 Gastrointestinal focused classes were delivered to a total of 35 and 28 patients respectfully. Class attendance rate is 87%. Total nursing hours to teach these classes was 28 compared to the 63 hours that would be required with one-on-one sessions. Hours provided back to frontline nursing equaled 35 hours. Thus far, there is a 22% patient survey response rate revealing the majority of participants find the sessions very helpful.

Discussion

Nurse educators are enthusiastic about this new teaching method. Patients are actively participating in the sessions. In addition to telehealth training, nurses needed coaching on presentation skills and developing comfort with teaching formally to a group. Debriefing sessions held weekly allow teams to seek feedback from experienced educators on the steering committee and solve technical problems that arise. Based on the results of these 2 pilot offerings, intentions are to expand to other diseases such as Lung Cancer or content areas such as Advanced Care Planning. The project has successfully changed culture and bias against group education as impersonal and inferior.

Oncology Nursing Forum. 2025 Mar 1;52(2):410–411.

P703. Fostering Effective Long-Term (FELT) Between Oncology Nurses and Medical Students Learning and Relationships

Dee Wu ¹, Reema Moussa ², Cara Kelley ³, Caroline Preskitt ⁴, Kristen Squires ⁵, Tai Athay ⁶

Professional Development

Significance & Background

A newly implemented FELT program, inspired and developed by oncology nurses (ON) and medical students (MS), that incorporates think-pair-share opportunities has been developed. The literature review highlights the scarcity of such collaborative activities between experienced nurses and MS. One limitation could stem from the high demands of the medical field and the uncertain cost-benefit impact of participation.

Purpose

The FELT initiative emphasizes the mutual benefits for nurses and medical students through collaborative discussions on education, mentorship, and real-life and career-relationship building. Evaluated were the participant enthusiasm, discussion process, timing(quarterly), and identification of practical items which contribute to the overall benefit for the team.

Interventions

Starting with 3 nurses and 3 med students, which is gradually expanding to approximately 10 oncology nurses from our clinic. Content is focused on genetic testing, chemotherapy side effects, and practical job skills. We found that in-service is important to the implementation as it is designed to be conducted near clinical areas so that nurses and staff can participate with minimal disruption to their duties. Further, three forms of content to engage different modal learning styles are used during the in-service. These are diagrams/tables, visual mnemonics, and podcast summaries, as well as a combination of all three.

Results

The pilot has shown that the cost-vs-benefit score from surveys (0–1) from users was 0.76 for medical students and 0.84 for nurses. Of the types of materials utilized, visual mnemonics scored the highest, while podcasts showed the lowest scores. However, providing users with all three modalities of learning provided the greatest key benefits and was our final choice for application.

Discussion

Many nurses find mentorship enriching in their careers such as when providing guidance to patients and others. Sharing experiences with medical students is potentially therapeutic and enhances interprofessional exchange. For nurses, it offers additional rewarding mentorship and greater access to networks such as with early physicians and ONS mentors. For students, it provides learning from nurses, building alliances, and practicing skills beyond intense classwork and high-stakes testing. It is hypothesized that participants will show greater professional growth through FELT over time. This project is assessed through surveys, video analysis, and future access to the validated instruments we are working to procure. We are now anticipating growing the FELT program as the positive impacts on metrics have initially been demonstrated.

Oncology Nursing Forum. 2025 Mar 1;52(2):411.

P704. Establishing A Nurse-Led Research Infrastructure in a Safety Net Community Hospital

Debra Wujcik ¹, Faye Jornadal ², Susan Owenby ³, Alecia Fair ⁴

Healthcare Delivery

Significance & Background

Commission on Cancer accreditation is the quality hallmark for community cancer programs that meet standards based on the type of facility, program structure, services provided, and number of cases accessioned annually. A safety net hospital with an 83-year history of continuous accreditation was struggling to meet the requirement for >2% clinical trial (CT) enrollment per year. Despite partnering with academic institutions to refer patients for CT participation, barriers facing uninsured patients to receiving care at these partnering institutions persisted. To address this gap, the Chief Executive Officer (CEO) authorized an independent research department.

Purpose

To address this gap, the Chief Executive Officer (CEO) authorized the formation of an independent research department. This paper describes the essential components, processes, and early outcomes.

Interventions

A doctorally prepared oncology nurse researcher was contracted to assess physician interest and organizational readiness. A timeline with milestones was approved by the CEO and a program kickoff was held in September 2023. Year one goals included 1) hiring and training staff, 2) developing SOPs 3) dedicating infrastructure, and 4) opening 5 cancer treatment trials. Physicians with research interest but lacking clinical release time and experience in research administration were identified. A regular monthly meeting with department heads was started to educate the key stakeholders about clinical research and to plan for the needed staffing and equipment. Start-up funds were approved with the goal of securing funded studies to cover salaries and operations.

Results

A director of research (DOR) with CT and management experience was hired within the first quarter. The DOR continued the monthly meetings and began to meet with pharmaceutical representatives. The first selection for study participation occurred within the first six months, with several others quickly following. The first study opened to accrual 10 months after the DOR was hired and the first patient was enrolled by the end of the first year.

Discussion

To meet the research mission, the CEO of a safety net hospital determined an independent research department was needed. With careful planning and a measured approach, a nurse-led research infrastructure for CT was established. Key elements for success will be discussed including top-down organizational support, physician buy in, and experienced research leadership. Other strategies for success are budgeting to cover all research expenses, matching trials to the patient population, and ongoing organizational education.

Oncology Nursing Forum. 2025 Mar 1;52(2):411–412.

P705. Infusion-Related Reactions (IRR) and Management in Patients with Red Blood Cell (RBC) Transfusion-Dependent (TD) Relapsed or Refractory Lower-Risk Myelodysplastic Syndromes (LR-MDS) Treated with Imetelstat from the Imerge Phase 3 Trial

Donglan Xia ¹, Patrick Brooks ², Qi Xia ³, Shyamala Navada ⁴, Tymara Berry ⁵, Yazan Madanat ⁶

Treatment Modalities and Managing Administration

Significance & Background

Imetelstat, a first-in-class telomerase inhibitor, is approved in the United States for the treatment of patients with RBC-TD LR-MDS who relapsed or are refractory to or ineligible for erythropoiesis-stimulating agents based on the pivotal phase 3 IMerge trial (NCT02598661). IMerge demonstrated durable efficacy of imetelstat versus placebo for ≥8-week, ≥24-week, and ≥1-year RBC transfusion independence, with a generally manageable safety profile in this patient population (Lancet. 2024;403(10423):249–260).

Purpose

To describe the incidence and management of IRRs in IMerge.

Interventions

In IMerge phase 3, patients (imetelstat, n=118; placebo, n=59) were premedicated with an antihistamine (25–50 mg diphenhydramine or equivalent) and corticosteroid (100–200 mg hydrocortisone or equivalent). Imetelstat was infused every 4 weeks at 7.1 mg/kg (equivalent to 7.5 mg/kg imetelstat sodium) with monitoring for ≥1 hour after infusion. Grade (gr) 1 IRRs were managed symptomatically. Gr2–4 IRRs required infusion interruption: gr2 were managed symptomatically until resolution to gr1, gr3 required supportive care until resolution to gr1, and gr4 required imetelstat discontinuation. Dose modifications, supportive care measures, and treatment discontinuations were recorded.

Results

The most common premedication antihistamines and corticosteroids were dexchlorpheniramine, diphenhydramine, and chlorphenamine and hydrocortisone, dexamethasone, and methylprednisolone, respectively. Any-gr IRRs occurred in 9 (7.6%) imetelstat-treated patients and 2 (3.4%) placebo recipients (both gr1). Majority of IRRs with imetelstat were gr1–2 (77.8%) without any gr4 IRR observed. IRRs are not time dependent and may occur after >1 year (Table). The most common IRR in imetelstat-treated patients was headache (n=5 [4.2%]). There were no anaphylaxis/hypersensitivity IRRs. Median time-to-onset of the first IRR was 85 days (range, 1–603). Gr3 IRRs occurred in 2 (1.7%) imetelstat-treated patients, with a median time-to-onset of 107 days (range, 85–128). One gr3 hypertensive crisis event occurred during cycle 3 and 1 gr3 noncardiac chest pain event occurred during cycle 5; neither patient discontinued treatment due to IRRs. Recurrence of IRRs occurred in 4 (3.4%) imetelstat-treated patients. Treatment interruption due to IRRs occurred in 5 (4.2%) imetelstat-treated patients; all patients restarted treatment. Paracetamol/acetaminophen was the most used treatment for IRRs. Twenty-five of 29 (86.2%) IRRs in the 9 imetelstat-treated patients resolved within 1 day.

Discussion

Premedication led to a low overall IRR rate (7.6%). IRRs occurred at any time during treatment. Dose modification, supportive care, and monitoring were adequate to manage most IRRs without the need for therapy discontinuation.

Oncology Nursing Forum. 2025 Mar 1;52(2):412.

P706. The Special Family Cultural Manifestations of Terminally ILL Patients Influencing Hospice Care Practice: A Qualitative Study

Wang Xinru ¹, Sheng Yu ², Zhu Xinyu ³, Yuling Jia ⁴

End of Life

Significance & Background

During hospice practice, health care professionals need to continuously improve their ability to understand the thoughts and behaviors of patients and their families in a specific cultural context. Recognizing and respecting the cultural identity of patients and safely meeting their needs, expectations and rights are prerequisites for providing local hospice practices. Past reports on the practice of hospice in China from the cultural perspective were mostly reviews or literature studies, the phenomenological methods were seldom used to explore the cultural roots of the hospice practice. Therefore, the phenomenological method of qualitative study was adopted in this study. The patients with terminal disease, their families and the families of deceased patients were interviewed for the purpose of understanding the influence of Chinese culture on hospice practice.

Purpose

To explore the culture-specific issues encountered by medical staff, patients and their families in the clinical practice of hospice care in China.

Interventions

The purposive sampling method was adopted to select 8 terminally ill patients and 12 family members of terminally ill patients who were interviewed on the process of end-of-life treatments and care. The interview subjects were from three tertiary A hospitals, 2 community health service centers and 1 hospice hospital in Beijing during September 2021 to July 2022. The interview data were analyzed, categorized and thematically extracted by Colaizzi 7-step analysis method.

Results

Four themes and eight sub-themes were analyzed. The influences of cultural factors on hospice clinical practice were reflected in family decision participation and responsibility sharing under collectivism culture; the influence of moral and emotional integration under filial piety culture; personal emotional connection under reverse care on personal choice of disease care, life support and future affairs arrangement; the lack of end-of-life dialogue and interaction between patients and their families under the traditional view of life and death.

Discussion

Chinese culture is an important issue that cannot be ignored in the promotion of hospice care based on our experience and clinical practice. Medical staff should explore and provide appropriate and cultural safe hospice care centering on the three-party decision-making of doctors and patients and their families; reverse care and filial behavior between patients and families; family interaction on end-of-life topics.

Oncology Nursing Forum. 2025 Mar 1;52(2):412–413.

P707. Professional Development Through Nurse-Scientist Collaboration: Recruiting Black Patients with Colorectal Cancer for a Physical Activity Randomized Controlled Trial

Jingle Xu ¹, Marco Fajardo ², Tammy Triglianos ³, Andrea Fulcher ⁴, Emma Stewart ⁵, Rachel Hirschey ⁶

Professional Development

Significance & Background

Black patients are underrepresented in oncology research due to poor racial considerations in study methodology, medical mistrust, and structural healthcare injustice. Despite this inequity, nurse practitioner (NP) students receive limited training to promote health equity in oncology research and practice. By collaborating with a research team led by a nurse scientist to improve physical activity (PA) among Black patients newly diagnosed with colorectal cancer (CRC), NP students develop research and health equity advocacy skills, potentially enhancing the translation of evidence-based practice.

Purpose

To develop and evaluate a research practicum for NP students to gain direct training in research and health equity in a research study targeting Black patients with CRC under an NCI-Designated Cancer Center.

Interventions

NP students in a master’s program enrolled in a research practicum over one to two academic semesters, which included 60 hours of hands-on experience in a health equity research study and a final critical reflection using the Describe, Examine, and Articulate Learning (DEAL) Model, under the mentorship of nursing faculty with expertise in health equity and oncology. The 60-hour practical training included:

■ Health equity training.
■ Immersion into the research protocol.
■ Recruiting and screening Black patients.
■ Informed consent.
■ Engagement with local advocacy groups.
■ Adapting research methods to the unique needs of Black patients.

One critical reflection was done at the end of the practicum using the DEAL Model. Thematic analysis was used to identify recurring themes in the critical reflection data.

Results

We identify themes representing NP students’ observations on health equity research, interactions with underserved patient populations, research study protocols, advocacy group engagement, application of research skills to future clinical practice, and their overall professional development. We also identify the screening, consent, enrollment, and refusal rates of the research study in addition to the reasons for refusal and eligibility.

Discussion

The health equity research practicum is a testament to the power of collaboration in professional development. It directly immerses NP students in collaborative research and advocacy efforts, fostering a mutually beneficial relationship between students and nurse scientists. This collaboration enhances NP students’ ability to engage with study participants through a health equity lens, improve research outcomes, and advance evidence-based practice. Looking ahead, future studies could expand to include practicums focused on additional underrepresented oncology patient populations such as Hispanics and Adolescents & Young adults.

Oncology Nursing Forum. 2025 Mar 1;52(2):413–414.

P708. Perceptions of Cervical Cancer Prevention Improved After Interactive Education in Northwest Nigeria

Mfuh Yafeh ¹, Christopher Lukong ², Clara Ejembi ³

Radiation

Significance & Background

Cervical cancer poses a significant public health challenge in Nigeria, where it remains a leading cause of cancer-related deaths among women. Low awareness, widespread misconceptions, and stigma surrounding cervical cancer and its prevention exacerbate this problem, leading to underutilization of critical preventive measures such as screening and vaccination. In Northwest Nigeria, where health and educational infrastructure are less developed, young women particularly students are at risk due to their limited knowledge about cervical cancer. This lack of awareness impedes informed decision-making and timely medical intervention, highlighting the need for effective educational strategies.

Purpose

To evaluate the impact of an interactive cervical cancer prevention education program on the perceptions of female students in selected institutions in Northwest Nigeria. The study aimed to determine whether this intervention could enhance students’ understanding of cervical cancer, its prevention, and the importance of early detection, thereby promoting positive health behaviors.

Interventions

This involved an interactive educational program that included participatory learning sessions and Focus Group Discussion s (FGDs). These sessions actively engage students, allowing them to assess and expand their existing knowledge, correct misconceptions, and learn about cervical cancer prevention in a supportive setting. Topics covered included causes and risk factors of cervical cancer, the significance of regular screening and vaccination, and strategies to overcome barriers to prevention. The participatory approach encouraged students to ask questions, share insights, and engage in peer and facilitator discussions, while FGDs provided a platform to explore perceptions and address persistent concerns.

Results

The study revealed a significant improvement in students’ perceptions of cervical cancer prevention post-intervention. Before the program, only 40.6% of students had positive perceptions, 25.0% held negative views, and 34.4% were undecided, with an aggregate mean score of 1.06. After the intervention, positive perceptions increased to 64.1%, negative perceptions decreased to 22.1%, and the undecided group reduced to 13.8%, demonstrating the effectiveness of the educational program.

Discussion

This study underscores the effectiveness of interactive educational programs in enhancing awareness and perceptions of cervical cancer prevention among young women in Northwest Nigeria. The significant shift in perceptions following the intervention highlights the value of participatory and culturally relevant health education. Expanding such programs could significantly reduce cervical cancer rates and mortality in Nigeria, emphasizing the need for sustained educational efforts to ensure long-term behavioral change and increased use of preventive services.

Oncology Nursing Forum. 2025 Mar 1;52(2):414.

P709. A Weighty Matter: Improving Oncology Patient Care Through Evening Assessments

Robert Yeranosyan ¹, Philip Tu ²

Quality and Safety

Significance & Background

Daily weights are a crucial component of care for oncology patients, particularly those undergoing chemotherapy. Weight assessments are essential for determining appropriate chemotherapy dosages and monitoring fluid retention. This academic inpatient unit specializes in hematological oncology, focusing on chemotherapy, immune therapies, and cellular therapies. However, the unit faced challenges in obtaining daily weights due to patient refusals between 5 and 7 a.m., with feedback indicating that this early timing disrupted patients’ sleep hygiene. As a result, treatments were delayed, and weights were missed. To address this issue, the nursing team implemented a change to nightly weights taken between 8 and 10 p.m. This adjustment aimed to enhance patient compliance while ensuring that staff utilized either the maxi-move or standing scale for accurate weight measurements.

Purpose

The purpose of this project was to increase patient compliance with daily weight assessments by shifting the measurement timeframe from early morning to evening.

Interventions

Several strategies were employed to promote compliance with weight assessments:

■ Nursing staff were instructed to check daily weights between 8 and 10 p.m.
■ In cases of patient refusal, a clear escalation process was established: the Certified Nursing Assistant (CNA) would notify the Registered Nurse (RN), who would inform the charge nurse, followed by the manager, and ultimately, the oncology team during rounds if further intervention was needed.
■ Nursing staff were required to use a maxi-move or standing scale for the most accurate weight measurements.

Results

The effectiveness of the intervention was assessed by analyzing data from Electronic Medical Records (EMR). Before the implementation of the new weight protocol, compliance from September 2021 to September 2022 stood at 94%. After implementation, the compliance increased to 98%.

Discussion

This nurse-led initiative has the potential to significantly improve patient care by enhancing compliance with daily weight monitoring, thereby optimizing chemotherapy dosing and fluid management. By fostering better sleep hygiene and respecting patients’ preferences, this approach not only supports clinical effectiveness but also prioritizes the well-being of patients in an already challenging environment. This project exemplifies the positive impact of innovative nursing practices on patient outcomes and the quality of care in oncology settings.

Oncology Nursing Forum. 2025 Mar 1;52(2):414–415.

P710. Turning the Tide: How One Unit Fights Clabsi While Expanding its Oncology Population

Robert Yeranosyan ¹, Philip Tu ², Zenith Chua ³

Management

Significance & Background

Established three years ago to meet rising oncology demands, this academic hematology-oncology unit has experienced significant success in growing its services. Despite this success, the unit now faces a challenge: an increase in central line-associated bloodstream infections (CLABSI).

Purpose

Through innovations and collaborations, the nursing leadership leads the efforts to combat CLABSI by introducing bundle compliance, enhancing hand hygiene practices, and creating a culture shift.

Interventions

The following strategies have been implemented to create lasting practice changes within the unit:

■ Enhancing Bundle Adherence: Leadership introduced e-learnings, changes to the CHG bath process, and daily bundle audit tools focusing on individual elements for central line maintenance.
■ Improving Hand Hygiene Compliance: Leadership utilized innovative technology (Ecolab) to track and enhance hand hygiene performance.
■ Creating a Culture of “Central Line-Centered Care (CLCC):” Leadership provides full support for nursing-led CLABSI reduction initiatives.

Results

The following data are being measured to evaluate the effectiveness of our interventions:

■ CLABSI Standard Infection Ratio (SIR): 1.06 (FY24) vs. 1.22 (FY23), representing an 8% reduction. Zero CLABSI cases were reported from July to September 2024.
■ Number of CHG Bath Refusals: 47 (FY24) vs. 208 (FY23).
■ Hand Hygiene Compliance Rate: 77% (Ecolab) vs. 57.4% (Pre-Ecolab).
■ Daily Bundle Audits Tool Completion Rate: 100% since the tool’s introduction.
■ Nurse-Led CLCC Initiatives: Four initiatives presented at ONS from 2022 to 2024.

Discussion

The rapid expansion of our unit has led to an increase in central line days and higher patient acuity. With many competing priorities, we carefully implemented our interventions based on a shared governance model. This model ensured that all voices were heard and that our interventions were grounded in a collaborative approach. By doing so, we successfully fostered a sense of ownership and accountability within our team. Furthermore, we aimed to deliver our data in real-time. For example, by utilizing innovative data collection programs, we were able to share CHG compliance and hand hygiene data with our staff within the same shift. Lastly, we placed a strong emphasis on staff recognition. We developed recognition programs to celebrate our milestones, both big and small. This approach has led to high staff satisfaction, which in turn has contributed to improved patient outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):415–416.

P711. Development of A Person-Centered Health Coaching Program for Cancer Patients Receiving Chemotherapy

Hyun mi You ¹, Eun Young Park ²

Patient Education

Significance & Background

Chemotherapy causes physical and psychological side effects, which reduces the quality of life of cancer patients. Therefore, it is important for oncology nurses to perform the role of person-centered care that strengthens the self-efficacy of cancer patients and provides appropriate nursing care tailored to the individualized needs of patients. Additionally, a way to provide efficient nursing care is through patient-centered coaching.

Purpose

This study developed a health coaching program based on person-centered nursing theory tailored to the supportive care needs of cancer patients receiving chemotherapy by applying the ADDIE model.

Interventions

The program consisted of face-to-face coaching (3 times) and phone coaching (4 times) for a total of 270 minutes in 7 sessions from the time of treatment planning to the start of the second chemotherapy. The program consists of chemotherapy management knowledge for the health system & information needs, psychological intervention for psychological needs, lifestyle habits, and discovery of the meaning and value of life. The purpose of this program is to help change positive perception of body and mind health management and chemotherapy by understanding oneself and setting and implementing individual, step-by-step goals. To verify the effectiveness of the program, 17 patients planning to receive chemotherapy from July 1 to September 16, 2023 participated in a single-group before-after design, and the final 15 patients completed the program.

Results

The result of this study, self-efficacy, quality of life, and the oncology patients’ perception of the quality of nursing care improved compared to before the program. The self-efficacy (t=5.60, p <.001), emotional state of quality of life (t=3.31, p=.005), and the oncology patients’ perception of the quality of nursing care (t=8.13, p <.001) were statistically significant difference.

Discussion

This program was confirmed to be a practically applicable intervention that can improve the self-efficacy of cancer patients receiving chemotherapy, improve their quality of life following treatment, and provide a good nursing experience. We suggest researchers to verify the effects of the program using a controlled study with a large sample of cancer patients receiving chemotherapy. Additionally, it will be necessary to establish a system to help cancer patients efficiently self-manage, as well as to establish specialized training courses and develop counseling costs for cancer patients to self-manage.

Oncology Nursing Forum. 2025 Mar 1;52(2):416.

P712. Implementation of Urgent Palliative Care Consultation

Rebecca Youngling ¹, Grace Maurer ², Kasey Bowden ³

Coordination of Care and Navigation

Significance & Background

In an outpatient oncology urgent care clinic within an academic medical center a trend was noted among patients with significant symptom burden without an established relationship with a palliative care provider. These patients had 33% imminent mortality if they were seen in the oncology urgent care clinic three or more times a month. Due to limited availability of palliative care appointments, these patients were more likely to be hospitalized and die in the inpatient setting due to symptom burden beyond the abilities of outpatient management.

Purpose

This project’s purpose was to increase awareness of patients with significant symptom burden and improve timely access to palliative care services.

Interventions

To address limited access to outpatient palliative care, an advanced practice provider was embedded in the oncology urgent care clinic to offer urgent consultation for appropriate patients. Nurses began tracking how many times patients were seeking symptom management appointments. Once a patient requested their third visit of the month, the nurse alerted the primary oncologist or the oncology urgent care provider to place a referral to the embedded urgent palliative care provider.

Results

Between December 2023 and September 2024, the urgent palliative care clinic saw 62 patients. Of the 26 who passed away, 23 were enrolled in hospice prior to their death. On average, the time from an urgent palliative care visit to death was 38 days. During this period, hospitalizations for symptom management reduced with only one being deemed preventable.

Discussion

Identifying and advocating for at-risk patients has improved quality of care at the end of life and decreased inpatient mortality. Additionally, oncology patients have experienced less suffering. Plans are in place to increase the availability of urgent palliative care appointments.

Oncology Nursing Forum. 2025 Mar 1;52(2):416–417.

P713. Addressing Moral Distress and Emotional Challenges in Oncology Nursing: A Peer Support Group Initiative

Fatemeh Youssefi ¹, Rachel Kelley ², Paul Yu-Angel ³, Rev Paul Yu-Angel ³

Professional Development

Significance & Background

Moral distress occurs when nurses know the ethically correct action but are constrained from taking it. Oncology nurses face this distress in addition to compassion fatigue, burnout, emotional labor, and mental health struggles due to the mounting responsibilities they shoulder. Factors triggering moral distress include constant exposure to suffering, end-of-life decisions, and staffing issues. This is a growing cause for nurses to leave their professions prematurely.

Purpose

Neglecting emotional conversations or lacking knowledge to handle moral distress can lead to physical and mental symptoms like abdominal discomfort, headaches, and social withdrawal. Historically, nurses have adopted unhealthy behaviors to cope, such as detachment and lack of motivation. Addressing these issues effectively is crucial for the wellbeing of nurses. Oncology nurses, in particular, need support due to their specialized training and the daily risks they face.

Interventions

A peer support group was formed by nursing leadership in 2016 at an academic healthcare institution. By 2022, it expanded to include chaplains, doctors, social workers, and more. This initiative provides a safe space for staff to discuss the challenges they are facing. Facilitators receive comprehensive training, including a four-hour session and three real-time shadowing sessions to gain mastery of communication with participants. This peer support group is in high demand, with oncology staff requesting more sessions. Since January 2024, there have been 11 sessions for outpatients teams and eight sessions for inpatient teams, averaging 10 participants per session, with 50% being oncology nurses. Resources provided include the ONS PODCAST, self-care interventions, spiritual support, one-on-one sessions, and Employee Assistance Programs.

