Understanding Multimodal Cancer Therapy Assignment Paper

Understanding Multimodal Cancer Therapy Assignment Paper

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A proposal reflects synthesis of the student’s knowledge from prior coursework and clinical work in an area of interest or expertise. The Capstone project plan should include a needs assessment, rationale, problem statement, goals and objectives, theoretical framework, project activities/methods (including human subjects), project timetable, necessary resources, and evaluation as well as related appendices. The student’s successful development of a Capstone project proposal determines that the student is prepared and qualified to synthesize the learning and clinical practice of the program into a project that demonstrates the advanced level of nursing practice required at the doctoral level. The final project proposal for this class will also be submitted to the Capstone community agency mentor(s) concurrently with submission to the course faculty. The Capstone project plan must show logical progression of thought, good literary style, and acceptable practices of scholarly writing. All sections should be included even if it is not complete Understanding Multimodal Cancer Therapy Assignment Paper.

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Abstract

This DNP project proposal focuses on the implementation of an evidence-based high-risk patient management HEART (High ED/Admission Risk Therapy) team protocol at Mount Sinai West to reduce unnecessary ED visits and unplanned hospital admissions of adult oncology patients receiving multimodal cancer therapy. It explores the extent to which the Kotter’s 8 steps change model as the selected theoretical framework and the Plan-Do-Study-AACT (PDSA) model as the selected methodology will be used to support implementation of the proposed evidence-based intervention. The core findings of this project proposal shall create a better understanding of the impact of the HEART team protocol on the quality of care and support provided to cancer patients and survivors currently receiving multimodal therapy at Mount Sinai West hospital. Focused on attaining a 20% reduction in potentially avoidable ED visits and hospital admissions, the project seeks to enhance nurses’ early detection and recognition of the risk factors and primary causes of ED visits and hospitalization of cancer patients after the initial oncology care; boost nurses’ knowledge of high-risk patient assessment and symptom management, and foster multidisciplinary team (MDT) collaboration in an attempt to prevent unplanned hospital admission and avoidable ED visits within 30-days of multimodal cancer therapy at the identified facility. As a quality improvement intervention, the proposed project is focused on meeting the OP-35 measure and other clinical guidelines employed to ensure a significant reduction in effects of treatment-related complications and emergencies amongst the growing population of cancer patients and survivors.

Table of Contents

Abstract. 2

1.0 Background and Significance. 4

2.0 Problem Statement. 6

3.0 Need Assessment. 7

4.0 Review of Literature. 8

5.0 Theoretical framework. 12

6.0 Goals, Objectives and Expected Outcomes. 14

Goal 14

Objectives. 14

Expected Outcomes. 15

7.0 Methodology. 15

Project Site and Population. 16

Anticipated phases of the Project. 17

Obtaining support from stakeholder’s process. 17

Initial Implementation steps. 18

Outcome Measure/Measurement Instruments. 19

Benefits/Risks. 19

Participant Recruitment. 19

Ethical and Consent Procedures. 20

Project Timeline. 20

8.0 Conclusion. 21

References. 22

Appendices. 29

1.0 Background and Significance

Cancer patients and survivors regularly utilizes the Emergency Department (ED) for a range of diagnoses both related and unrelated to their chronic medical condition, yet ED outcomes for cancer patients receiving multimodal cancer therapy is not sufficiently documented in the United States and abroad.  Findings from the reviewed literature indicates that a significant number of cancer patients receive care in the ED at some point after their diagnoses, with a projected 4.5 million visits to the emergency department reported each year (Young et al., 2020). Alsuhebany et al. (2022) established that cancer patients presenting in the emergency department units experience increased risk for hospital admissions and other detrimental outcomes (an increase in social and economic costs, high number of comorbidities) in comparison to patients without cancer. As such, cancer patients and survivors represent a distinct patient population and may benefit from implementation of evidence-based interventions to help in the management of treatment-related toxicity and specific cancer-related complications (Qian et al., 2021). Caterino et al. (2019) established that many of the cancer patients and their caregivers or families tend to experience a good deal of anxiety and stress, particularly when required to operate in the high intensity ED setting. Other stressors that are often experienced by the patients during the ED visits include lengthy waiting times; poor communication between patients, staff and families; unexpected procedures; the occurrence of unexpected or acute onset concerns and lack of proper integration across the interface of cancer care between general practice, specialist cancer services and the emergency department (Biganzoli et al., 2021; Haugen, 2020)Understanding Multimodal Cancer Therapy Assignment Paper. Enhanced comprehension of the distinct clinical and non-clinical needs of cancer patients presenting to emergency departments, and proper identification of areas for further improvements in the quality of care and support offered to cancer patients currently receiving multimodal therapy, is urgently needed.

