Look for zebras: Identification of immunotherapy patients in the emergency department
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Elizabeth J. Winokur, PHD, RN, CEN; Enza Esposito Nguyen, DNP, RN, ANP-BC, AOCNP; Johnny D. Nguyen, BS
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Purpose: Immunotherapy use is increasing in frequency among oncology patients as a single treatment or combined with chemotherapy. Immunotherapy related adverse events (IrAE) have unique presentations that are often overlooked or misdiagnosed. This IRB approved study sought to evaluate the effectiveness of microteaching on ED nurses and physicians’ identification of IrAEs and timely initiation of definitive therapy.
Design: A prospective, descriptive design using an identical pretest/posttest was used to determine the effectiveness of microteaching on knowledge about immunotherapy and IrAEs. Retrospective medical record reviews were used to evaluate patient outcomes.
Setting: Large Southern California Emergency Department.
Participants/Subjects: All Emergency Department Nurses and Physicians were invited to attend education sessions and participate in the study. A total of 73 (66%) RNs and 16 (72%) Physicians participated. A statement on the pretest/posttest indicated that completing the test indicated consent to participate in the study. No identifying information was collected. No participants attending the microteaching declined to participate in the study.
Methods: In July 2018 following IRB approval, tailored microteaching sessions of 10 minutes in length were scheduled. Sessions occurred before or after staff meetings, at change of shift huddles, and at the monthly physician meeting. The six-item test pretest/posttest evaluated familiarity with immunotherapy, and identification of and appropriateness of treatment for patients with IrAEs. A paper version of the pretest was given prior to the education which was delivered to nursing in small groups consisting of 1 to 6 participants. All physician participants received education at the same time. Immediately following the teaching participants completed the posttest. A retrospective review of electronic health records was conducted to determine the timeliness of identification of IrAEs and appropriateness of treatment.
Results/Outcomes: A Phi coefficient was calculated to measure the association between pretest and posttest scores on five questions. For the RNs, all items demonstrated an increase in knowledge (p <.0001). The sixth question sought to identify the number of IrAEs that the RN could correctly identify. This item increased from a pre-education mean of 0.52 (range 0-4) to 3.77 (range 1-7) following the microteaching. Physician education also demonstrated increases in knowledge post education although only two items reached statistical significance. This is posited to be the result of related immunotherapy education presented earlier in the year. Patient data demonstrates increasing numbers of immunotherapy patients in 2018. Preliminary data suggest that patients with IrAEs are being identified earlier allowing prompt initiation of appropriate treatment.
Implications: Increased use of immunotherapy for cancer and other indications suggests that the number of patients presenting to the ED with IrAEs will continue to grow. Early identification of these patients is critical to the initiation of appropriate therapy. Microteaching sessions were effective in conveying this information as demonstrated by increases in knowledge and improved patient outcomes.
Emergency Nursing 2019. Held at the Austin Convention Center, Austin, Texas, USA
Type | Poster |
Acquisition | Proxy-submission |
Review Type | Abstract Review Only: Reviewed by Event Host |
Format | Text-based Document |
Evidence Level | Descriptive/Correlational |
Research Approach | N/A |
Keywords | Immunotherapy Related Adverse Events; Microteaching; Research |
Name | Emergency Nursing 2019 |
Host | Emergency Nurses Association |
Location | Austin, Texas, USA |
Date | 2019 |
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