Cancer Center’s New Treatment Guideline Streamlines Nursing Time, Sustains Patient Safety
Implementing a standard guideline for nursing management of patients receiving new U.S. Food and Drug Administration–approved chemotherapy, immunotherapy, and biotherapy (CIB) decreased 1:1 patient–nursing hours by nearly 65% and saved more than $100,000 per year at one health system in south Florida, a team of nursing leaders reported (https://ons.confex.com/ons/2024/meetingapp.cgi/Paper/14062) in a poster presentation at the 49th annual ONS Congress® in April 2024.
Because of the potential for serious side effects, nursing leadership at the University of Miami Health System implemented a protocol in which all patients receiving newly approved CIBs were assigned to 1:1 nursing care. Required nursing hours increased to meet those needs, but it “reduced the unit’s financial productivity,” the speakers said (https://ons.confex.com/ons/2024/meetingapp.cgi/Paper/14062).
In response, the presenters convened an interprofessional group that included nursing leadership, clinical pharmacists, providers, finance, and the unit’s medical directors to collaborate and develop a guideline. The guideline advises that:
- A newly approved CIB that meets inpatient criteria triggers the health system to coordinate in-service sessions and training for CIB-competent nurses and other healthcare professionals on the cancer care team.
- After all members of the interprofessional team receive the in-service, they vote to assign the guideline’s predetermined risk assessment scale (see sidebar) and determine the appropriate staffing for a prespecified number of administrations.
- After the team completes the prespecified number of administrations, it reassesses whether escalation or deescalation are needed.
Over 15 months, the health system saw 63 admissions that met the criteria. During the implementation period, the nurses reduced 1:1 patient care hours from 320 to 117. When calculated for costs, the guideline resulted in an estimated annual savings of $102,848, the speakers said (https://ons.confex.com/ons/2024/meetingapp.cgi/Paper/14062).
“These collaborative efforts resulted in safe patient care without negative outcomes while decreasing costs,” the speakers said (https://ons.confex.com/ons/2024/meetingapp.cgi/Paper/14062). “This guideline has fostered increased collaboration among various departments engaged in the comprehensive treatment team. With this increase in efficiency, nurses are more available to other patients in the oncology unit and to prevent staffing shortages.”
Read how two other institutions are using innovative solutions to maximize oncology nurse staffing during a nursing shortage (https://voice.ons.org/news-and-views/innovative-solutions-to-maximize-oncology-nurse-staffing-during-a-nursing-shortage) in ONS Voice’s feature article, then find tools and resources to guide your own nursing staffing and care delivery models in ONS’s Staffing Learning Library (https://www.ons.org/learning-libraries/staffing).