Welcome to the Neutropenia SIG!AgendaIntroductionsApprove 2015 Congress MinutesP
Bittner, John, General Manager;Program Director has reference to this Academic Journal, PHwiki organized this Journal Welcome to the Neutropenia SIG!AgendaIntroductionsApprove 2015 Congress MinutesPresentation: Ins in addition to Outs of Neutropenia: Inpatient in addition to Ambulatory CareNeutropenia SIG LeadersBarbara J. Wilson, CoordinatorAllison Streeter, Coordinator- ElectAlison Gardner, Newsletter EditorNancy Corbitt, Virtual Community Adm.Janet Cogswell, Ex-Officio
This Particular University is Related to this Particular Journal
Ins in addition to Outs of Neutropenia: Inpatient in addition to Ambulatory CarePresented byAllison Streeter, BSN, RN, OCN®Mid Dakota Clinic, Bismarck, NDBarbara J. Wilson, MS, RN, AOCN®, ACNS-BCWellStar Regional Medical Center, Marietta, GAFinancial DisclosureBarbara J. Wilson, RN, MS, AOCN, ACNS-BCNurse Speakers Bureau as long as AMGEN, Genentech, TEVAWill not be discussing off-label useContact in as long as mation: firstname.lastname@example.orgAllison Streeter, BSN, RN, OCNNothing to discloseObjectivesExplain the rationale as long as conducting a risk assessment as long as neutropenia prior to each chemotherapy cycle.Identify three patient risk factors as long as developing infection during chemotherapy induced neutropenia.Identify h in addition to washing in addition to bundled care as long as central venous catheter care as evidence based interventions recommended to reduce infections.
EvidenceBasedResourcesCDCNCCNONSONS, 2014Incidence of Infection in Cancer PatientsApproximately 50% of patients with solid tumorsApproximately 80% of patients with hematologic malignancies60,000 patients will be hospitalized this year as long as infection1 of 14 will dieCDC, 2015Risk AssessmentsPrevention in addition to Treatment of Cancer-Related Infections National Comprehensive Cancer Network (NCCN, 2016)Prevention of InfectionOncology Nursing Society Putting Evidence Into Practice (PEP): A Pocket Guide to Cancer Symptom Management (ONS, 2014)
It All Starts with Prevention!Comprehensive Risk AssessmentPatientDiseaseTreatmentRegimenNCCN, 2016Patient Risk FactorsAge > 65 years, Female gender, Low BMI Comorbidities: cardiovascular, liver or renal diseaseLab abnormalities:Increased LD, Bili, Alk PhosDecreased Hgb, AlbuminPoor per as long as mance or nutritional statusActive infection or open wound or recent surgeryDisease Based FactorsAdvanced stage of disease Bone marrow involvementType of cancer: hematologic, lymphoma, lung, breast, colorectal, ovarianSpecific genotypesHistory or presence of neutropenia
Treatment Based FactorsMyelosuppressive therapyCurative treatment goalRelative Dose Intensity (RDI) goal >85%Some medications (immunosuppressive)Regimen intensity:high dose dose dense myeloablativeRegimen RiskHigh: ANC <500 as long as > 10 days Acute leukemia induction or consolidation Allogeneic HCTIntermediate: ANC <500, 7-10 days Autologous HCT Chemotherapy w/ purine analog Multiple myeloma, CLL, lymphomaLow: ANC<500, < 7 days St in addition to ard treatment as long as most solid tumorsInpatient & OutpatientEducate staff, patients, family to st in addition to ardize practices Use teach back strategies Individualize in as long as mation / resourcesDevelop evidence based policiesAdhere to established policiesAddress inconsistencies/ noncomplianceReward best practices Preventing Infection StrategiesPersonal CareVaccinations AntimicrobialsGrowth factorsMedical / care setting strategiesEnvironmentLife style risksPersonal Care to Minimize Infection RiskH in addition to Hygiene: Be as long as e eating, after using bathroom or shaking h in addition to sOral Care: Soft toothbrush, non-alcohol mouthwash, rinse oftenBathing: Daily, pat dry, moisturizeGrooming: Electric razors, careful nail/cuticle clippingWomen: Wipe