Advocate Sherman Hospital

Presentation Notes

Evidence-Based Practice poster presented at Nursing Passion: Re-Igniting the Art & Science, Advocate Aurora Health Nursing & Research Conference 2022; November 9, 2022; virtual.


Background: In the United States, 1.7 million new cases of cancer were diagnosed in 2018 and proved fatal for over half a million people. Approximately 25% of patients will take oral chemotherapy, many of whom do not take as prescribed.

Purpose of initiative: Increase oral chemotherapy adherence by implementation of a nurse-driven process using a monitoring tool to identify potential barriers. In the outpatient cancer center, this tool used during first four weeks of prescribed oral chemotherapy will increase patient’s adherence and satisfaction.

Implementation plan: The Iowa Model Evidence-Based Practice was used. American Society Clinical Oncology/Oncology Nursing Society National Standards for Safe Administration and Management of Oral Chemotherapy were used aligning patient monitoring and education. All adult patients, 18 years and older, prescribed oral chemotherapy in the outpatient cancer center were included in this project. A patient oral chemotherapy adherence tracking tool was created, including scripted questions and reliable Morisky Medication Adherence scale, used during weekly assessing adherence, symptom management, toxicities, and potential barriers to treatment. All concerns expressed by patients and identified barriers were communicated to oncologists and referred to multidisciplinary team.

Outcomes: During this one-month project timeline, oral chemotherapy adherence increased from 70% to 78%. Identified barriers were addressed. Patients verbalized satisfaction with nursing intervention. Two of the 4 non-adherent patients experienced medication delivery delays from the same specialty pharmacy. Significant increase in nursing knowledge of oral chemotherapy and adherence.

Implications for practice: Delays identified at the one insurance-approved specialty pharmacy were addressed and continue to be monitored. Workflow process includes weekly calls to every patient prescribed oral chemotherapy for the first month after initiation and continue as needed. The Oral Chemotherapy Safety Patient Education tool, approved by Advocate Sherman Hospital’s Patient and Family Advisory Council, will continue to be provided to all patients prescribed oral chemotherapy.

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