Aim: The purpose of this quality improvement project was to develop a nurse-driven protocol to provide a safer, quicker, and less complication-prone alternative for the administration of vasopressors. Background: The use of vasopressor medication is a common life saving intervention used to achieve hemodynamic stability in critically ill patients. Vasopressor infusions are routinely administered through central venous catheters (CVC) for fear that extravasation into subcutaneous tissue will result in ischemic injury. There are many potential complications of obtaining central venous access for vasopressor use, including pneumothoraces, arterial punctures and hematomas. Design: Quality improvement project. Methods: An interdisciplinary team developed a written protocol for the administration of vasopressors through peripheral intravenous (PIV) catheters based on the available scientific evidence. Key components of this quality improvement project were patient safety, a team approach and skilled monitoring of the infusion site. Critical care nurses were responsible for the line insertion, maintenance and identification of possible extravasation. All catheters placed were confirmed by ultrasonography and if extravasation of medication was suspected, the extravasation protocol was followed without delay. Results: The protocol developed was utilized in a study by Cardenas-Garcia et al. (2015). Extravasation occurred in 19 of 734 patients (2%) without any tissue injury following the use of the extravasation protocol. This evidence-based protocol for peripherally administered vasopressors decreased central line use and the potential complications from the placement of CVCs. Strict adherence to this evidence-based nurse-driven protocol was essential for the safe administration of vasopressors via PIV access. Conclusion/Clinical relevance: Peripheral administration of vasopressors has many beneficial implications for nursing practice. A nurse-driven protocol for peripheral vasopressors can eliminate the need for CVCs, which will reduce the incidence of central line-associated blood stream infections and decrease the number of central line days. This also may eliminate potential complications from CVC placement. Lastly, peripherally administered vasopressors may prevent a delay in treatment often experienced with placement of a central line.

The American Society of Clinical Oncology (ASCO) recommends that all patients with a diagnosis of advanced cancer be referred to a palliative care team within 8 weeks of diagnosis. The bene ts of early integrated palliative care are well recognized, however, there is a lack of consensus to guide operational aspects of a palliative care service within a comprehensive cancer center. In this study, we explore current palliative care referral patterns at an academic cancer center and provide recommendations for operationalizing palliative care services as a program within comprehensive cancer centers in order to adequately meet the needs of patients with advanced cancer. MethodsA retrospective chart review of patients with newly diagnosed metastatic cancer or advanced hematologic malignancy seen by the palliative care team at a comprehensive cancer center from January 1, 2021, to October 31, 2021 was conducted. IRB approval was obtained prior to the initiation of the chart review. ResultsA total of 243 patients with newly diagnosed metastatic cancer, or advanced hematologic malignancy were included in this review. Patients with gastrointestinal (26%), gynecologic (19%), and thoracic (21%) malignancies constituted 66% of the total cohort. The most frequent reason for referral was pain (52%). Thirty-nine percent of patients were referred within 8 weeks of an advanced cancer diagnosis. ConclusionASCO recommends that all patients with advanced cancer be referred to a palliative care specialist within 8 weeks of diagnosis. Of the newly referred patients with advanced cancer, only 39% were referred to the palliative care

Purpose The American Society of Clinical Oncology (ASCO) recommends that all patients with a diagnosis of advanced cancer be referred to a palliative care team within 8 weeks of diagnosis. The benefits of early integrated palliative care are well recognized, however, there is a lack of consensus to guide operational aspects of a palliative care service within a comprehensive cancer center. In this study, we explore current palliative care referral patterns at an academic cancer center and provide recommendations for operationalizing palliative care services as a program within comprehensive cancer centers in order to adequately meet the needs of patients with advanced cancer. Methods A retrospective chart review of patients with newly diagnosed metastatic cancer or advanced hematologic malignancy seen by the palliative care team at a comprehensive cancer center from January 1, 2021, to October 31, 2021 was conducted. IRB approval was obtained prior to the initiation of the chart review. Results A total of 243 patients with newly diagnosed metastatic cancer, or advanced hematologic malignancy were included in this review. Patients with gastrointestinal (26%), gynecologic (19%), and thoracic (21%) malignancies constituted 66% of the total cohort. The most frequent reason for referral was pain (52%). Thirty-nine percent of patients were referred within 8 weeks of an advanced cancer diagnosis. Conclusion ASCO recommends that all patients with advanced cancer be referred to a palliative care specialist within 8 weeks of diagnosis. Of the newly referred patients with advanced cancer, only 39% were referred to the palliative care team within 8 weeks of their diagnosis. This large gap suggests the need for a consensus with regard to operationalizing the palliative care team.