Healthcare advances through research and learning. All medical breakthroughs started with a question.  

This can be seen at the SIH Cancer Institute, where nurses are encouraged to ask questions and look further into clinical practices. Throughout 2023, nurses identified three areas of improvement and utilized evidence-based practice to successfully advance patient care.  

Their hard work paid off. These three projects were selected by the Oncology Nursing Society (ONS) to be presented at the annual ONS Congress in Washington D.C. 

“This was one of my dreams when I first became an oncology nurse and understood what ONS does for the oncology nursing community,” says SIH Oncology Nurse Krystal Ramsey. “To be a part of a community that values collaboration and innovation means so much, especially sharing it with great friends and co-workers. It is an emotional experience for me and one that I hope to recreate in the future.” 

The Oncology Nursing Society (ONS) is a collaborative nursing organization consisting of over 35,000 oncology nurses across the country. The annual ONS Congress is one of its largest conferences focused on oncology nursing, providing learning opportunities across panels, presentations and exhibitions by oncology nurses from hundreds of healthcare institutions.  

SIH Cancer Institute nurses will present on three topics: 

“Evidence-based practice is the process of taking research and translating it into clinical practice,” says SIH Clinical Director of Oncology Dr. Susie O’Neill. “There’s many things we do because we’ve always done it that way, until someone asks why. That’s where evidence-based practice starts, is with a question.” 

Dr. O’Neill praises the nursing staff for asking questions, saying they’re eager to make things better for patients. Nurses are dedicated to finding the best practice for patient care. 

“I want people to know that no question is insignificant.  If you have a clinical inquiry, ask it and use the evidence to find the answer you are seeking.  It may confirm that your current practice is best practice, or it may point you in a whole different direction,” says SIH Cancer Institute Infusion Manager Brooke Toedte.  

She continues to champion evidence-based practice and how it allows nurses to shape patient care. 

“I want to encourage our nurses here at SIH to continue to develop professionally through certification, publication and presentation.  Never be discouraged by the fact that we are a rural community system.  We can impact the profession of nursing and best practice nationally and do not have to be from a big organization to do so.  The nurses here at the SIH Cancer Institute are committed to excellence in care and that is exactly what they deliver!” 

Read further for additional information about each SIH Cancer Institute nurse’s project. 

Evidence-Based Practice at the SIH Cancer Institute

Written and presented by SIH Oncology Director Susie O’Neill, Implementation of Evidence-Based Practice in a Rural Cancer Center Utilizing a Multi-Faceted Approach discusses how the SIH Cancer Institute utilizes evidence-based practices to improve outcomes for patient care. Evidence-based practice (EBP) incorporates the best available research findings into patient care processes. Nursing staff identify a problem or a question, research current practices and evidence, apply findings to current clinical procedures and improve patient care processes.  

During her presentation, Susie will discuss how the SIH Cancer Institute implemented a formalized EBP structure. As a rural healthcare organization, SIH nurses had no prior formalized EBP training, heavy patient workloads, limited time and limited access to research documentation, making this a difficult journey. One key strategy saw four nurses attend an EBP workshop to be trained as EBP mentors. Quality tests were established by these trained mentors, who guided SIH oncology nurses through the new process. Once trained, nurses implemented three EBP projects to improve the patient experience during outpatient procedures.  

Peripheral IV Distress to Success

Presented by Hannah Smith and Kaylee Cohen, Discharging Outpatients with Peripheral Intravenous Catheters for Next Day Use discusses reducing patient distress by updating SIH's IV process to allow for a multi-day, extended use peripheral IV. During cancer treatments, a peripheral IV is used to give patients medications, fluids and transfusions directly into their veins. They are often placed in the back of the hand or the inner elbow. While some IVs need to be removed immediately once infusion is complete, others can be left in place for multiple days.  

In 2023, SIH saw an increase in patient distress due to patients receiving consecutive daily treatment. SIH’s former policy required all IVs to be removed before the patient could be discharged, meaning patients needed a new IV placed each day. Hannah and Kaylee will discuss the development of a new policy to allow for multi-day, extended use peripheral IVs. Staff created a “nursing bundle” that contained peripheral IV insertion information and maintenance standards. Extended use peripheral IVs placed for up to five days saw a 91% success rate. In addition to reducing patient distress, this updated policy saved equipment cost and nursing time.  

Saline for Subcutaneous Ports

Written by Krystal Ramsey, Brooke Toedte and Jessika Hawkins, Evaluating Normal Saline Locking for Subcutaneous Ports for Patients on Treatment and 90-Day Maintenance Flushing discusses the benefit of saline over heparin to flush subcutaneous ports in patients. A subcutaneous port is a catheter placed under the patient’s skin in the upper chest area that delivers medications, transfusions, and fluids. To keep these ports operating properly, they need to be routinely flushed with a thinning agent to prevent platelet clotting and maintain proper functioning.  

During the presentation, Brooke will discuss how the SIH team transitioned away from heparin to using saline as a port flushing agent. By monitoring the use of alteplase, a drug used to dissolve blood clots, staff could identify if saline-only flushing worked as well as when heparin was used to flush ports. After one year of implementation and monitoring, the team concluded there were minimal differences between using saline and heparin to flush subcutaneous ports.