ANAHEIM, CALIFORNIA—Pre- and postimplementation surveys are effective tools to confirm staff understanding of and adherence to a new neurologic assessment process for patients receiving high-dose cytarabine, according to a presentation at the Oncology Nursing Society (ONS) 39th Annual Congress.

High-dose cytarabine is associated with a 28% incidence of neurotoxicity and requires prompt recognition and action to prevent irreversible neurologic damage. Stephanie Szoch, RN, BSN, OCN®, and colleagues with the University of Maryland Greenebaum Cancer Centers Nursing Clinical Practice Council of Baltimore, Maryland, developed a standardized neurologic assessment process and related documentation. The goal was to support evidence-based practices.

The study evaluated the nursing staff’s knowledge about new processes. To gauge the staff’s impressions of the assessment tool’s clinical utility, the survey asked: Is it appropriate? Is it accessible? Is it practicable? Is it acceptable?

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The preimplementation survey was a 10-question 5-scale Likert questionnaire. The results showed that 1 in 4 nurses reported receiving inconsistent information about what to do, and 1 in 5 said that the assessment form was not easy to complete. Identified knowledge deficits were addressed through educational sessions that covered how to conduct neurologic assessments and how to use the form.

The neurologic assessment form was used for 5 months, with the nurses surveyed again after implementation. Sixty-six nurses completed the preimplementation survey, and 65 nurses completed the postimplementation survey, which demonstrated significantly higher comprehension of neurologic assessments and reasonable time for completion.

In addition, the nurses reported that using the standardized form increased assessment and documentation consistency and facilitated communication about abnormal results.

But the true measure of how well the new assessment process was performing was in the charts, Szoch said. A retrospective chart audit reviewed improvements in the number of assessment forms that were completed and signed, that were completed correctly, and that the doctor was called if indicated.

Szoch’s team concluded that evaluating a practice change is crucial to understand its effectiveness, staff adherence, and to identify new problems that may arise, and that implementation surveys are effective tools for these metrics.


Szoch S, Bigelow B, Kaiser K. Evaluating the implementation of a neurologic assessment form for patients receiving high-dose cytarabine. Presented at: Oncology Nursing Society (ONS) 39th Annual Congress; May 1-5, 2014; Anaheim, CA.

Prepared by Kathy Boltz, PhD, and Joyce Pagán