New QI Initiative Boosts Oncology Nurse Confidence in Triage of N/V/D

Nausea, vomiting, and diarrhea (N/V/D) remain some of the most prevalent and distressing side effects for patients undergoing cancer treatment. Without timely intervention, these symptoms frequently escalate into severe complications, including dehydration, systemic infection, and avoidable hospitalizations.

At the recent ONS Annual Congress, researchers Jaclyn Ose, DNP, APRN, FNP-C, and Morgan Rivera, MSN, APRN, FNP-BC, AOCNP, presented a compelling quality improvement (QI) initiative aimed at bridging the gap in nursing knowledge and confidence regarding these critical toxicities.

The burden of unmanaged toxicities

Oncology nurses in outpatient settings serve as the frontline defense for symptom management. However, the researchers noted that a lack of standardized protocols often leads to inconsistent patient outcomes and delays in care escalation.

The project, conducted at an academic outpatient oncology clinic at the Sylvester Comprehensive Cancer Center, sought to determine if a targeted educational intervention could move the needle on triage consistency and nurse confidence.The baseline data revealed a significant educational void. Prior to the intervention, 92% of triage nurses reported receiving no formal training in N/V/D management. Furthermore, 67% of the nursing staff did not utilize a standardized grading system during their initial assessments, relying instead on subjective judgment rather than evidence-based tools.

Implementing a structured solution

To address these gaps, Ose and Rivera developed an interactive in-service presentation. This educational session went beyond simple lectures, incorporating case-based discussions, a review of current clinical guidelines, and the introduction of specific decision-support tools.Central to the intervention was a "Cheat Sheet" that integrated the Common Terminology Criteria for Adverse Events (CTCAE) v5.0. This tool provided nurses with clear, objective definitions for grading the severity of symptoms from Grade 1 to Grade 4. Additionally, the training emphasized "Red Flag" symptoms — such as an inability to tolerate oral fluids, fever, or bloody stool — that require immediate escalation to a provider.

To further streamline communication, the team implemented a structured SBAR (Situation, Background, Assessment, Recommendation) communication tool tailored specifically for N/V/D reporting.

Significant gains in confidence and practice

The results of the post-intervention survey demonstrated a marked improvement in nursing self-efficacy. The percentage of nurses who felt "very confident" in triaging N/V/D rose from 25% at baseline to 33% post-intervention, while those reporting they were only "slightly confident" dropped from 25% to just 11%.

Remarkably, 100% of the participating nurses reported that the educational session improved their ability to assess and triage these common toxicities. The researchers observed that nurses demonstrated a much clearer prioritization of symptom severity and were more adept at identifying the "red flags" that necessitate urgent medical intervention.

Addressing barriers to care

While the educational intervention successfully boosted knowledge, the QI project also highlighted systemic challenges that nurses face in the field. Key barriers identified by the participants included unclear symptom descriptions from patients and difficulties in reaching providers for timely escalation.

Despite these hurdles, the enthusiasm for structured learning remained high, with 83% of nurses expressing a desire for continued education in this format.

Looking forward: A model for other toxicities

The success of this initiative underscores the vital role that oncology nurses play in early symptom recognition. By providing nurses with objective grading tools and clear escalation criteria, cancer centers can promote safer, more consistent triage practices that may ultimately reduce acute care visits.

Ose and Rivera suggested that future steps for the clinic may include the development of a standardized N/V/D triage algorithm and the expansion of this educational model to cover other high-impact oncology symptoms. As oncology care continues to shift toward the outpatient setting, empowering frontline nurses with these evidence-based tools is essential for maintaining patient safety and treatment adherence.

Reference

1. Ose J, Rivera M. Improving Triage Management of Nausea, Vomiting, and Diarrhea in Oncology Patients: A Quality Improvement Initiative. Poster presented at: ONS Annual Congress; May 15, 2026; San Antonio, TX.