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Amy Mchale, I do agree patients struggle with using the equipment and I miss the days when I can just do it myself and recheck their vitals.
It would be nice if the triage protocols were completely targeted for the oncology patient. We have entire hospitals designated to caring for cancer patients (NCI). I’m not sure if a program exists but there is definitely a need. The James needs to use all of their brilliant specialists to make individual protocols for their patient population that everyone can use.Sorry for the later response.
Patti, how do you currently monitor the biometric values? Do we ask the patient if they have a home BP cuff or a pulse ox? Is any equipment provided to them currently?
The James has partnered with a company called Veris. Currently Gyn/Onc, thoracic Med/onc and BMT are using the program. Patients are supplied with veris equipment a thermometer, blood pressure cuff scale, pulse ox and a scale. Patients are directed to take their vitals daily. They also have the ability to report symptoms through the veris platform. The providers give orders as far as parameters for each biometric measurement. If patient’s vitals are outside of parameters, the triage staff are alerted and then RN will call and assess the patient.
Personally, I feel like a lot of people have devices that obtain their vitals anymore. As a triage nurse I do include this information in our assessment. We already tell every patient to call with a fever of 100.4 or higher for the most part here at the James. We have to rely on whatever equipment they have to obtain this information. We don’t provide thermometers to all of our patients. I know when I worked on SSCBC we used some of our patient satisfaction money to buy thermometers from the dollar Tree. I wouldn’t have said they were the highest quality but for those patients that didn’t have a thermometer or means to buy one it was better than nothing.
apple watches now can track heart rate, ECGs, respiratory rate, and blood oxygen levels.Jeff thanks for your input. You bring up a good question “Are we able to customize the symptoms we are tracking based off disease line?” The James covers hundreds of specialties. Can we generalize triage questions or symptom management questions to capture every medical risk for all of these areas of medicine? or should each area have their own specific assessment tools?
Hello, My name is Patti Gabel and I currently work on the Clinical Call Center team. My colleagues and I remotely monitor James patients. We monitor both biometric values (blood pressure, heart rate, temperature, oxygen saturation and weight) and patient reported symptoms. I choose this topic because it was relevant to my current practice.
Melstrom et al., (2022) focused on monitoring general and urologic oncology surgery patients. The need for monitoring surgical patients after discharge is more crucial now than in the past because the advancements of minimally invasive procedures has allowed for earlier discharges when compared to the more invasive surgical technique. Thus, the postoperative complications that would have occurred in the hospital during postoperative recovery are occurring in the home or outpatient setting. Much of the current evidence focuses on remote monitoring of patient reported symptoms not physiologic data (vital signs and daily steps). This small study looked at the feasibility of remote perioperative telemonitoring of patient-generated physiologic data and patient-reported symptoms. The adherence level for completing vital signs and electronic surveys decreased over time. The greatest atypical vital sign was observed on day 2 after discharge and was oxygenation. It was found patients are the most vulnerable on post op day 2 with taking the fewest steps per day and having lowest appetite. Post operative day 2 was identified as a critical time in care and the outpatient team should be ready to intervene if necessary.
Offodile et al.,(2023) focused on the remote monitoring of the gastrointestinal or thoracic cancer medical oncology population. Oncology patients receiving active treatment often have side effects from treatment and/or their cancer requiring frequent medical visits and even hospitalizations. It was stated that remote symptom monitoring, via electronic patient-reported outcomes (PROs), has been associated with significant improvements in health-related quality of life, health resource utilization, and clinical outcomes. Remote biometric data can provide supplementary information that enhances patient-provider communication and clinical decision-making regarding symptom management. As a triage nurse I’m often asking whether or not the patient is capable of taking their vitals to provide the medical team with more clinical information to make the safest treatment plan. I also ask patients to take pictures and send them through osu mychart. This is helpful to provide additional information when a patient is calling in with complaints of a rash or incision changes.
Will the research/information in this article change or influence your practice? If so how? Yes, this information has validated current practice. The article that focused on surgical patients did discuss having a time frame of utilizing this resource and after the patient is outside the time frame they could be off boarded. Since this practice is new, we don’t always off board patient at any given time frame.
What other questions does the article raise about current practice? how can we make this practice mainstream in the outpatient setting? It’s new to providers and not fully integrated into the epic system so providers forget it’s part of the patient’s care.
Do you agree/disagree with the conclusions of the author, why? I agree that remotely monitoring patients can be a helpful tool to caring patients.Thank You for hosting Jessica. Great topic! I too am not familiar with Quantum technology. I’m Patti from James Triage/Post Discharge.
What was the knowledge gained from the article?
By reading these articles I gained knowledge about quantum technology. It being a branch of physics that describes the behavior and energy at extremely small scales.
This technology sounds life altering for our patients. If patients can be diagnosed at early stages with less tumor burden they will have the possibility of better outcomes.
I had never thought of our current diagnostic tools as insufficient, but they are unable to detect small numbers of cancer cells compared to the capabilities of quantum technology.
Quantum Cryptography also sounds very promising. Cybersecurity has become a huge concern in my lifetime. Especially sense we highly depend on technology in healthcare.
Will the research/information in this article change or influence your practice?
These articles give me hope that one day our current diagnostics tools to work up a patient (X-ray, nuclear magnetic resonance, ultrasound-based imaging and computed and positron-emission tomography) will be obsolete.
What other questions does the article raise about current practice? How far are we from this technology becoming available to the public? How expensive are these new methods for hospital systems to integrate into practice?Greg-I agree that “junk foods that have zero health benefits (such as high fructose corn syrup) should be taxed to help cover the increased health costs they create with their consumption.”
