title: Evolution of a Rapid Hydration Protocol.
abstract: The Oncology Division of the Children's Hospital of Philadelphia (CHOP) embarked on a comprehensive project to reduce chemotherapy errors. Careful review of all systems revealed many areas for improvement. Using a unique systems improvement approach, the interdisciplinary team carried out many concurrent change projects. This article describes a project carried out by the nursing staff to improve the safety of chemotherapy administration. Nurses realized that the majority of chemotherapy infusions occurred in the evening and nighttime hours after prolonged prehydration, leading to many "handoffs" and possibilities for error. Nurses developed a novel method of prehydration, delivering a large volume of fluid in a rapid infusion. The "Rapid Hydration Protocol" greatly reduced duration of hydration without adverse effects. Rapid hydration decreased the time needed for hydration and the number of nurses involved in the first day of chemotherapy, and contributed to having chemotherapy begin earlier. The project achieved the goals of improving systems and reducing handoffs. The impact of this project, in combination with the widespread efforts of the error reduction team at CHOP contributed to significant improvements in chemotherapy safety. Nurses developed and tested this innovative hydration strategy, which continues to be very effective.
authors.affiliation: Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA. tracy@email.chop.edu
authors.forename: Ellen
authors.initials: E
authors.lastname: Tracy
authors.forename: Susan
authors.initials: S
authors.lastname: DiTaranto
authors.forename: Richard B
authors.initials: RB
authors.lastname: Womer
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002985:Clinical Protocols; D006776:Hospitals, Pediatric; D006801:Humans; D007262:Infusions, Intravenous / Q000451:nursing*; D008508:Medication Errors / Q000517:prevention & control*; D020380:Needs Assessment; D024802:Nurse's Role; D015403:Nursing Evaluation Research; D009859:Oncology Nursing / Q000458:organization & administration*; D010347:Patient Care Planning; D010348:Patient Care Team / Q000458:organization & administration; D015143:Philadelphia; D015397:Program Evaluation; D017751:Safety Management / Q000458:organization & administration; D013997:Time Factors; D017749:Total Quality Management / Q000458:organization & administration*
chemical_list: D000970:Antineoplastic Agents