Nutritional Support: Enteral Nutrition Pathway for Children Undergoing Hematopoietic Stem Cell Transplantation.

BACKGROUND:  Children undergoing a hematopoietic stem cell transplantation (HSCT) are at a higher risk for malnutrition, which could be reduced by enteral nutrition (EN) support. OBJECTIVES:  This study evaluated the safety and feasibility of implementing an EN pathway for children undergoing HSCT. METHODS:  An evidence-based, standardized EN pathway was implemented for children undergoing HSCT. Parenteral nutrition and EN rates were compared among patients pre- and postimplementation, and t tests and chi-square tests were performed. FINDINGS:  A larger proportion of patients received EN and had an increased number of EN days (8.3 versus 5.3 days) postimplementation, which was clinically significant but not statistically significant. Postimplementation, 15 patients required EN and parenteral nutrition. The EN pathway was safe, but had limited feasibility because of the difficulty of placing and maintaining the nasojejunal tube.

Oral Chemotherapy: An Evidence-Based Practice Change for Safe Handling of Patient Waste.

BACKGROUND: Safe handling practices for patient waste have focused on patients receiving IV chemotherapy, but these practices do not address safe handling for patients receiving oral chemotherapy. OBJECTIVES: The aim of this article is to evaluate evidence and formulate best practice recommendations for handling and disposing waste from patients receiving oral chemotherapy. METHODS: A literature search established a framework for the project. For healthcare providers and staff, procedures were established to access biohazard supplies and to follow safe handling of patient waste post-oral chemotherapy administration. Supply cost utilization was evaluated pre- and postimplementation. Staff perceptions were assessed six months after project implementation. FINDINGS: The cost of supplies per patient day increased minimally. Staff self-reported use of biohazard precautions when handling patients' waste increased. The majority of staff reported that they had access to supplies and were knowledgeable regarding safe handling procedures six months after this practice change.