Standardized Assessment Tool Prevents Chemotherapy-Induced Neurotoxicity

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Proper assessment before administration of cytarabine can identify neurotoxicity when it is potentially reversible.
Proper assessment before administration of cytarabine can identify neurotoxicity when it is potentially reversible.
The following article features coverage from the 2017 Oncology Nursing Society's Annual Conference in Denver, Colorado. Click here to read more of Oncology Nurse Advisor's conference coverage.            

DENVER, CO — Standardized tools linked to patient electronic medical records improve efficiency and thoroughness of patient assessment and documentation, potentially preventing neurotoxicity caused by high-dose chemotherapy, a presentation at the 2017 Oncology Nursing Society Annual Congress has shown. 

High-dose cytarabine is frequently used in postinduction treatment for patients with acute myeloid leukemia. Unfortunately, 8% to 26% of patients experience irreversible neurotoxicity, a potentially dose-limiting adverse effect. Cerebellar assessment before administration of each dose of cytarabine can identify neurotoxicity when it is potentially reversible.

“Chart audits identified a lack of consistency in documentation of cerebellar assessments. Variability was noted in the frequency, type, and number of tests performed, and thoroughness of documentation,” explained Mary Fournogerakis, BSN, RN, OCN, at Froedtert & the Medical College of Wisconsin in Milwaukee. Therefore, Ms Fournogerakis and colleagues sought to standardize assessment and documentation of cerebellar function at their facility.

The researchers conducted a comprehensive literature review to identify best components of a cerebellar assessment, and collaborated with the oncology physicians at their facility to define the assessment components they wanted include in the new standard.

The new tool included the following components: level of consciousness, orientation, general motor response, rapid alternating movements, finger to nose, pupil assessment (PERRLA), nystagmus, general mobility, hand grip, dorsiflexion, plantar flexion, heel to shin, and patient signature. Instructions on how to perform each test were included.

On approval of the standardized cerebellar assessment tool by the nursing Shared Governance council, the researchers worked with the informatics team to create an electronic document that linked to the patient's electronic medication administration record (eMAR).  

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