Learning Objective 1: discuss an oral care protocol for oncology patients as a first step in preventing and treating oral mucositis.
Learning Objective 2: discuss multidisciplinary collaboration necessary for development of an evidence-based oral care protocol for oncology patients.
Methods: Oral mucositis is a challenging side effect of cancer treatment. Consequences of oral mucositis are extensive including increased costs of at least $1,700/patient depending on severity (Elting, Cooksley, Chambers & Garden, 2007; Jones, Qazilbash, Shih, et al., 2008; Lalla, Sonis & Peterson, 2008; Nonsee, Dandade, Markossian, et al., 2008). Clinician’s knowledge of evidence-based oral care is limited (Barker, Epstein, Williams, Gorsky, Raber-Durlacher, 2005; Binkley, Furr, Carrico, & McCurren, 2004; Potting, Mank, Blijlevens, Donnelly & van Achterberg, 2008) and nurse’s skill with oral care needs improvement (Potting, Mank, Blijlevens, Donnelly & van Achterberg, 2008). A multidisciplinary team was formed to review the evidence and develop an oral care protocol that would be applicable to adult and pediatric oncology patients for the inpatient and ambulatory settings. A model (Titler & Everett, 2001) was used to guide implementation of the evidence-based changes which included: developing a protocol, educating nursing and medical staff, outreach strategies, modifying the computerized charting systems, and providing audit and feedback after implementation. The protocol was approved by the Professional Nursing Practice, Staff Education, and Pharmacy and Therapeutics committees in Spring 2009. The evidence-based oral care protocol was implemented and included a change in oral care products.
Results: A nursing knowledge assessment was developed by the Oral Mucositis Committee and disseminated through WebSurveyor after the policy and education had been in place for 3 months. The knowledge assessment was completed by 116 nurses and provided feedback for areas needing additional education (e.g., lanolin lip care). Merely changing dental floss, toothbrushes, and toothettes provided a savings of ~$900 or 4.4% for 2009.
Conclusion: Given the patient risk, discomfort and cost of oral mucositis, prevention is particularly important and must start with evidence-based oral care practices.
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