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I had the same question several years ago when we were first developing our nursing practice for CAR T cells administration, patient assessment and documentation of such for pediatrics. Via an interdisciplinary group which included a neurologist, neuropsych, an intensivist, nursing educator, bedside nurse and transplant physicians among others we decided that the CAP-D (Cornell Assessment for Pediatric Delirium) would be the best validated instrument t to utilize for this patient population. Although somewhat subjective, it allows for anyone to administer the test without patient fatigue regarding the exercises or questions that may be asked of them. We also require a daily handwriting sample for those patients who can write. The CAP-D is done at the end of each 12 hour shift and as needed by the bedside nurse. The nurses were educated to alert the provider when they evaluated the patient with a score of 9 or greater. The CAP-D was integrated into our CAR T flowsheet in Epic as well. We provided the staff with Education in July of 2017 in preparation for our upcoming CAR T patients. I include CRS, and the CAP D education in the orientation of my new staff as well as in my Pediatric Oncologic Emergencies Course.
I know that our intensive care physician secured permission to use the CAP D and incorporate it into our EMR as well.
Hope this helps.
—————————— Maritza Salazar-Abshire, MSN, MED, RN, CPON Senior Nursing Instructor The Children’s Cancer Hospital at The University of Texas MD Anderson Cancer Center Houston, Texas USA 713-745-0383 firstname.lastname@example.org —————————— ——————————————- Original Message: Sent: 08-04-2018 11:18 AM From: Leticia Valdiviez Subject: CAR T Neuro Assessment Tools
This is a great question. Out side of what the KITE CAR T study uses (and can’t be shared) I have yet to come across anything. Dr. Pulsipher let me know one of our new attending physicians has an interest in this and I will pass along her response to this question. Just emailed her yesterday.
I also asked our neuropsych team about this and they could not think of a tool that could be administered by just any team member.
I would be interested in hearing if anyone has a tool.
—————————— Letty Valdiviez, MSN, RN, CPHON CAR T Coordinator Children’s Hospital Los Angeles ——————————
Original Message: Sent: 08-04-2018 09:58 AM From: Chris Donaghey Subject: CAR T Neuro Assessment Tools
Does your facility use a validated tool for neuro assessments during CAR T?
The CARTOX-10 exists, but it has limited pediatric applicability.
I haven’t heard of so many tools from other places other than handwriting samples/assessments, identifying people in the room, etc.
—————————— Chris Donaghey, MSN, RN, PCNS-BC, CPN, CPHON Clinical Nurse Specialist – Riley Cancer Center Riley Hospital for Children at IU Health Indianapolis, IN ——————————