Individuals diagnosed with the different types and stages of cancer are often admitted to the hospital or cancer center as emergency cases for acute care in comparison to the general population (Dufton et al., 2022). Smith and Carlson (2021) established that cancer patients tend to experience increased exposure to infection, long wait times, and receive treatment from staff that is less experienced with treatment-related problems and cancer-related complications. With close to 1.6 million new cases of cancer reported each year in the United States, the number of morbidities and mortalities amongst people with cancer is increasing, ,whereby about 600,000 people estimated to die of cancer annually (Haugen, 2020). Xu et al. (2021) indicated that whilst the survival rates have increased due to advances in the early detection, prevention and treatment of cancer, the management of this chronic illness often demands a highly coordinated approach amongst the staff and patients as well as their caregivers beyond the preliminary oncology care.

Against this backdrop, genuine collaboration and effective communication within the multidisciplinary teams of healthcare professions involved in general oncology care is urgently needed. The various healthcare practitioners are required to work together (both formally and informally), and to gain a leveraged understanding of their assigned roles and responsibilities in order to successfully meet the healthcare needs of cancer patients (Kurteva et al., 2023).  Gallaway et al. (2021) indicated that such inter-professional collaboration and communication has the greater potential to contribute to a reduction in medical errors and fragmentation of care, enhanced access to optimal patient care and satisfaction, enhanced patient adherence to prescribed care, and reduced ED visits. Some of the indicators of ED performance that should be given consideration include a focus on reducing time to receiving care, time to discharge from emergency department and reducing readmission rates among highly complex cancer patients (Stone, 2020)Understanding Multimodal Cancer Therapy Assignment Paper. The utilization of multidisciplinary care in an ED setting can go ahead to enhance the provision of adequate care to cancer patients at risk of unplanned ED visits, unnecessary hospitalizations as well as nursing home placements (Eskander et al.,  2018). Selby et al. (2019) argued that multidisciplinary teams are integral to enhancing cancer care coordination and treatment delivery based on their leveraged ability to reinforce best practices, procedures and policies as well as to encourage comprehensive, tailored and proactive care planning and execution.

Therefore, the ultimate importance of this scholarly project proposal is to integrate the core findings from the field and the reviewed literature evidence to create a better understanding of how the incorporation of an evidence-based high-risk patient management HEART (High ED/Admission Risk Therapy) team protocol into the clinical practice of an healthcare facility can lead to a reduction in unnecessary ED visits and unplanned hospital admissions by 20% amongst adult patients receiving multimodal cancer therapy. The core findings of this project will help to educate the various healthcare professionals and providers involved in oncology care on how the multidisciplinary approach can contribute to optimal care of people with cancer in the emergency department, and most importantly, help to boost effective communication, symptom management and supported decision-making by the ED teams at the Mount Sinai West Hospital.