In our lifetime we watched society change their behavior when it came to cigarettes. Wouldn’t it be amazing if our eating habits could improve a crossed all social economic classes?As far as resources for our patients I know that Dr Clinton with GU med/onc had told me about the Garden of Hope a program for James patients and caregivers.
The mission of the Garden of Hope is to provide evidence-based nutritional information and education on the benefits of a plant-based diet. The 1.5-acre garden is located at the Waterman Agricultural and Natural Resources Laboratory on The Ohio State University campus. Registered participants for the two-year Garden of Hope program have the opportunity to harvest over 100 varieties of produce including vegetables, herbs, fruits, and edible flowers from June – October. During scheduled harvest sessions, staff is available to answer gardening and nutrition questions. Orientation is required for both cancer survivors and their caregivers to participate in the program.
Hello, My name is Patti and I work with Trish in Triage here at the James.
What was the knowledge gained from the article?
To be honest I was shocked to see that a healthy diet can prevent about 30% of carcinogenesis. I also found it eye opening that, chronic inflammation can put you at risk for cancer and even progression of existing cancer. It also surprised me to learn that antioxidant polyphenols play crucial role in the inhibition of inflammation. “A lower incidence of cancer has been observed in countries where eating habits involve a low intake of meat, moderate intake of dairy and alcohol, and the frequent consumption of fruit and vegetables rich in bioactive nutrients.” This contradicts what I was taught as a kid because it was stressed upon me to drink a lot of milk, and my major source of protein was red meat. We need better education to the general public.
Will the research/information in this article change or influence your practice? If so how?
I will recommend consuming more than five servings of vegetables and fruits in a day to diminish the risk of cancer initiation.
What other questions does the article raise about current practice?
Are supplements as effective as natural polyphenolic compounds found in fruits and vegetables?
Do you agree/disagree with the conclusions of the author, why?
I agree vegetables and fruits are potent disease preventive agents that help to combat cancer due to their strong antioxidant properties. However more research is needed to support the use of polyphenols in the treatment of cancer.Amber, I didn’t realize,” Once toxicity has occurred, patients remain susceptible for symptom recurrence-even if checkpoint inhibitors have been discontinued.”
Amber, it seems like Check-point inhibitor patient can start with mild side effects and they could rapidly become worse.
Definitely presents different then antineoplastics.Hi Jeff,
You mentioned using atropine for those that experience diarrhea. Atropine works as a competitive antagonist at anticholinergic receptors. I’ve seen it used with Sacituzumab and irinotecan because they have the potential of causing cholinergic syndrome. I’m not sure if that’s the same mechanism as check point inhibitors.Hello! My name is Patti and I work with Kathy and Trish in the clinical call center department.
What was the knowledge gained from the article?
Immune checkpoint blocking antibodies are an exciting line of therapy that are being used to treat several types of cancers. I’m seeing more patients on these therapies in my current role. The autoimmune side-effects have been at times very challenging for the providers to treat. The regimens that are combination of immunotherapies have a higher risk of auto-immune side effects. The side-effects can affect all organ systems I find that to be unique.
Will the research/information in this article change or influence your practice? If so how?
I’m currently a triage nurse here at the James so this information is very applicable to my work. I think in the cases where patients are needing to utilize the emergency services of their local hospital some local providers might not be familiar with these drugs and the potential side effects. Empowering the patient to educated local providers and encouraging the collaboration of James providers with local providers.
What other questions does the article raise about current practice?
Side effects can occur months after completion as others have said that makes this very difficult to catch. Treatment Algorithms are always helpful tools when caring for complicated patients.
Do you agree/disagree with the conclusions of the author, why?
It was mentioned that some might be under reporting adverse side effects which can be detrimental to the health of our patients.It would be nice if we could do a skin test and have a better idea of who’s going to react. Especially the platiniums drugs. It’s a real unknown when and who’s going to react. At least taxanes reactions are usually in the first 15 minutes.
When I was working at SSCBC infusion I saw the medical team go back and forth, on whether or not premeds could be eliminated after the patients was exposed to the drug at least twice. I always found this interesting on why the chose one way or the other.
Hello, my name is Patti and I work in the Post-discharge/Triage Nurse team. Jodi, Thanks for leading this journal club.
What was the knowledge gained from the article? These articles gave me a nice review of the risk of reaction for paclitaxel and docetaxel. Paclitaxel 10% risk of reactions despite giving premedication with antihistamines and a corticosteroid. Docetaxel has a 5% risk of reaction. I also found it interesting that nonimmediate HSRs to taxanes can present as skin eruption, described as maculopapular and sometimes as flushing, with onset from several hours to 15 days after the drug infusion. When working with this patient population they often receive dexamethasone and it can cause facial erythema which is seen as an adverse side effect of drug.
Carboplatin HSR affect an estimated 5% of the general oncologic population and occur at a rate of approximately 1% of all platinum administrations. When administering this drug in the oncology infusion clinics it seemed more prevalent than 5%. Maybe it was because the patient population I served received more than 7 cycles because the incidence of HSR in up to 27% of patients receiving seven or more cycles of carboplatin has been reported.Will the research/information in this article change or influence your practice? If so how? In my current role as a triage nurse I’m definitely going to try to assess more for the delayed reactions when assessing patients after they’ve received their chemo.
What other questions does the article raise about current practice? When I was working in the SSCBC infusion we stopped giving premeds which included pepcid abnd benadryl to our docetaxel patients because the studies showed that patient were going to react to this drug no matter if premeds are given or not. Patient still received the decadron day before, day of, and day after. However, our patients that were diabetic only received decadron day of usually. This surprised me that an antihistamine didn’t prevent a hypersentivity reaction.
