(04) “Recognizing Decline: Nurse’s Role in Outpatient Care”

Location: Exhibit Hall D

First Author Presenting(s)

Allyssa Baker, BSN RN CPHON (she/her/hers)

Outpatient Clinical Leader
Nationwide Children's Hospital
Dublin, Ohio, United States

Co-Author Not Presenting(s)

MC

Maureen Cantwell, BSN RN CPHON

Outpatient Clinical Leader
Nationwide Children's Hospital
Hilliard, Ohio, United States
Amanda Croxton, MSN CPNP

Nurse Practitioner
Nationwide Children's Hospital
Worthington, Ohio, United States
Mindy J. Bibart, DNP, RN, CPHON(C), NEA-BC, CPPS, SSBB (she/her/hers)

Clinical Director, Hem/Onc/BMT/Apheresis
Nationwide Children's Hospital
Blacklick, Ohio, United States

Title: “Recognizing Decline: Nurse’s Role in Outpatient Care”

Abstract : Basis of Inquiry:
Pediatric hematology/oncology/blood and marrow transplant (PHOB) patients can decompensate quickly. Early recognition and intervention can improve patient outcomes. Limited scientific evidence supports the identification of acutely ill patients in the clinic setting. A knowledge gap regarding the recognition of acutely ill and decompensating patients in the outpatient PHOB setting can cause delayed interventions and poor outcomes.

Purpose/

Objective:
We aimed to answer the practice question: For adult learners in the pediatric PHOB clinic, do small group case study reviews improve knowledge of early recognition of decompensating patients?

Methods:
Nursing leaders identified the knowledge gap in early recognition through post-event reviews. Literature supports social learning strategies as effective interventions for adult learners. The team selected small group case study reviews as a flexible and convenient way to engage most nurses in a busy PHOB clinic. The first case study examined splenic sequestration, based on a patient encounter from phone triage, assessment, and intervention. The case study was written with the assistance of chat GPT, and the information was validated by an advanced practice provider (APP). A nurse leader facilitated 6 small group reviews over 3 days. PHOB nurses attended sessions. Intervention effectiveness was measured with pre- and post-tests, along with participants’ feedback. Given the first case study’s success, the nurse leader facilitated small group reviews for a patient with sepsis, following the same process as the initial reviews.

Findings:
Sessions were easily incorporated into a busy clinic. We invited 60 nurses to participate. Twenty-five nurses attended the hematology sessions (18 pre-surveys, 11 post-surveys). Correct responses improved by 20% (76% - 96%). Twenty-five nurses attended the oncology sessions (18 pre-surveys and 11, post- surveys). Correct responses improved 6% (94% - 100%). Participants appreciated the interventions convenience and effectiveness. We will continue this intervention for on-going education.