Background: Chemotherapy and radiation therapy, the mainstays of current cancer treatment, often result in devastating side effects involving the oral cavity. Mucositis, an inflammatory and/or ulcerative lesion of the oral and/or gastrointestinal tract is a common therapy-related toxicity. Mucositis significantly impacts patients’ overall physical and functional well-being, as well as quality of life. There is strong evidence suggesting that the implementation of preventive strategy, such as patient and family education on the importance of oral hygiene practices, can lower the incidence of mucositis. The evidence also suggests that mucositis can be prevented or managed by performing rigorous oral hygiene, leading to lower occurrence in severity and in progressive symptoms. Research suggests that the implementation of preventive strategies such as patient and family education can lower the severity of mucositis symptoms, and the nurse plays a unique role in performing this patient and caregiver education at every opportunity of point of care.
Objective: To develop a standardized patient education booklet for oral assessment, oral hygiene practices, and symptom management of mucositis in populations with cancer.
Methods: The evidence-based practice (EBP) project was initiated using the Johns Hopkins model for the question development and project management. The EBP project will be carried out in phases. The first phase is to standardize an oral assessment tool for mucositis across populations and settings and the development of a practice policy. The mucositis EBP workgroup developed a pilot to gather data on the selected oral assessment tool to show evidence that the tool was endorsed by the staff nurses who were using it. In addition, the workgroup brought the project through the appropriate hospital councils to incorporate the oral assessment guide (OAG) into the daily shift assessment. Included in phase 1, the nurse educator completed the education of all of the nursing staff on oral assessment, oral hygiene, and chart documentation. Next, phase 2 included the development of a standardized patient education and a nursing policy that governs when and how education and assessment are performed. We are now approaching phase 3, in which the mucositis workgroup will be developing standards of treatment based on OAG score, known as the mucositis protocol.
Results: A patient-centered education program on the identification of the signs and symptoms of mucositis and on oral hygiene practices will be accomplished by developing a transdisciplinary EBP team, inclusive of advanced-practice nurses, staff nurses, pharmacists, dieticians, oncologists, dentists, and patient and caregiver representation. This EBP team will identify best educational practices and will incorporate patient preferences for education content, and assure collaborative decision-making among team members. The focus of this project will be the implementation of a patient-centered cancer education program related to oral hygiene practices and the identification of the signs and symptoms of mucositis. Comprehensive oral assessment conducted by the nurse will lead to earlier identification of the signs and symptoms of mucositis. Rapid detection of the onset of mucositis by the patient and the nurse will lead to implementation of interventions that will promote improved patient outcomes. The project goals include patient and caregiver early recognition of the symptoms of mucositis and improved quality of life patient outcomes in the areas of pain, dehydration, and weight loss. Therefore, with the identification, selection, and implementation of the OAG with oral hygiene practices, earlier recognition of mucositis symptoms and early initiation of the appropriate treatment will result. The EBP project has completed phase 1. During this phase, a pilot study was completed on 492 oral assessments. These assessments included 24 registered nurses and 5 advanced-practice nurses. The results of this pilot showed that 82% of users agreed on utilizing the OAG as the assessment tool, because it was thorough. In addition, 86% of the participants felt the tool was user-friendly. In phase 2, the Mucositis EBP workgroup is standardizing the patient education booklet; the nursing policy on performing oral assessment; and oral hygiene practices. A follow-up chart audit performed after the initial nursing staff education on oral assessment documentation showed a 64% increase and was occurring in a policy-compliant manner. Phase 2 included having the workgroup present the new OAG to be placed in the electronic medical record to the hospital informatics council.
Conclusions: At the conclusion of this EBP project, patients and caregivers will be able to demonstrate and articulate an oral assessment, the signs and symptoms of mucositis, and oral hygiene practices. The oncology nurses’ role is intended to enhance cancer care for symptom management. This EBP project of standardizing oral assessment skills, oral hygiene practices, and intervening with a mucositis protocol will become part of the oncology nurses’ armament to aid the patient through the treatment process, thus resulting in enhanced cancer care.
