Development and implementation of a risk assessment tool for chemotherapy-induced neutropenia.

PURPOSE/OBJECTIVES To evaluate a tool developed and implemented to help practitioners assess the risk of chemotherapy-induced neutropenia (CIN) and its complications in patients with nonleukemia cancer types. DESIGN Retrospective survey of chart records. SETTING Community-based oncology practice. SAMPLE The medical records of 85 adult patients treated with new courses of chemotherapy, regardless of the cancer type or stage; 50 charts belonged to patients treated before the implementation of the tool and 35 to patients evaluated with the tool. METHODS A risk assessment tool for CIN that was developed using risk factors from published studies and national guidelines was implemented. Patients who were found to be at increased risk for CIN were given colony-stimulating factor (CSF) support starting with the first chemotherapy cycle. The effectiveness of the tool was evaluated by comparing clinical outcomes before and after the implementation of the risk assessment tool. MAIN RESEARCH VARIABLES Febrile neutropenia, IV antibiotic use, hospitalization for neutropenia, and chemotherapy dose reductions and delays. FINDINGS Chemotherapy dose delays, febrile neutropenia, treatment with IV antibiotics, and hospitalization for neutropenia occurred less frequently in patients assessed with the tool and managed with the algorithm for CSF use than in those who were not assessed. CONCLUSIONS The Risk Assessment for Neutropenic Complications Tool is effective in helping practitioners determine which patients are at high risk for CIN and its complications IMPLICATIONS FOR NURSING By using the tool to identify patients treated with chemotherapy who need growth factor support, nurses can help to reduce the incidence of neutropenia and its complications.