Improving Pituitary Lab Evaluation Following Radiation Therapy For Sinonasal/Nasopharyngeal Malignancies

Authors

Brandon M. McAnulty, MSN, APRN, AGACNP-BC, RNFA, University of Texas Health Science Center at HoustonFollow

Author Biographical Info

Brandon is an accomplished healthcare professional with a career spanning nearly a decade in nursing and advanced practice. After graduating with a Bachelor of Science in Nursing (BSN) in 2016, Brandon began a fulfilling journey in the Neurotrauma ICU at Memorial Hermann, located in the prestigious Texas Medical Center.

Driven by a desire to enhance their expertise and take on greater responsibilities, he became an Adult Gerontology Acute Care Nurse Practitioner in December 2019. He initially continued his work in critical care before obtaining his first assist and making a significant transition into a surgical role. Currently, Brandon is part of the distinguished team at MD Anderson in the Department of Head and Neck Surgery, where he applies his skills and knowledge to improve patient outcomes.

In pursuit of further professional growth, Brandon is currently working towards a Doctor of Nursing Practice (DNP) at the University of Texas Health Science Center at Houston, aiming to deepen their clinical and leadership capabilities. With a commitment to excellence in patient care and a passion for continuous learning, Brandon is dedicated to advancing the field of nursing and contributing to the health and well-being of their patients.

Date of Doctor of Nursing Practice Project Completion

2025

Faculty Advisor

Dr. Lisa Thomas

Abstract

Purpose: The purpose of this QI project was to create a standardized order set aiming to increase consistency in lab work completion for improved monitoring of pituitary dysfunction in patients diagnosed with sinonasal and nasopharyngeal malignancies. Background: Radiation therapy is important in the treatment plan for this population. The hypothalamic-pituitary axis is frequently included within the radiation field, contributing to radiation induced pituitary dysfunction. There is no established order set for outpatient pituitary lab monitoring at the organization. Methods: Established order sets were modified to include pituitary labs to create a centralized ordering workflow among providers from all three departments through a PDSA (Plan-Do-Study-Act) framework. All providers received online education. Compliance and data were collected every three weeks to monitor implementation progress. Data from EPIC EHR (electronic health record) was analyzed using descriptive statistics to compare pre- and post-implementation pituitary lab evaluation rates with a target adherence rate of 80% or higher. Results: The modified order sets showed gradual progress in provider compliance in ordering pituitary labs, though challenges persisted. At order set implementation, lab monitoring improved, reaching a peak of 62% compliance at the six weeks post-implementation mark. Pituitary lab ordering compliance improved 30% from pre-implementation baseline. Implications: Ending cancer and preventing secondary disease sequelae is at the forefront of the organization’s goals. A standardized order set reduces provider variability, leading to improved provider consistency with ordering lab work. Ongoing adjustments and leadership support is essential for continued improvement.

Keywords

pituitary labs, pituitary dysfunction, radiation therapy, order sets, sinonasal, nasopharyngeal, malignancies

Recommended Citation

McAnulty, MSN, APRN, AGACNP-BC, RNFA, Brandon M., "Improving Pituitary Lab Evaluation Following Radiation Therapy For Sinonasal/Nasopharyngeal Malignancies" (2025). Doctor of Nursing Practice Final Project Abstract. 55.
https://digitalcommons.library.tmc.edu/dnp_abstract/55