UNIVERSITY PARK, Pa. — Penn State Ross and Carol Nese College of Nursing doctor of nursing practice (DNP) student Hailey Cleveland was awarded the Excellence in Nursing Quality & Safety Award by the Penn State Health Milton S. Hershey Medical Center during National Nurses Week in May. The award recognizes Cleveland as "an outstanding medical professional" and highlights her DNP project investigating how to prevent inflammation of the digestive tract and mouth in pediatric patients with cancer.
This inflammation, called mucositis, causes significant painful lesions, ultimately resulting in subsequent poor nutrition, bleeding and infection. It is most commonly a result of chemotherapy infusions, in which sensitive fast-growing cells — such as hair follicles or cells in the gastrointestinal tract — are killed off. Painful sores of varying degrees develop due to the loss of healthy mucosa membranes in the mouth, affecting more than half of children who receive high-dose chemotherapy.
Cleveland said she saw an opportunity to develop evidence-based informational guidelines using oral cryotherapy — a low-cost preventative method of placing a cold product, such as ice or a popsicle, in the mouth for the duration of the chemotherapy infusion shown to help prevent cells from absorbing the chemotherapy and dying.
“It's my passion working with these kids,” Cleveland said. “So, I wanted to do something that can make their quality of life so much better and to give them the best possible outcomes across the board.”
Given continuous improvement’s critical role in the healthcare field and serving as a guiding priority for the medical center, Cleveland’s oral cryotherapy guidelines and documentation methods helped bolster its pre-existing mucositis prevention and oral care policy.
Using Cleveland’s guidelines, 38 staff nurses learned more about mucositis identification, documentation and oral cryotherapy prevention. With the new knowledge, staff nurses administered the oral cryotherapy to three high-risk pediatric oncology patients — none of whom had prior mucositis — during their chemotherapy infusion. None of the three patients developed mucositis.
While Cleveland did not directly measure the effect of oral cryotherapy on pediatric oncology patients, she did find a direct correlation between increased oral cryotherapy implementation following her documented guidelines and decreased incidence of mucositis in the small sample of pediatric oncology patients. As well, staff surveys evaluating perceived acceptability, appropriateness and feasibility, showed positive perception of the oral cryotherapy, which Cleveland said is a critical piece in the success and sustainability of quality improvement projects.
Cleveland said she hopes to pursue a second implementation of the project with broader patient inclusion criteria, such as age and chemotherapy regimens, opening the door to treat others with oral cryotherapy, and to streamline the education so more health care providers and patients can benefit.
“I want to positively impact the outcomes of these kids and by implementing this new evidence-based technique, we can achieve that,” Cleveland said.