front to back; Avoid tampons or doucheSafe Sex Personal Care cont.Avoid crowdsAvoid people with colds, infections or open soresWear sunscreenAvoid gardeningAvoid rectal thermometers, suppositories, cathetersProper dietExercise/Rest balance Household CareSafe Food H in addition to lingRemove shoes when entering homeAvoid animal eliminationsWater as mold potentialIce machines, denture cups, water retaining toys, bird fountains, vases, humidifiers, etc.Staff members- stay home when sick!Vaccinations After HCT4-6 months as long as Influenza6-12 months as long as DTaP, Hib, HepA, HepB, Meningococcal, in addition to Pneumoccocal 13>12 months as long as Pneumoccocal 23>24 months as long as MMR or Zoster only if no GVHD or ongoing immunosuppression & pt is seronegativeNCCN, 2016VaccinationsInfluenza: Yearly, only inactivatedTDaP/Td: One dose then booster every 10 yrsHPV: 3 doses through age 26Pneumococcal: Complete 3 doses of Prevnar 13 then have one dose of Pneumovax 23Meningococcal: 1 dose if other risk factors presentPolio: st in addition to ard as long as children, not routine adultsCDC, 2016
Vaccinations Cont.HiB: post HSCT recipients onlyHepatitis A: 2 doses only if necessaryHep B: HCT recipient & donor c in addition to idatesZoster (live): 3 months after chemotherapyMeasles, Mumps & Rubella (MMR) & Varicella (live): 3 months after chemoYellow fever (live): endemic areas onlyProphylactic AntibioticsRecommended as long as patients expected to have prolonged severe neutropenia.Flouroquinolones are recommendedLevofloxacin in addition to ciprofloxacin have been evaluated to most.(NCCN, 2016)Prophylactic AntifungalsPrimary preventionRecommended as long as adults in addition to children when prolonged severe neutropenia is expectedHCTchronic steroids
Colony Stimulating Factors (CSFs)CSFs reduce risk of febrile neutropeniaComparison of prophylactic vs reactive pegfilgrastim by (Flores & Ershler, 2010)852 pts age >65 yearsSolid tumors FN reduced by 60% (p=0.0001)NHL FN reduced by 59% (p=0.004)CSF Primary Prophylaxis16% reduction in neutropenia related hospitalizationSEER data analysis in 2011 (Rajan, et al)Duration of neutropeniaInfection rateMedical Care, 49, 649-657CSF Secondary ProphylaxisPrevious febrile neutropeniaIV antibioticsDose reductions below therapeutic thresholdPotential as long as life-threatening infection in the next treatment cycleNCCN, 2016
Colony Stimulating FactorsNo outcome difference in as long as mulationsFilgrastim (Neupogen, Zarxio, Granix)Pegfilgrastim (Neulasta, Leukine)Demonstrated effectiveness to stimulate WBCs to prevent infectionTiming: <14 days be as long as e next tx or >24hrs afterOutpatient Specific AppointmentsScreen as long as potentially infectious patientsEducate patients to call ahead if they have symptoms of infectionIf appointment is non-urgent, rescheduleInvolve registration staff to expedite getting patient to private room / areaMinimize contact with other patientsDevelop policies with ED to fast track patientsContact PrecautionsWhen patient presents with: stool incontinence loss of skin integrity: rash, wounds secretions not containedSeparate from other patientH in addition to hygiene, wear glovesDisinfect environmentCDC
Changing Policies in addition to PracticesUpdate policies in addition to reference evidence based sourcesMonitor as long as adherence to practiceUse Journal Club as long as matStart small with trial or pilot Questions
Bittner, John General Manager;Program Director
Bittner, John is from United States and they belong to KGHR-FM and they are from Tuba City, United States got related to this Particular Journal. and Bittner, John deal with the subjects like Music Programming
Journal Ratings by Beloit College
This Particular Journal got reviewed and rated by Beloit College and short form of this particular Institution is US and gave this Journal an Excellent Rating.