Results

The program’s success is evident from the testimonies of nurses who attended the sessions and the follow-up requests. Sessions often start with nurses expressing feelings of being close to quitting and end with gratitude for the support provided. Comments like “Thank you for being here for us and listening to us” and “Having this space really helps me de-stress” highlight the program’s impact. Providing this resource helps alleviate mental anguish, ultimately leading to increased retention of oncology nurses.

Discussion

Oncology nurses face life and death situations daily, leading to significant stress. The physical demands and continuous learning required to provide the best care to patients can be overwhelming. Support initiatives like this offer oncology nurses a chance to explore and share emotions in a safe space.

Oncology Nursing Forum. 2025 Mar 1;52(2):417.

P714. Testicular Cancer Awareness

Eric Zack ¹

Screening, Early Detection, Genomics

Significance & Background

Testicular cancer is a rare disease that often affects young men compared to most other cancer types. Despite its very high cure rate using traditional treatment modalities such as surgery, radiation, and chemotherapy, a testicular cancer suspicion and/or diagnosis can cause serious psychological stress, fear, and anxiety that contribute to its morbidity in an otherwise healthy person. Oftentimes, these concerns are not addressed or outright ignored. It is important to bring awareness to this possibility and help younger men become more comfortable with discussing these concerns privately and/or publicly in a safe learning environment.

Purpose

Not knowing their risks can lead to delays entering the healthcare arena which might result in a later staged cancer, which then becomes more challenging to effectively treat and cure.

Interventions

This oncology nurse volunteered his time and expertise to partner with a non-for-profit community organization and offered free health education about testicular cancer to young high school men in the Chicagoland area. This community organization had already developed strong relationships with many of these high schools and supplemented specific health education and awareness programs as part of that school’s health education series. The young men were enrolled in their usual heath class and were typically separated from their female classmates into different rooms where testicular cancer was presented and discussed. The health education was paired with a testicular cancer survivor who shared his past experiences fully knowing he had survived and was well today despite having this serious disease in the past. Each session allowed time for questions and answers for both the health care expert and the survivor to address.

Results

Standardized qualitative and quantitative surveys were completed by the students at the end of the program that offered feedback to the medical expert, the cancer survivor, and the community organization to measure its program impact and suggestions to improve the program.

Discussion

Most male high school students found the program to be helpful, effective, and interesting having not been exposed to this information in the past. However, a small proportion of students did not respond well to the graphic nature of what was discussed. Anecdotally, a couple of students were diagnosed with an early staged testicular cancer shortly after our awareness campaign, which likely resulted in a minor surgical intervention to obtain a cure.

Oncology Nursing Forum. 2025 Mar 1;52(2):417–418.

P715. Carcinogenesis for Public Education

Eric Zack ¹

Patient Education

Significance & Background

The process of carcinogenesis is very complex and not yet fully understood. What we do know is that exposure to certain chemicals and/or substances called carcinogens can initiate DNA damage inside cells that then alters the genes that control the cell division cycle. Proto-oncogenes and tumor suppressor genes can be adversely affected. Sometimes, exposure to these cancer-causing substances occurs unknowingly and/or by accident. However more commonly, these substances enter our bodies through purposeful lifestyle behaviors and choices in a recurring fashion. Preventative strategies that focus on increasing public awareness through education, health fairs, and volunteerism as well as professional advocacy are essential for the health, safety, and well-being of our fellow human beings. Most lay people have very little understanding of the linkages and the consequences of what they allow inside their bodies that can possibly lead up to cancer development.

Purpose

This presentation will briefly describe the role of specific carcinogens in the process of carcinogenesis, specifically regarding altering proto-oncogenes and tumor suppressor genes and with other pertinent hallmarks of cancer. Scientific explanations on why a cancer might not respond to therapy, relapse, and progress despite treatment or even change completely to another form will be explained.

Interventions

This presentation will share valuable and reliable resources of information for the oncology nurse to utilize while performing health promotion and cancer prevention strategies geared for the public’s benefit and to increase awareness. Patients are usually more open to receiving heath information from oncology nurses compared to most other health care providers.

Results

There are approximately 63 to 122 substances known to cause human cancer with hundreds more thought to be probable causes according to most recent reports from the National Toxicology Program (NTP) and the International Agency for Research on Cancer (IARC) respectively. Many of these substances exist in our environment, our food supply, and in things we consume or ingest; and many are legal for purchase in the Unites States. In contrast, other known substances are available that can offer some protection by blocking and/or repairing these altered genes.

Discussion

Although cancer development cannot be completely avoided, purposeful adjustments to our lifestyle choices can have a potentially significant beneficial impact, safeguard our bodies from these DNA alterations, and ultimately lessen the risk of cancer in most individuals.

Oncology Nursing Forum. 2025 Mar 1;52(2):418.

P716. Establishing a Nursing Competency to Manage Research Patient’s Implanted Vascular Access Device to Help Further Define the Role and Duty of the Clinical Research Nurse

Tracey Zahn ¹, Victoria O’Flynn ², Jamie Littleton ³

Management

Significance & Background

The Clinical Research Nurse (CRN) role is developing rapidly in tandem with oncology clinical trial evolution. Lack of defining characteristics of the CRN role has been identified as a continuing source of conflict as CRNs are currently being hired into practice to support the complex patient care needs of clinical trials without formal competency programs in place. This piloted implanted vascular access device (IVAD) training program is the first incorporated nursing skill to support a model where CRNs provide comprehensive direct care to clinical trial patients. This CRN IVAD pilot begins to define one of the many roles and duties compulsory of the oncology CRN.

Purpose

This project’s purpose was to establish CRN participation in managing IVADs of research patients and define CRN competencies. This pilot marries fundamental nursing skills with clinical trial expertise. CRNs will be the resource expert when providing both research and standard of care for all IVAD oncology research participants.

Interventions

CRNs were given nursing policies and procedures as self-directed electronic training to review and sign off. CRNs were then partnered with an infusion nurse for a 4-hour shift to solidify skills and demonstrate competency. In addition, electronic medical record documentation training was provided for CRNs. Supplemental hands-on training was provided if warranted. A procedural resource binder was created for reference. CRNs are assigned a rotating schedule to cover IVAD access for research patients.

Results

Establishing a nursing competency to manage research patient IVADs and help further expand the role of the CRN in clinical trials positively impacts CRNs by creating role definition and specific nursing skill application. IVAD training marks the first defined clinical nursing skill competency required for CRNs hired. In addition to the complex ethical and educational skills required by CRNs, IVAD management has successfully started a larger process to further expand the competencies of CRNs.

Discussion

The role of the CRN is new in the institution and continues to be developed with the goal to use the nurses to their full potential. In piloting this project, the CRN role is further being defined and positively impacting the way oncology CRNs are delivering direct research patient care. This project is expected to improve patient outcomes and promote evidenced-based practice for nursing.

Oncology Nursing Forum. 2025 Mar 1;52(2):418–419.

P717. Providing Culturally Sensitive Care: Development of a Supportive Care Clinic for Mandarin/Cantonese Speakers With Cancer

Kaifan Zhao ¹, Carey Ramirez ², Jeannine M Brant ³

End of Life

Significance & Background

Communication is a significant concern for Mandarin/Cantonese speakers with cancer. While translation apps can facilitate conversations between clinicians and Asian patients, inaccuracies exist. For example, some words have a word-for-word translation from Mandarin/Cantonese to English such as cardiology; however, supportive/palliative care (SPC) translations can be misleading and can mean to connive, tolerate, or appease another person. A complete translation of SPC requires a full paragraph of Chinese characters for complete understanding. To learn more about the local populations’ perspectives on SPC, a Mandarin/Cantonese NP within the organization conducted a community survey of 100 Mandarin or Cantonese speaking persons at a local supermarket. Only 2 persons understood the meaning of palliative/supportive care; 14 thought it was synonymous with end-of-life care, and 84 were unaware of the meaning. These data illustrate a clear need for a culturally sensitive SCP clinic.

Purpose

The purpose of this presentation is to describe the development and initial outcomes of a Nurse Practitioner (NP)-led SPC Clinic for Mandarin/Cantonese speakers at a large National Cancer Institute designated cancer center in southern California. While approximately 2500 Mandarin/Cantonese speakers are seen each year, very few accepted consultations for supportive care.

Interventions

A Mandarin/Cantonese speaking NP recognized the challenges of Mandarin/Cantonese speakers with cancer who would benefit from SPC and collaborated with colleagues to become the provider of choice for these patients. The provider was able to provide language-sensitive care to better explain SPC, fully assess/manage symptoms and suffering, discuss advance directives and decision-making, and make referrals to Hospice that provides bilingual service if indicted.

Results

Over the past year, 52 patients were seen in the clinic; 40 Chinese, 10 Taiwanese, and 2 others. Mean age was 63.1 (SD 12.3), range 46–91 years of age; 52% were male. The most common cancer diagnoses were lung cancer (30.8%) and gastrointestinal cancer (28.8%). Only 4/52 understood the meaning of palliative care. Advanced directives were discussed with 86.5% of patients; 13.3% completed an advanced directive. 94% did identify a surrogate decision-maker for care.

Discussion

This is an early effort to provide culturally appropriate care to Mandarin/Cantonese speakers. Future work will focus on capturing language specific patient-reported outcomes, collaborating with community-based bilingual home health/hospice agencies, precepting bilingual NP and RN students from local universities, and exploring reasons why patients remain reluctant to complete advance directives.

Oncology Nursing Forum. 2025 Mar 1;52(2):419.

P718. Impact of Breathing/Grounding Exercises on Nurse Stress Levels: A Three-Month Study

Jean Zissler ¹

Professional Development

Significance & Background

Oncology Nurses are often subjected to high levels of stress due to the nature of their profession. The physical, emotional, and mental demands of patient care, combined with long shifts and frequent high-stakes decision-making, create an environment where stress can be overwhelming. Stress management is critical for maintaining the well-being of Oncology Nurses and ensuring optimal patient care.

Purpose

This study seeks to address a crucial gap in stress reduction strategies tailored for nursing professionals. By implementing a simple, time-efficient breathing/grounding exercise at the start of each shift, this project aims to empower nurses with tools to manage their stress in real-time.

Interventions

This project involves a structured breathing/grounding exercise, implemented at the start of each work shift over a three-month period. The intervention will include the following steps: 1. Pre-intervention survey: prior to beginning the intervention, all participating nurses will complete a baseline survey assessing their current stress levels, with questions focused on how they feel at the start of their shifts and throughout the workday. 2. Breathing/grounding exercise: At the beginning of each shift, all nurses will participate in a guided exercise lasting 3 minutes using the 4-4-4-4 breathing method. The lights are turned down and the use of meditation music and chime bells are used as well. This practice is designed to promote relaxation, calmness and mental focus. 3. Daily implementation: the breathing/grounding exercise will be performed at the start of each shift for a total of three months. 4. Post-Intervention Survey: At the end of the three-month period, nurses will be asked to complete the same four-question survey used at the start of the project. The survey will assess any changes in their perceived stress levels and overall wellbeing. 5. Data Collection and Analysis: the results of the pre and post intervention surveys will be compared to assess the impact of the breathing/grounding exercise on Oncology Nurses stress levels.

Results

The breathing/grounding exercise appears to have had a positive effect on reducing high stress levels among the Oncology Nurses.

Discussion

(See graph and discussion attached) This suggests that the intervention had a beneficial impact on the overall workplace stress environment for Oncology Nurses.

Oncology Nursing Forum. 2025 Mar 1;52(2):419–420.

P719. Transition of Research Participants from Clinical Trials to ssIND Protocols: The Clinical Research Nurse Role

Danielle Zubka ¹, Mark Jones ², Sara Whittington ³, Terease Waite ⁴

Coordination of Care and Navigation

Significance & Background

A research sponsor notified the Research Team of the discontinuation of its Phase I/II single-agent trial. Participants receiving ongoing clinical benefit from the trial’s investigational product (IP) were given the opportunity to transition to a post-trial access program (PTAP). The Research Team determined the most efficient manner to continue providing IP was the creation of individual single-subject investigational new drug (ssIND) applications. Once transitioned to the PTAP, participants would receive IP via individualized treatment protocols (ITP). The clinical research nurse (CRN) functioned as the Research Team’s nexus for the PTAP by collaborating with the Regulatory Manager (RM) and several Cancer Center departments to execute the ssINDs.

Purpose

Establish the role and workflow of the CRN in facilitating uninterrupted provision of IP via a PTAP to three research participants through the development and implementation of ssINDs.

Interventions

The CRN collaborated with the RM and internal and external stakeholders to ensure the trial’s transition to ssINDs by:

■ Notifying participants of the trial discontinuation, confirming ongoing interest in receiving IP, and providing reassurance of the process
■ Drafting ITPs for principal investigator approval and RM submission to the FDA and Cancer Center Institutional Review Board
■ Creating order sets for IP administration
■ Ordering IP and managing inventory
■ Ensuring continued treatment access in the investigational infusion unit (IIU) to maintain continuity of care
■ Training IIU staff on updated protocol interventions and nursing management
■ Securing reimbursement funding to offset travel costs associated with research visits

Results

Over the six-month transition of the trial to ssINDs:

■ The ITPs were implemented as intended and without interruptions in clinical care
■ Workflows for aligning stakeholders’ essential roles to mobilize PTAPs were established
■ The multidisciplinary care team gained skills and knowledge necessary to care for participants receiving treatment via ITPs
■ CRN responsibilities in PTAP transitions were defined
■ Participants’ monthly disease response assessments indicated continued clinical benefit of the IP

Discussion

The CRN played a pivotal role in providing appropriate PTAP access to clinical trial participants. Establishing distinct CRN responsibilities was crucial in ensuring the engagement of necessary stakeholders and adherence to clinical and administrative demands. Collaboration between the CRN and RM was paramount in leveraging Cancer Center resources and coordinating transitions in the participants’ clinical care. The workflow instituted throughout this process can serve as a framework to guide CRNs through future PTAP transitions.

Oncology Nursing Forum. 2025 Mar 1;52(2):420–421.

P720. Rising to the Challenge: Outcomes of Embracing a Career Transition

Jennifer Zwink ¹

Professional Development

Significance & Background

It is vital for nurses at all levels of practice to be flexible and open-minded. This nurse leader recognized the potential to have a tangible positive impact by embracing a new role, even if it was different from the path they thought they wanted their career to take. A reorganization at a large academic medical center resulted in the creation of a Senior Director of Oncology Services position.

Purpose

This presentation will describe how a former Associate Chief Nursing Officer (ACNO) utilized a growth mindset to successfully transition into a new role and lead work that resulted in exemplary patient outcomes.

Interventions

The nurse leader started by developing relationships and assessing needs. Structures and processes were created for the oncology service line to excel. Examples include the initiation of strategic planning retreats, the origination of two new nursing director positions, and implementation of shared governance department-based councils. This nurse leader fostered the expansion of a culture of safety by addressing scope of practice concerns, hardwiring procedural time-outs, celebrating good catches, and ensuring safety event loop closure.

Results

A 100% overall increase of safety event reporting was seen rising from 150 to 300 events per month. The creation of a Mortality Committee with monthly case reviews and a Chemotherapy Quality Improvement Committee contributed to the organization moving up 27 spots in the US News and World Report Cancer rankings. A dedicated oncology urgent care clinic was expanded resulting in a 55% improvement in decreasing avoidable ED visits. Standardizing work across 22 infusion clinics increased patient access and timeliness of treatment by decreasing select appointment times from 60 to 15 minutes, thus increasing chair utilization time from 62% to 89%. Focusing on medication safety led to BD Alaris™ pump integration, bar code scanning, and arm banding. Clinical nurses were supported and empowered to complete projects such as developing workflows for oral chemotherapy medication adherence monitoring.

Discussion

Positive outcomes cannot be realized without the nurse leader embracing change personally and supporting others through change. Leading based on a desire to fulfil the organizational mission to improve lives resulted in improved patient outcomes and increased nurse empowerment.

Oncology Nursing Forum. 2025 Mar 1;52(2):421.

I1. Updated Efficacy and Safety Results from Checkmate 67T: Subcutaneous (SC) VS Intravenous (IV) Nivolumab (NIVO) in Patients with Previously Treated Advanced or Metastatic Clear Cell Renal Cell Carcinoma (CCRCC)

Daniel Adamczyk ¹, Maria T Bourlon ², Laurence Albiges ³, Mark Breckenridge ⁴, Zhuoxin Yu ⁵, Saby George ⁶

Treatment Modalities and Managing Administration

Significance & Background

The evolving treatment paradigm in oncology has created an unmet need for administration options to improve patients’ treatment experience and reduce healthcare inefficiencies. SC delivery may address these challenges and is typically preferred by patients over IV delivery (O’Shaughnessy et al. Eur J Cancer 2021; Lonardi et al. ESMO 2022). CheckMate 67T (NCT04810078) is an ongoing multicenter, randomized, open-label, phase 3 study comparing NIVO SC and IV in previously treated patients with advanced/metastatic ccRCC. Primary efficacy and safety results (8 months’ minimum follow-up) were previously presented (ASCO GU 2024; ASCO 2024).

Purpose

Provide updated efficacy and safety results from CheckMate 67T after extended 15-months’ minimum follow-up.

Interventions

Patients were randomized 1:1 to receive either NIVO SC 1200mg + recombinant human hyaluronidase PH20 Q4W or NIVO IV 3mg/kg Q2W until disease progression, unacceptable toxicity, consent withdrawal, completion of 2 years’ treatment, or death.

Results

In total, 495 patients were randomized into NIVO SC (n=248) or NIVO IV (n=247) arms. Baseline characteristics were balanced between arms. Consistent with the primary analysis, after 15 months of follow-up, efficacy was similar for NIVO SC vs IV, including objective response rate (26.6% [95% CI, 21.2–32.6] vs 20.6% [15.8–26.2]) and median progression-free survival (6.3 [5.1–7.5] vs 5.7 [5.2–7.4] months). Overall survival rate (95% CI) at 12 months was 72.4% (66.2–77.6) and 72.9% (66.7–78.2) with NIVO SC and NIVO IV, respectively. The safety profile of NIVO SC remained consistent vs NIVO IV, with no new safety signals identified and comparable rates of adverse events (AEs) between the arms: AEs, 93% (230/247) vs 94% (231/245); treatment-related (TR) AEs, 62% (152/247) vs 66% (161/245). TR local injection site reactions (LISRs) occurred in patients in both SC (7%, 18/247) and IV (2%, 5/245) arms. In the SC arm, most patients with LISR (17/18) experienced grade 1 reactions, whereas in the IV arm, most patients with LISR (4/5) had grade 2 reactions. In both arms, a similar proportion of patients with TR LISRs required medication: NIVO SC, 2% (5/247); NIVO IV, 2% (5/245).

Discussion

Efficacy and safety profiles of NIVO SC in this analysis were comparable with NIVO IV, consistent with the primary analysis. These updated results continue to support NIVO SC as a new option with reduced administration time (<5 min) to improve patient experience and healthcare efficiency.

Oncology Nursing Forum. 2025 Mar 1;52(2):421–422.

I2. Nursing Best Practices and Adverse Event Management for Patients Receiving Patritumab Deruxtecan (HER3-DXD) In The Herthena-Lung01 Study

Linda Ahn ¹, Jodie Pindulic ², Becky Tombleson ³, Esther Adeyinka ⁴, Michelle Munroe ⁵

Symptom Management and Palliative Care

Significance & Background

The treatment landscape for EGFRm NSCLC following progression on an EGFR TKI and platinum-based chemotherapy is fragmented and suboptimal and represents an area of high unmet need. HERTHENA-Lung01 was a phase 2 study in patients with advanced or metastatic EGFRm (ex19del; L858R) NSCLC that progressed following at least two lines of treatment, one of which was a third-generation EGFR-directed TKI. In HERTHENA-Lung01, HER3-DXd demonstrated an overall response rate of 29.8%, with a median duration of response of 6.4 months and a median progression-free survival of 5.5 months. While toxicity was considered manageable, adverse events (AEs) occurred during the study that necessitated support from the multidisciplinary team. Nurses and nurse practitioners (NPs) play a critical role in managing AEs associated with HER3-DXd throughout the course of the treatment journey.

Purpose

To review monitoring strategies and clinical management of key AEs (ie, nausea/vomiting, hematologic toxicities, interstitial lung disease [ILD], fatigue, and alopecia) associated with HER3-DXd.

Interventions

Nurses/NPs managed AEs within the parameters of the HERTHENA-Lung01 protocol, deferring to institutional guidelines where appropriate. Their perspective regarding best practices and implications of care specific to the management of AEs associated with HER3-DXd administration was collected and reported here.

Results

Nurses/NPs highlighted that the most clinically significant AEs associated with HER3-DXd administration were nausea/vomiting, hematologic toxicities, ILD, fatigue, and alopecia, with the highest occurrence of grade 3 or higher AEs being hematologic toxicities (thrombocytopenia, 20.9%; neutropenia, 19.1%; anemia, 15.1%; and leukopenia, 9.8%) and provided their perspectives in managing AEs in patients receiving HER3-DXd. Overall, 41.3% of patients had a dose interruption due to an AE; however, there was a low rate of treatment discontinuation (8.4%). The care provided by nurses/NPs not only optimizes the experience of patients receiving HER3-DXd but may also contribute to treatment adherence by quick and effective management of AEs that, without intervention, could lead to treatment interruption and/or discontinuation.

Discussion

Nurses/NPs, as part of the multidisciplinary team, play a critical role in the management of patients’ AEs. Through education, counseling, and provision of care where appropriate, nurses/NPs were able to manage patient expectations, enhance knowledge, and assist in home management of significant AEs, contributing to an optimal patient experience while receiving treatment with HER3-DXd.

Oncology Nursing Forum. 2025 Mar 1;52(2):422–423.

I3. Development of the Barriers and Facilitators of Chronic Cancer Pain Self-Management Instrument: A Mixed Method Study

Batool Almasri ¹

Symptom Management and Palliative Care

Significance & Background

Minimizing barriers to chronic cancer pain self-management and maximizing facilitators is crucial to improved pain outcomes for cancer survivors. No available instrument measures both barriers and facilitators for chronic cancer pain self-management. While many studies identified the barriers to cancer pain management using Ward et al. (1998) Barriers Questionnaire (BQ), many essential factors were not addressed, including discrimination, and transportation, family and medical support and self-efficacy.

Purpose

To develop and test an instrument that measures barriers and facilitators of chronic pain self-management among people with cancer.

Interventions

A sequential exploratory qual-QUAN mixed method design was used. Ten cancer people with chronic pain were interviewed. An exhaustive literature review and results of the Phase I qualitative study resulted in development of 151 instrument items. Two rounds of expert reviews were conducted to establish content validity during Phase II. Experts’ ratings supported a 72-item measure with a content validity index of 95%. Phase III consisted of administering the 72-item measure to 200 participants with chronic cancer pain; They were recruited from one of the main outpatient oncology center and Facebook support groups. Exploratory factor analysis was conducted using principal component analysis and oblique rotation, including Promax rotations with Kaiser normalization.

Results

The analysis resulted in two “constructs” that underlie nine inter-related latent variables measured by the instrument. Seven were considered as barriers (health care providers’ relationship; fear of side effects; fear of addiction, dependence and tolerance; beliefs; psychological stressors; discrimination; and transportation). Two were considered as facilitators (self-efficacy and active role; and family, friends, and social support). The total explained variance was 65.8%. Internal consistency for the two constructs’ subscales was acceptable to good.

Discussion and Implications

The newly developed Barriers and Facilitators of Chronic Cancer Pain Self-Management instrument addresses essential factors not currently included in existing measures that affect pain self-management among cancer people with chronic pain, including patient-healthcare provider communication, discrimination, psychological factors and transportation. Also, the developed instrument will be the first to assess the facilitator-related factors, including family, friends, social support, self-efficacy, and the active role of the patient. Health care organizations could administer the BFCCPSM instrument as part of continuous quality improvement efforts. Results would help to develop organizational-level and provider-level mitigation strategies, to confront the pervasive issue of bias in chronic cancer pain management.

Oncology Nursing Forum. 2025 Mar 1;52(2):423–424.

I4. Enhancing Cancer Care Navigation: Digital Platform Usability

Douglas Blayney ¹, Samira Daswani ²

Coordination of Care and Navigation

Significance & Background

Cancer patients (pts) and caregivers (CG) often describe cancer care as a fragmented, difficult journey without a map. During her cancer treatment in 2020, Daswani found that clinic nurses were the most approachable source of information.

Purpose

Based self- and family- management theories (doi:10.1016/j.outlook.2008.10.004), Daswani developed a paper-based planner to help patients prepare for appointments, track symptoms, and manage care. A digital version was later created with an “if-this-then-what” subway map interface providing comprehensive information and support to facilitate nursing interactions before, during and after a physician visit. We conducted usability testing with patients and advanced practice providers (APP) , with APP “willingness to use” at 10/10 and “willingness to recommend at 100/100 (JCO Oncol Pract 19, 2023 (suppl 11; abstr 552)).

Interventions

In 2024, the paper planner was given to patients and caregivers with metastatic non-Small Cell Lung Cancer, and its usability was assessed (JCO Oncol Pract 20, 2024 (suppl 10; abstr 259)). Users were invited to evaluate the map via virtual appointment, given four weeks of free access, and usage was tracked.

Results

Results are shown in the attached table 1. This is an ongoing study that is actively still enrolling. 37 patients received the initial paper planner, and 18 responded wanting access to digital platform. 10 patients have on boarded onto the system, spending an average of 107 minutes on the platform. Participants averaged 6.8 sessions on the platform in the first month, exceeding the 29% of patients who accessed their patient portal more than 6 times annually (HINTS6 2022). All users indicated that the platform would improve communication with their care team and help them (a) ask better questions, (b) understand current and future treatment options, and (c) feel more prepared to manage the cancer experience.

