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verification of height and weight results

  • 1.  verification of height and weight results

    Posted 11 days ago
    ​good morning, I am currently looking for what would be acceptable as a change in patient height and weight in an ambulatory outpatient clinic setting.
    we are asking the medical assistants to recheck ht and wt with a second staff member if they have results:  height 2 CM different and weight 10% change from last reading. Does anyone any policies, references that could be used to support these values?  Are there different values that should be followed?

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    Alice Cockerel MSN RN ONC CNL
    Clinical Nurse Educator 2
    Miami Cancer Institute- Baptist Health South Florida
    Miami FL
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  • 2.  RE: verification of height and weight results

    Posted 10 days ago
    Hi Alice,
    Our parameter is: current BSA must be within 10% of the BSA when the treatment plan was placed.

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    Grace Brown MSN RN AGCNS-BC OCN
    Oncology Clinical Nurse Specialist
    Spectrum Health
    Grand Rapids, MI
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  • 3.  RE: verification of height and weight results

    Posted 9 days ago
    Just curious....  are we talking about
    1) all patients or just active treatment pts
    2) policy for CMA (or whoever checks Ht/Wt)  to trigger a "recheck"


    In my experience...  it takes a significant shift in weight to adjust a BSA by 10%  ( I know ..  I have been trying to decrease mine! ;)


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    Anna Krout, RN, MS, OCN
    Nurse Manager
    Cancer Care Associates of York
    York PA
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  • 4.  RE: verification of height and weight results

    Posted 6 days ago
    EPIC has been handy. I put this bit of code into a smartphrase, and this gives me a table with the last 12 weights. EPIC will also draw a graph, though only of the last month.

    @LASTWT(12)@

    Over 2kg weight change or symptomatic triggers orthostatic vitals. Most of my patients are head and neck receiving both chemotherapy and radiation therapy. The weights definitely can vary substantially after a rough weekend, or they can appear to jump or be stable right following chemotherapy. I use the same table after treatment as it is a useful gauge of how well the patient is recovering. Since we take their weight three times a week, looking at the last value doesn't necessarily communicate the overall trend.

    We have nurses now doing the weight checks for on treatment patients, and I get to automatically review changes myself with the smart phrase. The parameters are treated as a very soft guideline.

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    John Hillson RN
    Hillsborough NC
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  • 5.  RE: verification of height and weight results

    Posted 6 days ago

    In terms of dosing, we look at does the change in BSA reflect more than a 10% difference in the final dose(s) of chemotherapy.

     

    Because we have adult patients, variation in height would be either variability in measuring or an error, and the weight could be an actual variation or an error.

     

    For example, if the MD orders chemo based on a height of 172 cm and 65 kg, and I measured the patient at 171 cm and 66 kg, we would re-calculate the BSA and check for the differences.

     

    Of course we verify the accuracy of the height and weight.

     

    Karin


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  • 6.  RE: verification of height and weight results

    Posted 5 days ago
    OMG!  This is so helpful for the "smart phrase".  We only know a few in my clinical research department-like @DOB@.  Is there anyway you could list a couple of others?
    Thanks so much!



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    Melyssa Foust MSN RN
    Cancer control/CCDR Manager Clinical Research
    Spartanburg Regional Med Ctr
    Spartanburg SC
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  • 7.  RE: verification of height and weight results

    Posted 5 days ago
    http://docshare.tips/epic-smart-phrases_5751525fb6d87f8c1e8b5783.html

    This link has a number of basic useful bits of code. If you find the Smart Phrase manager tab, you just enter the pieces that you want.

    I tend to have these listed in most of the phrases I use, with a few introductory phrases. The vitals phrase creates a chart of the last five full sets of vitals so I just need to refresh whenever new ones are taken. the Weight phrase, you can pick another number of pieces of data. the problem list and past medical history save me a lot of time banging around in the chart. Definitely recommend making one of your signature - I sign my name with three keystrokes. The labs, I automatically get the last reported values so I see who did not have their blood work drawn that morning or who has levels that might need intervention.

