Utilizing a standardized order set to increase speech pathology referrals in head and neck cancer patients.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 324-324
Author(s):  
Carly Gerretsen ◽  
Corrine Jurgens
Keyword(s):  
Head And Neck ◽  
Chart Review ◽  
Speech Pathology ◽  
Post Intervention ◽  
Referral Rates ◽  
Order Sets ◽  
Rate Of Speech ◽  
Order Set

324 Background: Treatment of head and neck cancers may include radiation, and side effects will result in short and long-term dysphagia. This can lead to feeding tube usage, malnutrition, loss of social interaction, and reduced quality of life. Rehabilitation therapies are available with speech pathologists to improve outcomes. Evidence supports initiating therapy prior to radiation. Computerized order entry systems (CPOE) support standardization of evidence- based order sets. The purpose of this study was to examine the effect of a standardized order set on referral rates to speech pathology in adult patients undergoing radiation treatment for head and neck cancer. Methods: A quality improvement project was implemented an outpatient oncology clinic within an academic hospital using the PDSA format. Approval was obtained through the hospitals quality assurance officer, and it was determined that IRB approval was not necessary. A chart review was completed to assess the rate of speech pathology consults. A brief education program targeting ordering providers was completed including demonstration of the order set. Post intervention chart review was performed to assess the change in referral rates. Results: A chi square analysis was used to compare the difference in referral rates and found to be statistically significant, x² (1, n = 56) = 17.147, p < 0.01. Demographic data was analyzed using descriptive statistics. The sample was mostly Caucasian (82%), male (84%) with an average age of 63. The most common cancer diagnosis was larynx (36%). The percentage of referrals post intervention (82%) was significantly higher than pre-intervention (18%) consistent with the hypothesis that a standardized order set would increase speech referral rates. Conclusions: Use of a CPOE system with standardized order sets increased the rate of speech pathology referrals. The success of this order set has led to an expansion of the project, and creation of additional order sets. Standardized computerized order sets should be considered to increase referrals to underutilized ancillary services. Providers should be encouraged to create relationships with these services to improve patient’s quality of life and long- term outcomes.

Improve optimal treatment in head and neck cancer patients (HNCA).

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 227-227
Author(s):  
Glenn Morris Mills ◽  
Rebecca L. DeKay ◽  
Srinivas S. Devarakonda ◽  
Jennifer Nicholson ◽  
Lee Ann Maranto ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Creatinine Clearance ◽  
Head And Neck ◽  
Neck Cancer ◽  
Chart Review ◽  
Speech Pathology ◽  
Post Intervention ◽  
Pareto Chart ◽  
Peg Tube ◽  
Practitioner Education

227 Background: Since 2011, 50% of HNCA patients receiving concurrent chemoradiation with Cisplatin (CIS/XRT) have not been able to complete their therapy per protocol (dose over time interval) leading to suboptimal therapy. Based on historical data, the non-completion rate for patients HNCA receiving radiation/ high dose Cisplatin was 15%. We aim to improve this in our patients. Methods: A chart review of patients on CIS/XRT conducted and, using a Pareto Chart, the data indicated Acute Kidney Iinjury as the major cause for failure of completion. Using methodology from ASCO’s Quality Training Program, a process map for patients on treatment was created and an Ishikawa diagram (cause and effect) assisted in pinpointing breaks in processes. A telephone survey of surviving patients further clarified inadequacies. Using the Plan, Do, Study, Act (PDSA) improvement cycle, inadequacies were identified. Results: Chart review showed that significant side effects from treatment began around the 2nd cycle of Cisplatin in spite of adequate IV hydration following chemotherapy. Inadequate documentation of dietary and speech pathology consultations, patient weight and serum creatinine levels during treatment were noted. Patients reported minimal PEG tube education and infrequent use of PEG tube for hydration. Analysis of post treatment weight and creatinine level revealed a significant change in creatinine clearance. Checking daily weights, speech pathology and dietary consult prior to initiation of therapy, added hydration instructions to EPIC PEG tube instruction sheet, and nurse practitioner education and follow-up in symptom management clinic were part of the PDSA cycle interventions. If 2lb. weight loss, patients were brought in for repeat lab and IV hydration. Conclusions: Patients with advanced head and neck cancer are frail and subject to acute toxicity from chemotherapy. Change in Creatinine Clearance is a sensitive measure of renal damage/likely predictor of non-completion. Post-intervention patients had fewer unplanned admissions leading to lower costs. PDSA helped identify inadequacies in our education and monitoring processes. More post intervention data are needed to determine if true improvement in patient outcomes exist.

Efficacy of Internal Neurolysis for Trigeminal Neuralgia without Vascular Compression

2021 ◽  
Author(s):  
Ming-Wu Li ◽  
Xiao-feng Jiang ◽  
Chaoshi Niu
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Chart Review ◽  
Vascular Compression ◽  
Internal Neurolysis ◽  
Facial Numbness ◽  
Relief Rate

Abstract Background and Objective Trigeminal neuralgia is a common neurologic disease that seriously impacts a patient's quality of life. We retrospectively investigated the efficacy and safety of internal neurolysis (nerve combing) for trigeminal neuralgia without vascular compression. Patients and Methods This study was a retrospective review of all patients with trigeminal neuralgia who were admitted between January 2014 and February 2019. A subgroup of 36 patients had no vascular compression at surgery and underwent internal neurolysis. Chart review and postoperative follow-up were performed to assess the overall outcomes of internal neurolysis. Results Thirty-six patients were identified, with a mean age of 44.89 ± 7.90 (rang: 31–65) years and a disease duration of 5.19 ± 2.61 years. The immediate postoperative pain relief (Barrow Neurological Institute [BNI] pain score of I or II) rate was 100%. The medium- to long-term pain relief rate was 91.7%. Three patients experienced recurrence. Facial numbness was the primary postoperative complication. Four patients with a score of III on the BNI numbness scale immediately after surgery had marked improvement at 6 months. No serious complications occurred. Conclusion Internal neurolysis is a safe and effective treatment for trigeminal neuralgia without vascular compression or clear responsible vessels.

