The development and implementation of the Non-Elective Solid Tumor (NEST) Treatment Verification Process allowed oncology nurses to efficiently escalate treatment concerns related to patients undergoing non-elective treatments. These data were first presented by Thea Malile, MSN, RN, Yale New Haven Hospital, New Haven, Connecticut, at the Oncology Nursing Society (ONS) Annual Congress. 

“For inpatient admissions where treatment was not planned, nurses needed an objective assessment tool to capture…concerns around inappropriate administration to critically ill patients on general oncology units and in ICU settings,” wrote Malile and coauthors.

Based on results from a quality and safety review of patient mortality following non-elective treatment, researchers created standardized documentation for the NEST Treatment Verification Process. Using these documents, nurses record key clinical indicators of adverse events including vital signs, performance status, treatment protocol parameters, and additional outstanding clinical considerations (nutrition deficits, abnormal lab values, infection, etc.). Nurses then escalate these documents to an impartial physician reviewer who determines whether the non-elective treatment is safe to administer.

Between January and July 2023, the NEST Treatment Verification Process was completed 70 times at Yale New Haven Hospital. Through the system, 34 cases  were flagged for poor performance scores, inappropriate lab values, and abnormal vital signs that required escalation. While 28 of those cases were approved to receive treatment, 12.5% of cases were delayed due to the complexity of the patient’s condition or concern for post-treatment outcomes. 

“The NEST assessment gives nursing the ability to escalate their concerns around treatment with supporting data and standardized documentation,” concluded Malile et al. “Providing nurses with this assessment tool promotes autonomy while keeping patient safety and goals of care at the center of our practice.”

Source: 

Malile T, Flanagan B, and Shevlin C. Non-elective solid tumor anti-cancer treatment assessment: Empowering nurses to raise clinical concerns prior to administration. Presented at Oncology Nursing Society Annual Congress; April 24-28, 2024; Washington, DC.