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Learning Objective 1: discuss the importance of an evidence-based oral mucositis assessment to support nursing assessment and documentation of oral mucosal changes.
Learning Objective 2: discuss implementation of an evidence-based oral mucositis assessment.
Methods: Patients describe oral mucositis as the most distressing side effect of cancer treatment (Jaroneski, 2006). Oral mucositis is problematic, resulting in delayed treatments, reduced treatment dosages, altered nutrition, dehydration, infections, xerostomia, pain, and increased healthcare costs (Brown & Wingard, 2004; Sonis, et al., 2004). After reviewing the evidence and comparing tools, Eilers’ Oral Assessment Guide was chosen for clinical use as the oral mucositis assessment tool for all oncology patients and was piloted in September 2006. The translational research model (Titler & Everett, 2001) was used to guide implementation of the evidence-based changes which included: educating nursing and medical staff, outreach, developing a policy and procedure, modifying the computerized charting systems, and providing audit and feedback after implementation occurred.
Results: Pilot evaluation on adult leukemia and bone marrow transplant (ALBMT) demonstrated that 87% of patients had an abnormal oral assessment, with 62% of patients having measurable oral mucosal changes. Nursing questionnaires showed that staff felt they were able to identify at risk patients using the oral assessment (3.3; 1-4 scale) and that the tool accurately identifies mucosal changes (2.9; 1-4 scale). Hospital-wide roll out occurred in October 2007. In July 2008, a chart audit of the assessment tool demonstrated that documentation department-wide was 87%. Documentation of the assessment was being done 100% of the time on pediatric and adult hematology-oncology and bone marrow transplant units. The assessment documentation rate was 88% for head and neck radiation outpatients. Other ambulatory areas have an opportunity for improving nursing assessment and documentation of oral mucositis and future audits are planned.
Conclusion: Oral mucositis is a distressing side effect of oncology treatment that needs to be accurately assessed and documented before moving on to prevention and early intervention.
See more of: Evidence-Based Practice Sessions – Oral Paper & Posters