    @M@ @FNAME@ @LNAME@ is a @AGE@ @SEX@ who is here today for ***.

    Objective:
    @VITALSMULTCOMMENTS@
    @LASTWT(12)@
    History:
    @PMH@
    Current Problem list:
    @PROB@

    @RESUFAST(WBC,HGB,HCT,MCV,PLT)@
    @RESUFAST(NA)@
    @RESUFAST(K)@
    @RESUFAST(BUN)@
    @RESUFAST(CREATININE)@
    @RESUFAST(mg)@
    @RESUFAST(Calcium)@
    @RESUFAST(phos)@
    @RESUFAST(alb)@
    @RESUFAST(tbili)@
    @RESUFAST(AST)@
    @BRIEFLAB(ALT)@
    @BRIEFLAB(ALKPHOS)@
    @RESUFAST(GLUCOSE)@

    You can use the search function in the Smart Phrase manager to find specific stuff.

    {blank multiple:19196::"no additional interventions","A","B","C"}. Put whatever you want in place of A, B, or C, or use the same format to add any other blanks - you will have a drop down menu that you just highlight all of the options that you want, then double click.

    {blank single:19197::"A.","B:","C."}   Creates a drop down menu in the middle of a sentence and then you click on the one option that you want.


    Hope that helps. This is the best part of Epic IMO.

    John




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    John Hillson RN
    Hillsborough NC
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  • 8.  RE: verification of height and weight results

    Posted 5 days ago
    Five years into Epic and you've just blown my mind! Thank you!!
    I only had the signature shortcut...
    Karin

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    Karin Leppanen RN MS OCN
    Nurse Manager of Cancer Svc, Ambulatory Clinics and IVTherapy
    Beverly and Addison Gilbert Hospital, Lahey Health System
    Byfield MA
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  • 9.  RE: verification of height and weight results

    Posted 3 days ago
    You are the BOMB!  I am printing this list out to share with staff.
    Thanks!

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    Melyssa Foust MSN RN
    Cancer control/CCDR Manager Clinical Research
    Spartanburg Regional Med Ctr
    Spartanburg SC
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  • 10.  RE: verification of height and weight results

    Posted 5 days ago
    Hello Alice, Nuring practice at our centre is  to check weight prior to each cycle and compare to baseline. All patients are reviewed the day prior to treatment and sometimes a dose reduction is warranted due to reported side effects or weight loss. This allows our centre to organise compounding of the right dose & volume in time for treatment the next day.
    There have been occasions when patients have not reported or played down side effects - fearful that treatment might be ceased.
    When a patient arrives they weigh themselves & give the print out from the scales to their Nurse when they are seated in their chair for treatment.
    If there is a weight loss or gain of more than 10% - the dosage of chemotherapy is adjusted. We notify the Oncologist and will either defer until we can get the correct dose compounded and flown in  from our pharmaceutical company or proceed with treatment and dose reduction for the next cycle.
    The weight and BSA are one of the 2 nurse checking processes prior to hanging or commencing an infusion.
    We no longer use the practice of calculating dose & volume and adjusting how many mls need to be infused and set the infusion pump.  if there is a weight loss. We have to discard stock if the dose is amended  - this is expensive and impacts on our budget. Patients do not pay for treatment or oncologist appointments and reviews.
    To minimise any impact of weight loss we educate and reiterate the need to contact our centre if there has been any issues with loss of appetite or weight loss. We would then refer to our Dietician for assessment and commencement of nutritional support.
    This practice has worked very effectively and it is uncommon to discard chemotherapy due to weight loss and risk of over dosing and unacceptable exacerbation of side effects.

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    Penelope Stevens - Clinical Nurse Consultant
    Cancer Care Coordinator
    Cancer Care Service
    Hervey Bay, Queensland
    Australia
    penelope.stevens@health.qld.gov.au
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