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2.0 Problem Statement

The growing number of emergency department visits and high number of hospital admissions amongst patients receiving multimodal treatment represent a major problem behind the increasing healthcare costs, reduction in care delivery and management of patients’ clinical risks, and the poor patient outcomes (Crawford, 2018). Moreover, findings from the reviewed literature revealed that increased ED usage amongst patients with cancer can be attributed to a myriad of factors including fearfulness, insufficient communication and language skills, cultural background, insurance status, lack of social support, delays in seeking help, medication non-adherence, gender, race, socioeconomic status, among others reasons (Haas et al., 2021)Understanding Multimodal Cancer Therapy Assignment Paper. As a quality improvement approach, implementation of the HEART team protocol at Mount Sinai West Hospital will have positive implications on the relationships between improvement in prevention, early detection and recognition of the primary causes and risk factors for ED visits and unplanned admissions as well as improvements in the nurses’ knowledge of symptom management and high-risk patient assessment.

3.0 Need Assessment

There are more than 5 million attendances by Americans managed by EDs annually. People with cancer often present to the emergency departments of hospitals or cancer centers for the management of concerns related with their cancer diagnosis and/or treatment. Some of the main reasons behind ED visits by people with cancer include infection, pain, fever, respiratory symptoms, gastrointestinal toxicities, bleeding, injury, neurologic complaints, circulatory symptoms, and existence of other comorbidities (Huang et al., 2021). At Mount Sinai West, at least 14 unplanned ED visits were reported in 2022, representing about 35.89% of ED visit rates. Moreover, a majority of the ED visits at the facility were amongst older people (65 years and above) with cancer, and that the chief complaints for this particular population included neurologic complaints, fatigue, respiratory symptoms, injury, metabolic/endocrine as well as gastrointestinal and respiratory complaints (Pettit, Sarmiento & Kline, 2021).  As such, the adoption of a multidisciplinary team approach at the identified cancer care facility can boost the capacity of healthcare professionals to identify the key causes and risk factors behind the high ED visits and unplanned admissions amongst cancer patients and survivors, and to adopt patient-centered, evidence-based interventions improve the quality of care delivered to patients at high risk for preventable acute care (Hubler et al., 2022)Understanding Multimodal Cancer Therapy Assignment Paper.

4.0 Review of Literature

The researcher conducted a systematic review of available literature findings on ED visits and hospital admissions amongst cancer patients. The main online databases utilized in this study to search to appropriate information and data on the research topic include: MEDLINE (n= 32), PubMed (n= 68), Science Direct (n=50) and Cochrane (n=53).  With regards to the inclusion criteria, only peer-reviewed articles and books that focused on the application of multidisciplinary team approach to provide optimal care of people with cancer in the emergency department were included in the final review. Moreover, the search strategy focused on articles published in the English language, and written within a five-year span, 2017-2023. The key words and terms used in the search process include: cancer patients, emergency department visits among people with cancer, multidisciplinary team cancer team, unnecessary emergency visits, unplanned hospital admissions and burden of cancer care. In terms of the exclusion criteria, research studies that failed to comprise full-text, abstracts, and those published before 2017 and in foreign languages other than English were not included in the review. Only 40 sources were included in the final review based on their credibility, timeliness, validity and relevance to the research topic Understanding Multimodal Cancer Therapy Assignment Paper.

Research findings have shown that cancer patients and survivors are increasingly more likely to visit an emergency department of a cancer center or healthcare facility for acute care compared to the general population (Qian et al., 2021; Hamilton et al., 2016). In a retrospective study, Gallaway et al. (2021) established some of the common symptoms reported by cancer patients and survivors presenting to the ED and they include: respiratory complaints (e.g. shortness of breath, pneumonia, respiratory distress, cough, acute bronchitis, hemoptysis); gastrointestinal symptoms ( e.g. loss of appetite, vomiting, gastroenteritis, abdominal pain, food poisoning, nausea, bloating); neurologic complaints (e.g. dizziness, altered mental status, seizure, drowsiness); pain (e.g. abdominal pain, chest pain, extremity pain, other pain)Understanding Multimodal Cancer Therapy Assignment Paper; and dehydration (e.g. hypernatremia, dehydration). Other symptoms include bleeding; injury (e.g. piece, cut, sting, bite, injury, poisoning, motor vehicle accident, excessive heat, drowning, ,firearm); fever (e.g. febrile, chills, neutropenia); hypertension (high blood pressure); fatigue (e.g. weakness, malaise); and medication refill (e.g. prescription, refill medication, lost script, requesting script) (Hubler et al., 2022; Crawford, 2018). The studies concluded that a better understanding of the core symptoms and chief complaints behind the ED visits and hospital admissions of people with cancer is needed in order to inform the adoption of best practices aimed at boosting care coordination, and proper management of symptoms as well as timely referral to supportive or palliative care and access to high quality oncology care.