Discussion

Initial feedback on the digital platform was positive. We will further explore its use by nurses to educate patients. The platform and planner will continue to be tested and refined based on user data.

Oncology Nursing Forum. 2025 Mar 1;52(2):423–424.

I5. USCOM IV Algorithm for the Prevention and Management of Targeted Therapy-Related Cutaneous Adverse Events

Ana Greenberg ¹, Jennifer Choi ², Alice Ho ³, Beth McLellan ⁴, Mario Lacouture ⁵, Jonathan Leventhal ⁶

Coordination of Care and Navigation

Significance & Background

Targeted therapy has transformed oncologic treatment by targeting specific molecules and pathways essential for cancer cell growth. Cutaneous adverse events are common with targeted therapy and vary in presentation and severity based on the type of treatment. Patients treated with targeted therapy, particularly epidermal growth factor receptor inhibitors, experience more frequent cutaneous side effects with an associated greater impact on physical and emotional quality of life compared to patients treated with cytotoxic chemotherapy. Dermatologists and members of the oncologic team play key roles in managing these cutaneous side effects and promoting patient education and preventive care, which improve overall health outcomes for cancer patients.

Purpose

The US Cutaneous Oncodermatology Management (USCOM) project provides resources for preventing and managing cutaneous adverse events related to cancer therapy, aiming to enhance quality of life for cancer patients and survivors. The USCOM panel previously published three foundational algorithms for skin management to support clinicians treating oncology patients. The purpose of the panel’s current work was to develop an algorithm for treating targeted therapy-related cutaneous adverse events.

Interventions

The USCOM advisory panel conducted a literature search to identify six common targeted therapy-related cutaneous adverse events. With the results of the literature search, the panel utilized expert clinical opinion and experience via a modified Delphi approach to provide practical guidelines for treatment of these cutaneous conditions.

Results

Common targeted therapy-related cutaneous adverse events identified include acneiform rash, pruritus, xerosis, paronychia, hyperpigmentation, and hand-foot skin reaction. The algorithm (see attached figure) consists of three steps: 1) general precautions for patients before, during, and after targeted therapy, which include using gentle cleansers and moisturizers, along with photoprotection, 2) assessment of cutaneous side effects related to targeted therapy, determining severity and risk, and evaluating whether an urgent dermatology consultation is required, and 3) addressing specific skin-related side effects caused by targeted therapy, with guidelines for grading, prevention, and treatment.

Discussion

Given the widespread use of targeted therapies in cancer treatment, targeted therapy-related cutaneous adverse events are common and require prompt diagnosis and management to mitigate disruption of treatment and optimize patient quality of life. By identifying these common cutaneous reactions, healthcare providers who interface with cancer patients can streamline consultation and initiation of therapy as suggested by the practical treatment algorithm developed herein.

Oncology Nursing Forum. 2025 Mar 1;52(2):424.

I6. Evaluation of a Database Containing Pharmacy and Nursing Real-World Hazardous Drug Wipe Test Following Use of an Air-Cleaning Closed System Transfer Device to Assess Surface Contamination

Marie-Claude Gutekunst ¹, Akshar Patel ², Christopher Curtin ³, Diana Valencia ⁴

Quality and Safety

Significance & Background

Hazardous drug (HD) exposure through environmental contamination is a critical concern in oncology nursing, impacting both patient and nurse safety. Despite guidelines aimed at reducing occupational exposure, measurable concentrations of cytotoxic drugs are still found on workplace surfaces.

Purpose

Air-cleaning closed system transfer devices (CSTDs), designed to prevent the escape of HDs, offer increased protection to clinicians through various stages of handling HDs, from compounding to administration. This Real-World Data (RWD) evaluation assessed surface contamination using wipe test data collected from multiple hospital systems and outpatient facilities using an air-cleaning CSTD between 2018 and 2022.

Interventions

HD contamination in US hospitals and outpatient facilities using surface sampling kits after implementing and air cleaning CSTD was evaluated. Wipe test collection was performed in pharmacy and nursing areas. The sampling was conducted every six months over three years, targeting five HDs with a detection threshold of 5 ng. Data from 43 facilities were consolidated into 18 health systems and 507 areas into nine locations (i.e pharmacy, nursing area, patient admin/floor). Results were categorized by occurrence, mean level of contamination by HDs, and locations.

Results

From 2018 to 2022, 5531 wipe analyses revealed a mean of only 4.45% contamination. Values ranged from 5.1 to 3,420.0 ng, with a mean of 54.8 ng. Contamination varied across hospitals, peaking at 25%. 5-Fluorouracil had the highest contamination occurrence (21.2%) and mean level (105.4). After removing an outlier, Paclitaxel showed the highest contamination level (79.4 ng). Patient Admin/Rooms had the highest contamination (28%), while staging locations had the lowest (0.6%). Most hospitals (95.6%) had low or undetectable contamination. Data showed that 11 institutions consistently had contamination below 5%, suggesting best HD handling practices.

Discussion

This RWD evaluation suggesting that preparing and administering HDs using air cleaning CSTDs shows low surface contamination and could decrease exposure to clinicians. Level of contamination is highly variable across locations due to HDs handling and cleaning practices at a particular facility, emphasizing the need for standardized handling and cleaning practices and strictly defined standards for acceptable limits for handling HDs on surface contamination. Some institutions had extremely low surface contamination and best practices for HD handling should be standardized. These insights are crucial for oncology nurses to enhance safety measures and minimize HD exposure risks in their practice.

Oncology Nursing Forum. 2025 Mar 1;52(2):424–425.

I7. Advanced Breast Cancer Patient Advocates Deliver Patient Empowerment: ABCDE Pre-Intervention Qualitative Interview Analysis

Abbey Kaler ¹, Meagan Whisenant ², Ginny Kirklin ³, Alex Frenzel ⁴, Elise Neal ⁵, Zayd Razouki ⁶

Healthcare Delivery

Significance & Background

While patients living with cancer are increasingly involved in decision-making about their care, they remain largely uninvolved as funded research investigators. Importantly, patients typically lack training in and relevant experiences with research methods. For the project, patient advocates are defined as ‘volunteers who are passionate about advancing the mission of the Advanced Breast Cancer (ABC) Program and advocate for patients and their care.’

Purpose

Our long-term goal is to facilitate patient advocates in assisting with ongoing cancer research projects. We aim to understand patient advocates’ experience and perspectives on research, further patient advocates’ training and talent and investigate whether advocates can expand their role to actively participate in ongoing research initiatives. Patient advocates enrolled in a research method training program and here, we report their experiences and perspectives regarding participation as a member of a research team pre-training.

Interventions

Individual, semi-structured, qualitative interviews using an interview guide consisting of open-ended questions were conducted by a trained interviewer. The interviews lasted about one hour and were conducted before participants started the Stanford Medicine’s Public Led Opportunity Training (PLOT) course. MAXQDA 2022 qualitative software was utilized. The full coding team met and agreed on the major themes represented in the interviews.

Results

All participants (n=5) were female, four self-identified as living with ABC and one self-identified as being an ABC caregiver. Participants had an average age of 52 years (SD 5.25, range 45–57). One participant was employed full-time, two were unemployed, and two were retired; all participants were married. Table 1 includes all themes yielded and example statements from qualitative interviews.

Discussion

ABC patient advocates believe they have unique contributions to make to clinical research and have a unique experience that can enhance the research. Participating in research empowers patients advocates and represents an avenue to contribute to other patients. Facilitators for patient advocates to be part of the team include feeling that the research topic is important to them, acknowledging patient advocates as part of the team, and preferably being compensated for their time/effort. Barriers to patient advocate including time commitment, training, and health challenges. These barriers to participation should be considered when involving patient advocates in research. Next steps for our project will capture patient advocates’ experience after completing the training and pairing patient advocates with research teams using qualitative methods.

Oncology Nursing Forum. 2025 Mar 1;52(2):425–426.

I8. Efficacy and Safety of Darolutamide in Combination with Androgen Deprivation Therapy in Patients with Metastatic Hormone-Sensitive Prostate Cancer: Phase 3 Aranote Trial

Brenda Martone ¹, Kunhi Parambath Haresh ², Neal Shore ³, Isabella Testa ⁴, Fred Saad ⁵

Treatment Modalities and Managing Administration

Significance & Background

Patients with metastatic hormone-sensitive prostate cancer (mHSPC) may experience few disease-related symptoms but, without effective treatment, they have a high risk of progression to metastatic castration-resistant prostate cancer (mCRPC), which has poor prognosis. In the phase 3 ARASENS study, the androgen receptor inhibitor (ARI) darolutamide in combination with androgen deprivation therapy (ADT) and docetaxel significantly improved survival and delayed mCRPC progression versus ADT and docetaxel in patients with mHSPC. However, not all patients are willing or able to receive docetaxel treatment.

Purpose

The ARANOTE trial (NCT04736199) evaluated the efficacy and safety of darolutamide with ADT versus ADT alone in patients with mHSPC.

Interventions

In this global phase 3 trial, patients were randomized to darolutamide 600 mg orally twice daily (n=446) or placebo (n=223), both with ADT. Radiological progression-free survival (rPFS, primary endpoint) and secondary endpoints, including overall survival (OS), time to mCRPC, time to prostate-specific antigen (PSA) progression, PSA response rates, time to pain progression, and treatment-emergent adverse events (TEAEs) were assessed.

Results

Darolutamide plus ADT significantly improved rPFS (hazard ratio [HR] 0.54; 95% confidence interval [CI] 0.41–0.71; P<0.0001) versus placebo plus ADT. There was a positive trend in OS, with a reduction in risk of death of 19% (HR 0.81; 95% CI 0.59–1.12), although data are immature. The rPFS benefit was achieved regardless of whether patients had high- or low-volume disease. Darolutamide also showed clear benefits over placebo in all other secondary efficacy endpoints, including time to PSA progression and time to pain progression. Incidences of TEAEs, including TEAEs commonly associated with ARI therapy, were low and similar between the darolutamide and placebo groups. Notably, the incidence of fatigue was lower with darolutamide (5.6%) than placebo (8.1%) as were discontinuations due to TEAEs (6.1% vs 9.0%).

Discussion

When discussing treatment options with patients, it is important to consider efficacy, safety, and the impact of treatment on patients’ quality of life. The ARANOTE study demonstrates that darolutamide plus ADT significantly delays radiological progression and helps patients live longer, with a well-tolerated safety profile, including a low incidence of adverse events that can be troublesome for patients. Together with the positive results of the ARASENS study, the findings from ARANOTE provide the option to select treatment in mHSPC with and without docetaxel to meet patients’ individual needs and preferences.

Oncology Nursing Forum. 2025 Mar 1;52(2):426.

I9. Mitigation of Gastrointestinal (GI) Side Effects among Patients Receiving NALIRIFOX for Metastatic Pancreatic Ductal Adenocarcinoma (mPDAC)

Pareshkumar Patel ¹, Ashley Laursen ², Camryn Lieb ³, Fiona Maxwell ⁴, Eileen O’Reilly ⁵, Ann Marie Siney ⁶

Treatment Modalities and Managing Administration

Significance & Background

Oncology nurses play a pivotal role in assessing and managing side effects of chemotherapy. Based on the results of NAPOLI 3 (NCT04083235), NALIRIFOX was approved by the US Food & Drug Administration in February 2024 as a first-line treatment option for adults (no upper age limit) with mPDAC; it is also recognized by the National Comprehensive Cancer Network guidelines and recommended as a preferred, Category 1, treatment option. Diarrhea is a known dose-limiting adverse event (AE) associated with irinotecan-based chemotherapy. Analysis of GI AE management in NAPOLI 3 has not yet been reported.

Purpose

To examine the GI AE management strategies utilized among patients receiving NALIRIFOX in NAPOLI 3.

Interventions

Patients (N=770) with untreated mPDAC were randomized (1:1) to receive NALIRIFOX (liposomal irinotecan 50 mg/m² + oxaliplatin 60 mg/m² + leucovorin 400 mg/m² + 5-fluorouracil 2400 mg/m²) or nab-paclitaxel plus gemcitabine. Pharmacological management of diarrhea per institutional or international guidelines was permitted, but not mandated. In this post-hoc analysis, the incidence of GI AEs and management strategies across overall survival (OS) subgroups (≥16.0 months, 11.0–<16.0 months and <11.0 months) were analyzed descriptively among patients receiving NALIRIFOX in North America; statistical tests were not performed.

Results

Among patients receiving NALIRIFOX in North America (n=112), diarrhea occurred in 86.4% (grade 3, 26.3%; grade 4, 0%), 73.7% (21.4%; 0%) and 80.8% (38.1%; 0%) of patients in the ≥16.0 months (n=22), 11.0–<16.0 months (n=38) and <11.0 months (n=52) OS subgroups, respectively. In those with diarrhea, atropine, loperamide and other antidiarrheal medications were received by 78.9%, 73.7% and 15.8% of patients, respectively in the OS ≥16.0 months subgroup (n=19), 75.0%, 75.0% and 17.9% of patients, respectively in the 11.0–<16.0 months subgroup (n=28) and 66.7%, 76.2% and 9.5% of patients, respectively, in the <11.0 months subgroup (n=42). Prophylactic use of atropine and loperamide was highest (68.4% and 57.9%, respectively) in patients with the longest OS and lowest (52.4% and 21.4%, respectively) in patients with the shortest OS.

Discussion

Proactive management of GI AEs in patients receiving NALIRIFOX may support improved OS outcomes. Oncology nurses support patients with mPDAC at every phase of their treatment journey. Assessing the signs and symptoms of chemotherapy-induced diarrhea, providing patient education accurately, and consulting with the medical team regarding appropriate prevention and treatment may optimize outcomes and prevent complications.

Oncology Nursing Forum. 2025 Mar 1;52(2):427.

I10. Large Retrospective Observational Study Demonstrates High Level of Performance and Safety Using a Powered Bone Access Sampling System for Bone Marrow and Bone Lesion Procedures

Thomas E Philbeck Jr ¹, Saman Najmi ², Kim Oliver ³, Chris Buller ⁴, Kevin McGill ⁵

Treatment Modalities and Managing Administration

Significance & Background

Bone marrow and bone lesion sampling are essential for evaluation of hematopoietic and bone lesion disorders. In 2007, a battery-powered bone access sampling system (BASS) was developed (Arrow OnControl, Teleflex Medical, Morrisville NC, USA) as an alternative to manual techniques.

Purpose

To demonstrate contemporary evidence describing both safety and performance of BASS across a broad range of patients and operators, a retrospective study was designed.

Interventions

Eighty-seven US practitioners from 87 independent centers participated in this retrospective chart review from November 2023 through January 2024. Each practitioner was contracted to identify consecutive patients within their practices undergoing BASS within 60 days of data extraction. A minimum sample size of 402 cases was calculated using performance criteria. An electronic CRF was used to collect and transmit de-identified data. Procedures included marrow aspiration, marrow core biopsy, and bone lesion biopsy. The primary endpoint was self-adjudicated successful specimen acquisition. Secondary endpoints were specimen diagnostic adequacy (amongst cases for which a pathology report was available) and freedom from documented device-related adverse events. The study was designed and sponsored by Teleflex and utilized centralized REB review (Advarra, Columbia Maryland, USA).

Results

Clinicians self-reported as physicians (n=36), nurses (n=30), and physician assistants (n=21) A total of 454 procedures were captured, including bone lesion biopsy (38%), marrow aspiration alone (23%), marrow aspiration plus core biopsy (20%) and marrow core biopsy alone (19%). Broadly, 53% of patients were male and 16% were pediatric, including <2 yrs (n=1), 2–12 yrs (n=18) and 13–17 yrs (n=52). Specimens were successfully acquired in 99.8% of cases. Among cases with available pathology reports (n=326), all (100%) were deemed adequate. Procedures were free of documented device-related adverse events in 98%. Reported adverse events were pain (5), hematoma (1) and loss of sensation (1). None required treatment.

Discussion

This retrospective study describes the largest cohort of procedures employing BASS and spans bone marrow aspirations, core biopsies, bone lesion biopsies, and pediatric patients—many performed by nurses. High rates of procedure success and low rates of acute adverse events were observed. The study is also the first to report a large number of cases in which specimens were evaluated for diagnostic adequacy, and all were deemed adequate. These favorable results suggest the need for a prospective randomized trial comparing BASS to manual biopsy in a similar diverse population.

Oncology Nursing Forum. 2025 Mar 1;52(2):427–428.

I11. Racial Disparities in the Management of Metastatic Colorectal Cancer: Findings of a US Patient Survey

Christine Racette ¹, Khadijah Ameen ², Kim Newcomer ³, Kathy Steinberg ⁴, Ashley V Calabrese ⁵, Jeneth Aquino ⁶

Management

Significance & Background

Colorectal cancer (CRC) is the second most common cause of cancer death in the US. CRC incidence and survival vary substantially by race, with higher incidence and lower survival rates in the Black population versus White and Hispanic populations.

Purpose

Using an online patient survey, we investigated the impact of patients’ race and cultural background on their metastatic CRC (mCRC) experience.

Interventions

The survey, conducted in the US between January and February 2024, involved adults with stage IV colon, rectal, or colorectal cancer. Questions explored patient profile, diagnosis experience, the role of patient advocacy groups (PAGs)/other resources, health-related quality of life, access to care and financial challenges, discrimination, and treatment experience. Patients were recruited via online panels and PAGs (BLKHLTH, COLONTOWN, Colorectal Cancer Alliance, and Family Reach). Raw data were not weighted and represent participants who completed the survey only. Sample data were accurate to within 5.3 percentage points using a 95% confidence level; all surveys are subject to multiple sources of error.

Results

Of 344 respondents, 254 were recruited online and 90 via PAGs; 55% were male, mean age was 56 years, and most patients were non-Hispanic White (46%), non-Hispanic Black/African American (25%), or Hispanic (22%). Around 90% of Black and Hispanic patients felt they experienced discrimination in terms of quality, timing, and access to care, as well as new treatments/clinical trial information. Black patients were more likely to feel their healthcare team did not understand their cultural background (34%) than White or Hispanic patients (both 15%; Figure). Furthermore, 40% of Black patients felt their treatment and care plans did not account for their cultural background compared with White or Hispanic patients (both 25%; Figure). More Hispanic patients sometimes, often, or always felt unheard or dismissed (67%) than Black (54%) or White (52%) patients. A higher proportion of Black (92%) and Hispanic (97%) patients felt affected by the financial impact of mCRC compared with White patients (80%), including many who had to choose between basic needs and treatment (20% each) or lost access to personal transportation (15% and 23%).

Discussion

The care of patients with mCRC can be impacted by their healthcare teams’ cultural understanding and cultural background. Improving cultural competency may help address disparities in healthcare and reduce the burden of disease for Black and Hispanic patients living with mCRC.

Oncology Nursing Forum. 2025 Mar 1;52(2):428.

I12. Biosafety of the Novel Oncolytic Immunotherapy RP1: Considerations from a Nursing Perspective

Michelle Rohlfs ¹, Alina Monteagudo ², Praveen Bommareddy ³, Jeannie Hou ⁴, Teena VanDaele ⁵

Treatment Modalities and Managing Administration

Significance & Background

The Oncology Nursing Society Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice provide limited guidance on the handling and use of oncolytic immunotherapy (OI) agents. While some guidance does exist for talimogene laherparepvec, the first FDA–approved OI agent, understanding safety and care considerations for OIs will be essential to patient care as this field rapidly expands. RP1 is an HSV-1–based OI currently in development. RP1 combined with the immune checkpoint inhibitor nivolumab has demonstrated clinical activity and a favorable safety profile in clinical trials.

Purpose

To examine the communal transmission potential of RP1 through biodistribution and shedding analyses from the phase 2 skin cancer cohorts of an open-label, multicenter clinical trial (IGNYTE; NCT03767348).

Interventions

RP1 was injected into superficial and deep tumors, then covered with occlusive dressings. Samples from blood, urine, dressing exteriors, injection sites, oral mucosa, and lesions of suspected herpetic origin were assessed for RP1 DNA by quantitative PCR assay. Positive RP1 DNA swab samples were further assessed by a 50% tissue culture infectious dose (TCID50) assay for the presence of live virus.

Results

This analysis included 278 patients (1573 blood, 1976 urine, 2052 oral mucosa, 1114 dressings, and 1947 injection-site swab samples). RP1 DNA was detected in 7.8% of blood, 0.2% of urine, and 18.4% of injection-site swab samples. The incidence of RP1 detection on injection-site dressing exteriors (9.5% of 1114 samples) was lower than that from injection sites (18.4% of 1947 samples), demonstrating that dressings act as a barrier to RP1. RP1 DNA was present at low levels on oral mucosa (0.9% of 2052 samples). At follow-up, RP1 DNA was detected only in injection-site swab samples. All available samples were confirmed to be negative for live virus by TCID50 assay. Eight swab samples from 7 patients from different locations were collected from areas of suspected herpetic infection; none tested positive for infectious virus. No communal or secondary transmission was reported.

Discussion

RP1 administration showed negligible potential for viral transmission to caregivers, patients, or their families. As more patients may be treated with RP1 (and/or other OIs) in various settings (eg, academic and community health centers, clinical trials, commercial setting upon FDA approvals, etc.), understanding of these findings is essential for nurses to effectively communicate safety and care considerations to patients.

Oncology Nursing Forum. 2025 Mar 1;52(2):428–429.

I13. Describing Hematological Adverse events (AES) and Utilization of Granulocyte-Colony Stimulating factor (G-CSF) among Patients Receiving Nalirifox for Metastatic Pancreatic Ductal Adenocarcinoma (mPDAC)

Keeran Sampat ¹, Mike Cusnir ², Paul Cockrum ³, Alexandra Sosinksy ⁴, Ann Marie Siney ⁵, Eileen O’Reilly ⁶

Treatment Modalities and Managing Administration

Significance & Background

Oncology nurses play a crucial role in assessing, managing and supporting patients experiencing adverse events associated with cancer treatments. Based on the results of NAPOLI 3 (NCT04083235), NALIRIFOX is approved by the US Food & Drug Administration for the first-line treatment of adults (no upper age limit) with mPDAC. Neutropenia, a known AE associated with cytotoxic chemotherapy, may be treated or prevented by administration of G-CSF; however, G-CSF usage among patients who received NALIRIFOX in NAPOLI 3 has not been reported.

Purpose

To examine the hematological AE management strategies utilized among patients receiving NALIRIFOX in NAPOLI 3.

Interventions

Patients (N=770) with confirmed untreated mPDAC were randomized (1:1) to receive NALIRIFOX (liposomal irinotecan 50 mg/m² + oxaliplatin 60 mg/m² + leucovorin 400 mg/m² + 5-fluorouracil 2400 mg/m²) or nab-paclitaxel plus gemcitabine. G-CSF treatment, or prophylaxis in those considered at high risk of febrile neutropenia, was permitted at the investigator’s discretion. This post-hoc analysis evaluated hematological AEs (i.e. neutropenia, thrombocytopenia, anemia) and G-CSF usage across subgroups (overall survival [OS] ≥16.0 months, 11.0–<16.0 months and <11.0 months) of patients who received NALIRIFOX in North America. Data were examined descriptively; no statistical testing was performed.

Results

In North America, 120 patients were randomized to receive NALIRIFOX (intention-to-treat population). Median OS in the OS ≥16.0 months subgroup (n=22) was not reached (95% confidence interval, 18.4–not estimable [NE]); in the OS 11.0–<16.0 months (n=38) and <11.0 months (n=60) subgroups, median OS was 14.5 (13.7–15.4) months and 5.6 (4.0–6.6) months, respectively. Among patients who received NALIRIFOX (n=112, safety population), the incidence of hematological AEs (40.9% overall; neutropenia, 22.7%; thrombocytopenia, 9.1%; anemia, 22.7%) and G-CSF use (59.1%) was highest in the longest OS subgroup (n=22). The incidence of hematological AEs (28.8% overall; neutropenia, 11.5%; thrombocytopenia, 5.8%; anemia, 23.1%) and G-CSF use (23.1%) was lowest in the shortest OS subgroup (n=52). Overall, 36.6% of patients (safety population) received G-CSF (28.6% prophylaxis; 16.1% treatment; 8.0% prophylaxis and treatment).

Discussion

Oncology nurses play a key role in triaging, assessing and mitigating neutropenia post infusion. Ensuring that patients who are symptomatic receive G-CSF as soon as possible may keep patients on infusion schedules for longer, and ultimately improve survival outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):429–430.

I14. Vascular Access Catheter Connector Management: the Potential Impact of an Ultraviolet Light Disinfection Method on Nursing Workflow

Gregory Schears ¹, Michael Fourkas ², Julia Rasooly ³

Treatment Modalities and Managing Administration

Significance & Background

Central line-associated bloodstream infections (CLABSI) are healthcare-associated infections with high cost-burden and significantly increased morbidity and mortality for patients with vascular access catheters. The current standard of care involves a 5–15 second alcohol or chlorhexidine wipe, or the use of alcohol caps for management of vascular access catheter connectors. However, evidence indicates that compliance to aseptic technique is often insufficient, putting critically ill patients at further risk. A quicker and easier method of disinfection is desired to improve nursing compliance and reduce CLABSI incidence rates.

Purpose

To assess improvements in nursing workflow and reduce CLABSI rates through the use of a novel ultraviolet-C (UV) light disinfection system for management of vascular access catheter connectors.

Interventions

38 nursing professionals with needleless connector and vascular access experience were recruited as participants in a mannequin-based simulation study. An in-service model was followed when training users in the UV-C disinfecting system. Snacks or a light meal were provided to serve as training decay (1 hour). Following training, normal use cases and four fault conditions were individually performed by users. Pre-intervention and post-intervention questionnaires were collected to assess their perception of the current standard of care and the UV-C disinfection system.

