Bettering Sleep Hygiene to Decrease Delirium and Improve Patient Satisfaction on an Inpatient Oncology Unit.

Poor sleep during hospitalization can negatively affect patient health, well-being, and satisfaction. This nurse-led quality improvement project aimed to promote quality sleep on an inpatient telemetry medical-surgical onco.

Implementing the 4 Ms in a geriatric oncology clinic to create age friendly cancer care.

BACKGROUND: Over 50 % of cancers occur in people aged 70 and older, and 60 % of all cancer deaths occur in this population. Cancer care for the older adult is complex related to comorbidities, age related changes and various social needs. They also may experience cognitive and physical limitations during their cancer journey. At Moffitt Cancer Center, 49 % of patients seen in clinic, in hospital, in diagnostic and procedure areas are 65 years of age and over. The purpose of this quality project was to craft age friendly cancer care utilizing the 4 Ms framework as a roadmap to enterprise spread at an NCI Designated Comprehensive Cancer Center. METHODS: Each new patient to the Senior Adult Oncology Program receives geriatric screening with SAOP-3, Timed up and Go and asked, "what matters most". The SAOP-3 Geriatric screening tool includes domains for screening depression and cognitive impairment. High risk medications prompt a pharmacy consult for deprescribing opportunities. RESULTS: Since becoming recognized as an AFHS, the 4 M's have been implemented in all inpatient units at 2 hospitals and continue to spread to ambulatory clinics on 4 outpatient sites. Further enterprise spread totals over 5500 geriatric oncology patients were screened utilizing the SAOP-3 screening tool.

Interprofessional Approach to Fall Risk Screening in Patients Undergoing Radiation Therapy.

Patients receiving radiation therapy (RT) for cancer are at greater risk for falls because of age, treatment, pharmacologic side effects, and cognitive or motor deficits. The Timed Up and Go (TUG) Test is a validated, objecti.

"What Matters Most" to Older Adults With Cancer: Advance Care Planning.

Approximately 1 in 3 adults have some type of advance directive. Advance care planning (ACP) is associated with greater use of supportive care services and decreased patient and family stress. Despite this, organizations continue to have difficulty in implementing effective programs for increasing ACP. Increasing knowledge and comfort of the health care team with end-of-life discussions and ACP is essential. Educational efforts should focus on decreasing known barriers to ACP discussions such as discomfort, unclear role, lack of experience, and limited education. Role playing and case discussions taught by geriatric resources nurses can help increase staff knowledge and comfort regarding ACP. Role playing allows staff to think about their own mortality and what will happen in various situations if ACP is not complete. Team members find that once they have completed their own ACP, they are more comfortable discussing ACP with patients and caregivers. Nurses should collaborate with social workers and chaplains for ACP education and discussing what matters most to them. Patients are encouraged to make sure that they provide advance directives to their health care providers. This article shares an interprofessional team approach to improving processes for ACP as a component of "what matters most" to older adults with cancer.

Integrating geriatric screening in the clinical setting: Recommendations for older adult oncology patients.

PURPOSE: The optimal time to assess older adults during cancer treatment regimen has not been established. This research study evaluated different points in time to reassess the geriatric oncology patient undergoing treatment. METHODS: This study included 250 patients who were new to the Senior Adult Oncology Clinic. Inclusion criteria were actively receiving treatment of chemotherapy, hormone therapy, radiation or other targeted therapies; age 65 or older if head and neck cancer diagnosis and age 70 or older with other malignancies referred to the program; and able to read and understand English. The SAOP3 is a two-page tool consisting of eleven questions and three instructional items followed by a scoring threshold, that was repeated at the patient's three- and six-month visits. RESULTS: Two hundred and thirty-eight patients completed the SAOP3 at baseline; 112 completed the SAOP3 at three months; and 90 completed the SAOP3 at six months. Fifty-four patents completed the SAOP3 at all three timepoints. Overall, SAOP3 results indicated referral for 42% (95% confidence interval = 36-49%) of patients at baseline. For the 54 patients that completed the SAOP3 at all timepoints, referrals decreased across the timepoints for the two most common referrals: nutritionist which was statistically significant (p = 0.03); and social worker which was not (p = 0.08). CONCLUSION: Utilizing the objective findings related to functional and cognitive status can aid in treatment planning and guide goals of care discussions with patients and families. Review of the follow-up screens at three- and six-months during the treatment process demonstrated the impact of cancer treatments in the older adult.

