Technology Is Illuminating the Full Spectrum of Care in Oncology Nursing

In order to achieve the goals made possible by recent technology advances in oncology nursing practice—including better quality care, better patient outcomes, increased efficiency, and reduced medication errors—oncology nurses will have to endure the growing pains of in-services and devote the necessary time to build expertise and master the new technologies before they can implement them into daily oncology nursing practice.

In the last few years, EMRs have begun replacing hard-copy paper charts. More outpatient oncology nurses are bringing laptops into examination rooms to document patients’ history and physical data, assess lab and test results, and document nursing assessments for toxicities related to chemotherapy or radiation. For inpatient nurses, some institutions, such as Hartford Hospital, CT, have implemented computers on wheels (COWs), a mobile laptop that can travel with the nurse from room to room and be used for recording assessments in real time.

Advanced technology may aid in the reduction of medication errors. Some institutions have implemented computerized physician order entry (CPOE), which requires providers to type, rather than handwrite, orders resulting in easy-to- read chemotherapy and medication doses, in turn, eliminating the need for nurses to decipher physician handwriting and reducing the risk for medication errors. Some institutions have implemented barcode-enabled, point-of-care technology (BPOC), which uses handheld computers to check the barcode on a patient’s identification band and confirm that the correct patient is receiving the correct drug and dose, administered via the correct route at the correct time.

Oncology clinical research trials are the backbone for evaluating new strategies to diagnose, treat, and prevent cancer. Technology has advanced research nursing practice in a variety of ways. For example, the manner in which data is collected is gravitating toward Web-based collection tools, as opposed to hard-copy case report forms. Because the data is transmitted in real time, incorrect responses can be flagged, detected, and corrected immediately. In the past, incorrect responses on hard-copy case report forms required an exchange of several days to several weeks, with corrected responses sent via fax or mail.

Wireless laptop computers have enhanced the ability of research nurses from the Cancer Clinical Research Office at Hartford Hospital to work beyond the four walls of a hospital research department. Nurses travel with wireless laptops, which meet hospital and research study security criteria, to satellite offices where they can confirm eligibility of patients, review protocols, and review informed consents. Research nurses can simultaneously document nursing progress notes in the Microsoft Access database, once eligibility has been confirmed and a patient has given consent to participate in a cancer clinical research trial.

In radiation oncology, the development of new technology and equipment for delivery of radiation has made a huge difference in reducing the side effects of radiation treatment. Great strides have been made in targeting and sculpting radiation doses to reduce damage to normal tissue while simultaneously delivering higher doses to targeted tumors. Patients, in general, feel better during treatment with a lower volume of healthy tissue affected. With technology playing a bigger role in radiation oncology, the need for patient education increases. Radiation oncology nurses must make special efforts to keep current in their own practice, so they are prepared to explain the complex concepts of radiation time to patients and families so they know what to expect during treatment and follow-up.

From a patient’s perspective, technology has allowed them to research their specific cancer on the Internet to learn more about diagnosis, staging, and treatment options and support services. Patients may also access hospital-based websites for hospital-specific statistics and benchmarks to determine number of oncology cases seen, surgeries performed, and patient outcomes. Oncology nurses can encourage patients to refer to peer-reviewed journal articles and research from appropriate resources. From a prevention perspective, patients can go online to determine their overall risk for diseases, such as breast cancer, by visiting such sites as www.breastcancerprevention.com. For information to help healthcare professionals and patients identify risks and benefits for chemotherapy for a specific patient after surgery, one can visit www.adjuvantonline.com.

Oncology nurses need to keep current in practice with developments in robotic surgery, used often, for instance, in gynecologic and prostate malignancies. Robotic surgery has resulted in smaller incisions, faster recoveries, and shorter lengths of stays. Education programs, such as the OR Live series provide opportunities for nurses, other healthcare professionals, and patients to view live robotic surgery, and participate in question-and- answer sessions with the surgeons.

Another aspect of this brave new world is the use of technology to explore the unique “fingerprints” of individual tumors. Currently, most patients are treated with the standard protocol, but in reality, only some patients may benefit from that specific treatment. Individual patients with the same kind of cancer do not always respond to standard treatment for that cancer in the same way. Only recently has technology advanced such that scientists can test each tumor for approximately 30,000 genes. These genes provide a molecular fingerprint that is unique for each tumor, just like the lines of a fingerprint identify an individual. By studying the molecular fingerprint, scientists will eventually develop new drug therapies that are personalized for each individual. This is the goal of the Moffitt Cancer Center’s Total Cancer Care program, in which about 15 hospitals around the country are participating.

Despite all of the progress and advances in technology, it is an unavoidable fact that many cancer patients will die of their disease. Although palliative care and end-of-life care within oncology nursing may not be considered by some to be high-tech, practicing nurses in this field rank high in the high-touch and compassion areas. Technology has provided opportunities for professional development, but more importantly, has led to the early diagnosis, prevention, and best treatment for patients to extend survival while maintaining quality of life.

Ms. Servodidio is the Coordinator for the Cancer Clinical Research Office at Hartford Hospital, Hartford, CT.