Results

Pre-intervention questionnaire results showed that nurses believe the current standard of care for connector management with an alcohol wipe conflicts with timely intervention 85.2% of the time and can often lead to contamination. After testing, users expressed that a faster, more effective needleless connector asepsis technique would help improve workflow during urgencies and emergencies 93.2% of the time compared to 84.7% of the time pre-intervention. Nurses overwhelmingly believed that CLABSI rates can be reduced with the help of faster and more effective connector disinfection both before and after simulated use.

Discussion

This mannequin-based simulation study demonstrates that there is significant potential for improvement in the current clinical workflow for vascular access catheter connector management through novel disinfection methods such as UV-C light. These improvements are critical for high-risk patient groups, such as immunocompromised oncology patients with implanted chemotherapy ports, who are likely to benefit significantly due to their increased susceptibility to CLABSI.

Oncology Nursing Forum. 2025 Mar 1;52(2):430.

I15. A Novel Cooling System to Evaluate Treatment Parameters for the Prevention of CIPN

Carole Spangler Vaughn ¹

Symptom Management and Palliative Care

Significance & Background

Chemotherapy-induced peripheral neuropathy (CIPN) is a common, often debilitating side effect of chemotherapy. CIPN has no cure and can significantly impair quality of life. Payors spend an average of $14,000 in excess healthcare costs per patient, per year, trying to deal with symptoms. A range of preventive approaches is being evaluated, targeting different aspects of the mechanisms leading to CIPN. These include pharmacological agents, exercise and physical therapy, nutritional supplements, emerging biological agents, and cooling. While no single solution has proven to be universally effective, several studies evaluating cooling the hands and feet have shown promise. The cooling procedure typically involves applying ice packs or cold gloves and socks to the hands and feet. Most studies apply cooling for 15–30 minutes before infusion, during infusion, and 15–30 minutes after. The post-infusion cooling time is limited by significant logistical challenges to continuing the cooling and may be a contributing factor to prior inconsistent results. Blood clearance rates are unique for each drug and are impacted by several factors. For example, Taxol’s clearance varies depending on the formulation, dose, and patient-specific factors, including liver function, age, and concurrent medications. Pharmacokinetic data suggests that cooling needs to continue for a significant amount of time, post-infusion, to allow the drug concentration in the blood to reach safe levels, for all patients. Cold capping to prevent chemotherapy-induced alopecia has been done since the 1970’s. The mechanism is likely similar to cooling to prevent CIPN. Patients who cool for four hours post-Taxol infusion, have a high likelihood of preserving their hair. We believe that four hours gives Taxol time to clear the blood, regardless of the variables surrounding each specific patient.

Purpose

To provide a method to evaluate the temperature and time needed to prevent CIPN.

Interventions

We will present usability data on a novel CIPN prevention cooling system in development, that allows a patient to safely and comfortably cool for several hours.

Results

We will show that the patients’ feet and hands are completely cooled and that the patient can have normal function allowing them to cool, without interruption, for several hours.

Discussion

This device will be the first to allow careful studies of constant, controlled cooling, for several hours, to study the impact of temperature and time on the prevention of CIPN.

Oncology Nursing Forum. 2025 Mar 1;52(2):430–431.

I16. Nursing Considerations for the Use of Intravesical Nadofaragene Firadenovec-Vncg in Patients with Bacillus Calmette-Guérin–Unresponsive Non–Muscle-Invasive Bladder cancer

Jennifer Sutton ¹, Toral Patel ², Caroline Branch ³

Treatment Modalities and Managing Administration

Significance & Background

Non–muscle-invasive bladder cancer (NMIBC) is a form of urothelial carcinoma that does not extend into or beyond the muscle layers of the bladder wall. Although intravesical Bacillus Calmette-Guérin (BCG) therapy is recommended as standard-of-care treatment for patients with high-risk disease, more than 40% of patients will become BCG-unresponsive. Radical cystectomy is considered definitive treatment for these patients; however, some are not suitable candidates for cystectomy and many prefer to avoid invasive surgery. Nadofaragene firadenovec-vncg (ADSTILADRIN^®), the first intravesical nonreplicating adenoviral gene therapy approved by the FDA for patients with high-risk BCG-unresponsive NMIBC with carcinoma in situ (CIS) with or without papillary tumors, is a potential bladder-preserving option.

Purpose

To present practical considerations for using nadofaragene firadenovec, including preparation for patient visits, administration, monitoring, and patient education.

Interventions

Clinical practice guidance for the use of nadofaragene firadenovec, from pre-instillation visit planning to post-instillation patient education are reviewed.

Results

In the phase 3 CS-003 study, over half of participants with CIS with or without papillary tumors exhibited a complete response 3 months after instillation. Nadofaragene firadenovec was well tolerated, with 4% experiencing study-drug related grade 3 adverse events (AEs) and no participants experiencing study-drug related grade 4 or 5 AEs. The demonstrated clinical utility and convenient quarterly dosing schedule distinguish nadofaragene firadenovec from other treatments for high-risk BCG-unresponsive NMIBC. Effective clinical use of nadofaragene firadenovec requires consideration of pre-instillation visit arrangements, confirmation of patient visits, and coordination with pharmacy staff to confirm nadofaragene firadenovec preparation. Nadofaragene firadenovec should be brought to room temperature prior to instillation as cold fluids may potentiate bladder spasms. Treatment with an anticholinergic prior to instillation is recommended to mitigate potential urinary spasm and fluid expulsion. Administration should be done manually via the syringe through the urinary catheter; gravity infusion or other methods of administration are not recommended. Careful monitoring and documentation of AEs (eg, leakage of fluid around the urinary catheter, bladder spasms, and urinary urgency) allows for appropriate supportive care measures to be provided. Educate patients on procedures regarding disinfecting urine and the importance of continued adherence, monitoring, and follow-up.

Discussion

Healthcare providers administering intravesical nadofaragene firadenovec help with visit coordination, drug administration, monitoring, supportive care, and education. Understanding best practices will help optimize safety and efficacy of nadofaragene firadenovec instillation and improve patient and caregiver experiences.

Oncology Nursing Forum. 2025 Mar 1;52(2):431.

I17. Enhancing Support for Oncology Caregivers: A Quality Improvement Intitaitve

Lauren Verity Moore ¹

Psychosocial Dimensions of Care

Significance & Background

In the U.S., the trend towards outpatient cancer care has underscored the essential yet often overlooked role of informal caregivers. These caregivers face significant challenges in providing care, yet they frequently lack adequate resources and support, impacting both their well-being and the quality of patient care.

Purpose

This quality improvement project assessed a 12-week support program aimed at enhancing support for caregivers at a large outpatient community oncology clinic and improving their caregiving experiences.

Interventions

The study employed a pre- and post-intervention design with primary caregivers of patients with advanced-stage cancer (N = 13). It featured weekly 1-hour virtual support sessions over 6 weeks, based on the FOCUS Program (Family involvement, Optimistic outlook, Coping effectiveness, Uncertainty reduction, Symptom management). The program targeted reducing caregiver burden and enhancing coping strategies and caregiver satisfaction. Assessment tools included the Zarit Burden Interview and Brief-COPE.

Results

While the intervention did not significantly reduce caregiver burden (P > 0.05), it notably increased caregivers’ awareness of their burdens, with mean scores rising from pre- to post-intervention. Although there was no statistically significant increase in adaptive coping skills (P > 0.05), descriptive results showed a positive shift in coping strategies, with increases in Problem-Focused and Emotion-Focused coping and a decrease in Avoidant Coping. This improvement suggests that the intervention successfully enhanced caregivers’ ability to handle their challenges more constructively. High post-intervention satisfaction among caregivers indicates a positive reception and a demand for ongoing support.

Discussion

The intervention’s main achievement lies in boosting caregivers’ awareness of their burdens and improving their coping mechanisms, rather than the quantitative reduction of the burden itself. These results highlight the importance of integrating structured support programs into oncology care settings to enhance caregiver resilience and stress management, vital for both caregiver well-being and the overall quality of patient care.

Oncology Nursing Forum. 2025 Mar 1;52(2):431–432.

I18. A Pump Paired with Short Primary IV Set, Compared to Standard Length Set, Delivers a Higher Percentage of Prescribed Antineoplastic Therapy Infusion

Colleen Wibbe ¹, Julian Micallef ², David Debono ³, Nicol Cremona ⁴, Aftab Alam ⁵

Treatment Modalities and Managing Administration

Significance & Background

Single channel Large Volume Pumps (LVP) are routinely used in administration of antineoplastic therapies. LVP compatible tubing sets come in different lengths with varying residual volumes (RV). In clinical practice the LVP’s air in line alarm notifies if the bag and administration set are empty, yet RV of drug remains in the primary set within and below the pump and may not be completely delivered even if followed by a fluid flush. RV can lead to under infusion and can compromise therapeutic benefit.

Purpose

A bench study was conducted to compare the residual volume of 3 commercially available primary sets, 2 short and 1 standard length, when paired with compatible single channel LVPs.

Interventions

RV of primary short sets Baxter (2R8404) and Becton Dickinson (BD) (2204–0007) was measured by injecting water from distal male luer to the air in line sensor. RV of B. Braun standard length primary set (490100) was measured by injecting water from the distal Y-site to account for one way check valve. The volume injected represented the RV of set and 30 sets each were evaluated for 95% confidence that 99% of measurements were within the tolerance limits.

Results

BD (2204–0007) set had an average RV of 0.68 mL, with lower tolerance limit (LTL) and upper tolerance limit (UTL) of 0.53 mL and 0.83 mL, Baxter(2R8404) had an average RV of 0.85 mL, LTL of 0.62 mL and UTL of 0.98 ml. B. Braun (490100) had the highest average RV of 11.40 mL, LTL of 10.00 mL and UTL of 12.81 ml. The tolerance intervals were significantly different for B. Braun (490100) compared to Baxter(2R8404) and BD (2204–0007). There is no significant difference between the tolerance intervals of Baxter and BD sets since they overlap and hence can be considered equivalent.

Discussion

Bench study highlights that for a 100 ml antineoplastic infusion, a standard set will only deliver on average 88.6ml while the short sets will deliver >99ml, this difference can translate into better therapeutic effect with short sets. We believe ASCO-ONS standards should incorporate the topic of appropriate IV sets for use with single channel LVPs in future guidelines.

Oncology Nursing Forum. 2025 Mar 1;52(2):432.

RS1. Diet as an Adjunct therapy in Reducing Chemotherapy Toxicities and Improving Patient Quality of Life: A Systematic Review and Meta-Analysis

Jessica Abene ¹, Sherilyn Tyburski ², Tanja VE Kral ³, Ryan Quinn ⁴, Jie Deng ⁵

Symptom Science

Purpose

This systematic review and meta-analysis analyzes existing literature regarding the relationship between different diets and chemotherapy toxicities, as well as the quality of life among patients undergoing treatment. It aims to identify the most advantageous diet for cancer patients.

Background and Significance

Despite pharmacological interventions to combat chemotherapy’s toxicities, patients still experience unpleasant side effects without a guarantee the treatment will cure them of cancer. An often overlooked and more novel pathway for possibly ameliorating the adverse effects of chemotherapy are dietary interventions.

Methods

PubMed, CINAHL, and Embase were used to select randomized control trials assessing the relationship between a specific diet and chemotherapy toxicities and/or quality of life in patients as of October 2023.

Findings and Interpretations

Out of 1419 records, 11 randomized control trials were included: 7 studies testing fasting variations; 1 testing a ketogenic diet; 1 testing a Mediterranean diet; 1 testing a plant-based, high-protein diet; and 1 testing an anti-inflammatory diet. Four studies examining a variation of fasting were included in the meta-analysis. Analyses were stratified by diet type. All diets indicate encouraging outcomes in that fasting may reduce chemotherapy adverse effects such as fatigue, nausea, vomiting, insomnia, mouth sores, diarrhea, and hematologic toxicities. Pooled odds ratios and 95% confidence intervals (CI) were obtained from the random effect model using STATA. The random effects meta-analysis showed no significant difference in the incidence of chemotherapy toxicities between fasting and non-fasting patients.

Discussion

There is insufficient evidence to determine which dietary intervention is the most advantageous, however, there is evidence that all the diets examined may reduce chemotherapy toxicities. No intervention can be ruled out. More research is necessary to discover a diet that improves cancer patients’ experience with chemotherapy.

Oncology Nursing Forum. 2025 Mar 1;52(2):432–433.

RS2. Exploring the Lived Experiences of Financial Burden among Breast Cancer Survivors: A Phenomenology Study

Eman Alsatari ¹, Majduleen Abu Fasheh ²

Survivorship, Palliative and Psychosocial Oncology Care

Purpose

To explore the lived experiences of breast cancer survivors and the financial challenges during their treatment and recovery.

Significance

Breast cancer can develop at any age after puberty, yet it is more common in later life and associated with the highest cancer treatment expenses. 2.3 million women have been affected by breast cancer worldwide, and it was the death cause of 685,000 cases in 2020. Improvements in cancer therapy have led to better outcomes for women in terms of mortality. Still, the financial burden of expensive treatment remains significant, as breast cancer is the second most expensive cancer treatment due to long-term costs.

Methods

This study used a descriptive phenomenological approach, with eight participants in the secondary data analysis. In the main study, the researcher conducted semi-structured interviews that lasted 45 minutes. The research team used purposive sampling for analysis, performed initial and focused coding, and wrote memos. Then, a codebook was developed, and Dedoose software was used as an organizational tool.

Findings and Interpretations

The results highlight the necessity of comprehensive support systems to deal with many financial issues confronted by breast cancer survivors, such as free financial counseling, support groups, and mental health resources to help cancer patients and their families manage financial and emotional challenges. Seven themes highlighted women’s shared obstacles, including the survivors’ experience, the importance of internal and external support, the financial burden, the economic experience, issues with insurance policies, and the influence on their quality of life.

Discussion

The study highlights the interconnectedness of breast cancer survivors’ experiences with their practical and economic challenges. It stresses the importance of providing free financial counseling, support groups, and mental health resources to support survivors. Additionally, the study advocates for universal access to affordable healthcare, including comprehensive coverage for cancer screening and diagnosis.

Oncology Nursing Forum. 2025 Mar 1;52(2):433.

RS3. Oncology Patients, Caregiver Experiences of Pain a Multicenter Study

Abeer Adeeb ¹, Husam Wishah ²

Caregiving

Purpose

This study aims to describe patients’ and families’ knowledge and experiences of cancer pain.

Significance

Cancer pain is the most common cause of suffering in terms of its effects on the patient’s daily activities, emotions, and well-being. In Saudi hospitals, there is a high incidence of pain among oncology patients but a lack of evidence about the Saudi patients’ perception experiences of cancer pain.

Methods

A multicenter descriptive cross-sectional quantitative design used. A convenient sample of (300) patients was admitted to a tertiary hospitals in Riyadh and met the inclusion criteria. A self-reported Patient Pain Questionnaire (Ferrell, 1994) and a self-reported Patient Family Pain Questionnaire (Ferrell, 1999) distributed after gaining the targeted subject’s consent. Both descriptive and inferential statistics used to analyses the result.

Findings and Interpretations

The study included 600 participants, comprising 300 patients and 300 caregivers. The majority of participants were male (67%), with an average age of 49 years ± 3.7 years. Caregivers were predominantly female (73%), with an average age of 37 ± 2.5 years. Findings revealed a significant lack of pain knowledge among both patients and caregivers regarding cancer pain, its assessment, treatment modalities, and dosage. Notably, caregivers reported a higher level of pain experience and severity compared to patients (p < 0.04). Caregivers reported significantly higher pain intensity scores for their patient compared to patients, t-test = 2.54, p = .015, d = 0.75. The effect size was large, indicating a substantial difference between the two groups. The 95% confidence interval for the difference was 1.23 to 4.56, suggesting that the true population difference is likely to fall within this range.

Discussion

Consistent with previous research, this study found that both patients and caregivers exhibited limited knowledge of cancer pain. However, caregivers reported a higher level of pain experience compared to patients, likely due to the emotional connection between the two. The majority of caregivers (98%) were first-degree family members, deeply invested in the patient’s well-being. The findings of this research offer valuable insights into the patient’s perspective on cancer pain. These insights can guide healthcare providers in developing strategies to improve the quality of care for oncology patients and their families

Oncology Nursing Forum. 2025 Mar 1;52(2):433–434.

RS4. Exploring Nurses’ Perspectives on their Roles and the Challenges in Delivering Cervical Cancer Prevention Services IN Southwestern Nigeria: Insights from a Qualitative Study

Esther Afolabi ¹, Adenike Olaogun ²

Healthcare Delivery

Purpose

This study explored nurses’ perceptions of their roles and challenges in delivering Cervical Cancer Prevention Services (CCPS) in Osun and Lagos States, Nigeria. Understanding these factors is crucial to addressing the gaps in CCPS delivery and improving health outcomes.

Significance

Nurses play a vital role in delivering quality CCPS in the healthcare system. However, there is limited information on nurses’ perspectives on their roles and challenges in performing these services. Understanding nurses’ perceptions can help address gaps and unmet needs in CCPS and ultimately contribute to cervical cancer prevention efforts.

Methods

A qualitative descriptive design was employed to explore nurses’ perceptions of their roles in CCPS. Purposive sampling was used to select 19 registered nurses from selected secondary health facilities in Osun and Lagos States, Nigeria. Key informant interviews were conducted utilizing a pretested interview guide with open-ended questions to facilitate dynamic discussions. Data were collected through audiotaped interviews, transcribed, and analyzed using content analysis to identify key themes. The study population comprised trained registered nurses providing CCPS in selected secondary health facilities.

Findings and Interpretations

The findings revealed 12 themes related to nurses’ roles, categorized into health education, HPV vaccination, screening, treatment services, and client follow-up. However, they reported facing challenges such as inadequate training and equipment, insufficient workforce, limited resources, and lack of collaboration with other healthcare providers, which hindered effective role performance.

Discussion

The study emphasized the crucial role of nurses in CCPS and highlighted the need to address the challenges they face to improve the delivery of these services. The study found that while nurses are knowledgeable and committed to their roles in CCPS, systemic barriers significantly impede their effectiveness. Strategies and recommendations include integrating CCPS into broader reproductive health services, enhancing training for nurses, and improving facility infrastructure to empower nurses as key players in the healthcare system and ultimately improve the delivery and uptake of CCPS.

Oncology Nursing Forum. 2025 Mar 1;52(2):434.

RS5. Albumin Levels and Survivorship in Patients with Pancreatic Cancer Stages II and III: A Retrospective Study

Fatmah Alamoudi ¹, Saunjoo Yoon ²

Survivorship, Palliative and Psychosocial Oncology Care

Purpose

This study aims to compare albumin levels between stages II and III and determine the cut-off values of albumin levels in stages II and III PC to associate it with survivorship based on the stage.

Significance

Pancreatic Cancer (PC) is a significant cause of cancer-related death in the United States. Long-term survival from PC remains dismal, with a 5-year survival rate of 13%. Serum albumin may predict inflammation and survivorship in PC; however, it has not been fully explored whether albumin levels affect survival differently based on stages.

Methods

We conducted a survival analysis using existing data (IRB#202001897). A total of 455 patients with PC stages II and III (³18 years) who visited the healthcare center between Jan. 1, 2012, and July 31, 2020, were included. Receiver operating characteristic curve analysis and Youden index (J) indicated that the optimal cut-off value of the albumin was 3g/dl and 3.4g/dl for stages II and III, respectively. Statistical significance was set at p <0.05.

Findings and Interpretations

332 patients were diagnosed with stage II and 123 with stage III. 52% were males, 52% were 73 years old, and 40% had tumors in the head of the pancreas. Significant differences existed in the mean albumin levels between stages II and III (p = 0.036). The Multivariate Cox proportional hazards model demonstrated the association of albumin levels with overall survival in patients with PC stage II at univariate and multivariate analysis (p = 0.002, p = 0.003, respectively). In univariate analysis, albumin level was associated with overall survival (p = 0.025) in PC stage III.

Discussion

Albumin level was positively associated with survival in our sample, showing significantly lower mean albumin levels (p = 0.036) of 3.5 g/dl in stage III with a cut-off value of 3.4 g/dl compared to 3.7 g/dl in stage II with a cut-off value of 3.0 g/dl. It suggests a different outlook with the albumin levels depending on the stages, signifying a stage-specific approach and precision interventions for those with lower than the cut-off values. The generalizability of the findings is limited due to the single-site data collection. Albumin levels are critical to predict survivorship. We need to assess the severity of albumin levels based on stages. Examining the association of survivorship with albumin levels by calculating the stage-specific cut-off value is innovative.

Oncology Nursing Forum. 2025 Mar 1;52(2):434–435.

RS6. Factors Hindering Women’s Participation in Breast Cancer Screening Services

Anas Alsharawneh ¹

Healthcare Delivery

Purpose

The study aims to identify which factors determine and hinder women’s involvement in breast cancer screening activities.

Significance

Women across the globe encounter several challenges that can hinder registering and adhering to breast cancer screening activities. Identifying barriers and facilitators influencing women’s participation can help improve recruitment and adherence to screening guidelines. This, in turn, would result in the early detection and identification of cancer at an earlier time when the disease is less invasive and has a better response to treatment, which can be associated with improved survival.

Methods

A cross-sectional design was used to survey 650 women from several settings in multiple cities.

Findings and Interpretations

Participation in breast cancer screening activities was found to be poor as most women did not participate in any of the screening activities, such as regular self-exams, clinical breast examinations, or mammograms. The study identified that the significant individual determinants that influenced breast cancer screening participation were uneasiness with one’s own body (μ= 3.44), barriers related to mammography (μ= 3.04), and exposure barriers (μ= 2.89). Health motivation was identified as a determinant with a high level of perception among the participants (μ= 3.73). The main non-individual determinants that influenced breast cancer screening were perceived environmental barriers (μ=2.80), Influence of religious beliefs concerning cancer (μ= 2.88), and perceived social barriers (μ=3.65).

Discussion

The study identified individual and non-individual factors influencing women’s involvement in breast cancer screening services. The findings highlight the need for tailored interventions to address these barriers and improve women’s enrollment in screening. Breast cancer campaign planners must address personal and internal factors and cultural and social norms and improve access to information and resources to increase awareness and encourage participation in screening activities.

Oncology Nursing Forum. 2025 Mar 1;52(2):435–436.

RS7. Examining Nurse Moral Distress and Trauma in the Coronavirus Pandemic: A Mixed-Methods Study of Inpatient Nurses

Blair Bobier ¹, Grace Conley ², Angela Maeder ³, Angela Maeder ⁴

Healthcare Delivery

Purpose

The purpose of this mixed-methods study was to describe the experiences of inpatient nurses working at a large, urban academic medical center during the Coronavirus Disease 2019 (COVID-19) pandemic.

Significance

While evidence suggests US nurses experience high levels of burnout, traumatic stress, anxiety, and depression, few studies have evaluated how experiences vary within the nursing workforce.

Methods

All (non-agency) inpatient clinical nurses were invited via email to complete an anonymous survey. We measured quality of life, post-traumatic stress disorder (PTSD) symptoms, anxiety, and depression using the following instruments: Professional Quality of Life Scale (ProQOL), Impact of Event Scale-6 (IES-6), Generalized Anxiety Disorder 2-item (GAD-2), Patient Health Questionnaire 2-item (PHQ-2). We collected demographic data including age, gender, race, ethnicity, education level, and years of experience. Qualitative data was collected via focus groups using a semi-structured interview guide from nurses in the emergency department, medical intensive care unit, a COVID medical unit, and an oncology unit. Leadership was excluded from focus group but could participate in 1:1 interviews. Audio recordings of focus groups and interviews were transcribed verbatim. We compared the scores for each instrument across unit using analysis of variance while controlling for demographic characteristics. We analyzed focus group and interview transcripts using thematic analysis. We interpreted the qualitative and quantitative arms in relation to each other.

Findings and Interpretations

337 participants completed surveys. Five focus groups and interviews were conducted with 13 total participants. When compared with other nurses, nurses who primarily cared for COVID patients were more likely to have responses concerning for PTSD (44.6% and 18.3%, p<.001), depression (28% and 12.2%, p=.002), and moderate burnout (88.5% and 74.3%, p=.006). Based on a linear regression, nurses with fewer years of experience were more likely to have symptoms of anxiety (p=.017) and PTSD (p=.009). Nurses who worked night shift experienced less compassion satisfaction than those working on day shift (p=.03). Qualitative analysis is ongoing. Emerging themes include burnout, anxiety associated with new responsibilities, feelings of isolation, and questioning profession and nursing identify.

Discussion

These findings suggest that nurses who primarily cared for patients with COVID-19 and nurses with fewer years of experience would benefit from mental health support. Inpatient nurses had a shared sense of isolation and compassion fatigue, but customized support is needed.

Oncology Nursing Forum. 2025 Mar 1;52(2):436.

RS8. Preventive Navigation: Triage and Risk Assessment Tool to Identify Patients that are Increased Risk for Hospital Admissions and ED Visits

Stephanie Bonfilio ¹, Jennifer Mulholland ², Karen Burke ³, Katherine Barrett ⁴, Stacey Ritter ⁵, Tonya Bohl ⁶

Healthcare Delivery

Purpose

This study aims to develop and validate a predictive risk-scoring tool for thoracic oncology patients undergoing systemic therapy. The goal is to correlate risk scores with hospital admission rates and, if validated, use the tool to reduce admissions for at-risk patients.

Significance

Oncology patients often require hospitalizations due to treatment-related side effects that are manageable in outpatient settings, according to the Centers for Medicare and Medicaid Services (CMS). However, existing literature lacks predictive tools to identify patients at risk of such hospitalizations.