In a cross-sectional descriptive survey study, Waller et al. (2023) attempted to examine the perceptions of brain cancer patients about what comprises of optimal care for cancer patients presenting to the emergency department. The study found out that cancer patients who present to the emergency department during their multimodal chemotherapy treatment tend to experience a higher risk of hospital admission. The researchers in other different studies recommended the need for adopting a collaborative, inter-professional approach to care that brings together an effective team of specialists working in emergency medicine, oncology, and other areas such as neurology, nursing and general practice (Zaccagnini & Pechacek, 2021; Pettit, Sarmiento & Kline, 2021)Understanding Multimodal Cancer Therapy Assignment Paper. In a qualitative study, Jairam et al. (2019) argued that genuine collaboration and effective communication within multidisciplinary team of healthcare professionals (including nurses, physicians, doctors, and administrative staff operating in outpatient and inpatient environments) is needed to guarantee the delivery of high-quality, patient-centered care. Some of the positive outcomes associated with the multidisciplinary approach include improvements in patient satisfaction, increased patient adherence to prescribed treatment and care, reduction in medical errors and fragmentation of care, and enhanced management of symptoms and complications associated with cancer-related problems and treatment-associated complications.

The study by Hjermstad et al. (2018) recommended the need for close collaboration between palliative and oncology care as the fundamental basis for achieving fewer admissions to acute care facilities and fewer visits to the emergency departments. Similar findings were reported by Majka and Trueger (2023) who claimed that adoption of evidence-based interventions by the multidisciplinary teams can contribute to improvements in cancer care and outcomes. Klotz et al. (2021) pointed out the HEART team protocol is largely geared at ensuring the team of specialists involved across the care continuum remains organized, well-led, efficient; communicate well and effectively within the multidisciplinary team and with their respective patients, and base their decisions on timely and sound information and data. Moreover, Terrones-Campos et al. (2022) asserted that the enforcement of the HEART team protocol can provide a highly flexible, multidisciplinary and collaborative approach aimed at enabling the implementation of clinical guidelines and procedures to identify potentially preventable visits and to enhance hospital outcomes for cancer patients in the emergency setting. Eskander et al. (2018) indicated that conformity with measure OP-35 can form a strong basis on which contemporary healthcare providers and cancer centers can engage in the active monitoring of the ED visit rates, hospitalization and re-hospitalization as well as hospital mortality across all principal diagnoses of cancer. Moreover, considering the multifactorial nature of the main causes and the risk factors behind increased ED visits and hospital admissions amongst cancer patients, adoption of the HEART team protocol can go ahead to inform the realization of cancer-specific pathways within an ED triage system for the purpose of enhancing outcomes in terms of reduced ED visits and reduced risks of hospital admission and death (Neugut & Bates, 2021)Understanding Multimodal Cancer Therapy Assignment Paper.

Findings from the reviewed literature indicate that a multidisciplinary team approach can be made effective through implementation of the HEART team protocol. Smith and Carlson (2021) found out that the HEART team protocol can be considered as an evidence-based guideline aimed at informing the outcomes of team discussions of staging and diagnostic investigations, and most importantly, enhancing collaboration amongst healthcare providers as well as patient-physician communication and interactions. Ideally, application of the HEART Team protocol by the multidisciplinary team may play a fundamental role in improving survival through strong focus on provision of individualized care, identification of patient needs and proper and timely coordination of suitable ancillary services (Teggart et al., 2022).  Other research findings by Haugen (2020) revealed that the use of a high-risk patient management team protocol can go ahead to boot multi-disciplinary team working and team decision-making, thus enhancing cancer staging accuracy, improving patient knowledge, increasing patient satisfaction with the MDT decisions, lowering decisional conflict and enhancing perception of risk. These findings indicates that the HEART team protocol is an important evidence-based intervention capable of streamlining the process of MDT working in terms of boosting patient involvement and patient knowledge to enable them make well-informed decisions regarding their treatment preferences, and other aspects of cancer care beyond the initial oncology care (Klotz et al., 2021)Understanding Multimodal Cancer Therapy Assignment Paper.

