Neutropenic Precautions:

Neutropenic Precautions:

Are They Beneficial?

The PROBLEM

• Neutropenic precautions haven't been researched since the 70s with the invention of BMTs (Larson, 2004).
• We have made advances in technology, antibiotics, treatments, infection prevention, etc. (Larson, 2004).

Are neutropenic precautions effective in reducing the infection rate of neutropenic patients?

Claire Turner, CCNS

Faculty: L. Patterson, MSN, APRN, BC

The EVALUATION

GOAL

Within 6 months of guideline implementation, patient satisfaction related to the new guidelines will be 95% or better and the rate of nosocomial infections in neutropenic patients will decrease by 25%.

THEORY

• Bridge the theory-practice gap (Upton, 2001)
• Utilize the management ideas known as best-practice transfer (evidence based practice on neutropenic precautions), team learning (scheduled seminars), and process change (implementation of new guidelines) (Tucker, Nembhard, & Edmondson, 2007)

The RESEARCH

QI MEASURES

Personal Protective Equipment

-More likely to acquire infection from normal flora

-CDC suggests following standard precautions

-Biggest breakdown in infection prevention is people not drying their hands completely after washing them (Shelton, 2003)

Private Rooms

-Private but not isolation rooms (Mank & van der Lelie, 2003)

Patient to Nurse Assignments

-Increased risk of infection when nurses care for neutropenic patients while concurrently caring for patients with communicable diseases (Shelton, 2003)

Exposure to Fruits, Vegetables, Plants, and Flowers

-Do limit exposure to plants and flowers

-Do not limit diet (Shelton, 2003)

• How many providers have attended the classes
• How many units have begun initiating changes
• What the average patient satisfaction is for each unit
• What the rate of nosocomial infections is for each unit

• Practice recommendations associated with neutropenic precautions are unnecessary and potentially psychologically damaging to the patient (Shelton, 2003).

*Personal Protective Equipment

*Private Rooms

*Patient to Nurse Assignments

*Exposure to Fruits, Vegetables, Plants, and Flowers

The RESOURCES

Larson, E. & Nirenburg, A. (2004). Evidence-based nursing practice to

prevent infection in hospitalized patients with cancer. Oncology Nursing, 31(4), 717-725. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed

Mank, A. & van der Lelie, H. (2003). Is there still an indication for nursing

patients with prolonged neutropenia in protective isolation?: An evidence-based nursing and medical study of 4 years experience for nursing patients with neutropenia without isolation. European Journal of Oncology Nursing 7(1), 17-23. doi:10.1054/ejon.2002.0216

Shelton, B. (2003). Evidence-based care for the neutropenic patient with

leukemia. Seminars in Oncology Nursing 19(2), 133-141. doi:10.1016/S0749-2081(03)00026-3

Tucker, A., Nembhard, I., & Edmondson, A. (2007). Implementing new

practices: An empirical study of organizational learning in hospital intensive care units. Management Science 53(6), 894-907. Retrieved from http://dx.doi.org/10.1287/mnsc.1060.0692

Upton, D. (2001). How can we achieve evidence-based practice if we have a

theory-practice gap in nursing today? Journal of Advanced Nursing 29(3), 549-555. doi: 10.1046/j.1365-2648.1999.00922.x

The PLAN FOR CHANGE

The University of Amsterdam

Personal Protective Equipment

-Don PPE following standard precautions

-Wash and DRY hands regularly

Private Rooms

-Neutropenic patients have a private room

-Neutropenic patients not isolated from human interactions

Patient to Nurse Assignments

-Should not provide concurrent care for patients with neutropenia and patients with communicable diseases.

Exposure to Fresh Fruits, Vegetables, Plants, and Flowers

-Exposure to plants and flowers discouraged

-Allowed to consume fresh fruits and vegetables as long as they are thoroughly cleansed

(Mank & van der Lelie, 2003)