Methods

Literature was reviewed to identify factors that increase the risk of hospital admission for cancer patients. Risk factors such as age, comorbidities, chemotherapies, performance status, malignancy type, prior admissions, lab values, barriers to care, and distress screening were found to increase risk. Based on those findings, the predictive risk-scoring tool, named PREVENT (Preventing Re-admission & ED Visits through Established Nursing Triage), was developed within the electronic medical record system. It assigns points to each risk factor, with total scores ranging from 0 to 20, where 0 indicates low risk and 20 indicates the highest risk. A retrospective chart review of chemotherapy cycle 1 day 1 (C1D1) and cycle 3 day 1 (C3D1) was performed to determine Individual patient risk scores and number of hospitalizations. Statistical analysis was conducted to assess clinical significance.

Findings and Interpretations

The review included 151 charts. Logistic regression analysis revealed that for C1D1, a score of 2 had a 4.59% chance of admission, while a score of 20 had a 57.86% chance (Chi-square=8.02, p=0.005). For C3D1, a score of 2 had a 4.37% chance of admission, and a score of 20 had a 50.43% chance (Chi-square=7.66, p=0.006). For C1D1, factors with significant clinical impact included ECOG Performance Status, chronic liver or kidney disease, and treatment considerations. For C3D1, previous hospital admissions and pain were significant. The confidence intervals for both cycles were wide, indicating some limitations in the model’s strength but providing useful boundary-setting data.

Discussion

PREVENT integrates various risk factors to predict admission risk. The study shows that factors such as ECOG status, comorbidities, and prior admissions have significant predictive value. Further research is needed to refine the tool and explore its applicability to other disease sites.

Oncology Nursing Forum. 2025 Mar 1;52(2):436–437.

RS9. Development and Psychometric Testing of the Oncology Nurses’ Professional Quality of Life Questionnaire: Phase III Results

Rebecca Boni ¹, Catherine Dingley ², Kyle Moxley ³, Emily Wise ⁴

Healthcare Delivery

Purpose

The purpose of this study was to develop and psychometrically evaluate the Oncology Nurses’ Professional Quality of Life Questionnaire (ON-PQOL). The purpose of the final phase was to analyze the relationships between the ON-PQOL and the Theory of Oncology Nurses’ Professional Quality of Life.

Significance

Oncology nurses are at significant risk of inadequate professional quality of life (PQOL), which can result in nurse turnover and poorer patient outcomes. Nursing research focused on PQOL has been conducted using surveys not designed for or validated amongst nurses.

Methods

The ON-PQOL was developed based on the four domains in the Theory of Oncology Nurses’ Professional Quality of Life (Accepting the context of oncology nursing, Bettering the world, Pursuing a calling, and Being valued) and validated amongst six internationally recognized content experts and 53 practicing oncology nurses during previous phases of the study. During phase III, practicing oncology nurses were recruited through social media and professional communities. Entry into drawings for gift cards was used as an incentive. Structural equation modeling guided evaluation of the ON-PQOL’s fit to the Theory of Oncology Nurses’ Professional Quality of Life.

Findings and Interpretations

Two hundred forty-three nurses from various inpatient and outpatient oncology settings in the United States completed the survey. Results were internally consistent (Preliminary α = 0.88). Factor analysis consistently demonstrated that the survey items within the Accepting the context of oncology nursing subscale, did not fit any of the models. This misfit is consistent with the theory because this domain is a prerequisite for the other domains. Confirmatory factor analysis was conducted using Maximum Likelihood estimation. The chi-square test was statistically significant, χ²(32) = 75.64, p < .001, indicating some degree of model misfit. However, alternative fit indices demonstrated satisfactory model fit. The Comparative Fit Index (CFI) = .949 and Tucker-Lewis Index (TLI) = .929, both suggesting an acceptable fit with the theory’s three remaining domains (Bettering the world, Pursuing a calling, and Being valued). The final ON-PQOL consists of 40 items within four subscales that correspond to the theory’s four domains.

Discussion

The ON-POQL has demonstrated reliability and validity through three phases of psychometric testing. It is a valid measure for all nurses providing direct oncology care. The ON-PQOL can be used in future research and evidence-based practice to evaluate and address PQOL amongst oncology nurses.

Oncology Nursing Forum. 2025 Mar 1;52(2):437.

RS10. Evaluating Pregabalin in Terminal Cancer Patients with Chronic Neuropathic Pain and Depression: An Observational Case Series

Mrinal Borgohain ¹, Pinaki Chakraborty ²

Survivorship, Palliative and Psychosocial Oncology Care

Purpose

Chronic neuropathic pain and depression are common and debilitating conditions in terminal cancer patients, significantly impacting their quality of life. Pregabalin, an anticonvulsant medication, is used for neuropathic pain and may also influence depressive symptoms. This study evaluates the efficacy and safety of pregabalin in this patient population.

Significance

To assess the impact of pregabalin on pain intensity, depression severity, and side effects in terminal cancer patients with chronic neuropathic pain and depression.

Methods

This observational case series included 10 terminal cancer patients experiencing chronic neuropathic pain and depression. Pregabalin was administered at a starting dose of 150 mg twice daily, with adjustments based on patient tolerance and pain response, up to 300 mg twice daily. Pain intensity and depression severity were assessed using the Brief Pain Inventory (BPI) and the Hamilton Depression Rating Scale (HDRS) at baseline, 4 weeks, and 8 weeks. Side effects were monitored using a self-reported side effect questionnaire.

Findings and Interpretations

Pregabalin led to a significant reduction in pain intensity and depression severity. The mean BPI score decreased from 7.8 (SD = 1.2) at baseline to 5.2 (SD = 1.4) at 4 weeks and 4.1 (SD = 1.5) at 8 weeks, representing reductions of 33.3% and 47.4%, respectively. The mean HDRS score decreased from 18.5 (SD = 4.0) at baseline to 13.2 (SD = 4.1) at 4 weeks and 9.8 (SD = 3.6) at 8 weeks, showing reductions of 28.4% and 47.0%, respectively. Side effects included dizziness (50%), drowsiness (40%), weight gain (30%), and dry mouth (20%). No severe adverse effects were reported. All patients completed the study, with 30% requiring dose adjustments.

Discussion

Pregabalin significantly alleviates both chronic neuropathic pain and depression in terminal cancer patients, with a manageable safety profile. These findings support the use of pregabalin in this patient population, though further research with larger samples and controlled designs is warranted to confirm these results and refine treatment approaches

Oncology Nursing Forum. 2025 Mar 1;52(2):437–438.

RS11. A Longitudinal Study on Palliative Care Competencies for the Early Career Registered Nurse

Cheryl Brohard ¹

Survivorship, Palliative and Psychosocial Oncology Care

Purpose

The overarching purpose of the proposal is to describe the long-term outcomes of palliative care education and nursing care experience on the knowledge, skills, and attitude of the practicing nurse who has received education while in nursing school. The study will provide insight into what components of palliative care education were efficacious in preparing the nurses to care for patients, family, or friends in palliative care, as well as during the COVID-19 pandemic.

Significance

The significance of this study is to explore and describe the effectiveness and utility of palliative care education and training during a UG nursing program as a means of providing excellent quality patient care during the palliative care period and end-of-life to the patients.

Methods

This prospective, exploratory, descriptive study is to test the long-term efficacy of an innovative teaching approach of using lectures and high fidelity simulation for palliative care competencies with nurses who have graduated. This is a non-randomized, quasi-experimental design using a convenient sample from 2015 to 2024 graduates. Using a HIPAA-secured survey software, alumni will receive a confidential email to complete the questionnaire. Researchers will collect demographic information, The Frommelt Attitudes Toward Care of the Dying Scale Form B, CARES-UG updated 2021 palliative care competencies modified as the one used in 2016 to 2019 as a Likert-scale instrument, questions about the three corresponding simulations for palliative care competencies, and other open-ended questions about the effectiveness and utility of the palliative care education during the nursing program.

Findings and Interpretations

The study and survey is under IRB approval at the time of this abstract submission. This study has 3 hypotheses. Hypothesis 1 Nurses will have high competency scores (Average of 4.0 – 5.0) on academic lectures and high fidelity simulations on their palliative care knowledge, communication, confidence, and satisfaction. Hypothesis 2 Nurses will have medium to high competency scores (Average of 3.5 – 4.0) on the influence of nursing care on their palliative care knowledge, communication, confidence, and satisfaction. Hypothesis 3 Nurses will have an overall palliative care competency in 2024 less than they had at the end of nursing school.

Discussion

The top three educational strategies that influence registered nurses in attaining undergraduate palliative care competencies will be identified. Recommendations for curriculum for palliative care will be presented.

Oncology Nursing Forum. 2025 Mar 1;52(2):438–439.

RS13. Establishing Content Validity of the Professional APN Relationships (PEARL) Survey to Measure Advanced Practice Nurse and Provider Collaboration

Leana Cabrera Chien ¹, Lacy Jo Graham ², Carolina Uranga ³, Rachelle Levy ⁴, Nimian Bauder ⁵, Jeannine M Brant ⁶

Healthcare Delivery

Purpose

The purpose of this study was to develop the ProfEssional APN ReLationships (PEARL), a survey to measure collaboration between APNs (Advance Practice Nurses) and Collaborating Providers (CPs). A model by Jones and Way (2006), which has seven essential elements of interprofessional collaboration (cooperative, assertiveness, autonomy, responsibility/accountability, communication, coordination, mutual trust/respect), served as a foundational framework to develop the instrument.

Significance

APNs bring a comprehensive and holistic approach to managing patients across the life continuum. In 27 states APNs function independently; however, most APNs work collaboratively with individual physicians or physician teams. No instruments were found in the literature that comprehensively measured the collaborative relationship between APNs and CPs. APNs at an NCI-designated cancer center sought to further explore these relationships.

Methods

The APN research committee convened to develop the survey using an iterative process. Eight team members generated 99 items over eight weeks. The team then reviewed the 99 items together for clarity, relevance, redundancy, and alignment with the Jones and Way collaboration elements; 26 items were deleted using this process. Of the 73 items remaining, 44 were re-worded. APN investigators re-reviewed the 73 items and refined and deleted items as needed during six team meetings; 59 items remained. The survey was sent to 10 APN experts (national, international) to establish content validity using the same criteria as above. All experts chosen will have published work, be leaders and/or board members of national nursing organizations or have over 10 years of APN experience.

Findings and Interpretations

The return rate was 100%. Median age of experts was 58 years (45–71), 90% were female, 70% White, 70% working in both inpatient/outpatient settings, and 60% worked in an academic setting; the majority had 21–30 years of experience. APN investigators revised and deleted items based upon input; items were retained with a 70% agreement of relevance and clarity by experts. This resulted in the PEARL protype survey with 48 items. Next steps include administering the instrument to a large diverse sample.

Discussion

The goal of the PEARL survey is to provide a better understanding of the relationship(s) between APNs and CPs and identify opportunities for growth. Next steps include administering the instrument to APNs nationwide to further refine the instrument.

Oncology Nursing Forum. 2025 Mar 1;52(2):439.

RS14. Interventions to Prevent Falls and Injuries in Inpatient Oncology Units: A Scoping Review

Elizabeth Capezuti ¹, Amil Tan ², Seema Lall ³, Maria Scaramuzzino ⁴, Patricia Tennill ⁵, Annie George ⁶

Healthcare Delivery

Purpose

Individuals with cancer are at a heightened risk of experiencing falls and related injuries during hospitalization. Considerable research has uncovered risk factors specific to oncologic inpatients. Our aim was to systematically perform a literature review to summarize and evaluate the effectiveness of interventions employed in this population.

Significance

Among the general adult inpatient population, adverse consequences of fall-induced injuries include heightened morbidity, prolonged hospital stays, and increased mortality rates, with such complications disproportionately affecting individuals with cancer. Moreover, injurious falls have the potential to impede cancer treatment progress. Individuals with cancer are at a heightened risk of experiencing falls and related injuries.

Methods

Guided by PRISMA statement, a health librarian conducted searches of five databases, which uncovered 1,039 unduplicated studies that were screened by two independent reviewers and resulted in ten quality improvement evaluations. The Quality Improvement Minimum Quality Criteria Set was used to evaluate their methodological quality of the ten intervention evaluations. Half of studies met criteria for high quality.

Findings and Interpretations

All studies used a multi-factorial approach to intervention and most based these on assessment with few targeting cancer-specific factors. Most interventions were staff-focused with a few incorporating the patient’s input. Assessment coupled with interventions individualized to the patient is optimal but can only be effective is the entire health team and the patient as aware of these factors.

Discussion

Nurse rounding enhances communication between the healthcare team and patients, while innovative technologies aid patient self-assessment and help recall the fall prevention plan using bedside monitors. Nurse rounding enhances communication between the healthcare team and patients, while innovative technologies aid patient self-assessment. Engaging patients in the process promotes patient satisfaction and intervention adherence, thus warranting more technology development and outcome research in this area.

Oncology Nursing Forum. 2025 Mar 1;52(2):439–440.

RS15. A Team-based Approach to the Integration of Therapeutic Clinical trials into Oncology Standard of Care

Frances Cartwright ¹, Rita Jakubowski ², Sarah Middlekauff ³, Nichelle Ogiste ⁴, Anna Schloms ⁵, Juliana Roddy ⁶

Healthcare Delivery

Purpose

An infrastructure was developed to integrate Randomized Therapeutic Clinical Trials (RTCTs) into Standard of Care (SOC) across oncology in a healthcare system to implement a standardized approach.

Significance

Providing care based on the outcome of RTCTs is critical to providing patients with access to the most effective therapies. Collaboration among the research and clinical care providers, and administrative/interdisciplinary teams is key to quickly and safely translating research into best-practice clinical care.

Methods

A core group of stakeholders across the system established criteria to identify two levels of participation in the integration of RTCTs into the SOC. Level One: Basic foundational awareness and interdisciplinary teaming demonstrated; Level Two: Interdisciplinary teaming demonstrated, staffing model and competency in alignment with integrating aspects of the RTCTs into SOC. Three ambulatory practices met the Level One criteria; one inpatient acute care unit and two hem malignancy practices met the Level Two criteria. An education/competency module was developed. Level two includes more tailored and comprehensive education and training based on the level of participation. A dashboard with process and outcome measures includes a baseline for pre-pilot go-live and ongoing post-implementation including the number of referrals initiated by the SOC team, number of trials embedded into the model e.g. enrollment, Composite measures of patient experience (Communication), composite measures of staff engagement (Teamwork), coordination of care (turn-around-time) from identification to enrollment, Quality Safety (adverse events, trial deviations, Safety reports related to TCTs).

Findings and Interpretations

A policy and procedure reflecting the updates in education and processes across the oncology system footprint was approved. The education/competency module is incorporated into the orientation for new nurses; the pilot sites will complete the education/competency modules and go live by December 1, 2024. An addendum is being added to the job description. The baseline data reveals opportunities to improve the process and outcome measures using the new. infrastructure. This is one of the American College of Surgery, Commission on Cancer, Quality Program Goals (Standard 7.4) for 2024–2025.

Discussion

The development of an infrastructure to support the integration of RTCTs into SOC is a “Triple Win” that: Advances critical thinking and heightens awareness of the importance of RTCT, promotes patient safety, advances timely access to care and confidence in the decision-making process and supports teaming among clinical, research, and administrative staff.

Oncology Nursing Forum. 2025 Mar 1;52(2):440.

RS16. Effects of the Rose (Rebuilding Osteo Strength with Exercise) Program on Osteoarthritis Symptoms, Osteoporosis Knowledge, and Self-Efficacy in Breast Cancer Survivors on Endocrine Therapy: A Randomized Controlled Trial

Lu Chen ¹, Ci Li ², Jiaming Ai ³, Jun-E Liu ⁴

Survivorship, Palliative and Psychosocial Oncology Care

Purpose

This study aimed to evaluate the effects of a 12-week multi-component bone health management program on osteoarthritis symptoms, osteoporosis knowledge, and self-efficacy in breast cancer survivors undergoing endocrine therapy.

Significance

Musculoskeletal side effects from adjuvant endocrine therapy are common among breast cancer survivors and can negatively impact both treatment adherence and quality of life. However, effective bone health management is often lacking for these patients. This study presents a detailed bone health management program that includes health education, exercise, and behavior change strategies, providing a valuable reference for bridging this gap.

Methods

Eighty-eight early breast cancer survivors treated with adjuvant endocrine therapy were randomly allocated into an intervention group (n=43) or a control group (n=45). The intervention group received a 12-week online-delivered rebuilding osteo strength with exercise (ROSE) program that included a home exercise regimen, online group exercise, bone-health education, and strategies for health behavior change. The control group received enhanced bone health information care. Data on osteoarthritis symptoms, physical fitness, osteoporosis knowledge and management self-efficacy were collected at baseline, postintervention, and at the 3-month follow-up.

Findings and Interpretations

After the intervention, the intervention group showed improvements in osteoarthritis symptoms across the pain, stiffness, and function dimensions, while the control group experienced an increase in pain with no significant changes in stiffness or function. Although no significant differences were observed between the two groups in individual dimensions, the overall symptom changes between the groups showed a statistically significant difference (p = 0.036). Additionally, the intervention significantly improved osteoporosis knowledge among breast cancer patients (p = 0.006), and the advantage of the intervention group persisted until the follow-up period. However, no significant impact of the intervention on self-management efficacy was observed.

Discussion

The ROSE program, which integrates exercise intervention, health education, and behavior change strategies, shows potential value in alleviating joint symptoms and improving bone health knowledge in breast cancer patients. However, further research is needed to verify its effect on enhancing self-management efficacy.

Oncology Nursing Forum. 2025 Mar 1;52(2):440–441.

RS17. ‘How Can I Take Things as they Happen?’ Unveiling Illness Perceptions among Patients with Gastrointestinal Tract Cancer: A Mixed-Methods Study

Yongfeng Chen ¹, Carmen WH Chan ², Liuxin Zhang ³, Kai Chow Choi ⁴, Marques Shek Nam Ng ⁵

Survivorship, Palliative and Psychosocial Oncology Care

Purpose

To integrate quantitative and qualitative data to achieve a comprehensive understanding of illness perceptions among patients with gastrointestinal tract cancer in a Chinese setting.

Significance

Modifiable factors explained more than half of deaths among patients with gastrointestinal tract cancer. Patients are expected to adhere to treatment and long-term surveillance, as well as adopt healthy lifestyles to promote survivorship. According to the common-sense model of self-regulation, illness perceptions guide these behaviors. China has the largest number of gastrointestinal tract cancer patients, representing more than one-third of the global cases. However, there is limited understanding of how these patients perceive their illness.

Methods

A convergent mixed methods study was conducted. In the quantitative component, the Brief Illness Perception Questionnaire was used to assess illness perceptions among 253 participants with GI tract cancer. In the qualitative component, illness perceptions reported by 37 participants were identified through semi-structured interviews using content analysis. After conducting separate analyses, the findings were integrated using side-by-side comparison and joint display, then presented through a narrative-weaving approach based on a theme-by-theme structure.

Findings and Interpretations

The average score for illness perceptions among this population was 38.59 (SD = 10.95). Based on the average score, items of illness perceptions ranked from high to low were concern, treatment control, understanding, personal control, timeline, consequence, identity, and emotional responses. The qualitative results confirmed the quantitative results in identity, concern, and causes; and expanded the quantitative results in consequence, timeline, personal control, treatment control, emotional response, and understanding of illness perceptions. Specifically, Patients suffer various symptoms and influences from cancer and regard their illness were incurable with oncoming death. With a strong desire to live longer, they rated high on treatment control while relatively low on personal control due to a lack of related knowledge. Support from families, healthcare providers, and experienced peers helped them interpret the illness more positively. It is noteworthy patients were highly concerned about cancer prognosis and death. Considering emotions as attitudes to confront illness, they relied on self-regulation to present less emotional responses in front of others.

Discussion

The integration of quantitative and qualitative findings supporting the application of the common-sense model of self-regulation. Support for disease interpretations, personal control, and negative emotion regulation may contribute to favorable illness perceptions.

Oncology Nursing Forum. 2025 Mar 1;52(2):441–442.

RS18. Feasibility and Preliminary Outcomes of a Self-Regulation Promoting Education Program among Patients with Gastrointestinal Tract Cancer Newly Taking Oral Anticancer Agents at Home: A Pilot Randomized Controlled Trial

Yongfeng Chen ¹, Marques Shek Nam Ng ², MeiMei Shang ³, Carmen WH Chan ⁴

Healthcare Delivery

Purpose

To evaluate the feasibility, acceptability, and preliminary outcomes of a self-regulation promoting education program on adherence management among patients with gastrointestinal (GI) tract cancer.

Significance

Patients with GI tract cancer reported suboptimal adherence to oral anticancer agents (OAA), reducing the therapeutic benefit and increasing mortality risk. Self-regulation is the conscious process to modulate cognitive, emotional, and behavioral responses to the changing environment for achieving specific goals. While being an important mechanism to foster behavioral change, little is known about how to utilize this self-regulation to enhance adherence to OAA among patients with GI tract cancer.

Methods

In March and April 2024, a two-arm pilot randomized controlled trial was conducted at two hospitals in Shandong, China. Twenty-four participants were randomized to the control or intervention group with a 1:1 ratio. The control group received the usual care. The intervention group received usual care as well as four sessions of self-regulation promoting education via both face-to-face meetings and phone calls. Feasibility was evaluated using eligibility, consent, attrition, and intervention adherence rates. Acceptability was assessed using a satisfaction questionnaire. Preliminary outcomes were assessed using adherence to OAA, illness perceptions, medication belief and self-efficacy, and self-management behaviors. Data were collected at baseline and post-intervention. Descriptive statistics were used to describe the study variables, and inferential statistics were employed to compare variables between the two groups. Cohen’s d was adopted to estimate the intervention’s effect size on outcome variables.

Findings and Interpretations

The consent rate was 64.86%. The attrition rate was 8.33%. Ten out of 12 participants in the intervention group finished all education sessions. All of them were satisfied with the educational content and perceived that attending the program was helpful. A favorable trend of higher self-management behaviors (Cohen’s d = 0.915), less negative illness perceptions (Cohen’s d = −0.714), more necessary beliefs (Cohen’s d = 0.451), higher medication self-efficacy (Cohen’s d = 0.431), and better adherence to OAA (good adherence: 90.91%) were found in the intervention group.

Discussion

This self-regulation promoting education program is considered feasible and acceptable. It is promising to promote adherence, self-management behaviors, medication self-efficacy, and positive illness perceptions. A full-scale randomized control trial is needed to explore its effectiveness in a larger sample.

Oncology Nursing Forum. 2025 Mar 1;52(2):442.

RS20. Intra-Arterial Carboplatin Chemotherapy: Hearing Evaluations in Children with Retinoblastoma: A Single Institution Study

Mary Elizabeth Davis ¹, Edith Guarini ², Kerri O’Connor ³, Jasmine Francis ⁴, David Abramson ⁵

Symptom Science

Purpose

Retinoblastoma (RB) is the most common primary cancer of the eye in children with about 8000 diagnosed yearly worldwide. RB can be cured with multimodality therapies including intravenous (IV) chemotherapy with carboplatin, etoposide, and vincristine. This therapy, however, is associated with serious toxicity, including bone marrow suppression, nausea/vomiting, and hearing loss from carboplatin. Hearing loss from IV carboplatin is usually irreversible. At many institutions, chemotherapy for RB is now given solely by intra-arterial (IA) administration.

Significance

While the success of IA chemotherapy is now clearly documented in the literature with preservation of children’s lives, eyes and vision, evaluation of hearing status associated with IA carboplatin administration needs to be confirmed.

Methods

A prospective pre-posttest design was employed to study children receiving IA carboplatin. Approval was obtained by the institutional review board. Children were excluded if they already had IA carboplatin or presented with hearing loss but were allowed if they had IV carboplatin and dosing was available. Hearing was evaluated prior to IA chemotherapy with carboplatin and 3–9 months after completion of therapy. Since most children are diagnosed at a young age, distortion product otoacoustic emission measurement (DPOAE) was the primary measurement. While DPOAE is technically not a true measure of hearing, it does correlate to hearing. A present DPOAE finding indicates functioning cochlear amplification, while absent DPOAEs indicate dysfunction. Tympanometry was performed to confirm no inner ear fluid. All examinations were accomplished by a certified audiologist using the same equipment, calibrated consistently by a qualified technician.

Findings and Interpretations

Due to the COVID pandemic, enrollment and study completion was severely hampered. Out of 40 who enrolled, twenty-two children completed pre and post testing and were evaluable. Children ranged in age from 2 months to 4 ½ years with mean age of 16 months. Sixteen were female. No child demonstrated measurable hearing loss. Findings suggest that IA carboplatin does not affect outer hair cell function, and DPOAE can provide useful information when monitoring children at risk of developing carboplatin ototoxicity.

Discussion

As novel cancer treatments become standard practice, care must be taken to examine and pre-mitigate potential toxicities. Retinoblastoma is a curable cancer. For children acquiring language, even small hearing losses can lead to communication difficulties. Within this single institution study, hearing loss was not associated with IA carboplatin through DPOAE measurement.

Oncology Nursing Forum. 2025 Mar 1;52(2):442–443.

RS21. Interdisciplinary Approach to Transitions of Care

Anne Delengowski ¹, Adam Binder ², Kristen Kriebel ³

Healthcare Delivery

Purpose

The purpose of this ongoing project is to allow for seamless transition of the oncology patient from inpatient to outpatient care. An additional purpose is to improve metrics including increasing discharge to home and assuring follow up appointments within 7 days.