The findings indicates that the use of evidence-based guidelines and collaborative interventions by the multidisciplinary team involved in the care of cancer patients presenting to an ED setting can lead to a significant reduction in potentially avoidable ED visits and unplanned hospital admissions and mortality (Patel et al., 2021).  As a SMART decision-making tool, The HEART team protocol can provide the requisite tools, algorithms and procedures that can be followed by the multidisciplinary team to monitor trends for patients at risk of cancer-related problems and treatment-associated complications while receiving multimodal therapy (Taberna et al., 2020).

In terms of rationale, the quality improvement project was primarily implemented with the core intention of meeting the criteria for measure OP-35, and to identify some of the driving and restraining factors behind the facility’s high ED visits and admission rates for patients with cancer. Implementation of the HEART team protocol is intended at evaluating the effectiveness of OP-35 in the identification of potentially avoidable ED visits for adult oncology patients receiving multimodal cancer therapy (Shelburne et al., 2022). Moreover, the project is justified by the extent to which guideline-based management of supportive care for treatment-related problems and cancer-related complications can be fully integrated into oncology care for the very sake of enhancing the quality of care delivered to cancer patients currently undergoing multimodal treatment at the selected facility, Mount Sinai West (Haugen, 2020).

5.0 Theoretical framework

Kotter’s 8-step change model is the theoretical framework that underpins the capstone project. Introduced in 1996 by John Kotter, this theoretical framework was developed following a comprehensive research of more than 100 organizations that were undergoing through a change process. As shown in Appendix 1, the eight steps in the process of change include: establishment of a sense of urgency, creation of powerful guiding coalitions, development of a strategy and vision, communicating the vision, removal of obstacles and empowerment of employees for action, creation of short-term wins, consolidation of gains, and the strengthening of change through embedding change in the culture of the given organization (Kotter, 2022)Understanding Multimodal Cancer Therapy Assignment Paper.

In terms of application, the basic tenets of this theoretical framework will be employed to inform the implementation of the HEART team protocol to boost care coordination and treatment outcomes for oncology patients receiving multimodal cancer therapy at Mount Sinai West.  The creation of a strong sense of urgency regarding the rising rates of ED visits and unplanned admissions amongst cancer patients and survivors under multimodal treatment will raise awareness of the risk factors and causes of this problem, identify opportunities and benefits of evidence-based interventions, and initiate stakeholder engagement and collaboration in an attempt to enhance the quality of care and support offered to people with cancer beyond the initial oncology care (Kurteva et al., 2023).  The formation of powerful guiding coalitions comprising of key stakeholders, organizational leaders and healthcare practitioners and support staff will also prove highly instrumental in ensuring multidisciplinary working and decision-making in favor of successful implementation of the proposed evidence-based intervention, the HEART team protocol (Waller et al., 2023). Another step involved the development of a clear vision and strategy using the SMART decision-making algorithm and checklist, timely provision of feedback) to ensure the proposed change process in favor of reduced ED visits and unplanned hospitalizations are reduced by implementing the HEART team protocol. Achieving success throughout the change proves demands all the team members and other involved parties to maintain effective communication to ensure the goals and objectives as well as mission and vision of the prosed project are successfully attained using the available resources. Equally, the removal of barriers (through staff training, employee empowerment) to realization of the multidisciplinary team approach can also enable the project team members to overcome resistance to change and to amplify the benefits of the HEART team protocol in line with the need for achieving higher quality care for cancer patients and survivors currently receiving multimodal therapy (Xu et al., 2021).  Other key steps include the creation of short-term wins (e.g. project approval, employee engagement) well as consolidation of gains (e.g. success stories) will also go ahead to inform the realization of holistic, patient-centered and high-quality care to patients at risk of unnecessary ED  visits and unplanned hospital admissions (Bayrak & Kitiş, 2018). Lastly, is it highly imperative to anchor the desirable change into the corporate culture of the healthcare facility through integrating the HEART team protocol into the mainstream clinical practice, capacity-building, and the sharing of success stories related to the project to ensure replication and further quality improvements (Selby et al., 2019)Understanding Multimodal Cancer Therapy Assignment Paper.