Direct care nurses and support staff thoughts and feelings about the reasons patients fall at a cancer center.

Extensive research addresses the prevalence and high fall risk for cancer patients related to age, diagnosis, treatment side effects, pharmacological side effects, and cognitive and/or motor deficits. The purpose of the study was to explore the thoughts and feelings that inpatient and outpatient oncology direct care nurses (registered nurses) and support staffs have about reasons patients fall; as well as their thoughts on what might be done to prevent falls. This descriptive qualitative study used focus groups as the method for discovery. Six themes were identified: Effect on Me, Guilt, Noncompliance, Poor Choices, Inconsistency, and No Authority. This study is significant and relevant because there is little previous research addressing staff thoughts and feelings about why patients fall and what additional interventions they think can be implemented to prevent falls. Findings from this study may be helpful in developing and/or refining current fall policies. Existing research suggests unlicensed patient care providers often have minimal participation in postfall reviews. This study suggests they can provide insight into why patients fall. Additionally, both registered nurses and unlicensed providers describe barriers that often impede their ability to work as a team to prevent patient falls. Findings from this study identified the need for the patient care team to strengthen collaborative work to create safer patient environments.

Fall risk and prevention agreement: engaging patients and families with a partnership for patient safety.

SIGNIFICANCE AND BACKGROUND: Falls are multifactorial in medical oncology units and are potentiated by an older adult's response to anxiolytics, opiates and chemotherapy protocols. In addition, the oncology patient is at an increased risk for injury from a fall due to coagulopathy, thrombocytopenia and advanced age. At our National Cancer Institute-designated inpatient cancer treatment centre located in the southeastern USA, 40% of the total discharges are over the age of 65. As part of a comprehensive fall prevention programme, bimonthly individual fall reports have been presented with the Chief Nursing Officer (CNO), nursing directors, nurse managers, physical therapists and front-line providers in attendance. As a result of these case discussions, in some cases, safety recommendations have not been followed by patients and families and identified as an implication in individual falls. Impulsive behaviour was acknowledged only after a fall occurred. A medical oncology unit was targeted for this initiative due to a prolonged length of stay. This patient population receives chemotherapeutic interventions, management of oncological treatment consequences and cancer progression care. PURPOSE: The aim of this project was to explore if initiation of a Fall Prevention Agreement between the nursing team and older adults being admitted to medical oncology units would reduce the incidence of falls and the incidence of falls with injury. INTERVENTIONAL METHODS: In order to promote patient and family participation in the fall reduction and safety plan, the Fall Risk and Prevention Agreement was introduced upon admission. Using the Morse Fall Scoring system, patient's risk for fall was communicated on the Fall Risk and Prevention Agreement. Besides admission, patients were reassessed based on change of status, transfer or after a fall occurs. EVALUATION/FINDINGS: Fall and fall injuries rates were compared two-quarters prior to implementation of the fall agreement and eight-quarters post implementation. Falls and fall injuries on the medical oncology unit had an overall reduction of 37% and 58.6%, respectively. DISCUSSION/IMPLICATIONS: A robust fall prevention standard does not ensure care team participation in all elements to reduce fall occurrence. Historically, the Fall Risk and Prevention Agreement had not been initiated on admission. Incorporating patients and families in discussions related to fall risk and prevention is consistent with collaborative communication. The Joint Commission and the Centers for Medicare and Medicaid Services in 2002 encouraged patients and family participation in the acute care experience to promote safety. The medical oncology patient in many cases on admission is identified as 'moderate' risk for fall. It is during the course of treatment and an extended length of stay that deconditioning and treatment side effects result in a fall. This patient population often overestimates their abilities and functional status.Engagement with patients and families during the admission process will hopefully communicate the need for a collaborative effort for fall prevention during the hospitalisation. Although this project is limited in data, integrating patients and families into care planning may have a significant impact in reducing falls in the 'moderate' risk patient. Additional studies including a multivariate analysis are needed to determine whether supporting evidence links fall reduction to the presence and use of a patient and family agreement.