Locally Advanced Head and Neck Cancer

2013 ◽  
pp. 237-244
Author(s):  
Anthony J. Cmelak ◽  
Kyle Arneson ◽  
Nicole G. Chau ◽  
Ralph W. Gilbert ◽  
Robert I. Haddad
Keyword(s):  
Head And Neck ◽  
Multidisciplinary Approach ◽  
Locally Advanced ◽  
Surgical Techniques ◽  
Squamous Cell Carcinomas ◽  
Advanced Head ◽  
Organ Function ◽  
Definitive Therapy

Treatment of locally advanced head and neck squamous cell carcinomas requires a multidisciplinary approach to be able to offer patients definitive therapy while aiming to preserve organ function and minimize acute and long-term toxicities. Advances in surgical techniques will be reviewed for both primary sites and the neck and also in the salvage settings. Recent data on concurrent versus sequential chemoradiotherapy in these patients will be reviewed, with emphasis on identification of appropriate patients for sequential chemoradiotherapy. Finally, advances in modern radiotherapy modalities that have resulted in improved dosimetry and quality of life following treatment will be reviewed.

Predicting Depression and Quality of Life among Long-term Head and Neck Cancer Survivors

2014 ◽  
Vol 152 (1) ◽  
pp. 91-97 ◽  
Author(s):  
Sami P. Moubayed ◽  
John S. Sampalis ◽  
Tareck Ayad ◽  
Louis Guertin ◽  
Eric Bissada ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Head And Neck Cancer ◽  
Cancer Survivors ◽  
Head And Neck ◽  
Neck Cancer

Dental Status and Quality of Life in Long-Term Head and Neck Cancer Survivors

2005 ◽  
Vol 115 (4) ◽  
pp. 678-683 ◽  
Author(s):  
Rebecca L. Duke ◽  
Bruce H. Campbell ◽  
A Thomas Indresano ◽  
Derek J. Eaton ◽  
Anne M. Marbella ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Head And Neck Cancer ◽  
Cancer Survivors ◽  
Head And Neck ◽  
Neck Cancer ◽  
Dental Status

State-wide quality improvement addressing overutilization of neurokinin-1 receptor antagonists.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 8-8
Author(s):  
Emily R. Mackler ◽  
Kelly Marie Procailo ◽  
Louise Bedard ◽  
Jennifer J. Griggs
Keyword(s):  
Quality Improvement ◽  
Response Rate ◽  
Quality Improvement Intervention ◽  
Receptor Antagonists ◽  
Post Intervention ◽  
Improvement Program ◽  
Neurokinin 1 Receptor ◽  
Order Sets ◽  
Neurokinin 1 ◽  
Order Set

8 Background: The overuse of neurokinin-1 receptor antagonists (NK1-RAs) is a focus of quality measurement within the American Society of Clinical Oncology Quality Oncology Practice Initiative (ASCO-QOPI) and the American Board of Internal Medicine (ABIM) as a Choosing Wisely measure. The Michigan Oncology Quality Collaborative (MOQC) is a statewide collaborative with participation of nearly 100% of oncologists. The purpose of this project was to provide quality improvement practice support for deimplementation of NK1-RAs in the upfront prevention of chemotherapy- induced nausea and vomiting (CINV) for low and moderate emetic chemotherapy regimens (QOPI measure SMT28a) to less than 30% in practices across the State, with lower scores indicating better performance. Methods: In 2018, MOQC added the QOPI SMT28a measure as part of its standard quality measure module for collection by all MOQC practices. A quality improvement intervention was initiated that consisted of 1) baseline assessments of measure performance, prescriber knowledge and beliefs, and pre-populated antiemetic order sets, 2) reporting practice and state-level performance to MOQC practices, 3) state-wide CINV education, and 4) a value-based reimbursement (VBR) related to measure performance. Post-intervention performance was assessed with the Fall 2019 and Spring 2020 QOPI-measurement. Results: Responses from a survey assessing pre-populated antiemetic order sets (32/43, 74% response rate), 23% of practices had a pre-populated order set for NK1-RA and/or olanzapine in moderate emetic regimens. The post-education order set survey found that 48% of respondents (25/43, 54% response rate) either modified or were in the process of modifying their order sets. Conclusions: Deimplementation of unnecessary and low value antiemetics in patients receiving low- or moderate emetic chemotherapy was possible via a state-wide quality improvement program that involved performance reporting to practices, collaborative-wide education, modification of standing order sets, and VBR based on performance. [Table: see text]

scholarly journals Quality of Life Among Long-Term Survivors of Head and Neck Cancer Treated by Intensity-Modulated Radiotherapy

2014 ◽  
Vol 140 (2) ◽  
pp. 129 ◽  
Author(s):  
Allen M. Chen ◽  
Megan E. Daly ◽  
D. Gregory Farwell ◽  
Esther Vazquez ◽  
Jean Courquin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Intensity Modulated Radiotherapy ◽  
Intensity Modulated ◽  
Long Term Survivors
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