6.0 Goals, Objectives and Expected Outcomes

Goal

The main purpose of the DNP scholarly project is to incorporate the HEART team protocol into the clinical practice of Mount Sinai West to reduce unnecessary ED visits and unplanned hospital admissions by 20% for adults receiving multimodal cancer therapy.

Objectives

This DNP project is guided by the following objectives:

1. Improve nurse recognition and early detection of primary causes and risk factors of unnecessary ED visits and unplanned admissions of adult oncology patients receiving multimodal cancer therapy.
2. Improve the nurse knowledge of high-risk patient assessment and symptom management.

Expected Outcomes

1. Reduce ED visits and hospital admissions by 20% among high-risk cancer patients receiving multimodal therapy at the radiation oncology department within the selected healthcare facility.
2. To integrate the HEART team protocol into the clinical practice of the facility to enhance the prediction and management of cancer-related problems and treatment-associated complications in order prevent avoidable ED visits and hospitalization.
3. To reduce the adverse health outcomes associated with unnecessary ED visits and unplanned hospital admissions amongst cancer patients and survivors receiving multimodal cancer therapy at the facility.
4. To foster multidisciplinary team collaboration in a quest to improve coordination of care across the care continuum for adult cancer patients to prevent unplanned admissions and preventable ED visits within 30-days of multimodal cancer therapy Understanding Multimodal Cancer Therapy Assignment Paper.

7.0 Methodology

The Plan-Do-Study-Act (PDSA) model is the quality improvement model that will be adopted to guide the implementation of the HEART team protocol at the Mount Sinai West Hospital. The recruitment of team members from the numerous field and expertise (nursing teams, physicians, social workers, nutritionist, supportive oncology team, and oncologists) will ensure a formidable and professional multidisciplinary team is established to tackle the issues at hand. The assigning of roles and responsibilities to the team of experts will create the basis for practical realization of the HEART team protocol. Conducting a comprehensive assessment of the evidence-based project will help to determine the efficacy, reliability and effectiveness of the evidence-based intervention in terms of realizing the set goals and objectives as well as projected outcomes. Continuous monitoring and evaluation of the core activities associated with the project will ensure the integration of best practices into the routine clinical practice at the facility, and in tackling some of the primary causes and risk factor behind the growing rates of potentially preventable ED visits and unplanned hospital admissions and even mortality faced by cancer patients and survivors beyond the initial oncology care. Adopting a 4-week training course will enable the multidisciplinary team to study and understand the risk factors behind the high rates of unnecessary ED visits and unplanned hospitalizations, and to best practices and guidelines to enhance care coordination and treatment delivery for cancer patients receiving intensive multimodal cancer therapy. The use of HEART team algorithms and checklist by the weekly NP-led symptom management clinic will help in the identification of high-risk patients, and subsequently, inform the adoption of patient-centered, evidence-based pharmacological and non-pharmacological interventions to reduce the effects of cancer-related problems and treatment-related complications within 30-days of multimodal cancer therapy.