Significance

Successful transitions of care for cancer patients is essential. As the care of this population can be quite complex, it is important to assure seamless transitions. The success of transitions is dependent on the interdisciplinary team coordinating the care and each member taking ownership for their role in the process.

Methods

An interdisciplinary group consisting of nurses, providers, pharmacist, therapists, case managers, social workers, financial advisors, transition navigator and scheduler meet Monday through Friday to review all oncology inpatients to support transitions of care. All members of the team participate and discuss their role in this process. The team discuss barriers and solutions to overcome these barriers. Approximately 40 patients are reviewed during the rounds. The rounds are half an hour and scripted based on discipline. In addition to medical milestones needed to be reached for discharge, issues such as AMPAC scores and need for therapy consultation, new medications needing patient education and potential pre authorization, rides to and from appointments and social needs.

Findings and Interpretations

The team has been in place for many years, but has made enhancements to achieve metrics. A transition nurse navigator is a new addition. The role is consulted for newly diagnosed cancer patients and at risk individuals. A patient service associate comes to rounds to assure appointments are made real time prior to discharge. Each patient has an appointment prior to discharge with a range of 72 hours to 7 days post discharge based on need.

Discussion

Oncology Transitions of Care Rounds Team who won the Award for Excellence in Interprofessional Collaborative Practice for 2024. This presentation will include a discussion of the process, individual roles and outcomes related to discharge to home and timely appointment followup

Oncology Nursing Forum. 2025 Mar 1;52(2):443.

RS22. Raising the Bar Improving Diversity, Equity, and Inclusion in Nursing Leadership

Kimako Desvignes ¹

Healthcare Delivery

Purpose

This initiative aimed to improve diversity, equity, and inclusion (DEI) within nursing leadership. In an academic healthcare setting in California, does developing a guideline improve DEI within nursing leadership compared to having no guideline?

Significance

This initiative is crucial given the increasing diversity of the U.S. population, which is projected to become a majority-minority by 2043 (Carter et al., 2015). Despite this demographic shift, nursing leadership does not reflect this diversity, impacting access to and quality healthcare care for ethnically marginalized populations (Matza et al., 2018). Addressing this gap aligns with the conference’s goal of fostering a more inclusive and equitable healthcare environment.

Methods

SWOT analysis and organizational readiness assessment were conducted. Developed risk mitigation strategies and budget created. Comprehensive literature search and critical appraisal completed. Formulated six guideline recommendations based on graded literature. Stakeholders rated the recommendations using a 4-point Likert scale. Analyzing data with Friedman’s 2-Way ANOVA and descriptive statistics to evaluate stakeholder ratings and feedback.

Findings and Interpretations

The evaluation showed strong stakeholder support for the guideline, with high ratings for mentorship programs (Mean: 3.67) and diverse recruitment (Mean: 3.65). The analysis revealed significant differences in how stakeholders rated the recommendations, indicating diverse perspectives on their importance and implementation. The guidelines positively impact DEI in nursing leadership, with evidence of improved stakeholder engagement and support for DEI initiatives. The findings suggest several implications for practice:

■ Focus on Mentorship and Recruitment: High ratings indicate these areas are strengths. Building on these successes can enhance DEI efforts.
■ Enhance Policy and Affinity Group Effectiveness: Moderate ratings for inclusive policies and affinity groups highlight opportunities for improvement. Addressing specific challenges can lead to better outcomes.
■ Support a Healthy Work Environment: Promoting a healthy workplace aligns with DEI goals, ensuring all employees feel safe and supported.
■ Align Organizational Values with DEI: Revisiting and reinforcing the alignment between organizational mission, vision, core values, and strategic plan with DEI principles can strengthen overall impact.

Discussion

Developing and implementing a guideline to improve DEI within nursing leadership is crucial for addressing disparities in leadership demographics. This guideline provides a replicable pathway for healthcare organizations to foster a more inclusive leadership structure, ultimately benefiting the quality of care and organizational culture. The positive evaluation results underscore the value of structured DEI initiatives and highlight areas for ongoing development and enhancement.

Oncology Nursing Forum. 2025 Mar 1;52(2):443–444.

RS23. Genetic/Genomic Needs Assessment and Intervention among Nursing Healthcare Providers in a Community Oncology Hospital Setting

Vicki Doctor ¹, Kate Sweeney ², Kimberly Crum ³, Stephanie Barendt ⁴, Laura Moreno ⁵, Leighsa Sharoff ⁶

Genetics

Purpose

This exploratory pilot aimed to determine nurses’ baseline knowledge, perceptions, attitudes, and comfort levels with genetics/genomics before and after they participated in educational training that could enhance their practice in the oncology setting.

Significance

With the completion of the Human Genome Project in 2003, there has been noteworthy progress in the scientific translation of precision oncology care. The development of the Core Competencies in Genetics for Health Professionals encourages clinicians to be appropriately trained to integrate genomically based patient care effectively and comprehensively. However, published studies reveal a need for additional clinical education for nurses to understand the fundamental principles of integration. Oncology nurses are key players in patient education and advocacy and must be better informed about genomics/genetics.

Methods

Nurses from three community oncology tertiary hospitals in Illinois, Arizona, and Georgia participated in a pre/post-test design IRB-approved study utilizing an adapted version of the Genetic and Genomic Literacy Assessment. Following the pre-survey, a one-hour educational virtual presentation based on the American Nurses Association Essentials of Genomic Nursing Competencies and Outcome Indicators (3^rd Ed.) was completed, and written material resources from the Oncology Nursing Society were provided. A post-survey invitation was sent to all virtual presentation attendees.

Findings and Interpretations

Forty-one participants completed the pre-survey with twenty-three post-survey completion. There was no statistically significant change in knowledge , perceptions, and attitudes between the pre/post survey responses. Nurses comfort level changed significantly (p value: 0.01 to 0.04) post educational intervention.

Discussion

The innovative era of precision oncology has ushered in a paradigm shift in managing patients with cancer. Translating this innovative knowledge about the utility and efficacy of precision oncology and the ethical and legal considerations of genomic/genetic-based testing is essential. The knowledge nurses gain in this field through education can lead to an increased ability and confidence to educate patients, enhanced genomic understanding and its importance in oncology care. Our innovative pilot demonstrates the impact of educational content on nurses’ comprehension and comfort levels with this content.

Oncology Nursing Forum. 2025 Mar 1;52(2):444–445.

RS24. Comparative Sleep Assessment among African American Survivors of Lung Cancer

Amanda M Dyer ¹, Karen Kane McDonnell ², Michael D Wirth ³, Judith Fouladbakhsh ⁴, Jean E Davis ⁵

Symptom Science

Purpose

To assess and compare sleep among African American survivors of lung cancer with and without chronic obstructive pulmonary disease (COPD) utilizing the Symptom Management Theory.

Significance

Survivors of localized non-small cell lung cancer (NSCLC, stages I–IIIA) experience poor sleep, which may be exacerbated by common comorbid conditions like COPD. However, few studies have specifically investigated sleep among survivors of lung cancer with COPD. Evidence is needed to promote a better understanding of sleep problems, their health impact, and interventions to manage symptoms of disturbed sleep.

Methods

This two-group, cross-sectional, descriptive study utilized cancer registry data to recruit survivors from a private practice in South Carolina. Participants completed sleep and symptom-focused questionnaires, 7 days of waist-worn accelerometry, and a 7-day sleep diary. An in-person interview was conducted at the study conclusion. Descriptive statistics assessed demographic, health status, and sleep characteristics. Inferential statistics assessed differences in sleep quality, quantity, and disturbances between survivors with COPD and without COPD. Interviews were professionally transcribed and analyzed using thematic analysis.

Findings and Interpretations

Sixteen participants enrolled, most were female (68.8%, n = 11), mean age was 68.9 years (range 45 – 84), 56.3% had Stage I lung cancer (n = 9), with a mean of 4.3 comorbidities (range 0 – 9) and 50% (n = 8) had COPD. The Pittsburgh Sleep Quality Index mean global score was 11.4 (range 8 – 16) for participants with COPD and was 8.1 (range 1 – 12) for participants without COPD. Self-reported sleep (<7 hours/night) and self-reported sleep efficiency (<85%) were inadequate. Accelerometry indicated adequate sleep efficiency, a high level of sleep disturbances, and highly abnormal, extended sleep duration. Qualitative analysis resulted in 5 themes including: perceived sleep quality ranging from terrible to good, multiple wakes after sleep onset was common, upon final awakening do not feel well rested, a sleep time routine is perceived as beneficial to improve sleep quality, and health providers inattention to sleep as a potential clinical problem.

Discussion

Research reveals a minority population of survivors of localized lung cancer experience poor sleep. This comparative assessment provides new evidence supporting sleep as an important clinical problem, providing support for the need to better understand and improve sleep. Establishing a clearer understanding of this relationship may lead to improved management of burdensome symptoms and health outcomes for this vulnerable population.

Oncology Nursing Forum. 2025 Mar 1;52(2):445.

RS25. A Nurse Led Model for Transition of Patients after Completion of Phase 1 Trials

Betty Ferrell ¹, Tami Borneman ², Finly Zachariah ³, Virginia Sun ⁴, Nathaniel Co ⁵, Vincent Chung ⁶

Healthcare Delivery

Purpose

This pilot project tested a model of support for patients transitioning after a Phase 1 clinical trial.

Significance

The recent ASCO guidelines and literature have shown that patients on clinical trials face many physical and psychosocial concerns and benefit from supportive care. Results from the authors’ previous research (N=479) with patients on Phase 1 clinical trials showed a lack in planning for care beyond the trial.

Methods

This was a single group, convenience sample with patients accrued at baseline of a phase 1 clinical trial and followed at 3 and 6 months after ending the trial. Baseline data was considered the primary focus representing the needs at time of transition off the trial and the 3 month outcome timepoint assessed impact of the intervention. Six month follow up assessed continued care and mortality. The study was IRB approved. In addition, interviews were conducted with 28 of the 37 subjects that provided further insight to the patient’s experience.

Findings and Interpretations

Patients (N=37) had significant needs for support across all QOL domains. The Transitions model was valuable in assessing QOL needs, facilitating patients’ understanding of disease status and access to supportive care services. Greatest QOL concerns for patients assessed by the FACT-QOL instrument were losing hope, coping with illness, accepting their illness, and ability to enjoy life. Spiritual Well Being data, assessed using the FACIT-Sp-12, showed positive ratings for reason for living and sense of meaning and purpose, and low ratings for illness strengthening their faith. The Psychological Distress Thermometer was used to measure distress which generally remained low. Scores were compared for the baseline measures with follow up at three months. One way repeated analysis of variance (ANOVAs) indicated no significant change over the 3 months in the scales. Chart audit data confirmed that this initial period in the first months after phase 1 trial completion was stable but in the subsequent months as the disease progressed, the patient’s status declined and there was high mortality.

Discussion

This pilot study demonstrated the need for supportive care integration in the clinical trials population to address unmet needs and to facilitate this important time of transition in the cancer care trajectory. Nurses provide essential support to patients completing clinical trials and the transitions often include QOL concerns. Nurses can facilitate these transitions to improve care.

Oncology Nursing Forum. 2025 Mar 1;52(2):445–446.

RS26. Improving Implementation of Survivorship Care: Qualitative Data Analysis Using the the i-PARIHS Framework

Karl Cristie Figuracion ¹, Jean Yi ², Eric Chow ³, Catherine Duggan ⁴

Survivorship, Palliative and Psychosocial Oncology Care

Purpose

In this study, using the i-PARIHS framework, we will begin to assess two of the core elements – evidence and context – and associated sub-elements through qualitative and quantitative methods at participating clinics. This abstract will present the qualitative findings aimed at assessing the nature and type of evidence, the qualities of the context in which evidence is being introduced, and the way the process is facilitated.

Significance

An increasing number of cancer survivors are transitioning from specialist oncology care to primary care providers. Survivorship care plans (SCPs) provide cancer survivors with a summary of their diagnosis and treatment, with directions for future care, and are intended to help transition patients from tertiary-level to primary care. However, the implementation of SCPs into routine cancer care remains challenging and often unsuccessful. Barriers identified include time restraint, lack of resources, and lack of training and consensus on what should be included in the SCP. Furthermore, only a few studies utilize implementation science frameworks to address these issues systematically. Therefore, as a critical step in improving SCP delivery and utilization, we propose using the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, to identify essential determinants of successful implementation of research into clinical practice.

Methods

We used snowball sampling to recruit primary care providers, oncology providers, and clinic administrators in primary and tertiary care centers across the United States. Participants provided verbal informed consent, and participated in a one-hour semi-structured video qualitative interview. Interviews were recorded, transcribed, and analyzed using Atlas.Ti (v8.7.0-2024-09-21). A predefined qualitative codebook that maps codes to the i-PARIHS framework domains was generated.

Findings and Interpretations

Analysis in Progress. Twenty participants were interviewed. Five providers were from the primary care settings (N=4 medical doctors; N=1 as advanced practice provider [APP]). Fifteen were from oncology centers (N=2, nurses; N=4, APPs; N=3, administrator/leadership; N=5, medical oncologists) and one patient advocate.

Discussion

The i-PARIHS framework allows for systematic assessment of priorities, gaps, facilitators, and barriers at a local and organizational as well as individual recipient level. Findings from these interviews are foundational work in improving cancer survivorship care. Not only will these rich qualitative data inform future implementation strategies of SCP delivery, but they will also elucidate the gaps in survivorship care.

Oncology Nursing Forum. 2025 Mar 1;52(2):446–447.

RS27. Advancing Health Equity in Lymphatic Pain and Lymphedema in Black Women with Breast Cancer: A Qualitative Study

Mei Rosemary Fu ¹, Jeanna Arbesfeld-Qiu ², Stephanie Korth ³, Howard Kremer ⁴, Cynthia Russell ⁵, Sue Lasiter ⁶

Health Equity

Purpose

The purpose of this study was two-fold: 1) to understand the perspectives of Black women with breast cancer on lymphatic pain, behavioral intervention for lymphatic pain and lymphedema; and 2) to identify the facilitators and barriers to implement such behavior interventions.

Significance

Lymphatic pain refers to pain, aching, soreness, or tenderness in the ipsilateral body or upper limb following breast cancer treatment. More than half of the 3.8 million women with breast cancer suffer lymphatic pain leading to impaired daily living function, psychological distress, and compromised quality of life. Most importantly, lymphatic pain is significantly associated with lymphedema, a chronic and incurable condition caused by an abnormal accumulation of lymph fluid. Black women are three times as likely to develop lymphedema compared to White women. Timely intervention for lymphatic pain can decrease the risk and severity of lymphedema. However, there are persistent barriers to timely interventions faced by Black women who are at high risk for developing lymphedema, pain, and other negative breast cancer related outcomes.

Methods

A qualitative and descriptive design with a purposive sampling method was used. In-depth and semi-structured interviews were conducted with 12 Black women with lymphatic pain or lymphedema. A rigorous and iterative data analysis method was used to examine the data, compare codes, challenge interpretations, and develop themes inductively.

Findings and Interpretations

Lymphedema remains unknown for the women without a diagnosis of lymphedema. Black women described lymphatic pain as “persistent pain that never goes away” and “nothing can help with the pain.” The women expressed frustration when their pain was not recognized, “trust me when I say I have pain.” Diverse perspectives were expressed regarding medication for pain. The women expressed their willingness to try behavioral intervention for lymphatic pain and lymphedema. They identified facilitators for implementing behavioral intervention: perceived efficacy to undertake “what is needed to be done,” perceived effectiveness of the intervention, “it is up to me” – willingness to assume accountability. They also identified barriers to the integration of behavioral intervention in their daily lives: “tiring spirit,” difficulty in establishing logistics for behavioral intervention, and “feeling to be pushed to do what is required.”

Discussion

Findings of the study can pave the way for more culturally appropriate behavioral interventions and develop culturally appropriate real-life implementation strategies for Black women to manage lymphatic pain and lymphedema.

Oncology Nursing Forum. 2025 Mar 1;52(2):447.

RS28. Patient Perspectives on Dignity in Oncology Nursing Care

Amanda Hall ¹, Michelle Harriman ²

Survivorship, Palliative and Psychosocial Oncology Care

Purpose

Dignity is an important aspect of patient-centered care for patients receiving outpatient cancer treatment. There is limited research that specifically investigates the meaning and significance of dignity in this context. Few dignity-promoting interventions in the setting of cancer treatment have been proposed in the literature.

Significance

This multimethod study sought to (1) characterize dignity as perceived by patients in an outpatient oncology clinic, and (2) assess the influence of an altered t-shirt intervention on perceived dignity among patients receiving cancer treatment.

Methods

A qualitative descriptive design underlies aim 1. Purposive sampling was used to select study participants. In-depth, semi-structured interviews were conducted with participants. Data analysis was guided by the principles of thematic analysis, involving the identification and interpretation of themes related to dignity. To address aim 2, a quasi-experimental, longitudinal study was proposed. Initially, participants responded to a questionnaire and after receiving the modified t-shirt intervention. Descriptive statistics characterized the sample at baseline and inferential statistics assessed for a pre-post difference in perceived dignity scores.

Findings and Interpretations

This study confirmed a positive effect for patients who received the interventional t-shirts to wear during cancer treatment sessions. Exploring the concept of dignity for patients receiving care through mediports showed when dignity was upheld patient satisfaction was higher. Examining dignity and supporting patient autonomy reflected improvement in the quality of care that is delivered. Defining the concept of dignity from the perspective of cancer patients receiving outpatient therapies determined if a change in perception of dignity existed among patients receiving the research intervention.

Discussion

This pilot study included 30 participants who had varying perspectives. Faith, life outlook, and level of acceptance of their disease process played a part in reactions noted. The interventional t-shirts support the notion of protecting privacy/dignity and can be worn multiple times to continue to provide the same level of protection. Most female participants felt uncomfortable when they had to remove their shirts to expose their mediport, whereas most of the male participants interviewed did not have this concern. Varying stages of disease progression and over 15 types of cancer diagnoses were involved. Details that could have changed from the first time they responded to the Patient Dignity Inventory until the post-survey included scan results, treatment problems, decline in personal well-being, or a change in treatment methods.

Oncology Nursing Forum. 2025 Mar 1;52(2):447–448.

RS29. Machine Learning Classification Models for GI Health in Cancer Survivors: Based on Telomere Length and Social Determinants of Health

Claire Han ¹, Xia Ning ², Christin Burd ³, Fode Tounkara ⁴, Anne Noonan ⁵, Diane Von Ah ⁶

Symptom Science

Purpose

The purpose of study is a pilot study to explore and identify the significant features including aging and social markers to classify gastrointestinal (GI) health conditions in a broad sample of adult cancer survivors, not just those over 65.

Significance

GI distress is prevalent and often persistent among cancer survivors, impacting their quality of life, nutrition, daily function, and mortality. GI health screening is important to prevent and manage this distress, leading to better overall health outcomes. However, accurate classification methods for GI health remain unexplored. Therefore, the current pilot study is to develop machine learning (ML) classification model of GI health, incorporating biological aging and social determinants of health (SDOH) markers. This approach enhances the performance of ML classification models by increasing sample size and provides a comprehensive understanding of GI health across different age groups.

Methods

This is a cross-sectional study. We included 645 adult cancer survivors from the 1999–2002 NHANES survey. Using training and test datasets, we employed six ML models to classify GI health conditions (better vs. worse), including logistic regression (LR), supportive vector machine (SVM), decision tree (DT), random forest (RF), gradient boosting machine (GBM), and extreme gradient boosting (XGBoost) models. These models incorporated telomere length (TL) from leukocytes, SDOH, and demographic/clinical data. Findings and Interpretations (Figure 1): Our ML approach was feasible for developing and validating the optimal model for GI health classification. Among the models, the RF performed the best, achieving a high Area Under the Curve (AUC) 0.98 in the training dataset. The GBM demonstrated excellent classification performance with a high AUC (0.80) in the test dataset. TL, several socio-economic factors, cancer risk behaviors (including lifestyle choices), and inflammatory markers were associated with GI health in both training and test datasets. The most significant input features for better GI health in our ML models were longer TL and an annual household income above the poverty level, followed by routine physical activity, low white blood cell counts, and food security.

Discussion

Our findings provide valuable insights into the classification and identification of risk factors related to GI health, including biologic aging and SDOH indicators. To enhance model predictability, further longitudinal studies are necessary.

Oncology Nursing Forum. 2025 Mar 1;52(2):448.

RS30. Longitudinal Analysis of Vigorous Physical Activity among Survivors of Adolescent and Young Adult Cancer in the Childhood Cancer Survivor Study

Rebecca Hoover ¹, Deborah Mayer ², Yutaka Yasui ³, Rachel Hirschey ⁴, Eric Chow ⁵, Hazel Nichols ⁶

Survivorship, Palliative and Psychosocial Oncology Care

Purpose

We analyzed longitudinal data from the Childhood Cancer Survivor Study cohort (CCSS) to describe changes in vigorous PA (VPA) since cancer diagnosis. We examined associations between cancer characteristics (type and treatment) and VPA participation among adult survivors of early AYA cancers, those diagnosed between 15 and 21 years old.

Significance

We analyzed longitudinal data from the Childhood Cancer Survivor Study cohort (CCSS) to describe changes in vigorous PA (VPA) since cancer diagnosis. We examined associations between cancer characteristics (type and treatment) and VPA participation among adult survivors of early AYA cancers, those diagnosed between 15 and 21 years old.

Methods

We calculated total VPA metabolic equivalence tasks (MET) hours/week for survivors and the frequency of survivors who increased, decreased, or had no change for VPA MET hours/week over three time points (T1-1999 or 2007, depending on study enrollment year, T2-2014, and T3-2020). We used longitudinal mixed-effects linear regression analysis to estimate the association between cancer type and treatment modality and VPA change.

Findings and Interpretations

This analysis included 1,460 adult survivors of early AYA cancers (54% female, 90% White-non-Hispanic, 78% work full time). At T1, 55% met VPA thresholds. The proportion of survivors who had a decrease in their VPA from T1 to T2 was 39% while from T1 to T3 the proportion of survivors who had a decrease in VPA was 43%. With a leukemia diagnosis as a reference (n=240), survivors of central nervous tumors (n=119) had significantly lower VPA participation [−2.15, CI (−3.54, −0.77)]. Compared to survivors who had a single treatment modality (reference=surgery only; n=116), those who had multimodal treatments (e.g., radiation and chemotherapy; n=97) had significantly lower VPA participation [−1.74 CI (−3.38, −0.10)].

Discussion

Our findings underscore the need for additional support for PA among AYA cancer survivors. AYAs diagnosed with central nervous system tumors and those who receive more intensive treatment modalities may benefit from PA interventions designed for their unique subgroup.

Oncology Nursing Forum. 2025 Mar 1;52(2):448–449.

RS34. Navigating Barriers: Enhancing Recruitment and Retention in a Palliative and Collaborative Care Intervention Trial (PACT) of Older Adults with AML and Their Carepartners

Nazneen Khan ¹, Dawn Klemm ², Ya-Ning Chan ³, Elissa Poor ⁴, Leonara Tisdale ⁵, Ashley Leak Bryant ⁶

Healthcare Delivery

Purpose

This work explores effectiveness of and possible factors influencing recruitment and retention.

Significance

There are multiple barriers for older adults to participate in research. The PACT (NCT04570709), delivered by a team of RNs, PTs, and OTs, was designed to help older adults (≥60 years) with Acute Myeloid Leukemia (AML) and their carepartners adapt to a new treatment, manage symptoms, lessen functional decline, and improve quality of life.

Methods

A sequential cohort-design was used to recruit control (September 2020–September 2021) and intervention (February 2022–January 2023) groups at the North Carolina Basnight Cancer Hospital. Both patients and their identified carepartners were approached. Recruitment strategies included: 1) informed leukemia team and inpatient oncology unit/infusion center, 2) collaborated with clinical pharmacist/nurse navigators and reviewed medical records to identify potential patients, 3) stated oncologist name and their support at recruitment. Retention strategies included: 1) compensation and 2) clear communication and reminders of appointments with study team. Parking vouchers were provided to intervention group.

Findings and Interpretations

Number of patients assessed for eligibility (n=128), excluded (n=35), screened eligible (n=93), unable to approach (n=39), approached (n=54), eligible but refused consent (n=16), and enrolled (n=38). Patient recruitment (approached) for control group (37%) differed from intervention group (33.3%). Across both groups; control group (n=20) and intervention (n=18); age 74 (SD 7.12), male (73.7%) female (26.3%), racial/ethnic diversity (21.1%). Across both groups (31 of 38, 81.6%), carepartners aged 66.4 (SD 11.4), 86% female, 14% male, 71% spouses/partners. Owing to COVID, high staff turnover and patient acuity limited number of intervention patients approached; intervention retention rate (39%) vs. control (65%). Patients and carepartners expressed that oncologist support increased likelihood for enrollment. Compensation and clear communication/scheduling with appointment times and rapport with research team are essential factors for retention.

Discussion

Strategies focused on optimizing recruitment and addressing barriers to clinical trial enrollment and retention can advance AML research. Nurses play a crucial role in this process, not only as primary points of contact for patients and carepartners but also as advocates who can help bridge the gap between clinical care and research participation. Their involvement in patient education, support, and navigation can significantly enhance trust and facilitate informed decision-making, ultimately improving both recruitment and retention rates.

Oncology Nursing Forum. 2025 Mar 1;52(2):449–450.

RS35. Poorer Quality of Life Outcomes are Associated with Higher Levels of Stress, Lower Levels of Resilience, and Poorer Adjustment to Cancer

Jung Ae Kim ¹, Astrid Block ², Sueann Mark ³, Steven Paul ⁴, Bruce Cooper ⁵, Christine Miaskowski ⁶

Symptom Science

Purpose

The purpose was to identify subgroups of patients (n=1324) with distinct quality of life profiles and evaluate for differences among these subgroups in demographic, clinical characteristics, and levels of global, cancer-related, and cumulative life stress; resilience; and mental adjustment to cancer.

