PUTTING POLICY INTO PRACTICE
The recommendations listed in Table 1 were included in the policy approved by the University of Iowa Hospitals and Clinics’ Professional Nursing Practice Committee in the spring of 2009. The evidence-based practice changes were implemented house-wide after working through several committees, including Staff Education and Pharmacy and Therapeutics. The policy was placed on the hospital intranet site for nurses to use as a reference after education and training were completed.
New oral care products The oral care practice changes included a change in the selection of oral care products used based on some of the recommendations. New soft toothbrushes were approved through the Products Committee, as the previous toothbrushes used for adult and pediatric patients were of poor quality, had caps, and were substituted with the use of toothettes by oncology patients. The Oral Mucositis Committee was also able to articulate the need for waxed floss for oncology patients, which had been unavailable previously, as well as the need to stock Biotene toothpaste. New toothbrushes, waxed floss, and decreased use of toothettes provided an annual cost savings of approximately $900 or 4.4%.
Evaluation Before the practice change was implemented, staff were surveyed regarding their knowledge of oral care frequency, oral care product use, and the nutritional needs of oncology patients. Chart audits are currently being done to collect data regarding documentation compliance based on the evidence-based oral care policy, and additional education and auditing will be determined by the Oral Mucositis Committee based on these results.
Many oncology patients develop oral mucositis as a result of the chemotherapy and/or radiation therapy they receive as part of their treatment regimen. Some of the adverse effects of oral mucositis include altered treatment plans, elevated risk for infection, pain, and increased health care costs.27 Given these adverse effects, prevention of oral mucositis is particularly important and should start with evidence-based oral assessment and oral care practices. n
Acknowledgements The authors would like to thank Sharon Baumler, Leslie Brautigam, Deb Bruene, Cindy Dawson, Gloria Dorr, Rhonda Evans, Kristin Febus, John Hellstein, Cindy Marek, Jean Ryan, Anne Smith, Jane Utech, Brandon Viet, and others for their active participation on the Oral Mucositis Committee and dissemination of committee work to their respective clinical areas.
Michele Farrington works at the University of Iowa Children’s Hospital/University of Iowa Hospitals and Clinics in Iowa City, Iowa. Laura Cullen works at the University of Iowa Hospitals and Clinics. The authors have indicated no relationships to disclose relating to the content of this article.