Project Site and Population

The proposed project will be implemented at Mount Sinai West, New York, in the United States. The facility operates a 24/7 emergency department, and has more than 511 inpatient beds. The facility provides individualized and comprehensive treatment plans for patients with different types and stages of cancer (Mount Sinai, 2023). The facility serves patients from the West Side and Midtown, New York City and beyond. In terms of current services, some of the main oncology areas of focus include: medical oncology, surgical oncology, radiation oncology, bone marrow transplantation, clinical trial and research, among other innovative cancer treatments and therapies (Mount Sinai, 2023)Understanding Multimodal Cancer Therapy Assignment Paper. In terms of the characteristics of the participants, the facility operates in a culturally-diverse environment where and hence a highly diverse team of participants will be engaged to implement the HEART team protocol. Only patients receiving multimodal cancer therapy will be recruited and the team of experts included will comprise of all the relevant site personnel actively involved in oncology care and related clinical areas. My interactions with site personnel and patients will be informed by a two-way, collaborative and individualized approach that embraces the contributions of each team member.

Some of the key resources that will influence implementation of the proposed project include the Emergency department unit at Mount Sinai West, medical staffing, supportive oncology service, ICT infrastructure, diagnostic tests and medical staffing within the facility (Waller et al., 2023). The facilitators comprise of the respective healthcare providers at the facility and the external technical assistance; the barriers include will include potential resistance to change, and lack of adequate resources; and the constraints may be the limited stakeholder training on the core elements of the HEART team protocol algorithms and checklists (Stone, 2020). Overcoming the identified roadblocks will be made possible through the staff training to equip the team members with relevant knowledge and competencies regarding the project; mobilization of relevant resources to avert potential shortages, and strategic change management to overcome resistance to change (Pettit, Sarmiento & Kline, 2021)Understanding Multimodal Cancer Therapy Assignment Paper.

Anticipated phases of the Project

Obtaining support from stakeholder’s process

Implementation of the HEART Team protocol is in line with the facility’s multidisciplinary and collaborative approach to cancer care. Therefore, the Mount Sinai West Hospital seeks to implement the OP-35 measure to come up with facility-specific reports on the list of cancer-related problems and treatment-associated complications behind the high rates of preventable ED visits and unplanned hospitalizations within the 30-days of multimodal cancer treatment.

Initial Implementation steps

The implementation begins with performing a comprehensive review of available literature on the risk factors behind high rate of preventable ED visits and hospitalizations amongst cancer patients and survivors receiving multimodal cancer therapy. Another step entails organizing a meeting and preventing the project plan to the senior management at the facility on the need for adopting a multidisciplinary team approach to cancer care beyond the initial oncology care (Keller, Wexner & Chand, 2018). Also meeting with the supportive oncology team and the nursing manager is an essential step aimed at ensuring proper allocation of roles and responsibilities. The development of the HEART team protocol algorithm is integral to ensuring the key elements of the program are integrated into clinical practice (Colley, Pracy & Jennings, 2021)Understanding Multimodal Cancer Therapy Assignment Paper. Moreover, development of the educational materials and provision of proper training and education to the nursing team and the multidisciplinary QI team will ensure enhanced awareness of the key goals and objectives of the project as well as other key areas of interest (Kowalczyk & Jassem, 2020). Creation of the evaluation criteria and tools will ensure the HEART team is evaluated thoroughly to determine and compare the pre and post ED visits and admission rates. Combined, these implementation steps are essentially focused on integrating the HEART team protocol into the corporate culture of the healthcare organization to ensure effective management of treatment-related complications and emergencies experienced by adult cancer patients receiving multimodal therapy (Appendix 2).

Outcome Measure/Measurement Instruments

In order to measure the outcomes of this DNP project, the following instruments will be used to evaluate the impact of the proposed project:  HEART Assessment chart Audits; Referral rates for HEART Team; Pre/post implementation ED/Admission rates; and the pre/post knowledge survey.

Benefits/Risks

Some of the benefits associated with the project include reduced social and economic costs associated with high rates of ED visits and hospital admissions amongst people with cancer. Others include improved psychological and physical wellbeing due to enhanced management of treatment-related emergencies and complications (Klotz et al., 2021). However, the loss of subject’s privacy and confidentiality of data collected and produced in the study may have detrimental effects on the participants. Strong emphasis will be made on upholding the ethical principles of beneficence, non-maleficence, informed consent autonomy and responsibility to ensure these risks of harm are minimized (Hjermstad et al., 2018)Understanding Multimodal Cancer Therapy Assignment Paper.

