Managing Cytotoxic Extravasation: Simulation-based tutorials to improve quality of care and patient safety for chemotherapy patients
Abstract
This paper reports on a quality improvement project that was conducted collaboratively by an oncology clinical nurse coordinator and simulation nurse educator. The project utilized simulation-based tutorials with a stepwise approach to train and evaluate the self-efficacy of oncology registered nurses working in a tertiary care hospital. A general assessment of the problem of cytotoxic extravasation was explored using an Ishikawa diagram and the factors responsible for such common issues in chemotherapy administration and oncology nursing practice were plotted. The Plan-Do-Study-Act (PDSA) approach was utilized to apply the quality improvement project method and to strategize the learning for the oncology nurses. The simulation tutorials approach used was an innovative educational activity. The project was completed by training each oncology registered nurse to enhance their efficacy in identifying and managing extravasation. The innovation of simulation-based education tutorials was effective in enhancing nurses’ practices. It also provided insight for continuous nursing education and evaluation that will impact the clinical practice routines in oncology care, thus saving patients from potential adverse effects of chemotherapy.
Keywords: cytotoxic, extravasation, simulation, quality of care, oncology
10.5737/23688076354606
Full Text:
PDFReferences
Al-Elq, A. H. (2010). Simulation-based medical teaching and learning. J Family Community Med., 17(1), 35–40. https://doi.org/10.4103/1319-1683.68787
Anand, U., Dey, A., Chandel, A. K. S., Sanyal, R., Mishra, A., Pandey, D. K., De Falco, V., Upadhyay, A., Kandimalla, R., Chaudhary, A., Dhanjal, J. K., Dewanjee, S., Vallamkondu, J., & Pérez de la Lastra, J. M. (2022). Cancer chemotherapy and beyond: Current status, drug candidates, associated risks and progress in targeted therapeutics. Genes Dis., 10(4), 1367-1401. https://doi.org/10.1016/j.gendis.2022.02.007. Erratum in: Genes Dis. 2024 Jan 20, 11(4), 101211. https://doi.org/10.1016/j.gendis.2024.101211
Asefa, S., Aga, F., Dinegde, N. G., & Demie, T.G. (2021). Knowledge and practices on the safe handling of cytotoxic drugs among oncology nurses working at tertiary teaching hospitals in Addis Ababa, Ethiopia. Drug Healthc Patient Saf., 13, 71–80. https://doi.org/10.2147/DHPS.S289025
Guerrero, J. G., Attallah, D. M., Gomma, N. H., & Ali, S. A. (2024). Improvements in practicing nurses’ knowledge, skills, self-efficacy, confidence, and satisfaction after a simulated clinical experience of caring for a patient undergoing chemotherapy: A quasi-experimental study. BMC Nurs., 23(1), 66. https://doi.org/10.1186/s12912-024-01727-0
Guerrero, J. G., Tungpalan-Castro, G. M., & Pingue-Raguini, M. (2022). Impact of simulation debriefing structure on knowledge and skill acquisition for postgraduate critical care nursing students: Three-phase vs. multiphase. BMC Nurs., 21(1), 318. https://doi.org/10.1186/s12912-022-01100-z
Kim, J. T., Park, J. Y., Lee, H. J., & Cheon, Y. J. (2020). Guidelines for the management of extravasation. Journal of Educational Evaluation for Health Professions, 17, 21. https://doi.org/10.3352/jeehp.2020.17.21
Koukourikos, K., Tsaloglidou, A., Kourkouta, L., Papathanasiou, I. V., Iliadis, C., Fratzana, A., Panagiotou, A. (2021). Simulation in clinical nursing education. Acta Inform Med. 29(1), 15-20. https://doi.org/10.5455/aim.2021.29.15-20
Langer, S. W. (2010), Extravasation of chemotherapy. Curr Oncol Rep, 12(4), 242-246.
Maldonado, E. B., Parsons, S., Chen, E. Y., Haslam, A., & Prasad, V. (2020). Estimation of US patients with cancer who may respond to cytotoxic chemotherapy. Future Sci OA., 6(8), FSO600. https://doi.org/10.2144/fsoa-2020-0024
Mamdouh Zakaria, M., Mohamed Alaa, S., & Mohamed Desoky, G. (2022). Oncology nurses’ knowledge and practices regarding safe administration of intravenous chemotherapy. Egyptian Journal of Health Care., 13(1), 1218–1231.
McDermott, O., Antony, J., Sony, M., Fernandes, M. M., Koul, R., & Doulatabadi, M. (2023). The use and application of the seven new quality control tools in the manufacturing sector: A global study. The TQM Journal., 35(8), 2621–2639.
McDermott, O., Antony, J., Sony, M., Rosa, A., Hickey, M., & Grant, T. A. (2023). A study on Ishikawa’s original basic tools of quality control in healthcare. The TQM Journal, 35(7), 1686–1705.
Meguerdichian, M., Bajaj, K., Ivanhoe, R., Lin, Y., Sloma, A., de Roche, A., Altonen, B., Bentley, S., Cheng, A., & Walker, K. (2022). Impact of the PEARLS Healthcare Debriefing cognitive aid on facilitator cognitive load, workload, and debriefing quality: A pilot study. Advances in Simulation, 7(1), 40.
Silva, A., Teggart, K., Heerschap, C., Galica, J., Woo, K., & Luctkar-Flude, M. (2023). The use of simulation-based education in cancer care: A scoping review. International Journal of Health Care Simulation, 1–11. https://doi.org/10.54531/auxj4316
Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ Quality & Safety, 23(4), 290–298.
Wenstrom, Y., & Margulies, A. (2008). European oncology nursing society extravasation guidelines. European Journal of Oncology Nursing, 12(4), 357–361.
Zafošnik, U., Cerove?ki, V., Stojni?, N., Belec, A. P., & Klemenc-Ketiš, Z. (2024). Developing a competency framework for training with simulations in healthcare: A qualitative study. BMC Med Educ., 24(1), 180. https://doi.org/10.1186/s12909-024-05139-1
Refbacks
- There are currently no refbacks.


