Publication Date

2025

Document Type

Dissertation/Thesis

First Advisor

Tanzillo, Tanya

Degree Name

DNP (Doctor of Nursing Practice)

Department

School of Nursing

Abstract

Abstract

Background: Patients receiving high-toxicity chemotherapy are at risk for post-infusion complications, which can result in unplanned hospital visits or admissions. Structured post-infusion follow-up may improve symptom management and reduce these events.

Local Problem: At North Region hospital, the 30-day post-infusion revisit rate was 31%, substantially exceeding the national average of 14.7%. A pilot program launched in 2021 reduced hospital visits by 7%; however, following its discontinuation due to staffing shortages and inadequate data collection, the rate subsequently increased, underscoring the need for sustainable interventions.

Methods: A quality improvement project was conducted in two, ten weeks phases. Phase 1 included a standard post-infusion office visit within seven days, while Phase 2 incorporated structured post-infusion follow-up call using the LACE Index for risk stratification and a standardized symptom assessment questionnaire. Hospital visits and admissions were tracked manually and through the OP35 quality measure.

Interventions: Phase 1 implemented a seven-day post-infusion visit. Phase 2 added a three-day follow-up phone call with the LACE Index and internal oncology department questionnaire to identify high-risk patients for urgent appointments prior to 7-day post infusion visit.

Results: Hospital visits remained low post-intervention, while hospital admissions increased, and follow-up process adherence was moderate with variability for high-risk patients.

Conclusion: Structured post-infusion follow-up is feasible and may enhance early symptom detection. Future projects should expand to include all chemotherapy regimens and integrate automated alerts to improve workflow adherence and sustainability.

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