Significance

Quality of life (QOL) is one of the most important patient outcomes. While chemotherapy has a negative impact on QOL, less is known about inter-individual variability in patients’ appraisal of their QOL during treatment and their associated risk factors. While a diagnosis of cancer and associated treatments are stressful, how patients’ perceptions of stress, resilience, and level of adjustment to a cancer diagnosis are associated with changes in QOL during chemotherapy warrant evaluation.

Methods

At enrollment (i.e., prior to their second or third cycle of chemotherapy), patients completed a demographic questionnaire, measures of stress scale (i.e., Perceived Stress Scale, global stress), Impact of Event Scale-Revised (IES-R, cancer-related distress), Life Stressor Checklist-Revised (LSC-R, cumulative life stress); resilience scale (Connor-Davidson Resilience Scale (CDRS)), and mental adjustment (Mental Adjustment to Cancer Scale (MAC)). Patients completed Multidimensional Quality of Life Scale – Patient Version six times over two cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct QOL profiles. Parametric and nonparametric tests were used to evaluate differences in risk factors among the QOL profiles.

Findings and Interpretations

Three QOL profiles were identified (i.e. Low (26.9%), Moderate (44.7%), High (28.4%)). Compared to High class, other two classes were younger, more likely to be female, and had higher comorbidity burden and lower functional status. Differences among the QOL classes in PSS, IES-R, and LSC-R scores followed a similar pattern (Low>Moderate>High). Differences were found among the QOL classes in CDRS (Low<Moderate<High) and MAC (Low>Moderate>High) scores.

Discussion

This study is the first to describe inter-individual variability in QOL outcomes among patients receiving chemotherapy. Levels of cancer-related stress reported by Low and Moderate QOL classes suggest that these patients meet the diagnostic criteria for post-traumatic stress and had levels of resilience below the normative score for the general population. Given that stress and resilience are modifiable risk factors, this information can be used by oncology nurses to design tailored interventions to improve patients’ QOL.

Oncology Nursing Forum. 2025 Mar 1;52(2):450.

RS36. Determinants of HPV Vaccine Uptake in Women in the United States: A Scoping Review of Socioecological Influences

Grace Kyei ¹, Evans Kyei ², Rockson Ansong ³

Health Equity

Purpose

This review investigates the determinants of HPV vaccine uptake among young women in the United States to enhance understanding and guide effective intervention strategies against HPV-related diseases, particularly cervical cancer.

Significance

The advent of HPV vaccines has significantly transformed preventative strategies against HPV-related diseases. However, vaccine uptake remains suboptimal among certain demographics. Understanding the factors influencing vaccine acceptance is crucial for designing interventions that improve vaccination rates and reduce health disparities related to HPV.

Methods

A comprehensive literature review was conducted on studies published in English over the past 15 years that focused on determinants of HPV vaccine uptake among U.S. females aged 9 to 65 years and older. The initial search yielded 854 studies, of which 15 met the inclusion criteria. Exclusion criteria were studies outside the demographic and geographic scope, those focusing on healthcare providers’ perspectives, and non-English language publications. Quality assessment was performed using the John Hopkins Assessment Tool to ensure the reliability of included studies. Key databases such as PsycINFO, CINAHL, and PubMed were searched using relevant keywords to ensure a thorough review.

Findings and Interpretations

The review identifies key determinants across individual, interpersonal, community, and societal levels that impact HPV vaccine uptake. Notable findings highlight persistent misconceptions about vaccine efficacy linked to age, education, and ethnicity, as well as socioeconomic factors like income, insurance status, employment, and nativity status. Interpersonal dynamics within families and healthcare settings, community-level barriers (e.g., language and cultural beliefs), and societal issues such as healthcare access and stigma significantly influence vaccine uptake.

Discussion

The findings underscore the complex interplay of social and structural factors influencing HPV vaccine uptake among young women in the U.S. Addressing these barriers requires a multifaceted approach involving policymakers, healthcare providers, community leaders, and individuals. Collaborative efforts are essential to ensure broad and equitable vaccine coverage, ultimately reducing HPV-related health disparities.

Oncology Nursing Forum. 2025 Mar 1;52(2):451.

RS37. Characteristics of Responders to Real-time Text Messages in a Symptom Science RCT

Victoria Loerzel ¹, Michael Owings ², Arsham Alamian ³, John Clochesy ⁴

Symptom Science

Purpose

The purpose of this analysis was to examine response rates and identify predictors related to responses to text messages in adults (age 50 and over) under treatment for cancer.

Significance

Researchers may experience challenges in collecting real-time data regarding cancer-related symptoms in people undergoing treatment for cancer. Technology-based strategies, like text messaging, for data collection may be helpful. However, little is known about who is likely to respond to text requests for data, especially in studies that include older adults. This study uses text messaging with a survey link to collect real-time data related to chemotherapy-induced nausea and vomiting (CINV) and self-management strategies used at home after treatment in a serious game intervention study.

Methods

An analysis of the first 50 participants in the Managing at Home randomized clinical trial was conducted. Participants were asked to respond to text messages at the same time each day for 6 days after chemotherapy treatment. Demographic (age, sex, education, language, computer use, ethnicity) and symptom (such as depression, fatigue, anxiety, number of symptoms) variables were examined using descriptive statistics and logistic regression.

Findings and Interpretations

48 participants with complete data were analyzed. A total of 858 texts were sent with 408 responses received resulting in an overall response rate of 47.6%. Participant’s mean age was 66.9 years (SD = 8.6). On average, participants sent 8.3 messages (SD = 7.7) at baseline. Participates aged 65 and younger were 6.2 times more likely (p = 0.036) to reply to the text messages than those 66 years and older. Those who were daily computer users were 10.5 times more likely (p= 0.017) to reply than occasional users. Patient symptoms at baseline were not associated with the likelihood of responding to text messages.

Discussion

Younger participants and regular computer users were more likely to engage in data collection through text messaging. Knowing who is likely to respond to text requests for data is important so researchers can intervene and encourage those less likely to engage in this type of important real-time data collection.

Oncology Nursing Forum. 2025 Mar 1;52(2):451.

RS38. Associations Between Family Caregivers’ Appraisals, Contextual Factors, and Patient Health-Related Quality of Life at Initiation of Radiation Therapy

Susan R Mazanec ¹, Susan R Mazanec ², Sumin Park ³, Sumin Park ⁴

Caregiving

Purpose

To investigate the relationships between caregiver (CG) self-efficacy, burden, and contextual factors and patient health-related quality of life (HRQOL) at the onset of radiation therapy.

Significance

Family caregiving, conceptualized as a stress process within a sociocultural context, involves CG appraisals and contextual factors that may influence patient HRQOL. Self-efficacy for caregiving, a type of appraisal, refers to the CG’s confidence in performing the tasks of caregiving and in managing their own health. Burden, another appraisal, is the CG’s perception of the impact of caregiving on their life. Contextual factors include social determinants of health, such as CG health literacy, neighborhood conditions, education, and income. Few studies have explored the relationship between CG appraisals of self-efficacy, burden, and contextual factors and patient HRQOL at the critical period of treatment onset. Understanding these relationships will identify targets for nursing interventions to improve patient and CG outcomes.

Methods

Using a cross-sectional design, baseline data from 244 patients with head and neck, esophageal, lung, rectal, and anal cancer and their family CG from an ongoing, two-group RCT (R37CA240707) testing a psychoeducational intervention during radiation therapy were used. Measures included The CG Inventory (self-efficacy), the CG Reaction Assessment (burden, CRA), the Brief Health Literacy Screening Tool, and the Ohio Opportunity Index (neighborhood conditions). The analysis included descriptive statistics and Pearson’s and Spearman’s rank correlations.

Findings and Interpretations

Greater CG annual household income was associated with higher patient HRQOL (ρ =.227, p<.001). Greater perceived burden specific to disrupted schedule (r=−.259, p<.001), financial problems (r=−.287, p<.001), lack of family support (r=−.186, p=.005), and health problems (r=−.249, p<.001) were associated with lower patient HRQOL. Greater CG self-esteem was associated with higher patient HRQOL (r=.205, p=.002). Associations were noted between CG self-efficacy and all subscales of the CRA: disrupted schedule (r=−.175, p=.010), financial problems (r=−.276, p<.001), lack of family support (r=−.301, p<.001), and CG health problems (r=−.366, p<.001), and CG self-esteem (r=−.360, p<.001). CG self-efficacy, health literacy, education, and neighborhood conditions were not associated with patient HRQOL.

Discussion

This study found a significant relationship between CG income and burden and patient HRQOL, along with a medium effect between CG burden and self-efficacy. While these findings highlight the interconnected nature of CG and patient well-being, causality cannot be determined. Further modeling is needed to identify intervention targets that could improve both CG and patient outcomes.

Oncology Nursing Forum. 2025 Mar 1;52(2):451–452.

RS39. Screening Tool for Sepsis in the Ambulatory Care Oncology Infusion Center

Ashley Miles ¹, Helen Evers-Hunt ²

Healthcare Delivery

Purpose

Sepsis, a critical condition requiring prompt intervention, is challenging to identify early in adult oncology patients due to varied symptoms and disease status. To address this, a Best Practice Advisor (BPA) using Systematic Inflammatory Response Syndrome (SIRS) criteria was implemented at Thomas Jefferson University Hospital’s Sidney Kimmel Cancer Center’s ambulatory oncology infusion center.

Significance

The study aimed to evaluate the effectiveness of the BPA in identifying sepsis among oncology patients in an ambulatory setting. We aimed to determine if the BPA could reliably prompt timely sepsis workups, thereby improving the efficiency of sepsis detection and management.

Methods

We conducted an outpatient BPA pilot study at Thomas Jefferson University Hospital’s Sidney Kimmel Cancer Center. The BPA, based on SIRS criteria, was used to trigger alerts for sepsis when two or more criteria were met.

Findings and Interpretations

The initial BPA demonstrated an abundance of false positive alarms. To improve accuracy, the heart rate threshold was adjusted from >90 to >100. This adjustment reduced false positives by 50% while maintaining effective sepsis detection. The revised BPA thus improved specificity and efficiency in identifying at-risk patients without compromising the detection of true sepsis cases.

Discussion

In conclusion, to safely and effectively identify and treat patients at risk for sepsis in the ambulatory setting with immunosuppressive drugs and avoid delays in care and risk of mortality the use of a BPA is likely to assist. The workflow with the BPA helps organize the sepsis work-up and ensure all steps are addressed promptly. By adjusting the Sepsis BPA criteria for the Outpatient Oncology population, increasing the specificity, the tool shows to be more efficient.

Oncology Nursing Forum. 2025 Mar 1;52(2):452–453.

RS40. Factors Affecting Cognitive Impairment in Patients Undergoing Radiation Therapy for Prostate Cancer: A Longitudinal Study

Mika Miyashita ¹, Yumiko Iwanami ², Masahiro Kenjo ³

Symptom Science

Purpose

Fatigue is associated with cognitive function in cancer patients. In those undergoing radiation therapy for prostate cancer, fatigue may be influenced by urinary system disorders, depression, and sleep disorders. This study aimed to investigate the factors affecting cognitive impairment in patients undergoing radiation therapy for prostate cancer.

Significance

Identifying symptoms that affect cognitive impairment offers deeper insights and informs nursing interventions for improving cognitive function.

Methods

A longitudinal study design was employed in this research. Eligible patients were 65 years or older and were scheduled to undergo radiation therapy for prostate cancer at the Hiroshima High-Precision Radiotherapy Cancer Center in Japan. Path analysis was conducted using Perceived cognitive impairments (CogPCI), a subscale of the Functional Assessment of Cancer Therapy-Cognitive Function version 3 (FACT-Cog), as the outcome variable. Fatigue, measured by the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue version 4, served as the mediating variable, while urinary system disorders, depression, and sleep disorders (assessed using the International Prostate Symptom Score (IPSS), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Pittsburgh Sleep Quality Index (PSQI), respectively) were the explanatory variables. Higher CogPCI and FACIT-Fatigue scores indicate better conditions, whereas higher IPSS, CES-D, and PSQI scores suggest worse conditions. Data were collected at three time points: T1 (before radiation therapy), T2 (after 30 Gy of radiation therapy), and T3 (at the end of radiation therapy). The path analysis utilized the changes in the three explanatory variables from T1 to T3.

Findings and Interpretations

One hundred and three patients (Mean age=75.3±5.5) participated in this study. The CogPCI was significantly influenced by the FACIT-Fatigue, PSQI, and age (direct effect=0.692, 0.162, −0.196; p<0.001, p=0.034, 0.005, respectively). The CES-D significantly affected to the FACIT-Fatigue (direct effect=−0.230, p=0.019). The influence of the IPSS and PSQI to the FACIT-Fatigue were close to significance (direct effect=−0.192, −0.193; p=0.054, 0.056, respectively). The CES-D, IPSS and PSQI indirectly influenced the CogPCI through the FACIT-Fatigue (indirect effects=−0.159, −0.133, −0.133, respectively). This path models explained 50.2% of the variance of the CogPCI.

Discussion

Managing fatigue is crucial for improving cognitive impairment in patients undergoing radiation therapy for prostate cancer. Additionally, addressing sleep disorders, urinary system issues, and depression may directly or indirectly enhance cognitive function. Further research with interventions is needed to demonstrate improvements in cognitive impairment through the alleviation of affecting symptoms.

Oncology Nursing Forum. 2025 Mar 1;52(2):453.

RS41. Common and Distinct Risk Factors are Associated with Worse Symptom Profiles in Younger Versus Older Oncology Patients Receiving Chemotherapy

Lisa Morse ¹, Steven Paul ², Bruce Cooper ³, Christine Miaskowski ⁴

Symptom Science

Purpose

Purposes were to identify subgroups of younger and older patients with distinct symptom burden profiles and identify risk factors associated with the worst symptom profiles within each of the age groups.

Significance

Differences in the occurrence, severity, and distress of common symptoms are reported between younger versus older oncology patients. However, no studies evaluated for inter-individual differences in symptom burden within younger and older patients.

Methods

Oncology outpatients with breast, gastrointestinal, gynecological, or lung cancer (n=1329) were dichotomized into younger (<60 years) and older (≥60 years) groups. Patients completed demographic and clinical questionnaires and measures of global, cancer-specific, and cumulative life stress, resilience, and coping prior to the initiation of their second or third cycle of chemotherapy. Memorial Symptom Assessment Scale evaluated the occurrence of 25 symptoms associated with cancer and its treatment. Separate latent class analyses were done within each age group to identify distinct symptom profiles. Differences among latent classes in demographic and clinical characteristics, stress, coping, and resilience were evaluated using parametric and nonparametric tests.

Findings and Interpretations

In younger group (n=741), four distinct symptom profiles were identified (i.e., All Low (28.8%), Moderate Physical and Lower Psychological (21.9%), Moderate Physical and Higher Psychological (34.6%), All High (14.7%)). Compared to All Low class, All High class was younger, more likely to be female, had a higher comorbidity burden, and a lower functional status. This class reported higher scores for all of the stress measures, lower resilience scores, and higher scores for venting and self-blame. In older group (n=602), three distinct symptom profiles were identified (i.e., Low (34.4%), Moderate (47.9%), High (17.7%)). Compared to Low class, High class was more likely to be female, had a higher comorbidity burden and a lower functional status, and received a more toxic chemotherapy regimen. This class reported higher scores for all of the stress measures, lower resilience scores and higher scores for self-distraction, denial, behavioral disengagement, and venting.

Discussion

First study to identify distinct symptom burden profiles in younger versus older oncology patients receiving chemotherapy. In younger group, differences in the occurrence of psychological symptoms differentiated among the symptom burden profiles. While some of the risk factors were similar, within the older group, patients in the High symptom burden class used more types of disengagement coping strategies. Reasons for these age-related differences require additional investigation.

Oncology Nursing Forum. 2025 Mar 1;52(2):453–454.

RS42. Enhancing the Lived Patient Experience for Long-Term Cancer Survivors: A Framework to Align Personal Values with Goals for Cancer Survivorship

Brenda Nettles ¹

Survivorship, Palliative and Psychosocial Oncology Care

Purpose

Innovations in cancer therapies and increased access to supportive care resources have allowed an increasing number of patients to live longer after their initial cancer diagnosis. The plan for cancer surveillance and need for additional treatment is based upon if the patient presented with an early stage of cancer, has recurrent cancer, or is living with an advanced stage of disease.

Significance

The lived patient experience of long-term cancer survivors is shaped by several factors including: the type of disease, length of time since initial diagnosis, comorbidities, perception of previous cancer treatment, and the identification of unmet supportive care needs. As with the management of other chronic conditions, the overall well-being of the patient may be negatively impacted by stressors associated with the uncertainty of their diagnosis, the management of the long-term effects of treatment, and the need for ongoing surveillance.

Methods

A holistic approach was required to fully address the needs of patients during this challenging phase of cancer care. The clinicians at an academic medical center recognized the importance of moving beyond the initial diagnosis by incorporating the values, beliefs, and goals of the patient into the plan of care. The clinical team also acknowledged that a patient’s values may change over time as they transition from active cancer care to surveillance. Frequent reassessments of patient values were completed during scheduled surveillance appointments to ensure their current goals of care truly aligned with their current personal identity and beliefs.

Findings and Interpretations

Patients seen for scheduled surveillance visits were provided clear information about their current prognosis and the potential side effects associated with their previous cancer treatment. Regular screenings of patient values empowered the patients to develop an enhanced sense of self beyond their cancer diagnosis. Their focus frequently shifted over time to goals that promoted a better quality of life rather than increasing the number of years of life after diagnosis.

Discussion

As more patients progress into long-term survivorship, clinicians must be better prepared to deliver whole person care. The evaluation of the patient experience and can be used to guide quality improvement in the delivery of cancer care across the trajectory of disease and promote quality of life during long-term survivorship.

Oncology Nursing Forum. 2025 Mar 1;52(2):454.

RS43. Program to Promote Ethical Empowerment of Oncology Nurses

Joyce Neumann ¹, Kim Littles ², Nicole Vaughan-Adams ³, Catherine Delanoix ⁴, Tara Tatum ⁵, Jennifer Freeman ⁶

Healthcare Delivery

Purpose

Ethical challenges are inherent in oncology nursing practice. Over the past year, our institution received 265 ethics consult requests, with 20% initiated by nurses. Goals of care was the primary reason for these consults. Clarifying and providing goal concordant care is the shared mission of the entire healthcare team and nurses play a critical role since they spend the most time with the patient and often receive privileged information about what is most important to them.

Significance

The Ethics in Nursing Practice Program (ENPP) was implemented by the nurse ethicist to empower nurses to play a more proactive role in identifying and addressing potential ethical issues before becoming a crisis that can impact the quality of patient care and contribute to moral distress. A major initiative of the ENPP was to create a Clinical Ethics Resource Nurse Program, aimed at having a specially trained ethics nurse on each inpatient unit and ambulatory clinic. The first cohort of five resource nurses on five inpatient units has completed a six-month clinical ethics certificate program and will begin working with nursing staff on their respective units to identify issues early and prioritize preventive ethics.

Methods

To clarify the focus of the resource nurses’ work with staff, a quality improvement proposal was approved to assess sources of moral distress and perceptions of the ethical climate on the designated units, examining the impact of the resource nurses’ program. The Measures of Moral Distress for Healthcare Professionals and the Hospital Ethical Climate Survey were distributed to the 442 nurses working across the five inpatient units.

Findings and Interpretations

A total of 275 surveys were returned, resulting in a response rate of 62%. Data analysis is currently underway to identify the root causes of moral distress and perceptions of the ethical climate.

Discussion

Based on the survey results, interventions will be developed to address issues identified on each of the five units. Monthly interventions may include educational programs, journal club, ethics rounds, and more. A second cohort is targeted to begin in February 2025 and will expand the program by another ten units.

Oncology Nursing Forum. 2025 Mar 1;52(2):454–455.

RS44. Feasibility and Preliminary Outcomes of a Psychoeducation Intervention for Caregivers of Children with Cancer Receiving Treatment: A Pilot Study

Lophina Phiri ¹, William Ho Cheung Li ², Patrick Gladson Phiri ³, Kai Chow Choi ⁴, Watipaso Wanda-Kalizang’oma ⁵

Survivorship, Palliative and Psychosocial Oncology Care

Purpose

This study aimed to test the feasibility and acceptability of the group-based multicomponent psychoeducation intervention among the caregivers of children undergoing cancer treatment and to evaluate its preliminary effectiveness on anxiety, depressive symptoms, coping, and health-related quality of life.

Significance and Background

Caring for a child with cancer is a highly stressful experience for caregivers due to the nature and complexity of treatment, which often leads to negative psychological emotions such as anxiety and depressive symptoms. The caregivers also report poor health-related quality of life and dysfunctional coping. Psychoeducation interventions have been used to manage anxiety, depressive symptoms, and poor health-related quality of life among caregivers of children undergoing cancer treatment. Still, their effectiveness among caregivers from low-income countries has not been well-documented.

Methods

This research used a two-arm parallel-group, single-blind, randomized controlled trial design with 24 caregivers of children undergoing cancer treatment. The participants were recruited from two pediatric cancer centers and were randomly assigned to either the intervention group, which received psychoeducation intervention, or the control group, which received usual care. The feasibility of the intervention was evaluated by tracking the recruitment rate, attrition rate, and adherence to the intervention. Additionally, acceptability was assessed through qualitative interviews with participants in the intervention group. Data was analyzed using an independent t-test, and Cohen’s d effect size was calculated.

Findings and Interpretations

The results showed that the consenting rate was 92.3%, adherence to the intervention was 84%, and the attrition rate was 4%. Participants reported numerous benefits, including increased knowledge, reduced stress, opportunities for interaction and learning, networking, and increased hope. The intervention group experienced significant reductions in anxiety levels (Cohen d Effect Size [EF]=1.013; p =.020), depressive symptoms (ES =.917; p=.035), and avoidant coping (ES = 1.101, p =.013), as well as improvement in problem-focused coping (ES=1.036, p =.019). However, there was no statistically significant difference between groups regarding changes in health-related quality of life (physical and mental health components).

Discussion

The study findings suggest that the group-based multicomponent psychoeducation intervention is feasible and acceptable. Moreover, they indicate that psychoeducation interventions are promising for enhancing psychological well-being. However, due to the limitations of the pilot study, additional comprehensive trials are needed to establish conclusive evidence.

Oncology Nursing Forum. 2025 Mar 1;52(2):455–456.

RS45. The Evolving Role of the Oncology Nurse. A Cross-Sectional Survey among Oncology Nurses in the USA

Natasha Pinheiro ¹, Brittni Prosdocimo ², Karen Waldrop ³, Nina Grenon ⁴

Healthcare Delivery

Purpose

The aim of this survey was to evaluate the current scope of oncology nursing practice in the United States of America (USA) and determine how this has evolved.

Significance

Oncology nurses play a crucial role in the care of cancer patients. During the COVID-19 pandemic, nurses’ role evolved to meet the needs of cancer patients. To date literature explores psychological sequelae and self-care needs. Little is known about the emerging roles of oncology nurses and the added responsibilities adopted since the pandemic.

Methods

A cross-sectional design study with a national online survey launched in January 2024. The study aimed to recruit around 200 oncology nurses. The survey explored demographic data, role in treatment, symptom management, and adaptation to telehealth. It also included open-ended questions exploring challenges and educational needs.

Findings and Interpretations

Over 6 months, 197 oncology nurses responded to the survey. The typical respondent was female (96%), having had over 10 years of nursing experience (34%) and a university Master’s or Doctoral degree (combined 53%) and working as an oncology nurse practitioner (23%) or nurse navigator (20%) in the outpatient setting (94%). Descriptive analysis revealed that 83% of US oncology nurses feel their workload has increased or significantly increased since the pandemic. The utilization of telehealth increased (83%) in addition it is predicted to increase (78%). Most of the respondents (84.3%) indicated they educate their patients about their disease, 63.5% find it rewarding, 20.8% find it challenging with the majority of these being infusion nurses. Additionally, a significant greater proportion of infusion nurses, specialized oncology nurses and nurse practitioners monitor and assess side effects regularly, than nurse navigators (p<0.05). Respondents reported that nurse’s role has evolved with more emphasis on patient empowerment (68%), and follow-up with patients (68%). The increasing use of telehealth, virtual clinics, and online apps to reduce the number of in-person patient visits were recurring themes of the qualitative data analysis. The need for more training on technology skills, new therapies, genomics, and emerging artificial intelligence were also identified.

Discussion

The results of this study allows for a better understanding regarding the emergent role of oncology nursing in patient care, symptom management, and quality of life approaches. There are specific needs in education and support for oncology nurses that can directly affect patient care and quality of life.

Oncology Nursing Forum. 2025 Mar 1;52(2):456.

RS46. Experiences of Body Image Changes in Chinese Hematopoietic Stem Cell Transplantation Survivors: A Qualitative Study

Jia Yin Ruan ¹, Ling Xiang Lu ², Wing Fai Yeung ³

Survivorship, Palliative and Psychosocial Oncology Care

Purpose

The purpose of this study was to explore the experiences of body image alteration in HSCT survivors in China and to describe how those changes influence individuals’ perceptions of body and self.

Significance

Body image changes are prevalent among hematological malignancy survivors who have undergone hematopoietic stem cell transplantation (HSCT) because of the illness and treatment. At present, a dearth of literature has explored how those individuals experience and perceive their changed body image.