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Participant Recruitment

The participants will be recruited using stratified random sampling whereby only cancer patients currently receiving multimodal cancer therapy at the facility will be included. Equally, the multidisciplinary team of experts will be recruited using purposive sampling to ensure only the most relevant members are included in the team.  The use of flyers will form a key part of the recruitment materials.

Ethical and Consent Procedures

All the participants involved in this DNP scholarly project were served with a written informed consent form by the researcher prior to commencement of the project. This enabled informed consent to be obtained from all subjects involved in this proposed project.

Project Timeline

The proposed evidence-based project plan will be developed, implemented and evaluated over the next 3 semesters. Each of team member of the multidisciplinary team will assume a set of responsibilities, tasks and deliverables as follows: DNP Student and Community Agency Mentor (identify gap in practice, planning and mentorship) to were conducted between July 22 to the end of August, 2022; DNP Student, leadership, mentor (meeting with nursing/medical directors to discuss adoption of high-risk patient management algorithm) to be conducted during the months of July, August, September, October, November, December of 2022 as well as February, March, April, and June, 2023; DNP student, nursing leadership (Meeting with nursing manager to discuss using high-risk nursing assessment tool in weekly On-treatment Visit) to be performed in October, November, December of 2022 and March, April, and June of 2023); DNP Student, RNs (pre-educate nursing team survey) to be conducted in May of 2023; NDP student, Registered Nurses (meeting with nursing team/ educate nursing them on the HEART algorithm and high-risk patient assessment checklist) to be conducted in May and June of 2023; DNP student, MDs, Nursing Manager, RNs, Social Worker, Nutritionist (HEART team building) to be realized in May and June of 2023; DNP student, MDs, Nursing Manager, RNs, Social Worker, Nutritionist (Implementation) to be conducted in June, July, August, and September; DNP student, HEART Team, stakeholders (Bi-weekly meeting with HEART TEAM, RN champion, and MD champion) to be executed in June, July, August, September and October of 2023; Registered Nurses (Post-Implementation RN survey) to be conducted in October of 2023;  DNP student (data collection and data analysis) to be conducted in October and November of 2023; DNP student (project completion) to be conducted in November; DNP Student, Senior leadership (Evaluation and Feedback) to be conducted in November and December of 2023) DNP student, Faculty (Dissemination of project and manuscript completion) to be conducted in 2024; and DNP student, senior management (discussion on sustainability and further study) to be conducted in 2024 (See Appendix 3)Understanding Multimodal Cancer Therapy Assignment Paper.

8.0 Conclusion

This project proposal is focused on reducing the high rates of potentially unnecessary ED visits and unplanned hospital admissions amongst cancer patients receiving multimodal cancer therapy at Mount Sinai West hospital. Adopting the HEART Team protocol was established as one of the evidence-based intervention to enhance the management of cancer-related complications and emergencies in favor of a better patient and health outcomes. As such, the findings indicated that having a detailed HEART team protocol in place can foster the adoption of comprehensive clinical guidelines and best practices to ensure timely need assessment and to boost access to relevant support and care beyond the initial oncology care in order to reduce the increased risk of ED visits and hospitalization amongst high-risk patients. Understanding Multimodal Cancer Therapy Assignment Paper

References

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Caterino, J. M., Adler, D., Durham, D. D., Yeung, S. C. J., Hudson, M. F., Bastani, A., … & Lyman, G. H. (2019). Analysis of diagnoses, symptoms, medications, and admissions among patients with cancer presenting to emergency departments. JAMA Network Open, 2(3), e190979-e190979. Doi: www.10.1001/jamanetworkopen.2019.0979.

Colley, S., Pracy, P., & Jennings, C. (2021). Radiology of head and neck cancer. Head and Neck Imaging, 133-142. https://doi.org/10.1007/978-3-030-80897-6_8

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