Assessing patient satisfaction with pain management through a continuous quality improvement effort.

A quasi-experimental study was conducted to evaluate patient satisfaction with pain management before and after a continuous quality improvement (CQI) project in a large, university medical center. The CQI project aim was to implement American Pain Society (APS) quality improvement guidelines regarding the recognition and prompt treatment of pain. A modified version of the questionnaire recommended by the APS Subcommittee on Quality Assurance Standards was used to survey 83 patients prior to implementation of the CQI effort and 89 patients one year later. Half of the patients reported moderate to severe pain both before and after the CQI project. Less than half reported complete relief of pain after treatment. Despite significant levels of pain and ineffective treatment, greater than 90% of patients reported being satisfied with pain management. Responses to open-ended questions were analyzed. Findings from the study are being used to develop a medical center-wide action plan to guide further CQI efforts to improve pain management.

Effect of subcutaneous granulocyte colony-stimulating factor injectate volume on drug efficacy, site complications, and client comfort.

PURPOSE/OBJECTIVES: To determine the effect of administering 1.6 ml (480 mcg) of granulocyte colony-stimulating factor (G-CSF) in one subcutaneous injection or two injections of 0.8 ml each. DESIGN: Experimental. SETTING: 27-bed bone marrow transplant intensive care unit of a metropolitan, university medical center in the southwestern United States. SAMPLE: Nonprobability; 76 women who received high-dose chemotherapy for breast cancer followed by hemopoietic rescue. METHODS: Subjects were randomized into an experimental group that received one injection per 480 mcg dose and a control group that received two injections per 480 mcg dose administered by research associates using a standardized injection technique. MAIN RESEARCH VARIABLES: Injectate volume. The number of days post-transplant until the absolute neutrophil count (ANC) returned to 1,000/mm3, the incidence and surface area in mm2 of site complications, and scores on Tursky's Quantified Pain Descriptor immediately following the injection(s). FINDINGS: No significant difference existed between the two groups in ANC recovery time, frequency or size of site complications, or intensity, reaction, or sensation of discomfort reported. CONCLUSIONS: Administering 1.6 ml doses of G-CSF in one injection instead of two does not result in slower ANC recovery, induration, more frequent or larger bruises or areas of erythema, or greater client discomfort. IMPLICATIONS FOR NURSING PRACTICE: Administering one injection instead of two may decrease patients' anxiety, the nursing time needed for preparation and administration of injections, patient instruction for self-administration, the potential for contamination of vials or loss of dose, and the cost of supplies.

Management of dermatologic complications of chronic graft versus host disease: a case study.

The purpose of this article is to illustrate a multidisciplinary team collaborative approach to the management of dermatologic complications related to chronic graft versus host disease (GVHD). GVHD is a complication of allogeneic bone marrow transplantation (BMT) and peripheral blood cell transplantation (BCT). The skin is affected in more than 80% of patients with chronic GVHD who received a BMT. Involvement can be limited or extensive and can seriously affect patient morbidity and mortality. Nursing care of the patient with chronic GVHD induces careful patient assessment, patient and family education, and interventions aimed at preventing or minimizing complications. A coordinated multidisciplinary team approach is essential for the successful management of chronic GVHD. Nurses play a critical role in coordinating the multiple disciplines involved in the care of patients with chronic GVHD.

Information guide for patients receiving total body irradiation before bone marrow transplantation.

Most patients with hematologic malignancies are conditioned for bone marrow transplantation with a regimen that includes the use of total body irradiation. This patient information guide was put together to simplify and standardize the type of instructions that patients receive before total body irradiation and to provide information for nurses who care for patients receiving such treatment. Content includes common questions asked by patients and families; a description of possible side effects; when side effects begin; and the patient's role in minimizing side effects.