Methods

A descriptive-qualitative approach was adopted. Purposive sampling was employed to recruit participants who had been treated in a tertiary hospital in Zhejiang Province between June 2021 and August 2024. Data was collected using audio-recorded, semi-structured interviews and analyzed by conventional content analysis.

Findings and Interpretations

A total of 19 participants, aged between 18 and 59 years, joined in this study. Three themes and 11 sub-themes emerged.

Theme 1

I am inadequate and worthless (a highly unusual appearance, devoid of regular physical functions, relying on external assistance to survive).

Theme 2

I am often entangled in disputes (facing a dilemma about revealing my medical and treatment history, grappling with the process of re-entering the workforce, struggling to uphold and live a healthy lifestyle, troubling symptoms causing me to dwell on thoughts).

Theme 3

I am a renewed version of myself (granted a new lease on life, upgraded overall appearance, refined and improved personality, shifted perspective on lifestyle choices).

Discussion

This study provides insight into the subjective body image change experiences of patients with hematological malignancies post-HSCT. Since the treatment of HSCT, HSCT survivors’ lives have altered significantly, and they are struggling to reinterpret their body image and selves. Consequently, positive self-evaluations and/or negative self-evaluations towards themselves are induced. More studies are needed to explore the underlying mechanism and associated influencing factors regarding how these various images were generated.

Oncology Nursing Forum. 2025 Mar 1;52(2):456–457.

RS47. Innovative Competency-Based Instruction Bundling in Nursing Education: A Pilot Study to Increase the Oncology Specialty Workforce

Tracy Ruegg ¹, Angela Keith ², Sarah Caffrey ³

Healthcare Delivery

Purpose

The study will evaluate the efficacy of a competency-based instruction bundling (CBIB) method in an experiential oncology nursing elective offered to baccalaureate nursing students through a novel academic-practice partnership. The intervention, infused with social determinants of health (SDOH) and cancer disparity education and designed to meet multiple AACN Essentials competency domains, may be able to serve as a model for increasing specialty-prepared nurses therefore mitigating key patient care shortages.

Significance /Background

Innovations in cancer care have enabled patients to live many years longer than years prior. However, this situation has contributed to a greater oncology nursing shortage than the overall nursing shortage. Lack of exposure to the specialty is a main reason prelicensure nursing students reject oncology as obtaining required education and clinical exposure is difficult. The nursing baccalaureate education landscape is converting to competency-based and more innovative teaching methods are needed to meet requirements in conjunction with the new generation of collegiate learners. Academic-practice partnerships are key to advancing nursing education science, enhancing health equity for all types of patients, and developing a sustainable model of producing nurses for holistic client care, especially within oncology practice.

Methods

This is a descriptive mixed methods design pilot study. Student participants will undergo an academic partnership-based oncology nursing education utilizing an innovative teaching method known as the CBIB. CBIB includes interactive flipped classroom style modules, real-time reflective voice journaling with wearable heart rate monitoring for field experiences, interactive escape rooms, student-designed cancer disparity case studies and patient with cancer journey reflection. Quantitative data will be obtained through valid and original questionaries. Qualitative data will be obtained individually and via a focus group.

Findings and Interpretations

Descriptive statistics and non-parametric tests will be used to analyze student data and effectiveness of the innovative teaching method, respectively. Qualitative data from the subjects will supplement the study aims.

Discussion

Findings from this study will broaden our understanding of student interest in oncology nursing, and the most effective teaching methods to prepare students for oncology specialty practice. Insight obtained from the CBIB instructional method will be valuable for competency development within nursing programs and vital for student education regarding increasing and retaining oncology nurses while addressing SDOH and cancer disparities to improve health equity.

Oncology Nursing Forum. 2025 Mar 1;52(2):457.

RS48. Understanding the Use of Traditional and Complementary Medicine by Children with Cancer in Jordan: A Mixed-Methods Study

Murad Sawalha ¹, Mohammad Alqudimat ²

Healthcare Delivery

Purpose

This study investigates the prevalence, patterns, and perceptions of traditional and complementary medicine (T&CM) use among children with cancer in Jordan. It aims to fill a gap in the literature by exploring both quantitative and qualitative aspects of T&CM use, including motivations and barriers to its integration with conventional cancer treatments.

Significance

This research addresses a critical gap in oncology nursing by examining the psychosocial aspects of T&CM use in pediatric oncology, a topic with limited attention in existing literature. The findings will deepen understanding of how cultural beliefs, family dynamics, and healthcare provider interactions influence T&CM use among pediatric cancer patients, guiding better integration of these practices into holistic cancer care.

Methods

A mixed-methods design was used, combining quantitative data from a descriptive cross-sectional survey with qualitative insights from semi-structured interviews. The quantitative component involved 50 parents of children undergoing treatment at a primary referral cancer center in Jordan. Data on T&CM use were collected via a validated proxy-report questionnaire. The qualitative component included in-depth interviews with a subset of these parents to explore their experiences and perceptions. The qualitative data were thematically analyzed to complement and expand the quantitative findings.

Findings and Interpretations

Quantitative results showed that 18% of parents used T&CM for their children, primarily to supplement conventional treatment and enhance well-being. The most common forms of T&CM were nutritional (77%) and psychological (33%) approaches. Key motivators included beliefs in T&CM’s potential to cure cancer, perceived safety, and a desire to reduce side effects. Qualitative findings offered deeper insights into parents’ decision-making processes, highlighting cultural beliefs and healthcare providers’ influence. Barriers to T&CM use included a lack of awareness and recommendations from healthcare professionals.

Discussion

The study emphasizes the need for oncology nursing to engage more with families about T&CM use, ensuring discussions are part of the care plan to address benefits and limitations. While T&CM use is relatively low, it is influenced by strong cultural and psychosocial factors that must be respected in pediatric oncology care. The findings suggest the importance of improving communication strategies between healthcare providers and families for the safe and effective integration of T&CM with conventional treatments. Future research should focus on guidelines to help oncology nurses support families in making informed T&CM decisions, enhancing patient outcomes and care quality.

Oncology Nursing Forum. 2025 Mar 1;52(2):458.

RS49. The Experience of Coping with Stress among Paediatric Haematological Patients Undergoing Chemotherapy: A Descriptive Qualitative Study

Zhou Shishuang ¹, Wong Cho Lee ², Chan Wai Man ³, Yang Yuan ⁴, Bei Dong ⁵, QI Yishu ⁶

Survivorship, Palliative, and Psychosocial Oncology Care

Purpose

To explore the experience of paediatric haematological cancer patients coping with stress while undergoing chemotherapy.

Significance

Paediatric haematological cancer is an extremely stressful event for children, introducing numerous physical, emotional, and social challenges. While previous studies have explored various aspects of children’s cancer experiences, such as symptom management, nutritional management, and supportive care needs. There remains a gap in understanding how paediatric patients cope with cancer during chemotherapy, particularly within the Chinese cultural context.

Methods

A descriptive qualitative study was conducted using semi-structured interviews. Data were analysed by thematic analysis using Nvivo 15.0.

Findings and Interpretations

Twenty-two hospitalised paediatric cancer patients aged 7–14 from mainland China were interviewed. Four themes emerged after analysis: Difficult journey (physical discomfort, challenges of hospitalisation, family burdens); Thoughts about sick days (worrying constantly, changing self and life, noticing positive changes); Approaches of coping with stress (letting emotions out and known, engaging in comforting activities, lacking adaptive coping skills); Support to get through (care and encouragements from family, comforts from friends, assistance from doctors and nurses).

Discussion

The findings show the multifaceted stressors that paediatric patients experience, alongside their coping strategies. Physical discomfort, challenges of hospitalisation, and family burdens are the main stressors for these children. Results also show paediatric cancer patients may experience positive transformations alongside the negative impacts of cancer-related stress. Furthermore, various coping strategies tried by patients are found, including emotional suppression, expression, regulation, and support. However, some participants faced difficulties in managing stress. The support systems play a vital role in their coping processes, implying the significance of family and social relationships in Chinese culture. Future studies should examine how stress and coping evolve across the cancer trajectory and explore effective interventions to manage cancer-related stress.

Oncology Nursing Forum. 2025 Mar 1;52(2):458–459.

RS50. The Rural Oncology Adult Patient Experience: The Case of Wyoming

Jennifer Stephens ¹, Chenoa Williams ²

Health Equity

Purpose

This study has generated knowledge and deepened understanding about the adult cancer patient perspective for those living in rural and frontier Wyoming.

Significance

Wyoming might only have 6 people per square mile, on average, but rural residents deserve innovative and progressive cancer care as much as those who live in more populated areas. Cancer is the second leading cause of death among Wyomingites according to the Wyoming Cancer Program (2021). The Wyoming Cancer Program (2021) reports that 42.7% of people in Wyoming have impaired access to any healthcare. Little research exists exploring the impact of cancer on rural and frontier patients in Wyoming, and this study has provided extensive data about what patients encounter while informing about significant social determinants of health.

Methods

This qualitative research project gathered extensive one-on-one semi-structured interviews with adult oncology patients in Wyoming over an 8-month period using snowball and purposive sampling. Forty-two patients were confidentially interviewed, and the data transcribed. With the goal of asking patients about their cancer care journey, from the diagnosis through to remission and survivorship, the qualitative methodology of Interpretive Description (Thorne, 2016) was chosen as it supports rich narrative and analysis. NVIVO was used in the process of thematic analysis.

Findings and Interpretations

This study sought to better understand the experience of the rural/frontier adult cancer patient in Wyoming to illuminate and inform current and future care planning. Several themes arose from the data about the patient experience including rural versus rurality, embracing complexities, patient-as-advocate, the centrality of community, and “cowboy culture.” Significant gaps in oncology care identified include a lack of oncology-focused palliative or supportive care options, a scarcity of specialists, and a significant absence of knowledge about minority populations including American Indians and Latinos.

Discussion

Opportunities for consortiums, collaborations, and creative problem-solving abound in Wyoming (Scott & Koller, 2019). Rural healthcare providers and administrators will find this knowledge useful in care planning, case management, telehealth administration, resource allocation, and as a foundation for improving psychosocial factors that impact the cancer journey. Future research inspired by this study include a pilot project to bring a nurse-led supportive care program to a county and a translational community-based project to explore the experience and understanding of cancer by American Indians in Western Wyoming.

Oncology Nursing Forum. 2025 Mar 1;52(2):459.

RS51. A Systematic Review: Evidence-Based Interventions to Increase Colorectal Cancer Screening Rates among Rural Residents in the United States

Fattona Umari ¹, Karen Kane McDonnell ², Otis L Owens ³, Demetrius A Abshire ⁴, Vera Bratnichenko ⁵, Michael Wirth ⁶

Health Equity

Purpose

This systematic review aimed to answer the question: What interventions work best to increase colorectal cancer (CRC) screening by any modality among rural populations within the United States (U.S.)?

Significance

CRC ranks as the second leading cause of death in the U.S. Despite advancements in screening, rural communities continue to face substantial barriers, resulting in lower rates of CRC screening and higher mortality rates compared to their urban counterparts. Rural racial/ethnic minorities face unique challenges when it comes to CRC screening. Hence, it is important to examine strategies that have been effective in increasing CRC screening among rural populations in order to enhance outreach and inform healthcare policy and practice.

Methods

Using The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, a search of the literature published in English between January,1997 and May, 2024 was conducted in four major databases (PubMed, CINAHL, Web of Science, and PsycINFO). Studies were considered regardless of the intervention implementation setting. The main outcome of the studies was the change in CRC screening rates post-intervention. Compliance with CRC screening was defined as the completion of any CRC screening modality recommended by the U.S. Preventative Services Task Force.

Findings and Interpretations

The initial search yielded 2,864 articles. Duplicates were removed. Articles were screened on the basis of titles and abstracts, resulting in 93 articles selected for full-text review. The final review included 16 articles that met the inclusion and exclusion criteria. Seven randomized controlled trials, 3 pre-post design studies, 3 quasi-experimental studies, 1 prospective single-group study, 1 cluster randomized study, and 1 with an unidentified study design were identified. Studies were conducted between 2002–2023. All interventions consisted of multiple components. Types of interventions included media campaigns, academic detailing, navigator use, community-based outreach, and culturally tailored interventions. Multicomponent interventions in rural communities demonstrated promising outcomes in increasing CRC screening rates.

Discussion

All studies examined initial screening uptake among participants. No study examined persistent adherence over time. Additional efforts should target expanding the reach of CRC screening to under-resourced rural settings. More interventions should be tailored to the specific needs and cultural contexts of racial/ethnic minorities living in rural communities.

Oncology Nursing Forum. 2025 Mar 1;52(2):459–460.

RS52. Building More Realistic Patient Expectations through Nursing Guidance and Education during Stereotactic Body Radiotherapy on the MRI Linear Accelerator for Prostate Cancer

Erica Varela ¹, Yaribel Mireles ², Marie Nalle ³, Deborah Lee ⁴, David Byun ⁵, Michael Zelefsky ⁶

Healthcare Delivery

Purpose

We prospectively surveyed 65 consecutive patients treated with stereotactic body radiotherapy (SBRT) on the MRI Linac to evaluate their treatment experience.

Significance

MRI-Guided SBRT is a recent innovation in prostate cancer treatment, delivering high-precision radiation in 5 sessions with minimal exposure to surrounding normal tissues. However, it requires patients to remain on the treatment table for longer due to real-time mapping and plan adjustments while in the confined space of an MRI scanner.

Methods

Sixty-five patients with organ-confined prostate cancer received MRI-guided SBRT, with a median dose of 40 Gy in 5 fractions administered every other day. Patients were required to complete a bowel preparation and instructed to empty their bladder before each session. Treatment planning was based on an initial MRI, followed by repeat imaging to confirm no movement of the prostate and surrounding organs immediately before the radiation dose delivery. The average on-table time for adaptive planning and treatment delivery was 50 and 20 minutes, respectively, with a median total room time of 75 minutes. At the 4^th or 5^th session, patients completed a survey evaluating their comfort on the treatment table, in the treatment room, and their comprehension of pre-treatment instructions.

Findings and Interpretations

86% reported their treatment experience met expectations, while 14% indicated unmet expectations. Common concerns included discomfort on the table (25%), prolonged treatment time (18%), and machine noise level (11%). 33% reported varying degrees of claustrophobia, with 15% requiring anxiolytics. Of 48 patients who experienced treatment-related symptoms, the most commonly reported were increased nocturia (48%), fatigue (45%), daytime voiding frequency (37%), and abdominal cramping/diarrhea (18%). Overall, 66% found symptoms manageable, while 24% required medication to alleviate side effects. 82% of patients felt adequately educated on potential side effects. Additionally, 88% understood bowel preparation instructions, with 67% feeling very confident in their ability to successfully complete the prep. Regarding dietary modifications, only 28% believed sufficient guidance was given to mitigate side effects.

Discussion

Overall, patients tolerated treatments on the MRI Linac well, despite the extended time spent on the treatment table for real-time adaptive planning and adjustments. More intensive pre-treatment patient education is critical to providing realistic expectations for treatment experience and reduce patients’ uncertainty and anxiety undergoing this novel treatment intervention.

Oncology Nursing Forum. 2025 Mar 1;52(2):460–461.

RS53. Participants’ Perspectives of an Efficacious Peer-Delivered Physical Activity Program for Breast Cancer Survivors

Karen E Wickersham ¹, Madison Kindred ², Danielle M Ostendorf ³, Amy G Huebschmann ⁴, Bernadine M Pinto ⁵

Survivorship, Palliative and Psychosocial Oncology Care

Purpose

To understand breast cancer survivors’ experiences in receiving the webMFT intervention.

Significance

Physical activity (PA) reduces treatment-related sequelae of breast cancer and improves survival for breast cancer survivors. The Moving Forward Together (MFT) program is a 3-month PA intervention that has demonstrated efficacy to increase breast cancer survivors’ moderate-to-vigorous PA in prior work. In the current study, 10 peer mentors were recruited from cancer care organizations and trained to deliver MFT to breast cancer survivors on a web platform (webMFT).

Methods

Participants (n=30) received weekly phone calls from their coach to problem solve barriers and set goals to encourage PA. Twenty webMFT participants were selected for an interview at the end of their participation in the webMFT randomized controlled trial. Interview guides were informed by RE-AIM (reach, effectiveness, adoption, implementation and maintenance) and the Practical Robust Implementation and Sustainability Model (PRISM). Interviews were audio-recorded, transcribed, coded by two independent researchers, and analyzed using thematic analysis.

Findings and Interpretations

Women (N=20) primarily identified as white (70%), non-Hispanic with an average age of 58.2 (SD 9.6) years. We identified seven themes that represented the experiences of participants in the webMFT group: #1 PA as a shared experience between coach and participant (“The cancer connection was there.”). #2 Supportive accountability by their coach, Fitbit use, and other sources of support (e.g., spouse). #3 The content, structure, and format of webMFT was acceptable, feasible, and appropriate for the participants. #4 webMFT promotes a shift in mindset and a body, mind, and spirit connection (“One key thing I learned from participating is that it’s more about your mind than your body. My body has not [stopped me] from reaching my goals, my mind has”). #5 Motivators (e.g., fear of recurrence, altruism) identified by participants reinforced their behavior change and/or webMFT experience. #6 Individual-level barriers (e.g., safety concerns) and external environment concerns (e.g., weather) for PA. And #7 Suggestions for improvement/additions to MFT (e.g., peer groups).

Discussion

Findings suggest webMFT was well-received by study participants and areas for consideration in future scale-up of the intervention. All participants described a body/mind/spirit connection, a shift in their mindset, and/or recognition of interwoven aspects of PA with their physical, mental, and emotional being. Their descriptions of this connection suggest an area where behavior change occurred and provides evidence of the impact of webMFT.

Oncology Nursing Forum. 2025 Mar 1;52(2):461.

RS54. Sensitivity to Uncertainty and Executive Function of Breast Cancer Survivors: Preliminary Findings

Yesol Yang ¹, Tonya Orchard ², Timothy Winschel ³, Jagan Jimmy ⁴, Darrin Aase ⁵, Darrin Aase ⁶, Stephanie Gorka ⁷

Symptom Science

Purpose

This pilot study aimed to explore the relationship if individual differences in sensitivity to uncertainty (i.e., intolerance of uncertainty [IU]) is related to executive function (EF) in breast cancer survivors (BCS).

Significance

Uncertainty is described as a situation in which something is unknown or as the experiential state of not being sure what will happen. BCS live with cancer-related uncertainty (e.g., cancer recurrence, long-term health concerns) throughout survivorship. All BCS face uncertainty, but some survivors show higher sensitivity to uncertain stressors (i.e., higher intolerance of uncertainty [IU]) and exhibit increased levels of anxiety, a risk factor for EF deficits. Much of the non-cancer studies have shown that IU underlies developing internalized psychopathology (e.g., anxiety, depression) and furthermore relates to EF. This suggests that IU could be a potential contributor to EF deficits; however, this hypothesis has not been tested in the context of BCS.

Methods

Twenty-one women with stage I–III BC (age 45–75) who completed chemotherapy 3 to 12 months before enrollment were included. Participants completed a multimodal assessment of IU which included a self-report measure and objective neural reactivity to uncertain threats. Bilateral anterior insula (aINS) reactivity to threat was used to capture objective neural sensitivity to uncertainty (i.e., objective IU). EF was assessed by neuropsychological tests, and other cancer-related symptoms including anxiety and fatigue were also assessed by self-report measures. Hierarchical linear regression analyses were used to assess the main effects of each type of IU on EF, and further explored their unique contributions to EF.

Findings and Interpretations

Greater aINS reactivity to uncertain threat was associated with lower EF, whereas no main effect of self-reported IU on EF was found. Furthermore, no association was found between self-reported IU and objective IU.

Discussion

Results suggest that identifying BCS with great aINS reactivity to uncertain threats could help prevent the incidence of EF deficits. This pilot study will inform the development of a validated risk prediction model for EF deficits, identify target mechanisms for prevention, and ultimately support the development of mechanistically driven treatment strategies to modulate aINS activity.

Oncology Nursing Forum. 2025 Mar 1;52(2):461–462.

RS55. Correlates Between High-Sensitivity Modified Glasgow Prognostic Score (hs-mGPS) and Overall Survival (OS) in Patients with Gastrointestinal (GI) Cancers

Saunjoo Yoon ¹, Jung A Kim ², Oliver Grundmann ³

Symptom Science

Purpose

This study aimed to correlate the hs-mGPS on OS based on three BMI categories.

Significance

GI cancers are estimated to cause the highest number of deaths (28.5%) among all cancer cases in 2024. Biophysiological markers may be associated with survival outcomes. However, it is not widely studied whether the overall survival (OS) of three BMI categories are associated with hs-mGPS calculated with albumin and C-reactive protein (CRP).

Methods

This retrospective comparative correlational study used de-identified data obtained from the Integrated Data Repository after obtaining IRB approval. Of 197 eligible patients, 21 were excluded and 176 were included in the final analysis. Inclusion criteria were patients who visited the institution between June 2011 and March 2014 who 1) were 21 years or older, 2) were diagnosed with any GI cancers as the primary site (e.g., gastric, biliary, esophageal, colorectal, pancreatic, small intestinal cancers) [ICD-9 codes: 150–159], 3) had at least two weight measurement points, and 4) had both albumin and hs-CRP laboratory results available. Hs-mGPS scores are from 0 to 2: 0 [hs-CRP <0.3 mg/dL and albumin ≥3.5 g/dL], 1 [hs-CRP ≥ 0.3 mg/dL and albumin ≥3.5 g/dL], and 2 [hs-CRP ≥0.3 mg/dL and albumin < 3.5 g/dL]. Patients were categorized into three BMI groups (low BMI < 20kg/m², 20 ≤ normal BMI < 25kg/m², and high BMI ≥ 25kg/m²). Due to the small sample size (n=13), the low BMI group was excluded from group comparisons, and the remaining two BMI groups (normal vs. high BMI groups) were compared for differences in demographic characteristics using a Chi-square test for categorical variables and a Jonckheere-Terpstra test for continuous variables. The Kaplan-Meier estimate of survival analysis was performed to evaluate the correlation between hs-mGPS and OS.

Findings and Interpretations

The mean age of patients was 65.2 ± 12.3 (min–max: 29–92) years, and 53.4% were 65 years and older. 82.4% were White, and 59.1% were male. The median albumin level was 3.0 g/dL, and hs-CRP was 70.20 mg/L. Nearly 70% of patients had a hs-mGPS of 2. Independent of the BMI group, those with a lower hs-mGPS (p=0.006) and moderate weight loss (p<0.01) showed significantly longer OS.

Discussion

The correlation between OS, BMI, and hs-mGPS is more complex, with longer survival in patients with moderate (<10%) weight loss throughout observation, and warrants further study.

[b1-forum-522-e13] Warshawsky NE, Caramanica L, Cramer E. Organizational Support for Nurse Manager Role Transition and Onboarding. Journal of Nursing Administration. 2020;50(5):254–260. doi: 10.1097/nna.0000000000000880. [DOI] [PubMed] [Google Scholar]

PERMALINK

Poster Abstracts

Footnotes

P1. New Graduate Transition to Practice: Effects of an Oncology Nurse Residency on Nurse Resilience

Kristi Adams, DNP, RN, OCN

Ashley Mitchum-Chapman, BSN, RN, OCN

Keri Fitzpatrick, MSN, RN, CNML

Management

Significance & Background

Purpose

Interventions

Results

Discussion

P2. Antineoplastic Medication Competency for the Experienced Nurse

Ashley Mitchum-Chapman, BSN, RN, OCN

Kristi Adams, DNP, RN, OCN

Management

Significance & Background

Purpose

Interventions

Results

Discussion

P3. Bringing Care to the Oncology Patient: Equipping Nurses to Provide Care Using a Novel Approach

Modupe Adenuga, MSN, RN

Alwine Acolaste, RN, OCN

Debrah Rigg, BSN,RN, OCN

Rachel Hutchinson, DNP, MHA, RN

Anne Saint-Louis, BSN

Leslie Landon, MSN, RN, NPD-BC

Treatment Modalities and Managing Administration

Significance & Background

Purpose

Interventions

Results

Discussion

P4. Centralized Cancer Surveillance for Patients and their Family Members with the BAP1 Tumor Predisposition Syndrome (TPDS)

Maria Gracia Agra, BSN, RN

Cathy Wagner, BSN, RN

Alexandra Lebensohn, MS, CGC

Azam Ghafoor, MD

Tenin Maglo, MS, CRNP

Raffit Hassan, MD

Screening, Early Detection, Genomics

Significance & Background

Purpose

Interventions

Results

Discussion

P5. Primary Nursing: Patient and Nurse Collaboration in Exceptional Care

Kerrin Albert, BSN, RN, OCN

Adonica Racicot, BSN, RN, OCN, MSPC

Brianna Taglione, MSN, RN, OCN

Carole DeAngelis, MSN, RN, OCN

Georgina Torres-Calhoun, BSN, RN

Jane Worrell, DNP, RN, OCN, NEA-BC

Quality and Safety

Significance & Background

Purpose

Interventions

Results

Discussion

P6. Creating a Streamlined Workflow for Equitable Patient Distribution in an Outpatient Infusion Center

Yvonnie Alcasabas, BSN, MBA, OCN

Greisi Avila, BSN, OCN, MSRN

Edwin Achimbi, BSN, MSN

Healthcare Delivery

Significance & Background

Purpose

Interventions

Results

Discussion

P7. Title: Developing a Comprehensive Head and Neck Radiation Oncology Service: Integrating Multidisciplinary Care and Advanced Technologies

Richie Alexander, RN, CMSRN

Healthcare Delivery

Significance & Background

Purpose

Interventions

Results

Discussion

P8. Development of a Workload Intensity Tool to Create Equitable and Safe Nursing Assignments on an Intermediate Care Hematology-Oncology Inpatient Unit